People are increasingly turning to the internet for health advice,
but how do they know they getting reliable information?
by Lisa Grossman
IF YOU regularly turn to a search engine to find out whether, say, you
should put ice on a twisted ankle, you're far from alone. Sixty-one
per cent of American adults seek out health advice online, according
to a survey published last month by the Pew Internet and American
Life Project.
Around a third of those surveyed admitted they changed their thinking
about how they should treat a condition based on what they found
online. Yet a growing body of evidence suggests that much online
health information is unreliable.
"My overall impression is that the quality of health information
varies wildly, almost ridiculously wildly," said Kevin Clauson, a
pharmacologist at Nova Southeastern University in Fort Lauderdale,
Florida. "If [a website] is treated as an authoritative source, and
there's evidence that it isn't, then it's potentially dangerous."
Several studies to be published in medical journals this year
highlight the issue. Pia Lopez-Jornet and Fabio Camacho-Alonso of the
University of Murcia, Spain, found that information on oral cancers on
the top websites gathered by Google and Yahoo searches was "poor"
(Oral Oncology, DOI: 10.1016/j.oraloncology.2009.03.017). Among
other things, the websites failed to attribute authorship, cite
sources and report conflicts of interest. And a study by a team at the
Charite University Medical Centre in Berlin, Germany, of googled
advice on how to deal with heartburn found that "the evidence for most
of the recommendations is weak to nonexistent" (European Journal of
Integrative Medicine, DOI: 10.1016/j.eujim.2009.05.001).
While these and other studies examined dozens of websites, most agree
that the site to watch is Wikipedia. Popular and easy to browse,
the user-generated encyclopedia is the eighth most visited site on the
internet, and the first stop for many seeking health information.
Wikipedia articles appear in the top 10 results for more than 70 per
cent of medical queries in four different search engines, according to
a study in this month's Journal of the American Medical Informatics
Association (DOI: 10.1197/jamia.M3059). It also gets more hits
than corresponding pages on the US National Library of Medicine's
MedlinePlus service.
This is worrying, and perhaps an indicator that some people's search
engine strategies may not be up to scratch. A 2002 study found that
most searchers use only one term in their searches and rarely look
past the first page of results - though internet users may have
improved the way they search since then (BMJ, vol 324, p 573). More
disconcerting is the percentage of doctors who turn to Wikipedia for
medical information: 50 per cent, according to a report in April by US
healthcare consultancy Manhattan Research.
Even more disconcerting is that 50 per cent of doctors turn to the
user-generated Wikipedia for health info
How does Wikipedia fare as a medical reference? Its collaborative,
user-generated philosophy generally means that errors are caught and
corrected quickly. Several studies, including one examining health
information, another probing articles on surgery, and one focusing on
drugs, found the online encyclopedia to be almost entirely free of
factual errors.
Better still, the articles improve significantly with time, according
to a study Clauson published last December in the The Annals of
Pharmacotherapy (vol 42, p 1814). "Wikipedia's editing policy does
work," he says.
But any Wikipedia page (beyond those locked to prevent vandalism) is
vulnerable to malicious editing - and some drug firms have been caught
removing negative information on their drugs from Wikipedia pages.
The site's other major flaw is its incompleteness. Wikipedia was able
to answer only 40 per cent of the drug questions Clauson asked of it.
By contrast, the traditionally edited Medscape Drug Reference answered
82 per cent of questions. "If there is missing safety information
about a drug, that can be really detrimental," Clauson points out.
For example, Wikipedia's page on the HIV drug Prezista makes no
mention of complications when used alongside St John's wort, the
herbal supplement used to treat depression. Their potent interaction
can cause the HIV therapy to fail.
On the other hand, the publicity Clauson's research garnered has
helped fix the shortcomings he highlighted. One error of omission -
that pregnant women should avoid the painkiller Arthrotec - was fixed
the same day Fox News ran a story on the study.
The medical community has taken note of Wikipedia's success, and has
made several attempts to replicate it. For instance,
specialty-specific wikis (editable web pages) such as
RadiologyWiki and WikiSurgery can be edited only by doctors.
A more general medical wiki called Medpedia, also written and
vetted by medical professionals, launched in February. Medpedia was
founded by San Francisco entrepreneur James Currier, who teamed up
with several prominent medical schools and organisations to build a
reliable medical database - with a social networking site at its
heart. It includes non-encyclopedic resources such as a section for
user Q&As and debates.
"Our goal is to be the place where physicians tell their patients to
go educate themselves," Currier told New Scientist. "Everyone can
benefit from a more educated patient."
But it's still always a good move to consult a professional before
starting a treatment, he cautions. "Anything they see [on Medpedia]
will be trustworthy stuff, but it's not complete. Nobody is," he says.
It will take a long time for these smaller wikis to match the
popularity of Wikipedia, however. "Ultimately, it will be easier to
change the quality of information in Wikipedia than to change the
search habits of an entire population," Clauson says.
The US National Institutes of Health is catching on. On 16 July, it
hosted an event at its headquarters in Bethesda, Maryland, with the
stated aim of teaching health professionals how to edit Wikipedia's
health pages and why they should think about doing so.
The Wikipedia of the future, it seems, looks set to become a far more
reputable place.
Some of the more reliable medical info sources
Health websites you can trust:
o MedlinePlus http://medlineplus.gov A directory of articles from
the US National Library of Medicine
o NHS www.nhs.uk The website of the UK National Health Service.
Its other website, NHS Direct www.nhsdirect.nhs.uk, now focuses
primarily on the swine flu outbreak
o Mayo Clinic http://mayoclinic.com A not-for-profit medical
practice with hospital and research facilities across the US
o WebMD www.webmd.com Written by doctors and reviewed by an
independent board
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