Intended for healthcare professionals

Rapid response to:


The quality of health information on the internet

BMJ 2002; 324 doi: (Published 09 March 2002) Cite this as: BMJ 2002;324:557

Rapid Response:

Available antidotes not exhibited, bureacracy not an answer

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

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.

Competing interests: No competing interests

17 March 2002
Adrian K Midgley
GP - sabbatical on Internetworking and health
Exeter EX1 2QS