1. LaCoursiere, Sheryl Perreault RN, PhD

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My recent journey into the world of SPAM began when I was recruiting subjects for my dissertation study, which focused on persons with cardiovascular disease who used the Internet. I had a recruitment plan in mind, which consisted of announcing the study on health-related newsgroups, cardiac sites, general health sites, and sites that appeal to minority participants. My recruitment message had passed muster by my committee and two major Institutional Review Boards (IRBs), so I felt confident that it was clear and concise, was not coercing anyone, and was generally innocuous. The message is illustrated in Figure 1.

Figure 1 - Click to enlarge in new window Sample recruitment posting.

I decided the first logical target were newsgroups that were the closely related to my participants of interest: cardiac patients. I also thought that there must be some people who had heart disease in the general newsgroups, so I decided to post on and Knowing that cardiac patients were usually on multiple medications and needed dietary changes, and also seemed appropriate. And because there is a 30% incidence of co-morbidity with diabetes, I also included BAD MOVE!


Four hours later I received a copy of an e-mail sent to the postmaster of my Web site, and "abuse@," which stated:


"The following message is spam (unsolicited bulk communications) to the newsgroup. It's off-topic, off-charter, and apparently sent to all the health-related newsgroups Ms. LaCoursiere could think of. Such behavior is a violation of the Website hosting policies at (which hosts It's also a much more clear violation of the user policies, where was used to post the message. You folks know the drill: please disconnect the spammer's account and Web site immediately for violating your company's policies. Whether or not it's your typical rip-off or pornography spam, allowing it to continue will cause people to block your sites in their news filters and eventually at the routers and interfere with your well-behaved customers."


I innocently wrote back and explained my reasoning. WRONG! Six hours later he wrote back, with more vituperative comments, three times the size of the original letter. I decided not to waste any more time and keep moving.


I then went to a dedicated cardiac site and posted my announcement on a discussion board. Eight hours later I received a letter from the "CEO" of the site, who advised me that I was violating his terms of service (which I had never seen, or agreed to); however, he was willing to let me access his patients for a mere $5,250 for "Newsletter sponsorship," or if I wanted to get fancy, $60,000 for direct mailings to 1,000,000 people. NOT!


My next step was to go to another cardiac site. At this site, the patients posted their e-mail addresses and stated that they were looking for cardiac support. I again wrote the patients and explained the study. WRONG! Sure enough, the next day I received a letter from the webmaster, telling me that he has been "VERY careful to protect our readers from this kind of thing," and that this message and my reply was being "BCC'd to the Board of Directors" (hmm, pretty shadowy if they are not named on the site). The signature line of the message read "I Love Jesus." THEN, 4 hours later, an anonymous "patient" signed into my site, with a username of, no return address, and no phone number. Feeling suspicious, I e-mailed him to welcome him to the study. The e-mail BOUNCED! I then went back to his site to see if anyone had responded to my posting. Instead I found a message by him to the patients, advising them to watch out for my "alleged study." Thanks, Buddy.


Meanwhile, I was receiving e-mail from patients who had read my postings at the various sites, telling me what a wonderful idea this was, and asking how could they sign up. Figuring the worst was behind me, I dove into the participation, which, after all, was the purpose of the entire project.


When the influx slowed down a bit a week later, I made rounds one last time to see if someone had posted a public message to me on one of the boards about the study. Then I went to the newsgroups. It seemed that my friend from the newsgroup, before he had written to me, had also seen fit to announce to every newsgroup where I had originally posted that my posting was SPAM. Scrolling on down, I found that my original message had generated 13 replies, which consisted of various constituencies arguing with each other over the 3 days following the posting. See Figure 2 for the dialog that ensued.

Figure 2 - Click to enlarge in new window Dialogue in

What was my first urge? To write a post, thanking Poster #4 for his explanation, and trying to convince the others that they really misunderstood what I was doing. I wrote the message out, and then thought, "I can't send this! I will be sinking to their level!"


What is the moral of this story? Number one, if you are recruiting on the Internet, "expect the unexpected." Number two, have a plan of how you will deal with the "naysayers." Number three, always go back to where you have posted-you may find yourself being discussed!


Is there is silver lining to my experience? Unequivocally, YES. I received e-mails for patients for up to a month afterward, thanking me for announcing the study and providing the opportunity to participate. The 6-week evaluations were very similar. It seems that I have had my "15 seconds of fame" in Internet history and the "SPAM watchers" have moved on to the next unwitting party.


Interestingly, after these messages appeared on the net, I started receiving what I would term as SPAM (Amazing discovery! This really works!) in the e-mailbox for the study. Where did they get the address? Who knows? I decided to save them all in a folder. From November 9, 2002, when the address was first used on the Internet, to January 16, 2003 I received 104 SPAM-mails! That's over 10 new "friends" a week!