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Rapid Responses: Rapid Responses published:
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A significant number of users are confused by medical information provided over the internet.
- Chinmay M Gupte, Cynthia Datta, Abdel NA Hassan, Ian D McDermott (11 March 2002)
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Useful health info!
- David A Robinson (12 March 2002)
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Anxiety about quality and accuracy of medical information on the Internet will go down in the future
- Cándido Hernández-López (14 March 2002)
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Samuel Johnson on regulating the internet
- Richard Smith (15 March 2002)
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Available antidotes not exhibited, bureacracy not an answer
- Adrian K Midgley (17 March 2002)
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Acceptance of websites as references by peer reviewed journals.
- Nicholas White, Shehan Hettiaratchy (19 March 2002)
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What makes health information on the internet different?
- s Vinod (28 June 2002)
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Chinmay M Gupte, Specialist registrar Musculoskeletal surgery and biomechanics,Imperial College, London W6 8RF, Cynthia Datta, Abdel NA Hassan, Ian D McDermott
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Editor, Purcell et al argue against the regulation of medical information provided over the internet.(1) However, they state that in the final analysis, it is the users views that are paramount. Our questionnaire study of patients attending an orthopaedic outpatient clinic in a district general hospital addressed use of the Internet and the perception of quality of information obtained. From 369 respondents (response rate 91%), 55.3% of patients had accessed the Internet. Of these, 52.0% had obtained medical information from this source. Access was linearly correlated with age (r2=0.975, p<0.01) and was also related to social status. A total of 25% of those who had visited a medical website reported that they had been left confused by the information provided. Of the 12.3% of patients who had researched their particular orthopaedic condition, 20% reported that the advice received from the surgeon in the clinic contradicted that obtained from the Internet. A total of 35.7% of patients would undergo an Internet -based consultation, whilst a further 25.5% would consider this, depending on the medical condition in question. This study suggests that the a significant proportion of “users” of medical websites will enter our clinics more confused than those who have not endeavoured to surf the internet. Moreover, the rate of perceived discrepancy between advice provided over the Internet as compared to that provided by the doctor in the clinic is worryingly high. However, the use of the Internet for this purpose looks set to increase. In the United States the American Medical Association has issued guidelines to govern aspects of its medical websites and has identified four major areas in which quality standards are required: content, advertising and sponsorship, privacy and confidentiality,and e- commerce.(2) On the basis of “users” views we suggest that the British medical establishment, and its individual specialities, set up similar guidelines for approved websites. At the very least, we agree with those who have suggested that patients require education in the rudiments of critical review when confronted with the wealth of information available over the Internet.(3) 1 Purcell GP, Wilson P, Delamothe T. The quality of health information on the internet. BMJ 2002:324;557-558 2 Winker MA, Flanagin A, Chi LB, White J, Andrews K, Kennett RL et al. Guidelines for medical and health information sites on the internet: principles governing AMA web sites. JAMA 2000:283;1600-6. 3 Ling CA. Guiding patients through the maze of drug information on the Internet. Am J Health Syst Pharm 1999:56;212-4. Chinmay M Gupte, specialist registrar
Cynthia Datta, senior house officer Abdel NA Hassan, specialist registrar Ian D McDermott, specialist registrar Department of Musculoskeletal Surgery, Imperial College, Charing Cross Hospital, London W6 8RF. Competing interests: none. |
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David A Robinson, e-Learning developer University of Aberdeen
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Sir, In response to the article I would like to point readers at a 'not for profit' health related web site developed by Prof. Ron Maughan and myself. The system built for Brendan Foster's web site onrunning.com provides simple, easy to use and easy to follow tailored health information, it even describes the difference between health and fitness. The site has over 8500 registered users and over 99% of the users think the site is useful and informative. It was developed with a small budget and is used daily. To access the site visit www.myhealthscore.co.uk. many thanks David A Robinson |
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Cándido Hernández-López, clinical pharmacologist Clinical Pharmacology Section, R&D Department, VITA-INVEST, S.A., Sant Joan Despí, Barcelona, SPAIN
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Accordingly with editorialists’ point of view (1) anxiety about quality and accuracy of medical information on the Internet will go down in the future. Taking into account an historical perspective - Purcell et al took the telegraph example but I suggest one better as the first movable type cast in metal invented in the 1400’s by Gutenberg - they conclude that the majority of these engines finish being rendered obsolete by newer technologies. Exactly in the same way as the social effects that invention produced, against of for. Really, in 1997 Impicciatore et al opened the Pandora box when they reviewed the Internet as a source of health information (2). However, an historical outlook also may be useful to give the realistic weight to this sort of papers. Conducting a simple seek by means of Medline database you can find a few number of papers devoted to the same problem of quality and accuracy of health information, but in other sources of information as mass media. In 1990, Gunderson-Warner et al concluded that the teratogen information available in 15 popular magazines, issued in 1985 regarding exposures in pregnancy, was frequently misleading, alarming, and unsupported by the scientific literature (3). Concretely, 55.4% of articles reviewed were scored as misleading or inaccurate. It is of interest to note that five years after this paper Hothan proceeded in the same manner with 14 highest-circulation popular magazines in Australia (4). However, in this occasion he found that 77.6% of articles, which offered information on drugs and environmental influences in pregnancy, were rated as accurate, while only 2.7% were rated as anxiety provoking or inaccurate. Other reviews published in the BMJ, as papers or letters, have showed their reservations about quality and accuracy of medical information in TV programmes (5-7). Several readings may be done subsequent to the above comments. Firstly, the referred problem of Internet is the same old problem of other non-medical or non-scientific sources of health information. Secondly, There are some doubts about a victorious effect of papers for improving quality and accuracy of healthcare information in mass media, including the Internet. As the web editor of the BMJ, Tony Delamothe, has repeated in some occasions: As for any other medium it varies widely, regulation does not seem like the right strategy for improving it. In conclusion, It would be obtuse to select the Internet as the target to propose a regulatory strategy. (1)Purcell GP, Wilson P, Delamothe T. The quality of health information on the internet. BMJ 2002; 324: 557-558. (2) Impicciatore P, Pandolfini C, Casella N, Bonati M. Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home. BMJ 1997; 314:18759. (3) Gunderson-Warner S, Martinez LP, Martinez IP, Carey JC, Kochenour NK, Emery MG. Critical review of articles regarding pregnancy exposures in popular magazines. Teratology 1990; 42:469-472. (4) Hotham NJ. Information on drugs and environmental influences in pregnancy in popular magazines: a critical review. Med J Aust 1995; 162:417-420. (5) Gordon PN, Williamson S, Lawler PG. As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas. BMJ 1998; 317: 780-783 (6) Steel R. Stories in TV drama series about psychiatry were researched in detail. BMJ 1999; 319: 384. (7) O'Connor S, Deeks JJ, Hawton K, Simkin S, Keen A, Altman DG, Philo G, Bulstrode C. Effects of a drug overdose in a television drama on knowledge of specific dangers of self poisoning: population based surveys. BMJ 1999; 318: 978-979. |
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Richard Smith, Editor BMJ
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One of the favourite hunting grounds for those with a passion for regulating and "getting things right" is language. In the preface to his great dictionary, Samuel Johnson wrote: "Sounds are too volatile and subtle for legal restraints. To enchain syllables, and to lash the wind, are equally the undertakings of pride." I think Johnson would have said the same about regulating the internet. Being dead, he cannot, of course, disagree with what I suggest he might have said. This is perhaps a naughty game to play. What might Plato have said about the internet? Richard Smith, Editor, BMJ |
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Adrian K Midgley, GP - sabbatical on Internetworking and health Exeter EX1 2QS
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The remedy for bad information is two fold:- Give good information; Comment adversely on the bad information Technical means exist for both of these, the former is trivial, since producing usable web pages is very easy, more doctors should do so. The second aspect is more interesting. Three technologies are or have recently been available that should be used by official and semi-official bodies. They are in general described as reputation managers and are a significant lack in the Web as it stands. Other systems can be used to similar effect, but the idea of central bureacratic pre-approval of web pages is lame, contrary to the direction of evolution of society and our profession, and only a fool would choose and expect it to work. I expect it to be the favoured option. The Third Voice system - which did not thrive as a commercial entity after the recent sure of interest in Internet businesses is one good model. In this comments relating to the specific web page in question are placed on a separate server and delivered to subscribers via a plug-in module or other addition to their web-browsing. They appear for instance in a window floating near the page dislay in the web browser. The Allegra peer review system, which maintained a datbase of information about subscribers (mine for instance would indicate that I am English, 40-50 years old, male, educated to degree standard and of a scientific bent) and produced an indication for each link to a page of what people _similar to me_ had felt about it. For those pages I surfed, I would have the opportunity to indicate with traffic lights whether I thought the page to be good, average or poor, and this information is collated in the central database. The third technology is that of the demonstrator project Annotea of the World Wide Web Consortium, and involves an Annotation Server, which anyone might establish, and which would present the assembled annotations to anyone subscribed to its service. Each of these systems has these characteristics:- They are independent of the websites to which they refer. They gather and then disseminate opinion from a population, and in general a population who use the sort of information to which they refer - and experience suggests are quite good at assessing it and better in the aggregate. They operate in real time, without delaying the presentation of new or topical information, and allow arbitrarily frequent updates. All of those aspects would be absent or reversed in the case of a central, State, service presenting approved information only, and attempting to prevent the publication of anything unapproved, or prevent citizens from consulting or believing other material. To hear such suggested in correspondence during the demonstration of the degree of effectiveness that strong, coordinated (uniform, 3 line whipped) reassurance is having with regard to the MMR mixture is disappointing. But not surprising, there are still people around who do not understand the nature of the revolution which Berners-Lee unleashed in 1993 with the invention of the Web, it is not less of a change than Gutenberg catalysed some generations earlier. To the anticipated FUD (fear, uncertainty and doubt) about the risks of legal action against a service that holds critical comment upon the idiocy that is Homeopathy, the arrant foolishness of Laetrile, Gerson Therapy and other quackery in cancer treatment, I say that a central information service unwilling or unable to firmly give those messages is probably one of the services that it should not issue one of its own licences to. Those who wish to dispell the balls on the Web need to show some of their own. The base article is good and interesting, the conclusion that the Web doesn't need new and different regulation is true. Those with good information must get it out there. |
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Nicholas White, Senior House Officer Department of Plastic Surgery, Charing Cross Hospital, London W6 8RF, Shehan Hettiaratchy
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Editor-We read with interest the editorial by Purcell et al(1) on the quality of healthcare information available to patients on the internet. Healthcare professionals increasingly rely on websites as a source of information. A possible guide to the quality of information on a particular site is the acceptance of that site as a reference in an article in a peer reviewed journal. We recently surveyed major surgical journals(2) to establish how they view the use of websites as references. The majority were happy to accept the use of websites without restriction. However, a few journals were concerned about the dynamic nature of websites allowing their content to be changed at a later date. A good previous record or belonging to a credible organisation were criteria deemed necessary by other editors. There was no uniform opinion across the journals surveyed. Further clarity is needed on the issue of websites as references. Defining a quality standard for such sites is going to be difficult and the use of any information obtained is best left to the judgement of the individual. 1 Purcell GP, Wilson P, Delamothe T. The quality of health information on the internet. BMJ 2002:324;557-558 2 White N and Hettiaratchy S. Do websites make suitable references? Ann R Coll Surg Eng (Suppl) 2001; 83: 169. |
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s Vinod, director center for cybermedicine and medical informatics
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What makes health information on the internet different? Sir, The authors of this paper[1] had failed to mention an important aspect that makes health information on The internet different from other sources. Health information on the internet is different from those on books[2] in the following respects. 1)Unlike accessing information in books, anyone could access a particular information independent of related information like disclaimers, information about the author and publisher, preface etc 2)Information on the internet is interlinked as a continuous string and often cannot be separated into discrete entities as in the case of books. Thus evaluating discrete pieces of a continuous string of information is perhaps the most foolish way of doing it. To date there has been no published literature on the link structures of websites offering health information. 3)Information on the internet can be rewritten or changed in no time , unlike hard copies which are rather permanent records. 4)Many of the instant and interactive communications like chat, e- mail etc which are the hallmarks of internet are difficult to evaluate.. 5)Many of the websites offer dynamic content 'tailored' to the needs of particular patient settings. Thus these information is presented in a wide spectrum and thus difficult to evaluate. [1]The quality of health information on the internet Purcell et al BMJ 2002;324:557-558 ( 9 March ) [2]Potential problems with trustmarking health information on the Net Vinod Scaria e-JCMI 2000(1) http://www.cybermedicine.150m.com/paper1.html -------------------------------------------------------------------------- ----------------------------------- |
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