Why sociology is necessary to understand online health behaviours

Despite being written in an era that pre-dated many of the digital technologies that have become important to society today, the implications of the sociological imagination (Mills, 1959), recognised in the simplest form here as the capacity to move from one social perspective to another, are still salient for understanding digital social phenomena.  The World Wide Web has rapidly transformed the world in the 20+ years it has been in existence, though it is not just the technology that has altered how society operates, but the social context, actors and online social actions which have also shaped the technology and its use in return. Hence a sociological understanding can help us to shed light on these new and emerging online behaviours and interactions. Sociology is particularly relevant as it becomes increasingly clear that the Web is not just one entity but many – created at various points of exchange between humans and digital technologies. Norms and motives shift and adapt to the various virtual spaces, contexts and environments. Different behaviours and practices are enabled by the opportunities provided in this ‘brave new world’. In this brief article I will explore how these general characteristics of the Web manifest themselves in what is a fast growing and controversial application of this technology – namely the practice of purchasing medicine online.

Health behaviour and the Web

Health related information has been reported as one of the main reasons individuals access the Web (Eysenbach, 2001). In addition Fox (2007) referred to the 2006 Online Health Search, a US survey by the Pew Internet & American Life Project, which showed that “prescription or over-the-counter drugs” was the fifth most widely searched health topic on the Web (Fox, 2007).  The most recent study conducted by the Pew Project in September 2012, found that 72% of Internet users they surveyed, say they looked online for health information within the past year. As well as providing knowledge, the Web is also a retail opportunity which allows the buying of medicinal products online. Even if obtaining medicine was not the original intention when visiting the Web, it provides the setting for advertising – including direct marketing such as pop ups. These may enable opportunist impulse buying whereby people do not realise that they are indulging in anything untoward. The issue is further complicated where the medicine is regulated and specified as prescription only. Although it is not illegal to purchase prescription only medicine rather than obtaining it from a health care professional; using a web supplier exposes the consumer to a plethora of criminal behaviour and health risks. The Web offers no guarantee on the quality and effectiveness of medicines supplied with no legal recourse available, especially if the product was obtained from an unregulated site. SPAM emails that bypass the healthcare system by advertising prescription only medicines further risks people’s health by encouraging self-diagnosis and self-medication. These also carry the risk of credit card fraud and PC viruses which could be associated with larger criminal associations and organisations.

Beck (1992) has purported that the increased propensity to conceptualise problems in terms of risk has been accompanied by shifts in both the role of the expert and the form and communication of their expert product. While the paternalism of the expert remains an important ‘definer’ (Beck 1992:29) of risks, significantly in terms of where they can be discovered and how they are best avoided, this role has supposedly undergone momentous changes. Beck alleges that expertise has both been ‘demonopolised’ (Beck, 1992:29) and ‘democratised’ (Beck, 1992:191).

In a society where risk is increasingly the justifiable basis for policy decisions, experts are relied on to both identify the causes of risks and intervene in the generation of risks to prevent their reoccurrence. Topical risks such as speeding or the use of mobile phones whilst driving, the relative riskiness of legal versus illegal drugs, and the effects and control of smoking in public places, are increasingly conceptualised as societal risk issues by the authorities, but are also more importantly, issues which are of particular interest to the public who are perceived as both the victim at risk and the problematic cause of the risk in such instances. The Web plays in instrumental role in enabling behaviour that on the one hand empowers individuals, but on the other increases their vulnerability and exposure to risky and unauthorised practices. The Web is seemingly implementing a shift towards a more libertarian model of healthcare, with the empowered patient/ consumer able to manage their health choices online.

 A sociological understanding of The Web 

The Web allows people to view Websites outside of the UK. It enables access to unregulated sites that have no form of governance and no authorisation to sell medicine. The likelihood is that no reference will be made to any risks the medicines may have, focusing purely on the supposed benefits instead. Personal interaction is reduced which may produce detachment and encourage disregard for the law/regulation. The consumer to some degree is removed from the proximity of the health risks and avoidance of ‘following the rules’ perhaps not carrying the same weight as when conducted in the ‘real-world’. The Web acts as a mask enabling the consumer to conceal and justify their actions. However, though the Web can provide anonymity to those who know how to exploit it, in practice many people will leave easily followable traces. These may not be self-evident to the individual though.

The advent of online pharmacies and health related information and purchasing online puts individuals in the position of a customer in the market place, able to make choices among the products marketed to them by commercial firms, rather than a patient subject to the authoritative guidance of professionals. The exercise of consumer choice and the need for the purchaser to take more responsibility to verify that the medicines available are what they claim to be is highly significant in relation to the Web. In some cases consumers are making decisions without consulting health professionals. There is conflict between the value of individuals being able to pursue their own interests and the values of efforts by the state to reduce harm, use public resources fairly and efficiently, and social solidarity.

Schneider and Sutton (1999) claim that the Web is a fertile ground for the commission of offences and behaviours difficult to detect or prosecute. The complex minefield of medicine regulation is difficult to enforce on the Web due to jurisdictional issues, and problems of concealment and anonymity. The purchasing of medicine online may be viewed as just another commodity which is digitally available. Though there is no risk of criminal sanction the consumer is still able to breach domestic regulation, suggesting that the law has yet to catch up with the Web. Any flouting of regulation may simply be part of the process in obtaining that which the Web makes so accessible. The extent to which the Web makes a difference to the structure and formation of the issue or whether it is purely replicating offline behaviour is unclear. Perhaps those who would not usually think about purchasing medicine and deviating away from obtaining it via authorised means are being subjected to the idea.

The issue of obtaining medicine using unorthodox means pre dates the Web. Previously people went abroad or conducted ‘shady’/ ‘underground’ deals, comparable with the obtaining of illegal drugs (Young, 1971). Such behaviour is socially unacceptable and punishable by law; however the Web omits the threat of sanction and allows denial. The risks of being caught are less though the law does not discriminate with its punishment for illegal activity. People can indulge in behaviour that they would not necessarily participate in offline, or in front of various audiences, creating a dichotomy of different behavioural presentations (Goffman, 1959) in the spaces of the Web. If a medicine that was available via prescription has been withdrawn it is no longer accessible in that country. However the Web has increased accessibility, its global reach means medicines are available in some jurisdictions and not in others; affording any person anywhere to procure them. What is legitimately available is constantly shifting and the Web does not always reflect this, allowing sales to be conducted outside authorised forms of supply.

The sociological imagination requires the ability to observe things socially and how they interact and influence each other. To fully appreciate the situation of online consumer health behaviours alternative points of view need consideration. Applying different perspectives of sociology to explore this phenomenon helps us to appreciate the wider context and acknowledge how the actions of people are far more important that the actions themselves.  In providing a ‘safe’ opportunity to purchase medicine the Web appears to remove or bypass some of the threats and sanctions normally associated with illegal drug purchasing, though the reality is that the risks have not been reduced but are simply more clandestine. New sociological and methodological approaches must be considered in trying to understand these emerging digital behaviours.

Lisa Sugiura is a PhD student in Web Science/ Health Sciences at the University of Southampton

References
Beck, U. (1992). Risk society: Towards a new modernity (Vol. 17). SAGE Publications Limited. Becker, H. (1963) Outsiders: Studies in the Sociology of Deviance. New York: The Free Press.
Eysenbach G (2001) Online prescriptions of pharmaceuticals: Where is the evidence for harm or for benefit? A call for papers – and for reflection Journal of Medical Internet Research 3(1): e1.
Fox S. (2007) Online Health Search. Washington, DC: Pew Internet & American Life Project. webcite
Goffman, E. (1959) The presentation of self in everyday life.’Garden City: NY.
Mills, C. W. (1959)The sociological imagination.
Schneider, J.L. and Sutton, M. (1999) ‘Keystroke crime: telling IT like IT is and the need for an Internet criminal activity survey’, Focus on Police Research and Development, Summer, London: Home Office.
Young, J. (1971), The Drugtakers: the Social Meaning of Drug Use, London: McGibbon and Kee. 


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