Your Interests Likely Tracked on Medical Journal Sites

Damian McNamara, MA

March 23, 2022

If you visit a medical journal homepage, it's likely that a third-party firm is tracking your browsing behavior — potentially to send you targeted advertising in the future.

New research reveals that more than 99% of the journal sites studied feature this third-party tracking.

"For physicians, accessing articles on medical journal websites — like a study on a new hypertension drug — could lead to profiling, including based on medical specialties and medical areas of interest," lead author Ravi Gupta, MD, told Medscape Medical News.

This in turn could "lead to unwarranted advertising from pharmaceutical and health companies," he said. Gupta is associate fellow at the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.

The cross-sectional study was published as a research letter March 18 in JAMA Health Forum.

Not only may healthcare professionals and researchers be unaware, but the "average journal editor or publisher may not even know that this tracking is in place or how it came to be," said study co-author Ari Friedman, MD, PhD.

Opting out of "cookies" on journal websites could be an option, but there could be a downside. "Prior work from my co-authors has shown that this can limit the ability to access articles," Gupta said. "The responsibility rests largely on medical journals and journal publishers to allow for greater user privacy."

Consider the Trade-Offs

The investigators note that although targeted advertising can raise awareness about new therapeutics, "it can also sway clinicians' prescribing patterns toward therapies with limited evidence of efficacy and cost-effectiveness," they write.

"Our hope is that, by making editors and publishers more aware of the trade-off involved, they will look at their own sites and take action to minimize or eliminate third-party tracking," said Friedman, an emergency physician with a secondary appointment in the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

How the Cookie Crumbles

Gupta, Friedman, and their co-author Matthew S. McCoy, PhD, identified all medical journals with an impact factor of 2.0 or more that also had clinically relevant subcategories of the Web of Science's life sciences and biomedical category.

They searched for third-party cookies on the journals' websites.

They found that 1239 sites (77%) included a third-party cookie. Journal home pages featured a median of eight cookies each (range, 1 – 17).

The investigators also visited each journal's home page using webXray to detect third-party tracking. Overall, they report that 1599 of 1605 (99%) of medical journal home pages included a third-party data request.

Third-party firms owned by Alphabet, Google's parent company, had data requests on 1593 of the 1605 (99%) of journal home pages studied. In addition, 40% of journal home pages had data requests from companies owned by Twitter, Facebook, Oracle, and Adobe.

The researchers looked for the advertising policies for the five most prevalent tracking firms to see whether they allow pharmaceutical ads or ads specifically targeted toward medical professionals. All five allow pharmaceutical advertising. However, they only found marketing disclosures for Oracle and Adobe, both of which permit ads specifically targeting medical professionals.

More Research Needed

The study did not include journals with an impact factor less than 2.0, a potential limitation. The impact factor reflects the mean number of citations a journal receives on average per year over the previous 2 years.

The researchers only assessed the presence of tracking, not the implications. "We don't really know the importance of this tracking, we can just see that it's there," Friedman said.

"But it is not a stretch to assume that at least some of this tracking is used to target prescribers, researchers, and patients in ways that lead to unnecessary healthcare spending in what is already the most expensive healthcare system on earth," he added.

Further research is needed to determine how tracking information influences targeted advertising to clinicians, the authors note.

"We have additional pending work that hopefully will disseminate these findings more widely to draw more attention to the consequences of third-party tracking, particularly on medical journal websites," Gupta said.

A "Concerning" Finding

"This is a nicely done study," said Niam Yaraghi, PhD, an assistant professor of business technology at the Miami Herbert Business School at the University of Miami, who was not affiliated with the research.

"I was very surprised to learn that almost all medical journals share their users' data with third parties that provide access to pharmaceutical companies," he added.

Yaraghi said the most interesting part of the study was the focus on medical journal websites. "As they point out in the paper, the fact that so much data is being shared with pharma is concerning," said Yaraghi, also a nonresident senior fellow at the Brookings Institution's Center for Technology Innovation.

"I would be very interested to see if pharma actually uses such access to analyze and use data — or is there only the risk or possibility of access?" said Yaraghi, who is senior author of a study published online November 9, 2021, in JAMA Network Open entitled, "Dark Clouds and Silver Linings: Impact of COVID-19 on Internet Users’ Privacy."

The Public Interest Technology University Network Challenge Fund, a fiscally sponsored project of the New Venture Fund, supported the study. The Public Interest Technology University Network's challenge grants are funded through the support of the Ford Foundation, the Hewlett Foundation, and the Mastercard Impact Fund with support from the Mastercard Center for Inclusive Growth, the Patrick J. McGovern Foundation, the Raikes Foundation, Schmidt Futures, and the Siegel Family Endowment. Gupta is funded by the Department of Veterans Affairs through the National Clinician Scholars Program. Friedman received grants from Public Interest Technology University Network and New America during the conduct of the study. McCoy has received grants from Public Interest Technology University Network and New America during the conduct of the study and being an uncompensated member of the University of Pennsylvania's Data Ethics Working group, which is funded in part by industry gifts to the university. Yaraghi has disclsoed no relevant financial relationships.

JAMA Health Forum. Published online March 18, 2022. Full text

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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