On-line Health Care for the Savvy Surfer
By JANE E. BRODY(N.Y. Times - 31 August, 1999)
What do you want to know about health? How to treat your arthritis? Which vitamins to take? How to quit smoking? How to find the best cardiac surgeon? What to do about your anxiety attacks? Are there any promising new cancer drugs? How to join a clinical trial? Or are you looking to join a support group of people who share your health problems? Perhaps you want to buy a prescription drug or consult a physician about a pressing medical matter without ever having to leave your home.
You name it, and chances are you'll find it on the Internet. This year some 25.5 million Americans are expected to turn to computers for answers to their health questions. When the Federal Government established an on-line health information initiative several years ago, 4.8 million people visited the site in its first 30 days of operation. Health issues, not weather or stock reports, are a major reason people now log on to the Internet. But chances are that much of the information and advice they glean from the computer screen will be biased, inaccurate and, in some cases, downright dangerous.
Good, Bad and Ugly
Typical Internet users have no assurance that medical advice dispensed on the World Wide Web has been properly tested for effectiveness or safety, and most people lack the expertise to assess the validity of what they find. Unlike peer-reviewed reports in medical journals, information on the Web is not screened by independent experts who can determine whether the conclusions and recommendations are warranted by the available evidence. There are no quality standards for statements posted on the Web, and anyone with some computer savvy -- from ordinary patients and purveyors of products to top medical experts and government agencies -- can set up a Web site and promulgate "facts" for you and me to find.
As the editors of The Journal of the American Medical Association put it: "When it comes to medical information, the Internet too often resembles a cocktail conversation rather than a tool for effective health care communication and decision making. The problem is not too little information but too much, vast chunks of it incomplete, misleading, or inaccurate."
Some physicians are concerned with the tantalizing reports on the Internet of unproven "nontoxic" remedies for serious health problems, which may prompt patients to abandon established treatments. "Seriously ill people, such as cancer patients, are particularly vulnerable to unsubstantiated claims about less toxic therapies and better overall outcomes," noted Dr. Maurie Markman, chairman of hematology and medical oncology at the Cleveland Clinic Cancer Center.
At the same time, the Internet can be an invaluable source of facts and guidance for people with all kinds of health problems, including rare diseases that have baffled their personal physicians.
For example, Jeff Newman, a commodity trader in Chicago, suddenly lost his voice to an incurable viral condition called recurrent respiratory papilloma, which caused polyps to form repeatedly on his larynx. After three operations, Mr. Newman sent out an E-mail query on the Web that led him to a remedy his doctor had never heard of -- one cup of cabbage juice a day -- and six months later another computer message directed him to Indole-3 powder derived from the active ingredient in cabbage, which aborted the growth of his polyps.
Likewise, a friend of mine suffering from plantar fasciitis, a painful inflammation of the tendon that connects the toes to the heel, derived far more valuable tips on treatment from patients who posted their own findings on the Web than from his doctor. His newly found Web friends, not his doctor, eventually cured him.
Search for Quality
Many of the Web sites uncovered when searching for useful health information have been established by commercial sources, especially pharmaceutical companies and producers of vitamins, herbals and homeopathic remedies. While this does not automatically mean the information is biased, Web browsers must be constantly on guard against being steered toward this or that product, which may or may not be appropriate for the condition in question. As the medical magazine Patient Care recently noted, "Web sites are used by unscrupulous marketers to sell various medications, books and devices."
Another common danger is information that is outdated. Unless Web sites are continually updated with the latest facts and findings, what you download may be too old to be useful.
While there is no guaranteed route to quality information on the Web, there are some guidelines that can increase the likelihood that what you are finding is both factual and useful.
First and foremost, check the source of the information. Who put it together? Whom does that person work for? What are his or her credentials? Who is the sponsor of the site? If it is a business, what kind of business? Might the tail of potential profits be wagging the dog? You are most likely to get reliable information from leading medical centers, university hospitals and government health agencies, like the National Institutes of Health, Centers for Disease Control and Prevention or the Food and Drug Administration. But keep in mind that even these sources have potential biases.
Next, check whether the information is based on reports published in leading medical journals. If all the references are to foreign or obscure publications you never heard of, be suspicious. And, of course, if there are no references, the statements may be based more on opinion than on fact.
Try to assess the objectivity and comprehensiveness of the information presented. Keep in mind that there is no way to stop someone from posing as a medical expert and dispensing erroneous advice. How many opinions does the advice reflect? A reliable source is likely to present various perspectives on a health matter. No one organization has all the answers, and even reputable sources reflect opinions that may be disputed by other experts.
Is the information current? A Web site on health should be updated monthly and should state the date of the most recent update.
Don't believe everything you read. Maintain a healthy skepticism. Check out Internet advice with your doctor, and don't start taking remedies recommended on the Web without first consulting your doctor.
Be very careful about the growing practice of on-line medicine. A doctor who cannot see or examine you physically necessarily lacks vital information about the state of your health, and is totally dependent on what you choose to report. This can easily result in misdiagnosis or improper or even dangerous treatment recommendations. The same caution should apply to ordering drugs on-line. Unless someone is checking you out for potential contraindications or interactions with other drugs you take, the consequences can be disastrous.
Last but not least, Jeanne C. Ryer, author of "Health Net" (Wiley, 1997), urges, "Use your common sense. If something sounds too good to be true, it probably is."
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