The Hindu Business Line : Health awareness at a click

Today the Internet provides lucid and detailed medical information, helping patients to make informed decisions and the doctor need not be the final authority on any illness. But the Net has its own disadvantages in this area.

Traditionally, medical practitioners worldwide considered themselves authorities on health and disease vis-a-vis their clients. The hapless sick would not dare question the healer. Now, however, thanks to the Internet, with the click of a button, anyone, anywhere, can get instant information on any health topic, anytime. Physician aloofness compels patients to turn to the Internet to help them make informed decisions.

Today, health-related Web sites get more hits than even pornography sites. A Google search revealed 2,46,000 articles on headache, 1,12,000 on aneurysms (including 2,490 on incidental aneurysms), 93,300 on deep brain stimulation, 47,200 on skull base surgery, 39,600 on Radiosurgery and 10,100 on cerebral embolisation. Even the crudest search yields several thousand references on the most bizarre topic.

It is estimated that at least 90 million surf the Net for medical information. A Harris Poll released in August 1999, mentioned that 75 per cent of US Internet users had looked for healthcare information in some form, with nearly half looking for disease specific information. Nine out of 10 of those users said they had found the information they wanted.

There are numerous Web sites such as Public Citizen, National Council on Patient Information and Education, Quackwatch, Alliance of Claims Assistance Professionals, Patients are Powerful, which inform patients on whether or not they are being treated properly. Lists of (more than 20,000) "Questionable Doctors" (USA) are available on the Net.

From Bmj.com

What are the implications of making available health information on the Internet? How can a layperson be assured of the credibility of the information her receives are some relevant questions. Here's an interesting case history. A few months ago, a 30-year-old man, working in a big town, developed severe headache and became unconscious. An emergency CT scan revealed a complicated problem. By the time I was consulted, the patient's family had scanned the Net on the subject. They had more Net prints than I had and were equally well informed. Luckily my opinion was in agreement with theirs!

In these days of instant information the doctor who does not know "what happened tomorrow" will be a dinosaur of the Jurassic era. Instant access to information is the name of the game.

Reliability of information

Here are some of the questions to keep in mind when seeking out medical information from the Internet.

Who maintains the site?

What are the credentials of those generating the content?

Does the site link to other sources of medical information?

When was the site last updated?

Does the site charge an access fee?

What is the relevance of the information provided?

Does the site disclose ownership and financial sponsorship?

Does the site disclose advertising and health information content sponsored by third parties?

Does the site disclose details of promotional offers, rebates and free items or services?

Does the site validate authenticity of information?

Advantages of the Web

The amount of health information universally available is increasing. Superb graphics, photographs and video clippings make it easy for the lay person to comprehend difficult concepts, subsequently enabling shared decision making between patient and physician/surgeon. With frequent revision it is possible to keep pace with evolving technology and practices on the Internet.

Disadvantages

However, for all its reliability and credibility of information, there are also some disadvantages associated with information seeking from the Internet. One of these is the absence of a central indexing system. Further, a Web page can be changed and there is no guarantee that what is seen one day will be there the next. Critically evaluating scientific information and data on paper is different from seeing audio or video clippings on aesthetically appealing Web sites. Even a quack with a computer, a modem, and the necessary software, can publish a Web page. Con artists have also infiltrated the Web sales hype and this has lead to unwarranted credibility. Furthermore, quality of information is variable and sometimes misleading.

The reader's gender, culture and age are not considered in web articles. The printed text is primarily designed for a specific segment of the population.

Apart from all this, some of the other disadvantages are:

Commercial interests influence online content

Information overload is a real problem.

Personal privacy norms might get sacrificed.

It is possible to read a Web page without having seen context pages or the "cover" page containing disclaimers, warnings, and the like.

Wrongly extrapolating Health information that is valid only in specific contexts.

What needs to be done

Doctors and medical societies can critically appraise Internet information and act as decentralised "label services". Health professionals should direct patients to sources of good quality health-related Web sites. A possible solution may be self-labelling of medical information by Web authors in combination with a systematised critical appraisal of health related information by users and third parties using a validated standard core vocabulary.

Labelling and filtering technologies such as PICS (Platform for Internet Content Selection) could supply professionals and consumers with labels to help them separate valuable from dubious health information. Electronic descriptions or ratings of digital works, in a computer readable form will validate authenticity. An information provider can directly embed labels in electronic documents and images, which can indicate content suitability.

Ratings by experts could be transmitted to organisations, publishers, and readers. Intended audience (from "kids" to "highly specialised researcher") can be used by authors to provide "context, "Source Rating" (from "highly trustworthy" to "known to provide wrong or misleading information") can be used by third party label services.

The author, a Chennai based senior neurosurgeon, is Secretary General of the Asian Australasian Society of Neurological Surgery.

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