Feb 12 2008

Medical Information on the Internet

Increasingly patients are turning to Google rather than their physician as a first stop when seeking health care information. The reasons for this are many and mostly obvious: the internet is easily accessible, it is private and discrete (at least most people perceive it as such), and increasingly people are turning to the internet as the repository of all human knowledge. There is also a lot of health information on the web. Just a couple of years ago health care information surpassed pornography as the number 1 type of information on the web.

This access to information is generally a good thing – more information is usually better than less information. But it does raise concerns about the quality of information on the internet, and this is especially true when using the internet as a source of medical advice.

There have been a number of studies looking at the quality and accuracy of health care information on the internet, and it is no surprise that the results are mixed. A new study, just published online in the journal Cancer, looks at the quality of medical information on website discussing breast cancer. They found that 5.2% of the information found was inaccurate. This is pretty good, but not good enough for medical information – especially when people may be relying upon this information to make preliminary health care decisions.

The authors looked at many variables – the URL extension, citing of authorship, last update, etc., in the hopes of finding some criteria they can use to predict which website are more likely to have few inaccuracies. Perhaps this can be used to automatically rate websites for their reliability. I predict any such strategy would ultimately fail as website authors will learn how to game the system – how to look reliable, just as website authors now game the search engine methods to get themselves ranked higher.

In any case, the authors found that there were almost no criteria that predicted the accuracy of the information – no short cut to quality control. Except, that is, one feature that stood out. They wrote:

The odds of inaccuracy for webpages having CAM among their topics were approximately 15.6 times those of sites not having the complementary medicine topic.

I must say, I am not surprised by this at all. Web sites promoting so-called alternative modalities were 15.6 times more likely to contain inaccurate information. And, this is not counting the CAM modalities themselves (that would be self-fulfilling) but rather they contained information about breast cancer that was simply inaccurate – as judged by two independent medical experts.

Why is this? It is difficult for me to give an answer that is not steeped in my own bias on the topic. Any speculation as to why this may be would need to be studies in follow up research to see if it is actually true. But with this caveat my guess is that website authors who are amenable to CAM topics have lower scientific and scholarly standards generally, and this is reflected in the content on their websites. I have argued before that CAM is an artificial category that exists only to carve out a niche where lower standard of evidence and logic can survive. This study, in my opinion, is partial validation.

An alternative hypothesis is that those who are engaged in fraud are likely to flock to CAM modalities because of the lower standards and because it is an area dominated by hope at the expense of skeptical analysis. That is fertile ground for charlatans and con artists. Such dubious websites are likely to contain misinformation, because misinformation is being used to set up the con – to convince people that the solution does not lie with mainstream medicine but with the miracle cure that is being sold.

Regardless of the cause, the authors final words are well heeded. They write:

Therefore, consumers who consult the Internet for information about breast cancer are likely to find accurate answers to their questions. However, they should be encouraged to maintain a healthy level of skepticism of online health information, consider the reputation of the source, and consult an appropriate clinician before taking action.

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