Prescription by subscription: the hidden risks of online healthcare

Adelaide University

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Whether it’s a last-minute script, medical certificate or weight-loss treatment, many Australians are turning to online commercial health platforms for their healthcare. But while this model of care is quickly becoming big business, it also raises some significant ethical and policy issues, including risks to patient safety and consumer protection, according to new Adelaide University research.

Analysing the multi-billion-dollar online commercial health platform sector, bioethicists identified how online platforms are blurring the lines between patient and customer, potentially weakening patient care while increasing the risk of fragmented or inappropriate treatment.

They warn that because of the sector’s rapid evolution, regulation has struggled to keep pace, raising concerns about insufficient oversight, unsafe prescribing practices and the unethical influence of commercial interests on treatment decisions.

It’s a timely push, especially with the Australian Commission on Safety and Quality in Health Care announcing it has been tasked with developing national safety and quality standards for virtual care.

In 2025, more than 11 million Australians had a telehealth consultation, illustrating just how embedded virtual care and telehealth has become in Australia.

But these commercial online health platforms go well beyond the type of telehealth people might get from their local GP or public healthcare system and often sell questionable products and supplements alongside medications.

Generally sitting outside the traditional healthcare system, online-only services typically market themselves as one-stop shops for expensive private prescriptions – for example, weight loss injectables such as Wegovy or Mounjaro, hair loss medications, or even controversial peptide and testosterone treatments spruiked by influencers.

Lead researcher and bioethicist Dr Hilary Bowman-Smart from Adelaide University’s Australian Centre for Precision Health warns that while online commercial health platforms may provide convenient healthcare, they’re also creating risks.

“There’s no doubt commercial online health platforms are responding to a demand,” Dr Bowman-Smart said.

“These platforms can offer care that feels fast and convenient, especially with people facing increasingly long waits and rising costs for their healthcare. However, this doesn’t always mean it’s high-quality, appropriate or affordable care.

“Many of these platforms get people to sign up to ongoing subscriptions or memberships, similar to Netflix or Amazon Prime. That’s not what we think safe and ethical healthcare should be about.

“If people turn to these platforms because they don’t have or can’t get in to see a regular GP, this can create risks for people taking multiple medications or who have more complex healthcare needs.

“Our concern is that many people’s healthcare could become brief phone consults with a doctor they’ve never met before, or patients just filling out a form or clicking through an online quiz without details being double-checked or verified.  

“Additionally, when people log on to a platform selling a specific ‘solution’, doctors can feel a lot of pressure to prescribe the solution that the patient wants or that the platform promotes, even if they don’t feel it’s right.

“There’s also the risk that important parts of a patient’s history or medical records get missed with short consults and the fact that many platforms don’t routinely use My Health Record.

“This can harm patients – such as a patient with an eating disorder being prescribed a weight loss injectable – but it can also make doctors feel a loss of professional identity and values, and like they’re just reduced to ticking boxes. That’s bad for both sides of the equation.”

Conducted in partnership with the University of Wollongong, the team of bioethicists were also concerned about the growing influence of commercial interests on healthcare.

Dr Patti Shih from the University of Wollongong said with some platforms used familiar online shopping tactics such as product bundles and discount codes to sell prescription medicines alongside supplements and other wellness products.

“With this model of care, evidence-based treatments can be used as a type of ‘Trojan horse’ to sell people add-on wellness products and supplements,” Dr Shih said.

“For example, someone who is prescribed a hair loss medication may also be sold a ‘tailored’ plan with daily vitamins and shampoo products for ‘optimal results’, without those add-ons necessarily having the same medical evidence.”

With reports of overdosing, inappropriate prescribing and adverse health effects, researchers say national standards for the sector couldn’t come sooner.

“We know this sector is growing, but without good evidence and national standards, we risk profit coming at the expense of high-quality and appropriate care,” Dr Bowman-Smart said.

“People need to understand that these online commercial health platforms are very different from traditional healthcare.

“We hope the development of national standards and the upcoming introduction of a National Medicines Record will certainly go some way, but there’s still so much we don’t know about how this sector is operating and what further safeguards may be needed to protect patients.

“In the meantime, Australians need better information about when online care is appropriate, what to look out for and when they need more comprehensive care.”

The research team is now building on the findings through an auDA Foundation-funded project, working not only with the general public, but especially young Australians and people in regional, rural and remote communities to gain better understand their experiences of online healthcare.

The project will include community dialogue groups, a national survey and consultation with healthcare professionals, and will inform a plain-language Health Online Toolkit for consumers and an Action Paper for policymakers, professional bodies and advocates.

 

Notes to editors:

• The research article is accessible here: Bowman-Smart H, Shih P. Prescription by subscription and the ethics of commercial digital health platforms. JME Practical Bioethics. 2026;2:e000189.

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Media contact:

Dr Hilary Bowman-Smart, School of Public Health, Adelaide University.
E: hilary.bowman-smart@adelaide.edu.au

Annabel Mansfield, Senior Media Adviser Adelaide University. M: +61 479 182 489
E: Annabel.Mansfield@adelaide.edu.au

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Journal

JME Practical Bioethics

DOI

10.1136/jmepb-2026-000189

Method of Research

Content analysis

Subject of Research

Not applicable

Article Title

Prescription by subscription and the ethics of commercial digital health platforms

Article Publication Date

11-Nov-2026

 

Elephants found to be increasingly isolated, leading to fractured social networks

With a troubling decline in the population, researchers warn of a tipping point for the highly social animals

University of California - San Diego

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UC San Diego researchers studied more than 400 elephants at the Udawalawe National Park in Sri Lanka.

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Credit: Credit: Udawalawe Elephant Research Project, CC BY-ND

Humans and many other social animals thrive in well-established community networks. Asian elephants are one example of a species that flourishes in groups that work together to access food and care for their young, among other social bonds.

University of California San Diego scientists in the School of Biological Sciences studying the intricacies of Asian elephant community structures have documented a troubling downturn in the population of the animals resulting in fractured social communities. Their study is published November 12 in Science.

Analyzing the social dynamics of more than 440 wild female Asian elephants over 12 years at the Udawalawe National Park in Sri Lanka, the researchers studied key shifts in the demographics of the elephants that seemed to trigger social communities becoming smaller and more isolated.

“We found that gradual accumulation of losses from turnover preceded sudden change in the social networks among females in a wild population of Asian elephants,” the researchers explained in the study, which was led by Postdoctoral Researcher Anastasia Madsen from the laboratory of Associate Professor Shermin de Silva in the Department of Ecology, Behavior and Evolution. de Silva also serves as president and founder of the conservation nonprofit Trunks & Leaves Inc.

The researchers’ analysis indicates a social structure tipping point. As the number of elephants in the population decreased over time, due to a combination of likely deaths, permanent emigrations of elephants and fewer incoming individuals, the population as a whole appears to have crossed a critical threshold that resulted in a shift from large, densely connected social communities, to smaller and less-connected social groupings.

“We see individual elephants leaving and possibly dying at accelerating rates, but new individuals are not coming into the population,” said Madsen. “With fewer individuals in the population, those who are left will naturally have fewer relationships. However, the remaining elephants are also changing their relationships with each other.”

This new dynamic is a cause for concern, says Madsen, since the animals leverage their social groups and connections to forage, acquire information and raise young.

“We can probably all relate to the feeling of social isolation brought about, paradoxically, with the advent of digital communications that seem to remove the physical constraints of needing to be in the same place at the same time,” said de Silva. “But for many social species, which includes ourselves as much as elephants, we have to remember that social connectivity is very much a matter of sharing space and building relationships throughout our lives. Crucially, in order to have resilient communities, we need to be able to replace the relationships that are lost over time.”

Many elephant populations are already impacted through deaths resulting from poaching and conflicts with humans. Other contributing factors may be disruptions in habitat connectivity and less food available for the elephants as ecological conditions change across the 119-square-mile park and surroundings.

The new social fracturing structure observed by the scientists may not be easily repaired, the researchers warn.

“In general, we need to be more aware of these types of tipping points where we see sudden shifts after changes have been slowly building up,” said Madsen. “Once we move past the tipping point, it’s much harder to go back to previous states.”

The new findings will serve future studies seeking to understand shifts in animal society structures, how to detect such tranformations and the factors responsible for vulnerabilities. The study also stimulates ongoing discussions for conserving elephant populations as humans expand into areas where elephants historically thrived.

“We are gaining more evidence that studying social patterns is an important tool for us to see when things are going wrong in natural populations and, hopefully, to be able to do something about it,” said Madsen.

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Journal

Science

DOI

10.1126/science.aef6714

Method of Research

Observational study

Subject of Research

Animals

Article Title

Increased demographic turnover and isolation precede social fragmentation in Asian elephants

Article Publication Date

12-Nov-2026

Asian elephants thrive in groups that work together to access food and care for their young.

The new findings serve future studies seeking to understand shifts in animal society structures.

Credit

Udawalawe Elephant Research Project, CC BY-ND

  

Solar power emerges as the most cost-effective renewable energy source for water pumping in Nigeria

New research comparing solar, wind, and biomass energy across Nigeria reveals that solar power offers the most economical solution for water pumping, providing valuable insights for sustainable water access and renewable energy planning.

Shenyang Agricultural University Collaborative Journals

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Investigation of solar-wind-biomass for water pumping application and wind shear determination across different locations in Nigeria

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Credit: Richard Oladayo Olarewaju, Ayodeji Samson Olatunji Ogunjuyigbe, Temitope Raphael Ayodele, Samson Oladayo Ayanlade, Ignatius Kema Okakwu & Olusola Kunle Akinde

Access to reliable water remains a major challenge in many parts of Nigeria, particularly in communities where electricity infrastructure is limited or expensive. Water pumping systems often depend on conventional energy sources, increasing operating costs and environmental concerns. As countries seek cleaner and more affordable alternatives, identifying the most suitable renewable energy technology has become increasingly important.

A new study published in Energy & Environment Nexus provides fresh evidence that solar photovoltaic (PV) technology is the most cost-effective renewable energy option for water pumping across six representative locations in Nigeria. The research also offers a detailed assessment of wind conditions across 37 locations, helping guide future renewable energy investments.

"Reliable access to water is essential for public health, agriculture, and sustainable development. Our findings highlight the importance of selecting renewable energy technologies based on local environmental conditions and economic performance rather than assuming that one solution works everywhere," said Richard Oladayo Olarewaju, corresponding author of the study.

To investigate the potential of renewable-powered water pumping, researchers compared 10 solar photovoltaic modules, nine wind turbines, and biomass-based electricity generation systems. The analysis covered six locations representing Nigeria's major geopolitical regions: Ibadan, Abakaliki, Benin, Abuja, Bauchi, and Dutse.

Using 11 years of solar radiation and wind speed data from 2014 to 2024, the team evaluated energy production efficiency and electricity generation costs through mathematical modeling and simulation.

The results revealed substantial differences between renewable energy technologies. Solar electricity costs ranged from $0.21 to $0.40 per kilowatt-hour, compared with $0.42 to $1.11 for biomass and $1.84 to $8.58 for wind energy. Solar power consistently achieved the lowest estimated electricity generation cost across all six locations.

Among the solar technologies examined, a Panasonic photovoltaic module delivered the highest capacity factor at every study site, reaching 19.09% in Dutse. For wind energy, the DW 54 EWT turbine demonstrated the strongest overall performance among the evaluated models. However, even the better-performing wind turbines could not match solar energy's economic competitiveness for the water pumping applications considered.

Beyond comparing energy costs, the researchers examined wind shear, which describes how wind speed changes with height above the ground. Analyzing 37 Nigerian locations, they identified wind shear exponent values ranging from 0.10 in Calabar to 0.48 in Asaba.

These findings could help engineers estimate wind speeds at different turbine heights, improving equipment selection and project planning.

The study also revealed important seasonal patterns. Solar radiation and wind speeds were generally lower during Nigeria's rainy season and higher during the dry season, emphasizing the importance of accounting for seasonal variations when designing renewable energy systems.

"Our results provide a practical foundation for policymakers, engineers, and energy investors to make more informed decisions about renewable-powered water infrastructure," Olarewaju added. "By prioritizing technologies that combine technical reliability with economic feasibility, communities can move toward more sustainable and affordable water supply systems."

The findings suggest that solar photovoltaic systems deserve priority consideration for renewable-powered water pumping in the locations studied, while biomass and wind technologies may remain relevant under different local conditions.

By connecting renewable energy performance with water infrastructure needs, the research offers a useful framework for expanding sustainable water access, reducing dependence on conventional fuels, and supporting cleaner energy development in Nigeria and other regions facing similar challenges.

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Journal reference: Olarewaju RO, Ogunjuyigbe ASO, Ayodele TR, Ayanlade SO, Okakwu IK, et al. 2026. Investigation of solar-wind-biomass for water pumping application and wind shear determination across different locations in Nigeria. Energy & Environment Nexus 2: e025 doi: 10.48130/een-0026-0019  

https://www.maxapress.com/article/doi/10.48130/een-0026-0019  

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About Energy & Environment Nexus:
Energy & Environment Nexus (e-ISSN 3070-0582) is an open-access journal publishing high-quality research on the interplay between energy systems and environmental sustainability, including renewable energy, carbon mitigation, and green technologies.

Follow us on Facebook, X, and Bluesky. 

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Journal

Energy & Environment Nexus

DOI

10.48130/een-0026-0019

Method of Research

Experimental study

Article Title

Investigation of solar-wind-biomass for water pumping application and wind shear determination across different locations in Nigeria

A molecular bridge Strengthens perovskite solar cells for higher efficiency and longer stability

Shanghai Jiao Tong University Journal Center

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• Bridging the 2-formylbenzenesulfonic acid salt molecule at the self-assembled molecules/perovskite buried interface enhances charge transfer via π–π stacking and passivates defects via Pb2+ coordination, yielding a superior power conversion efficiency of 26.21%.
• The modified devices demonstrate exceptional storage stability, retaining over 90% of their initial power conversion efficiencies after 4500 h in a nitrogen atmosphere without encapsulation.
• Na+ from 2-formylbenzenesulfonic acid salt effectively occupy A-site vacancies in the perovskite lattice, reinforcing structural stability and substantially improving device longevity.

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Credit: Leying Zha, Weilu Ding, Yalin Gao, Xiao Wu, Tinglu Song, Changhua Li, Chenghao Duan*, Xinhui Lu, Guilong Cai*, Suojiang Zhang*.

Perovskite solar cells have emerged as promising next-generation photovoltaic technologies, with rapidly advancing power conversion efficiencies and strong potential for scalable manufacturing. However, the performance and durability of inverted perovskite solar cells remain closely linked to the quality of the buried interface between the self-assembled molecular (SAM) hole-transport layer and the perovskite absorber. Poor interfacial adhesion, inefficient charge extraction, and defects within the perovskite lattice can promote non-radiative recombination and accelerate device degradation. To address these challenges, researchers from Henan University, the Institute of Process Engineering of the Chinese Academy of Sciences, The Chinese University of Hong Kong, and Beijing Institute of Technology have developed a molecular bridging strategy that simultaneously improves interfacial charge transport, defect passivation, and long-term device stability.

Why This Interface Matters

SAM-based hole-transport layers offer important advantages for inverted perovskite solar cells, including favorable energy-level alignment and low-temperature processing. Nevertheless, their molecular aggregation and incomplete substrate coverage can compromise the contact with the perovskite layer. Meanwhile, undercoordinated Pb2+ ions and A-site vacancies at the buried interface create defect sites that facilitate charge recombination and ion migration. Addressing these interconnected problems requires an interfacial modifier capable of strengthening adhesion while maintaining efficient electronic communication between adjacent layers.

Innovative Design and Mechanism

The research team introduced two sulfonate-based molecules, sodium methyl allyl sulfonate (SMAS) and 2-formylbenzenesulfonic acid sodium salt (2-FAS), as functional interlayers between the SAM and perovskite. Both molecules improve substrate wettability, regulate perovskite crystallization, and passivate interfacial defects through coordination between their sulfonate groups and undercoordinated Pb2+ ions. Notably, 2-FAS offers an additional advantage: its benzene ring forms strong π–π interactions with the conjugated SAM molecules, creating an effective molecular bridge that facilitates hole extraction and interfacial charge transfer. Its Na⁺ ions can also occupy A-site vacancies in the perovskite lattice, helping suppress ion migration and phase transitions while reinforcing structural stability.

Outstanding Performance

The optimized 2-FAS-modified inverted perovskite solar cells achieve a champion power conversion efficiency of 26.21%, with an open-circuit voltage of 1.164 V and a fill factor of 86.15%. This substantially exceeds the efficiencies of the untreated control (24.58%) and SMAS-modified devices (25.41%). More importantly, unencapsulated devices retain 90.06% of their initial efficiency after 4500 hours of storage in a nitrogen atmosphere, outperforming both the control and SMAS-based devices.

Applications and Future Outlook

By combining molecular-level interfacial bridging, defect passivation, and lattice stabilization, this work establishes a practical strategy for addressing multiple performance-limiting factors in inverted perovskite solar cells. The use of low-cost, readily available sulfonate molecules also offers advantages for accessible interface engineering. These findings provide a promising foundation for developing more efficient and durable perovskite photovoltaic devices, bringing their potential for long-term practical applications closer to reality.

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Journal

Nano-Micro Letters

DOI

10.1007/s40820-026-02278-6

Method of Research

News article

Article Title

A Buried Sulfonate Molecular Bridge for Synchronous Charge Transport and Defect Passivation in High‑Performance Perovskite Solar Cells

 

Feeling safe, being heard and staying connected are important to children receiving end-of-life care

University of Eastern Finland

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A systematic review conducted by researchers at the University of Eastern Finland brings together studies from mainland China and Taiwan. The review highlights the importance of emotional security, family relationships and culturally sensitive support for children receiving end-of-life care.

The needs of children approaching the end of life extend beyond pain relief and the management of physical symptoms. Children may worry about losing loved ones, wish to stay in touch with friends and seek reassurance that they will be remembered.

The systematic review, published in Palliative Medicine, analysed 16 studies conducted in mainland China and Taiwan and published between 2000 and 2025. The researchers examined the psychosocial and spiritual needs of children and their families, as well as how these needs were identified and addressed.

The findings highlight children’s need for emotional security, meaningful relationships, connection with others and opportunities to express their feelings and thoughts. Children’s spiritual concerns do not necessarily take a religious form. They may emerge through stories and imagination, or through questions about the meaning of life.

Family relationships play an important role in how children’s needs are addressed. Parents sometimes try to protect their child by avoiding conversations about death. Although well-intentioned, this may also limit children’s opportunities to express their fears, wishes and preferences.

The review also identified gaps in the support provided by professionals. Psychosocial and spiritual support was sometimes fragmented, while culturally informed guidance on communication and support for coping with grief were not consistently available.

“A child approaching the end of life needs more than physical care. Children should have opportunities to express their feelings, maintain their relationships and have their voices heard. Addressing these needs requires close collaboration between healthcare professionals, children and their families,” says Doctoral Researcher Xiao Liu of the University of Eastern Finland.

The researchers emphasise that the findings do not necessarily suggest that children’s needs in mainland China and Taiwan differ from those elsewhere. Rather, cultural expectations, family relationships and healthcare structures shape how needs are expressed and addressed.

The findings support integrating psychosocial support into paediatric end-of-life care. As members of multidisciplinary teams, social workers can support communication between children and their families, help identify psychosocial needs and connect families with appropriate services. Coordination between health and social care professionals and providers of psychosocial support should also be strengthened.

Relatively few of the studies included in the review explored children’s experiences directly through their own accounts. Children’s and families’ needs were more often described from the perspectives of parents and professionals.

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Journal

Palliative Medicine

DOI

10.1177/02692163261498541

Article Title

Psychosocial and spiritual needs of children at the end of life and their families in Chinese societies: A systematic review

Article Publication Date

6-Nov-2026