Evaluating Medical Information on the World Wide Web
Contents
- Why is evaluation necessary?
- Safe starting points
- Ratings or Reviews
- Medical Search Engines
- An acronym to help with evaluation
- Questions to ask when evaluating information from the World Wide Web
- Additional guides to evaluating information from the World Wide Web
- Strategies for discussing the contents of web pages with patients
Why is evaluation necessary?
There is no government agency or other authority that screens and controls the information posted to the World Wide Web. The Web encourages the open exchange of ideas, which is why access to the Web has been banned in some countries. However, this means that users must evaluate the information they find on the Web because the quality of information is so variable. Luckily, the web can be "self-correcting" - because of the convenience of the Web it is just as easy to find correct information as it is to find incorrect information! If users compare the evidence from a number of Web sites, then they can make informed decisions.
- More on evaluation health information from MedlinePlus.
- A theme issue of BMJ on the topic: "Trusting information on the net" was published March 9, 2002.
- The Federal Trade Commission web site offers numerous articles to help consumers avoid costly or dangerous health claims.
- 'Health Quackery: Spotting Health Scams
- Miracle' Health Claims: Add a Dose of Skepticism
- Operation Cure All
- A few Web sites track misleading information:
- A case study that models good critical thinking about health information:
- In spring 1999 an email message begins making the rounds.
- A pathologist's critical analysis of the claims.
- An Urban Legends website indexes the email.
- Example pages to evaluate:
- Commercial vs. Academic: http://www.mayo.edu and http://www.mayo.com
- Treatment Controversy
- As if allergies aren't bad enough
- If smart drugs are good for me, why do I have to go south of the border to get them?
- Provides abstracts but no citations
- Research hoax from the Annals of Improbable Research
Points to emphasize when talking with patients:
- Start your information search at a safe place. Rely on large, peer reviewed directories of health resources.
- Read reviews of sites to determine their value and accuracy of information.
- When you must search, use a search engine that selectively indexes medical web sites.
- Be especially cautious of the information you find, if you have conditions that are difficult to treat or can have a terminal outcome - if a treatment sounds too good to be true, it probably is!
- Never follow advice without first consulting a health professional such as your doctor, pharmacist, physician assistant, or nurse practitioner.
- Use the DOCTOr acronym to remember important criteria for evaluating web sites,
- Use an online guide to evaluating web pages.
A word about Wikipedia: Wikipedia is an online encyclopedia written and updated by volunteers from around the world. It is not considered an authoritative source for health information, nor is it recommended for serious scholarship.
Safe starting points
For patients:
- Healthfinder
- familydoctor.org from the American Academy of Family Physicians
- NLM's MEDLINEplus
- NOAH: New York Online Access to Health
- Google Coop Health Use the "from medical authorities" or "for health professionals" filters
- Intute: Health and Life Sciences
Evidence Based Medicine Sites for Consumers: Evidence based medicine is an effort by medical professionals to consider the results of all relevant, high quality, scientific studies before recommending the most effective course of patient care. These resources offer information to consumers that has been prepared using EBM principles.
- Ask NOAH About: Evidence-Based Medicine Learn more about evidence based medicine at a site designed for health care consumers.
- Behind the Medical Headlines Behind the Medical Headlines was created by physicians in Scotland to provide authoritative and independent expert commentaries on topical medical matters reported in the international media.
- Best Treatments Clinical evidence for patients, from the BMJ's Clinical Evidence resource. US users must subscribe through
- Consumer Reports Medical Guide.
- Cochrane Collaboration Consumer Network Understand the role consumer advocates can play in the Cochrane Collaboration.Browse summaries of Cochrane Reveiws
- Consumer Reports Best Buy Drugs Consumer Reports takes an evidence-based practice approach to prescription drugs, providing analysis on the most effective treatment and at what cost. Click on the "Drug Reports" link to see all reports.
- DISCERN Use a quality filtering tool to determine the validity and reliability of health information.
- Disease Mongering This website is devoted to the study of the techniques of 'disease-mongering', in particular the expansion of the boundaries of disorders, the medicalisation of normal life events and the portrayal of risk factors as diseases is prevalent in the medical marketing world.
- Doctor Evidence This fee based service provides evidence based information packets tailored to your medical profile and preferences to assist with diagnosis and treatment decision-making. The site also provides referral to specialists for treatment.
- eMedicine World Medical Library Free, up-to-date, evidence-based information. Searches can be restricted to a consumer option for information from online textbooks and a growing collection of consumer treatment guidelines.
- Health News Review Rates and reviews the accuracy, balance, and completeness of health reports in the news. Includes information on evidence concepts such as absolute vs. relative risk percentages, and the number needed to treat.
- Hitting the Headlines The York University Centre for Reviews and Dissemination in the UK scans the headlines for health stories, then creates an evidence based summary in plain language for health care consumers. Use the search box to locate summaries on specific topics. Results are sorted in reverse chronological order, from most recent to oldest.
- National Comprehensive Cancer Network (NCCN)/American Cancer Society Treatment Guidelines for Patients Click on link that says "NCCN/ACS Treatment Guidelines for Patients".
- Patient Decision Aids (Ontario Health Research Institute) Tested, evidence based guides to help patients make tough health care decisions.
- Summaries for Patients: Annals of Internal Medicine Search the ACP web site using keywords, for example: summaries for patients and common cold
- The Why? Files Created by the National Institute for Science Education to analyze current science topics as reported in the media. Browse the archives or use the search form to find a topic.
Ratings or reviews
Many directories provide reviews of the sites they index.
- Med Hunt The Health on the Net Foundation (the proponents of a widely adopted Code of Conduct for medical web sites) provides a medical search engine and reviews of medical web sites. Sites adhering to the HON code or visited and described by HON are featured in separate lists from general search results. Click on the results in the red results labeled "site(s) subscribing to the HONcode" or on the results in light orange labeled "site(s) visited and described by HON". Other sites (in the gray results) are from the web and should be more carefully evaluated.
- Medical Matrix Select a category, then look for star ratings next to links and descriptions. (Fee required)
- Medicine on the Net Reviews of medical web sites, print or online versions available by subscriptiion. (Fee required)
Medical search engines
- Mednets.com
- Scirus (Fee charged for some full text journal articles) Checkmark "Preferred Web Sites", then search your topic.
An Acronym to Help with Evaluation
Use the acronym DOCTOr to remember the key categories to evaluate:
- Design - the aesthetics and ease of movement around the site.
- Other - cost of use, is the site rated or reviewed?
- Content - the depth and quality of the information, its purpose and audience.
- Technical - the technology requirements of the site, the effectiveness of the technology used.
- Origin - the author and sponsor of the site, their qualifications for presenting the information, the date of the information.
Questions to ask when evaluating information from the World Wide Web
Design
- Does the page use color, graphics, backgrounds, or type styles which are attractive?
- Does the page use color, graphics, backgrounds, or type styles which enhance (rather than detract from) the page?
- Is the layout of the page appealing?
- Is the page layout organized and logical?
- Is the site easy to use?
- Is the page free of typographical or spelling errors?
Other
- Is there a cost for the site?
- Is the site rated by a reliable resource?
- Is the site reviewed by a reliable resource?
Content - Some of the most important questions you should ask and answer about a page or web site:
- What is the purpose of this page? (business, entertainment, education, research)
- Who is the intended audience? (information for the public, researchers, etc.)
- What is the scope of the page? (selective, comprehensive)
- If medical information or advice is given, is a disclaimer statement evident?
- Are side effects, complications, or drug interactions of a treatment discussed?
- Are outcomes or other claims based on scientific evidence or anecdotal testimonials?
- If scientific studies of the treatment are mentioned, were the studies randomized controlled trials, or some less reliable method of study?
- Does the treatment or intervention suggested conform to the recommendations of the best medical evidence?
- Is the information valuable or unique?
- Can the information be verified by another source? (printed, newsgroup communication, another web page)
- Are the links provided valuable?
Technical
- Does the page state what technology or plug-ins are needed?
- Are links to sites that provide the plug-ins provided?
- Does the page require technology that is not readily available?
- Does the page require technology that can not be used on your computer?
- Does the page warn the user of long file transfer times?
- Does the page integrate multimedia appropriately?
- Does the page engage and hold the viewer's attention through use of interactive technology?
- Is the page reliable?
- Do the links work?
- Is communication with the site secure?
ORigin - This information is often contained at the header and footer of the page
- Who is the author of the page?
- What are the author's credentials or qualifications for writing on the subject of the page?
- Are the biases of the author clear?
- Can the author be contacted via a mail to: link?
- Who is sponsoring the page?
- Can any information be gathered by examining the domain name? (sponsor, 3 letter type)
- Is the information timeless? Or is the page regularly updated?
Additional guides to evaluating information from the World Wide Web
- DICERN Users should read the General Instructions before using this evaluation instrument.
- The Internet Detective - is an interactive tutorial designed to educate web users about evaluation issues.
- Widener University Library Tutorial offers a guide to evaluating web pages of many different types, not just health related pages.
Strategies for Discussing the Contents of Web Pages with Patients
- Acknowledge the interest and effort he/she has shown in researching the topic on the Web
- Thank him/her for discussing their concern with you
- Ask him/her what questions the information has raised and what specific concerns they have - take notes
- If you have been presented with information that you have never seen before, ask if you can make an appointment to discuss the materials after you have read and thought about them
- Read the materials and view their contents on the Web. Determine whether the materials are part of a larger group of pages.
- Use the DOCTOr acronym and questions above to evaluate the contents of the page
- Read reviews of sites, if available, to determine the value and accuracy of information.
- When you discuss the content, present as balanced a view as possible based upon the evidence
- Stay calm and don't be provoked into an emotional argument. Your evidence and professional knowledge is your best persuasive tool.
- Use the opportunity to educate:
- Suggest Web sites that are safe starting points
- Encourage comparison of information to reliable sources
- Warn him/her to be cautious - remind him/her that the Web has no "quality control"
- Ask him/her to consult a health professional before following medical advice given on the Web
- If he/she doesn't accept your advice, offer to make an appointment with someone who's expertise they might accept
- Each individual must make their own decisions. We cannot "rescue" others from decisions we think are ill-advised.
Copyright 1998 -2008
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The URL of this page is http://hsclibrary.uchsc.edu/education/evaluating.php
Questions about this page should be directed to Lynne.Fox@uchsc.edu