Intended for healthcare professionals


Against internet exceptionalism

BMJ 2002; 324 doi: (Published 09 March 2002) Cite this as: BMJ 2002;324:556

There's nothing radically different about information on the web

  1. Sasha Shepperd (Sasha.shepperd{at}, senior research fellow,
  2. Deborah Charnock, research fellow
  1. Department of Primary Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF

    The sheer novelty of the internet continues to colour discussions of it. Attention paid to online health information invariably focuses on how it differs from what has gone before rather than how it has remained the same. Certainly, the internet provides swift access to large amounts of information that previously required determined tracking. Users can communicate rapidly through email, chat rooms, and other internet forums. And it is remarkably easy to publish and disseminate information, with little accountability.1 But are these enough to justify the belief that information retrieved via the internet differs radically from what has gone before, requiring an exceptional response?

    The combination of rapid access and wide dissemination makes it easy to understand the appeal of initiatives aimed at limiting access to misleading or inaccurate information on health. Allowing users to judge at a glance the quality of such information by the use of labels has been widely debated. 2 3 However, the exact purpose of controlling the quality of health information on the internet remains unclear.4 Health information in other media has not received the same degree of attention, even though the public is exposed to misleading and inaccurate information from a variety of sources. 5 6

    What has changed is the rapidly increasing consumer involvement in decisions about health care. Patients and their relatives are now accessing ever more information from ever more diverse sources, with health professionals having little or no time to help them manage what they have found.7 Yet good quality information is seen as a key component in increasing consumer choice and participation. As well as being accurate and up to date, information is expected to provide detailed explanations of likely outcomes with and without treatment, with any areas of uncertainty dealt with honestly.8 Determining whether treatment information reaches these standards rests largely on an analysis of its content.

    Suggested strategies aimed at ensuring public access to high quality health information online include kitemarks or seals of approval and the creation of databases of information that have been quality assured in some way. Kitemarks or seals of approval9 are usually based on checklists of desirable attributes of quality or some other feature of the information. However, most checklists are unstandardised3 and inaccessible to the public and so are an opaque way of conveying quality to the user. Screened databases require huge resources and may be impractical in terms of the volume of available health information and the resources needed for staff training and updating. Neither system takes into account the range of information available (both on the internet and in other media), the preferences of users, or the desirability of going down this route.

    An alternative is to take a “non-exceptionalist” approach to online health information. Many of the issues arising from the internet that cause concern are common to all types of information, with readability and accuracy of content causing the most anxiety. Solutions to these concerns are seldom restricted to a single method of delivering information.10

    A non-exceptionalist strategy should aim to help producers of health information publish high quality websites using explicit guidelines that take into account previous work11 and to provide users and providers with transferable skills. These standards and skills should be based on an understanding of search strategies that can be employed to retrieve high quality information (regardless of type) and how content can be appraised for quality. Providers of databases or bibliographies of health information can aid this process by highlighting the strengths and weaknesses of each publication screened and acknowledging that material may contain useful information despite falling short of quality criteria.12 Such initiatives will enable the user to supplement information found by using professionally developed databases and to build a set of core skills that can be applied in the dynamic context in which health information is available. These strategies will help users of all types of information. (They cannot, however, address the persisting inequalities of access to internet resources.13)

    Concerns about the quantity of available information and how it is delivered and accessed are valid, but these are separate from the issue of quality and should not deflect attention from the standards that need to apply across all information types and media.14 Future initiatives focusing on core standards and transferable skills will equip users, providers, and producers of health information to deal with rapidly developing new technologies, and the increasingly dynamic context in which health information is available.


    • We thank Peter Rose for his helpful comments on an earlier draft.


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