Reviews Web

Is there a future for links pages?

BMJ 2004; 328 doi: (Published 13 May 2004) Cite this as: BMJ 2004;328:1207
  1. Douglas Carnall, general practitioner (dougie{at}
  1. London

    It has been almost 10 years since the internet exploded into common use. Those who were going to learn html and install servers have done so, institutions have found their internet policies and are sticking to them, and users have settled down into comfortable patterns of behaviour. The internet is no longer “hot”: like plumbing, we'll certainly miss it if it's not there, but the grand visions of those heady days seem wrecked on the rocks of institutions just continuing to do what they have always done.

    In the mid-1990s, when search engines' relevance ranking worked poorly, it seemed to make sense to aggregate pages of links to help yourself, and others with similar interests, to capture the rare jewels of excellence amid a seemingly random deluge. Sheffield University's School of Health and Related Research (ScHARR) has long maintained an extensive series of links in evidence based health information worldwide, now reorganised as Netting the Evidence (

    These web chefs produce a rich soup: nourishing chunks of online database float in a rich broth of the critical appraisal teaching materials assembled by centres and units. However, as a search facility it is next to useless. The average BMJ reader (if such a thing exists) does not scan down the list of links, alight upon, for example, the Canadian Coordinating Office for Health Technology Assessment and then wander through to read an evaluation of spinal manipulation for infantile colic (little evidence for or against the notion that it might work, apparently).

    In the age of Google, producing pages of links has arguably been an activity of increasing futility. Google's underlying ranking mechanisms depend on human webmasters' linking activities to push the better quality pages to the head of the results page. So it is thanks to efforts of webmasters such as ScHARR's that entering the search term “Cochrane” in Google delivers the homepage of the Cochrane collaboration as its number one hit rather than, for instance, the Cochrane Group, a firm of Canadian civil engineers (ranked 37th).

    Netting the Evidence is a plentiful source of materials for anyone attending a critical appraisal course to teach or learn. However, like most pages of links on the net, the site delivers its fair share of “page not found” messages, as the originators of the linked materials reorganise their materials, endure server upgrades, leave, retire, die, or lose enthusiasm for the never ending maintenance that any quality web resource must have to flourish.

    ScHARR's persistence and energy is commendable when similar projects have been quietly forgotten, but this is not the web resource of the future. For that we need a project that combines both social and technical imagination: that harnesses the energy of the questioner, as well as the efforts of the traditional custodians of information.

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