VICUS.COM (28 Oct. 2000) -- Recently, I was asked to lecture on
evaluating the reliability and usefulness of medical information on
the Web during a meeting of the
American Medical Writers Association (AMWA) in New York City.
It made me take stock of what I had learned in the past year about
sources of medical information on the Internet and compare it to my
past careers in medical communications and academia. As the
Accreditation HealthCare Commission (also known as URAC)
begins its evaluation, I hope my perspective, as one who has come to
rely on the Internet as a source of medical information, will be of
some value to them.
I have four simple
standards for assessing medical information on the Internet: recognize
bias, discount jargon, don't be influenced by hearsay, and most
importantly, be willing to consider complementary and alternative
on its own terms.
1: Recognize bias
Remember, in addition to
learning the facts, it is critical to recognize the bias of the source
of the information. Mainstream allopathic medical publishers have
rightfully warned us that although the Internet is potentially a good
source of medical information, it suffers from a lack of independent
controls to ensure quality and fair balance. Furthermore, there is an
embarrassing degree of bias on the Web (Walker, et al.,
"Bias" is not
necessarily a bad thing. It simply means that the source of the
information (writer, editor and publisher) has a point of view it
intends to communicate to the reader. Once you know the point of view,
you can intelligently use the factual information to your advantage.
Bias is widespread among
CAM and allopathic websites. How else do you explain the rationale
for ignoring St. John's wort and SAMe in a recent review and editorial
on the treatment of depression in Hippocrates.
This journal is published in print and online by the Massachusetts
Medical Society (publishers of The New England Journal of
Medicine) to meet the needs of primary-care physicians. I would
suggest that today's primary-care doctors do not need another article
on the proper dosing of Prozac or MAO inhibitors as much as they need
guidance to answer daily questions from their patients about
There are two ways to
determine the point of view of the source of the material on a website. The most straightforward way is to take a few minutes to read
the "About…" pages. These tell the background and
objectives of the website.
The other way to learn
about bias is to know who pays the bills. Publishers who accept
advertising on topics and products that are the subject of their
editorial content will always be sensitive to the needs of their
sponsors. websites that sell things directly or provide links to
other sites where you can buy what you are reading about are in a
compromised position. This does not mean that what is on the site is
invalid. It just means that, as with everything else in life, it helps
to know where the other guy is coming from.
Standard No. 2: Discount
Another tool to assess
the validity of information on a website is to recognize and discount
any article that relies on jargon to make its point. Jargon is vague
and misleading phrases intended to lead the reader to make broad and
unsubstantiated conclusions. Examples of jargon that degrade the value
of an article include references to therapies that "boost the immune
system," "help remove toxins" and have
Articles about medical
topics must be specific in their claims. For example, an herb never "boosts"
the immune system. It may, however, raise the level of killer T cells
or alter antibody levels. And if it does, this should be stated along
with the potential clinical consequences of the effect. Also, if
massage helps to remove toxins, the author should disclose the toxins
being referred to. Finally, when the term "regenerative
properties" appears, my only advice is to leave the website
3: Don't be influenced by hearsay
Hearsay refers to
unsubstantiated statements. For example, in a scientific review, an
author who states that St. John's wort is as effective and better
tolerated than the prescription drug, Imipramine, should provide a
reference to the supporting study so the readers can see the data for
Standard No. 4: Consider
CAM on its own terms
A common complaint about
CAM is that it lacks the support of large studies, which are the
standard for assessing allopathic therapies. This is true and often
discouraging, but it should be remembered that the main reason for
large studies is that the Food and Drug Administration (FDA) requires
them and pharmaceutical companies are willing to fund them. Until
these factors are brought to bear on CAM, large, definitive studies
will be an uncommon occurrence.
We should never lower our
standards for assessing either allopathic or CAM interventions. At the
same time, we should not ignore or denigrate therapies simply because
the quantity of the data does not meet our highest expectations.
For many forms of
complementary medicine, the objective is to improve outcomes (often as
measured by improved quality of life), not to replace established
allopathic therapies. When viewed from that perspective,
"soft" endpoints may be adequate for a patient to decide it
is worth adding a complementary
therapy to his or her treatment regimen.
For example, I added yoga to
my treatment for allergies after reading a descriptive (but not
scientific) article by Rachel Schaeffer (Natural Health, March
2000). It takes five minutes each night while I stand in the shower. I
can feel my sinuses drain when I do it, and I think I have used less
prescription medicine this season. I didn't need a multicenter,
double-blind, crossover study to convince me to do it.
A final thought on
allopathic vs. CAM
1 shows the same person from Western and Eastern medicine
perspectives. Western medicine is mechanistic. Therapeutic objectives
can be achieved by replacing individual parts when they wear out.
Eastern medicine is more
like gardening; it is holistic. Simply removing a dead flower does not
return the body to health. It requires constant tending in order for
the garden to blossom and reach its full potential. Each part of the
garden, each action by the gardener, contributes to the whole. There
is no quick fix.
Russo Jr., PharmD., is senior vice president of medical
communications at Vicus.com. He is a pharmacist and medical writer
with more than 20 years of experience in medical education.
American Accreditation HealthCare Commission:
Chi-Lum B. Friend or foe? Consumers using the Internet for
medical information. J Med Pract Manage. 1999
Cooke A. Quality of health and medical information on the
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Marwick C. Ensuring ethical Internet information. JAMA. 2000
Apr 5; 283(13):1677-8.
Schaeffer R. Yoga notebook: Sinus pressure relief. Natural
Health. 2000 Mar; 30(2):108-109.
Winker MA, Flanagin A, et al. Guidelines for
medical and health information sites on the Internet: principles
governing AMA websites. American Medical Association. JAMA. 2000
Mar 22-29; 283(12):1600-6.