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 American 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 medicine (CAM) on its own terms.

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., 2000).

"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 alternative therapies.

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.

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 "regenerative properties."

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 immediately.

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 themselves.

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.

Figure 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.