Social Media Notebook: The Intersection of Health and the Law

MDNG Primary CareJuly 2010
Volume 12
Issue 7

Today, it's all about sexting, COPPA, and children's online privacy. Who knows what issues we'll have to face tomorrow?

Today, it’s all about sexting, COPPA, and children’s online privacy. Who knows what issues we’ll have to face tomorrow?

Helping people stay healthy isn’t easy for physicians. Not only must we abide by a host of science-based rules, guidelines, and best practices that are often open to wide interpretation and must be applied with each patient’s unique situation in mind, we also are bound by labyrinthine state and federal laws and regulations (not to mention all of the third-party payer hoops we have to jump through if we want to get paid for our work).

Physicians must deal with the interface of law and health every day. For example, when we counsel our young teen patients about drinking and driving, we are practicing at that interface. The driving and drinking ages are set by law and when teens do not abide by the law, they are taking unnecessary health risks as well as breaking the law. A technology-focused example of the interface between medicine and the law is sexting. Teens that send risqué photos of themselves via text message run the danger of being labeled as a sex offender ( This is why education is so important around this issue.

However, the hottest issue at the interface between health and law that is putting our kids at risk is one that most physicians and parents are unfamiliar with: the Children’s Online Privacy Protection Act (COPPA; COPPA was created in 1998 to protect children under age 13 from having their information collected online without parental consent. Websites that fail to comply with COPPA are fined heavily by the FTC.

When COPPA was developed in 1998, the Internet was in its infancy. The robust evolution of Web 2.0 with the likes of social media sites and blogs has caused the FTC to take a step back and ask if the current COPPA rule is still effective. To that end, a roundtable was convened on June 2, 2010, to discuss COPPA and tease through the many complex issues surrounding children’s online privacy ( I was one of many experts asked to participate and sat on the “Actual Knowledge” panel, representing the American Academy of Pediatrics.

One of the salient points of COPPA is being able to define that a site has what is called “actual knowledge” that a person signing up for a site is 13 or older. Many sites (Facebook for example) clearly state in the terms of service that persons younger than 13 years of age are not allowed to participate on their site. Many sites also have a page or section that allows users to report others whom they suspect are under age 13.

If a child under the age of 13 wishes to sign up for Facebook or other age-restricted websites, that child either has to lie about his or her age, or that child’s parent has to lie about the child’s age. This is unhealthy for the development of the child. If we condone lying in one setting, children may get the message that it is ok and try on that hat in other settings. We need to reinforce that rules and laws apply to the online world too.

Parents often don’t understand that kids under age 13 are incredibly vulnerable to the deceptive ploys of online advertisers and to content that is meant for a much older teen and young adult audience. This isn’t about connecting with friends and family but about keeping kids who are too young to negotiate a complicated social and commerce site away from that site until they have the maturity and social skills needed to stay safe in that online environment. If older teens struggle with the Facebook environment and settings, why in the world would we expose our younger kids to this, especially since we have to lie and break a law to do so?

As experts in kids’ health and development, it’s up to physicians to help parents stay on top of all issues that impact their kids’ lives, and that means being aware of laws like COPPA. We don’t need to be experts in all of the legal nuances, just savvy enough to help keep kids healthy online and offline. Today, issues such as sexting and COPPA are at the center of the debate on health, technology, and the law. Whatever issues tomorrow may bring, we’ll deal with them as they come and continue to find a way to address them during our all-too-brief appointments.

Gwenn Schurgin O’Keeffe, MD, FAAP, (aka “Dr. Gwenn”) is a pediatrician, health journalist, parenting and social media expert, and is CEO and Editor-In-Chief of Pediatrics Now (, an online health and communications company dedicated to providing reliable information for today’s busy families. She also writes the blog Dr. Gwenn Is In (

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