By Aaron Krol

September 26, 2014 | The Internet Corporation for Assigned Names and Numbers (ICANN), the Los Angeles-based nonprofit that sets global policy for Internet domain names, plans to shortly auction off the rights to sell health-related top-level domain names (TLDs), a scheme that is drawing protests from medical and public policy organizations. This morning, a commentary by lead author Timothy Mackey of the UC San Diego-affiliated Global Health Policy Institute appeared in the open access journal Globalization and Health, calling for a moratorium on the sale of these domain names until new rules can be instituted governing their use.

The addition of 21 health-related TLDs to the Internet, including .health, .doctor, .clinic and .medical, is part of a concerted expansion of Internet domains, which will produce over 1,000 new TLDs in the coming years. The leasing of health-related TLDs to registrars, who in turn sell domain names to individuals and organizations, is taking a variety of forms, but most are being sold off in open auctions.  A single organization, Donuts Inc., is currently in the running for 11 of these TLDs, including .health. Mackey's commentary raises concerns that websites with health-related TLDs could spread misinformation or sell unproven medical products, with the imprimatur of a seemingly official domain name. "It is self-evidently problematic to propound online scientifically unfounded information, or biased information, in an era where customers and patients are increasingly using the Internet as their primary source for health information," the commentary says. It also cites similar objections from the World Health Association (WHO), World Medical Association, European Commission, International Medical Informatics Association, and the independent ombudsperson who oversees ICANN's activities.

ICANN does require registrars to prevent domain name users from violating laws and regulations, but in practice, the commentary argues, has little power to enforce this policy. Moreover, while legislation does bar some of the most egregious Internet-related health practices, like selling prescription drugs online, it would not prohibit companies with serious conflicts of interest from purchasing .health domains. ICANN typically leases TLDs for ten-year periods, with a presumption of renewal.

Mackey's commentary suggests that a moratorium on health-related domains be set until stakeholders like ICANN, the WHO, and the UN-created Internet Governance Forum can create new "rules and guidelines, establishing decisionmaking processes, transparency policies, and certification/accreditation processes to create a subset of easily identifiable and protected health-related domains for the public interest." A specific suggestion is to make .health, and related TLDs, "sponsored" top-level domain names, similar to .aero and .post, which have stronger restrictions on use and are accountable to the specific industries they serve.

The WHO was at one point in contention to serve as registrar for the .health TLD, but has since withdrawn its application and petitioned ICANN for new safeguards surrounding .health domains.