Promotion of BHT on the Internet
1 Supplemental Digital Content 1: Coding Scheme, which provides an overview of the data extracted
Website Characteristics
1. Source of website (N=0; Y=1)
a. Health care provider is offering to prescribe BHT as a service b. Compounding pharmacy is offering BHT service/products c. Selling BHT products
2. Health care practitioner offering BHT services on website (N=0; Y=1) If healthcare professional then: (N=0; Y=1)
a. Medical Doctor (Family physician, OB-GYN, other) b. Pharmacist
c. Naturopathic Doctor d. Nurse practitioner e. Other (open field)
3. Type of service offering BHT services ((N=0; Y=1) a. Medical clinic
b. Compounding pharmacy
c. Homeopathic/naturopathic clinic d. Other (open field)
4. Region (N=0; Y=1) a. Canada b. US
c. Other (open field)
5. Other services offered (N=0; Y=1) a. Weight loss
b. Botox c. Laser d. Spa
e. Other (open field)
6. Date of website last updated - date BHT description
1. Definition of BHT provided (N=0; Y=1) 2. Definition of CHT provided (N=0; Y=1) 3. Type of BHT defined (N=0; Y=1)
a. Compounded BHT only
b. Commercial FDA/Health Canada approved BHT only
c. Both compounded BHT + commercial FDA/Health Canada approved d. Non-prescription BHT (type)
e. Not mentioned f. Other (open field)
2. Hormones defined as bioidentical (N=0; Y=1) a. Estrogen
i. Estriol ii. Estrone iii. Estradiol b. Progesterone c. Testosterone d. DHEA
3. Types of products being promoted, if mentioned (N=0; Y=1) a. Biest
b. Triest
Promotion of BHT on the Internet
2 c. Prometrium
d. Commercial Progesterone Cream e. Other (open field)
Efficacy claims made for BHT
1. BHT claimed to have benefits (N=0; Y=1)
2. BHT claimed to be effective for menopausal symptoms (N=0; Y=1) 3. BHT efficacy is compared to CHT for menopausal symptoms (N=0; Y=1)
If yes then:
a. More efficacious b. Equal efficacy c. Less efficacious
4. Above repeated for each: vasomotor symptoms, urogenital symptoms, bone loss
Safety Claims for BHT
1. BHT is claimed to be safe (N=0; Y=1)
2. BHT safety is compared to CHT as follows for each: general safety, breast cancer, cardiovascular disease, venous thromboembolism, and side effects (N=0; Y=1)
a. Less risk b. Equal risk c. More risk
3. Side effects for each: vaginal bleeding, headaches, bloating, breast tenderness (N=0; Y=1)
a. Mentions side-effect for BHT b. Mentions side-effect for CHT c. BHT is compared to CHT
i. Less side-effects ii. Equal side-effects iii. More side-effects d. Other side-effects (open-field) 4. Mentions contraindications (N=0; Y=1)
a. for BHT only b. for CHT only
c. for both BHT and CHT
5. Disclaimers from a regulatory body (N=0; Y=1) Reference to Scientific Literature
1. Provides evidence for BHT (peer-reviewed) (N=0; Y=1) 2. Provides evidence for CHT (peer-reviewed) (N=0; Y=1) 3. Other (open field)
Saliva Testing
1. Recommend saliva testing: (N=0; Y=1) a. To initiate HT
b. To monitor HT
c. Sells own saliva testing Target demographics
1. Target Gender (N=0; Y=1) a. Female
b. Male
Promotion of BHT on the Internet
3 2. Target conditions mentioned (N=0; Y=1)
a. menopause b. perimenopause c. andropause d. PMS
e. osteoporosis f. infertility
g. Other (open field) 3. Flesch-Kincaid Readability
4. Stock photos on website (N=0, Y=1)
i. Apparent Ethnicity (white, black, Asian, Aboriginal, South Asian, Other) ii. Apparent Socioeconomic Status (high and middle, low, not apparent) Marketing Strategies
1. Testimonials (N=0; Y=1) a. Patients
b. Celebrities c. Physicians d. Pharmacists e. Nurses f. Naturopaths g. Other
2. Does it indicate BHT as anti-aging? (N=0; Y=1) 3. Words to describe or promote BHT (N=0; Y=1)
a. natural b. physiologic c. individualization d. hormone imbalance e. wellbeing
f. other (open field)
4. Words to describe CHT (N=0, Y-1) a. synthetic
b. hormones used in WHI c. other (open field)
5. Links to advertisements (N=0; Y=1), Type - open field Brief DISCERN
(5-point Likert Scale as follows: 1 = not at all, 2 – 4 partial, 5 completely) 1. Is it clear what sources of information were used to compile the publication?
2. Is it clear when the information used or reported in the publication was produced?
3. Does it describe how each treatment works?
4. Describes the benefit of each treatment 5. Describes the risks of each treatment
6. Does it describe how the treatment choices affect overall quality of life?
Key: N = no, Y – yes, BHT – bioidentical hormone therapy, CHT – conventional hormone therapy
