# Presentation: 045172

## From Snake Oil to Penicillin: Evaluating Consumer Health Information on the Internet 

## Objective

- At the end of this workshop, you will be able to:
- Determine the accuracy, authority, bias, currency, and coverage of health information and its appropriate use as a consumer health information resource for the public.

## Pretest

- T       F   	All health information on the web is 			accurate and reliable.
- T       F   	Reference librarians can provide advice 		about health information.
- T       F 	About half of Internet health seekers 			thoroughly check the source and timeliness 		of information, and are vigilant about 			verifying a site’s information every time they 		search for health information.
- Name three criteria for evaluating a web site.

## The Issue

- Increase number of:
- Patients accessing information on the Internet
- Creating health-related web sites
- Patients believe Web is a reliable source of information
- The results of one study was published in JAMA
- (JAMA. 2001 May 23-30; 285(20):2612-21).

**Notes:**
Consumers have access to medical information like never before.  The Internet and its sophisticated search tools have resulted in:
A greater number of patients accessing information on the Internet.
 A number of people creating health-related websites
A number of research studies evaluating the search skills, information gained and quality of health information on the Internet. Every one of these studies shows over and over again that the quality of health information on the web varies tremendously.
There are valuable nuggest of information amid masses of JUNK.
Patients are believing that the Web is a reliable source of information....if its on the Web, it must be true.

The best way to find informaiton on the Internet is to go to sites that we know have reliable, accurate, current unbiased information. However, sometimes we HAVE to do that Google search to find information for a patron. When we do this, we must be sure that the information we provide is the best possible.

## Types of Web sites

- What is the **purpose **of the Web page?
- Advocacy (American Heart Association)
- Business/marketing (Pfizer)
- Informational (National Center for Health Statistics)
- News (CNN)
- Entertainment (Official Star Wars Fan Club)

**Notes:**
The first thing to determine is that is the purpose of the Web page? 
Ask class for the reasons people put up web pages.

## 5 Basic Criteria

- Accuracy, Authority, Bias, Currency, Coverage
- Each of these alone is meaningless, but together they create solid guidelines for evaluation. If you cannot answer the following questions, the web site your patient/patron is looking at is suspect!

**Notes:**
Each of these alone is meaningless, but together they create solid guidelines for evaluation. If you cannot answer the following questions, the web site your patient/patron is looking at is suspect!
Content on the Internet is unregulated, and therefore, anyone can publish anything on the Internet. There is sound medical information on the Internet along with dangerous information. You need to be able to tell the difference!
Ask yourself the following:
Why did the person create the page?
What’s in it for them?
Are they trying to sell me something?

## Accuracy

- Is the information accurate? Remember:
- Anyone can publish on the web
- Many web pages are not reviewed or verified by editors or peers
- Web standards to ensure accuracy don’t exist.

**Notes:**
Ask yourself the following:
If the information is factual, the basic question is whether the facts are accurate.
Unless the information appears in a refereed journal subject to peer review, you are depending on the authority and expertise of the author and the sources the information is drawn from.
Are the sources of the information clearly given? If the information is dawn from the writer’s own experience, was it based on simple observation or on carefully designed research

##    Accuracy example

**http://www.malepregnancy.com/**

**Notes:**
Male Pregnancy take a few minutes to check it out for accuracy.
Where is the Medical Center?
About us: what can we find out here?
Accuaracy of pregnancy statements?
What about the Time magazine cover?
What type of site is this? (spoof) What is its purpose? (entertainment)

## Authority

- Is the author an authority on the subject? Remember:
- It is often difficult to determine the authorship of Web pages
- If a name is listed, his/her qualifications are frequently absent
- Check if the Web page has the backing of a well-established organization, institution, or agency.

**Notes:**
Be sure to ask yourself these questions:
Do you know who the author of the information is? An unsigned piece of information does not have authority of a signed piece.
If it is unsigned, is it posted in a usually authoritative place (at the National Institutes of Health, for example)
What can you tell about the author? Is the author a student, physician, or firefighter?
Does the author bring any biases in posting the information

## The URL

- The Tilde
**~**
- The Domain
- “Dot coms”
- Contact Information
- About Us

**Notes:**
The tilde. Information that has the backing of an organization has better quality control than an individual, who has no one to answer to.  Does anyone know what a ~ stands for in a URL? (~ generally means that the information is from an individual and is not necessarily endorsed by the organization hosting the site.)

The Domain. “Dot coms” are not necessarily bad, “dot orgs” are not necessarily good! Look at the content. Also, beware of domains that indicate the that health sites originates outside the US. These may suggest treatment options that are not generally available in the US (Check the URL for .uk, .de, etc.)

Contact information. The more information an author provides about him/herself, the better. Be skeptical about names of organizations that sound prestigious; the “National Alliance for Cancer Treatment Analysis” may sound like a reputable organization, bit it could be out of someone’s basement.

About us. Always try to find the “about us” link to determine the authority and agenda of a particular site.

##    Authority example

**http://members.tripod.com/~tourette13/**

## Bias

- Does the author bring any biases in posting the information? Remember:
- Web pages often are “soapboxes”
- Goals of the author aren’t clearly stated
- Watch out for the emotional “kick”...photographs, exclamation points, huge fonts

**Notes:**
Questions to ask:
Can you judge the author’s purpose in posting the information? If the author’s purpose is to persuade you or sell to you, you must judge the information accordingly. For example, an evaluation of a pharmaceutical is questionable if it is posted on a competing pharmaceutical manufacturer’s site. It is more credible if its posted by a truly independent laboratory.

Who paid for the Web page?

##    Bias example

**http://www.dhmo.org**/

**Notes:**
Questions to discussion:
Who is the author? Is s/he an authority?
Who is the sponsor?
Does the information appear to be accurate? What is DHMO?
Is any bias evident?
What type of site is this? (spoof) What is its purpose?

## Currency

- Is the information current and timely? Remember:
- Dates are not always included
- If dates are included, it may not be clear if the date is the date created, the date revised, or the date the page was placed on the Web

**Notes:**
Questions to ask:
Is the information dated or can you tell from the content when it was written?
Is the information likely to change?
Is it recent enough to be useful?

##    Currency example

**http://www.pslgroup.com/dg950925.htm**

**Notes:**
Questions for discussion:
What dates can you find on the page? (c. 1995)
Has much changed about this topic since 1995?
Who is the author? Is s/he an authority?
Does the information appear to be accurate?
What type of site is this? What is its purpose?

## Coverage

- Many health sites are not comprehensive. The information may be accurate but important information may be left out. Remember:
- How does this information compare with other sources on the same topic?
- Is a better source available?
- Does the site have a disclaimer?

**Notes:**
Many health sites are not comprehensive. The information they give may be accurate, but important information may be left out.
Don’t stop with a single site unless you can answer these questions to your satisfaction.
How does this information compare with other sources (including published print sources) on the same topic?
Is a better source available? (Consider varying your approach to searching for relevant information.)
Does the site have a disclaimer that describes any limitations, purpose, scope, currency or authority of the information?

##    Coverage example

**http://www.medical-library.net/**

**Notes:**
Click on “symptom correlation” and type in “runny nose”
Questions for discussion:
What conditions are associated with a runny nose, according to this database? (Wegener’s Granulomatosis)
What other conditions could be associated with a runny nose that aren’t included here?

## Additional Resources

- Quackwatch.com
- Site developed by a psychiatrist
- His is anti-alternative/anti-complementary
- Site can be used to gather background information on questionable treatments

**Notes:**
Site claims there is no “science” to alternative medicine”

However, one can use this site to gather background information on questionable treatments (ex. Dr. Barefoot and coral calcium)

## Additional Resources

- MedlinePlus.gov
- Click on Health Topics (select health fraud)

## Posttest

- T       F   	All health information on the web is 			accurate and reliable.
- T       F   	Reference librarians can provide advice 		about 	health information.
- T       F	About half of Internet health seekers 			thoroughly check the source and timeliness 		of information, and are vigilant about 			verifying a site’s information every time they 		search for health information.
- Name three criteria for evaluating a web site.

## How to Reach Us

- Web site: http://nnlm.gov/
- Phone: 1.800.338.7657