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The procedure is currently under way to select a limited number of new generic top level domains (to complete the existing dot com, dot net and dot org). Some fifty submissions have been received by ICANN. The WHO submission attracted my attention because of its aim to use a "closed" domain as a lever to enforce quality in health information. The following interview of Joan Dzenowagis, a scientist at WHO clarifies their perspective. A number of interesting questions remain open for further thought.

Dot Health
Leveraging the quality of health information

What motivates WHO to apply to have the dot health top level domain (TLD) created?

There are two main reasons. The first is consumer protection. There is a need to have trusted sources of health information: improving not only the flow but also the quality of health information worldwide is one of the goals of WHO. The second is that WHO heels it has a crucial role to play in health in particular in terms of setting standards. Dot health will enable WHO to implement those.

In what way do consumers need to be protected?

Currently there are over ten thousand web sites dedicated to health and that doesn't even include medical and peripheral sites. Finding information is difficult. Then you have to know if it is suitable or useful. There is a lot of poor quality information on health on the Internet. There are scams. There is fraud and abuse. Given that the Internet is a global medium, when you have relatively unsophisticated audiences particularly in lower income countries, they are vulnerable to sophisticated scams. So individual consumers need a guide. Dot health would provide that.

How would it do that?

It would function as a brand. If you are looking for information in the printed media you know you are going to get different information in the New York Times than in the National Enquirer. Dot health, as a brand, would provide a trusted quality source for information. It would also be a way of making information easier to find. If you look at the top-level domain as the first search criteria, you won't have to look through the current plethora of sites.

In the printed media, quality is a question of editorial policy. But you will have no say on content. So how do you influence content quality?

We don't want to be a content cop. It would be more like a library where the users are able to make their own judgement because they are able to identify the source of information. Let me give an example. There might be fifty sites on cancer. This might range from diagnostics to different support groups. Your judgement on the utility and applicability of information is going to differ depending on the source. The key then is that the source is identified and that a standard is followed according to the source. So trustworthiness will be more a question of identifying the source rather than a check of individual information on the web.

From a consumer perspective that requires having a considerable understanding of the working of the system to be able to decide.

Yes. There is no easy solution. Verification, from our standpoint, goes hand in hand with consumer education and awareness. Right now there is no easy solution for finding quality information but as the brand develops there will be a judgement based on the existence of the brand itself. I expect to see an improvement of quality in the first six months due to the high barrier to entry of having to identify exactly who you are. That will naturally eliminate some of the scams and the fraud as well as some of the more marginal health sites.

The second reason for setting up dot health you said was to enforce standards. How would you go about setting up ethical standards for the use of this dot health domain?

Setting standards is one of our roles as an international organisation. We do that for essential drugs, for diagnostics, for many things. To do it, we draw on expert committees, on expert centres, on collaborating institutions of all kinds, in all countries. What we propose in this case is to build on an international process about ethics for the web that has already started. There are industry groups, a consumer groups, governments and a coalition of concerned groups like the American Medical Association working on this. We propose to harmonise the standards already being developed on the international level and validate them through our member states.

In opting to use a strategy centred on a top level domain, you are going to have to confront the problem of names whether they be trade names or generic terms. How will you handle that?

Through a consultation process, looking at what names could or should be excluded. Those might be names were there is sufficient international attention and work, like, for example, AIDS or malaria; key areas that organisations like the WHO, UNICEF or UNFPA are involved in. That wouldn't exclude the second level domain name. You could have, for example. The exact details have yet to be worked out.

The current three major top-level domains have no screening process whatsoever. That screening is extremely work intensive. How do you plan to finance it?

I agree that screening is work intensive, but the higher the barrier to entry, the fewer applications we expect to get. We don't expect to get 7,000 applications a day like a registrar in dot com. Registrars compete on their services and the cost of their services. We would operate on a cost recovery basis and work with competing registrars. The applicants would pay the fee to the registrar, not to us. We would support lower-income country applications through an existing process that we use in publishing called a revolving sales fund.

Requiring registrars to do screening is not currently in their remit. Isn't that going to be a problem?

We don't foresee it as a problem. We would choose registrars on the basis of their ability to perform such a task. They would be under a contractual agreement to do so.

So WHO will be neither a registry nor a registrar?

No. In the application process we have already had to identify the registry and we have chosen CORE. We will continue to work with them on keeping costs low, keeping the data consistent and deciding what is needed to maintain a smooth functioning of the domain name. They have already been a lot of help on that.

Opting to use a top-level domain to resolve a quality problem and a problem of trust is an interesting solution.

It is a concept that I discussed with Ben Segal (at that time trustee of the Internet Society) over a year ago. I hadn't realised that that had initially been the intent of dot com. NSI was unable to implement it because of the sheer volume of registrations. In discussions over the passed year with WIPO, I began to understand that maybe ICANN was moving in a direction that would make it possible to charter restricted top-level domains. When the application process for new top-level domains was announced in June, I immediately saw the possibility for dot health.

Part of the difficulty of developing standards internationally has been the doubt about their enforcement. Up until now there has been no possibility to enforce any kind of standards. The closest that people can come has been to put a "trust" mark on their site. Health On the Net (HON), for example, has a quality seal that you can download onto your site. But people use such trust marks without abiding by the standards. Health On the Net currently has no way to challenge them.

One of the foreseeable problems you might have concerns the neutrality of WHO in the process, because you are in a position of judgement.

We are not placing ourselves in that position. People who apply for use of a name under the TLD agree to abide by a known quality and ethical standard. It is a voluntary application on their part. We are not judging the quality. We say, "Here is standard, if you meet it, you get this name."

If you withdraw a name because of non-abidance by the rules, there is a form of judgement.

It is the same as running a race. There are cut off points. If you don't make it there, then you don't go on.

Who will check to see if they are meeting the standard as times goes on?

Right now, we are thinking in terms of random checks. We are hoping that the prospect of a random check will ensure compliance. We will have to evaluate very carefully if it is working or not. We have collaborating centres whose role is health information and dissemination and such work would fall under their remit. Our goal is not to be a content-cop, but to make this a wide process, inviting people to participate. The different e-health ethics groups, for example, could certainly have a role in this. The WHO's role will be more that of an umbrella organisation.

The opening up of the top-level domains is a real opportunity for international organisations or subject oriented organisations to operate and manage a domain name. We feel it is the role of those involved in the content itself to judge its quality and merit rather than it being run by a technology focused company.

Joan Dzenowagis, WHO
Interview, Alan McCluskey

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Created: November 3rd, 2000 - Last up-dated: November 3rd, 2000