Health Salvation or Snake Oil?

Navigating The Health Internet

by Michael Barnaby

Use of the internet to gather healthcare information increases daily – a recent Harris Interactive (Harris Poll) survey of 1,001 adults showed that in May and June 56% reported accessing the Internet, with 86% of those saying they searched for healthcare information online. Most respondents (40%) said they search the Internet for health information "sometimes," 33% "very occasionally" and 13% reported seeking health information online "often."

An estimated twenty-five thousand health-related websites now crowd the World Wide Web, each vying for consumer and physician attention, or "eyeballs." So where does one begin when seeking health information on the internet? How do you sort the wheat from the chaff? What criteria should a person apply - or a physician offer, a patient?

Many attempts have been made to develop instruments for evaluating health websites. At the time of its printing in 1999, one government study listed 29 different articles and evaluation tools available to consumers. But the tools themselves can be daunting – for example, the Rollins School of Health at Emory University offers a three page, 35 point evaluation form. Can we expect the average layman or casual "surfer" to study each site in such depth?

Although the internet is a comparatively new medium, with important and exciting uses and much potential, in many ways it can be compared to the world of print – newspapers, magazines, etc. And based on this, the same golden rule must still apply: Caveat emptor - Let the buyer beware.

With the exception of government, educational or university sites (".gov" and ".edu"), everyone is on the world wide web for the same reason: profit, pure and simple. Businesses, individuals and organizations (".org") abound, literally by the millions, with endless agendas - marketing, social, political, or personal. Whether to make a sale or a convert, there’s a product at the end. This isn’t meant to be taken as a negative statement, only as a reality.

Given this, before we attempt to evaluate them, can we possibly categorize these twenty five thousand health-related websites? Broadly speaking, I would categorize them as follows: "portals," products and services, condition-or-cause-specific, governmental and educational, and global. As we’ll see, often they are difficult to differentiate, with blurring of the lines often difficult to detect. A sample of each type follows:

• Healthfinder at http://www.healthfinder.gov. This site, sponsored by the United States Department of Health and Human Services, calls itself "a free gateway to reliable consumer health and human services information," offering "selected online publications, clearinghouses, databases, web sites, and support and self-help groups, as well as the government agencies and not-for-profit organizations that produce reliable information for the public." Healthfinder is an example of both a governmental and health portal, or gateway, site.
• The American Heart Association at http://www.americanheart.org. This non-profit, organizational site clearly is dedicated to a single subject or condition – the heart and its health. Nutrition, heart disease, stroke, exercise, science and much more are offered, but always pertaining to things coronary.
• Typing http://134.184.33.110/phreno/index.html into your web browser address bar will take you to The Phrenology Page, an in-depth, true-believer site extolling phrenology, or basing a person’s character on the shape of the skull. This site, along with NoFluoride2000, at http://www.nofluoride.com/, would be considered "single-cause" sites. At the other extreme, the American Heart Association is also a single-cause site.  MedMarket.com, at http://www.discountmedmarket.com is a typical site for purchasing medical products online.
• The scope of WebMD, at http://www.webmd.com, is global. They claim to be "the only company connecting all parties in healthcare - from patients to physicians to hospitals to insurers to employers and all other healthcare organizations."

One sure bet: Surf to the highly respected, non-profit Health On The Net Foundation at http://wolfgang.hcuge.ch/