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IF YOU want to stamp out nicotine addiction, shut all the quit-smoking clinics, argued an article in The Lancet in 1985. The rationale wasn't that clinics were ineffective, just too expensive to reach enough people. But perhaps there's another way to save money and reach the many thousands affected by smoking-related diseases: make use of the internet.

HealthMedia in Ann Arbor, Michigan is doing just that, with impressive results. The latest version of its Breathe program - when used with a nicotine patch - is getting quit rates to rival those of group therapy.

Breathe is one of a rapidly expanding stable of so-called e-health programs that use internet technology to change the way patients think or behave. Say your 7-year-old is soiling his underwear, a program called U-Can-Poop-Too is in clinical trials to see if it can help children with this condition, which affects up to 7 per cent of children under 12.

Need to better manage your diabetes? Your doctor may soon prescribe blood glucose awareness training using BGAThome. Depressed? Try MoodGym, an open-access site with 250,000 users from 203 countries, and a dedicated portal for the US air force. Also in development are programs to treat more serious mental health problems such as bipolar disorder (see "Wishing you good mental health"). Most e-health programs borrow heavily from cognitive behaviour therapy, which encourages people to change their emotions and behaviour by altering the way they think.

"Fifty per cent of disease management is behavioural," says Victor Strecher, director of the Center for Health Communications Research at the University of Michigan in Ann Arbor, and founder of HealthMedia. E-health raises the possibility of delivering $500 courses for 25 cents per person, and "knowing that you can reach millions", he says.