Fake internet medical information, parapharmacies and counterfeit drugs constitute a market worth hundreds of billions of dollars per year1–3 and pose a serious public health risk at the global level.4 Exposure of web visitors to fake and misleading information may decrease patients’ compliance to medically recommended treatments, promote the use of questionable and detrimental practices and jeopardise patient outcomes and survival.4–6 The threat posed by fake internet medical information may be of particular harm to patients where the burden of symptoms from the disease or treatment significantly influence quality of life, mood, daily activities and occupational and financial prospects or activity and family integrity.7 Across a range of cancers, where treatment toxicities, malnutrition, cachexia and pain can be significant factors the substantial functional and emotional needs and the motivation to find a solution leave patients with cancer and their relatives particularly vulnerable to fake information and treatments on the internet. What are the factors that may result in patients being exposed to, and potentially influenced by, such on-line harm? Clinical areas where there is a lack of a high-quality research base make it easier for misinformation to be seen as fact. In cancer medicine, for example, research into pain, malnutrition and cachexia does not attract significant funding and is not a popular field for oncologists, researchers or pharmaceutical companies. This may be as a result of competition with research seen as more cutting edge, for example, that using genome sequencing or translational molecular medicine or advanced radiotherapy techniques. It may also be a consequence of more difficult to define end points for clinical trials in these areas. Despite a slow observed improvement in symptom management in these areas over time, there remains an unmet need to adequately address patients’ nutritional and analgesic needs.8–11 Supportive service …