May 23, 2001
By Jennifer Warner
New York - People searching for health information on the Internet may have a hard time finding the facts they want, especially if they're searching for easy-to-understand information or Spanish-language content, according to new research.
A study published in the May 23 issue of The Journal of the American Medical Association found that less than a quarter of initial links provided by popular Internet search engines led to relevant content. Researchers also found Internet coverage of key information about 4 common health topics — breast cancer, childhood asthma, depression, and obesity — tended to be inconsistent and of variable quality.
According to the report, more than 60 million Americans went online in search of health information in the past year, and more than 70% of those who use the Internet report that the health information they find influences treatment decisions.
"The good news is that on English-language sites — for the most part — if information is covered, it tends to be accurate," says study author Gretchen Berland, MD, a Robert Wood Johnson clinical scholar at RAND Health, Santa Monica, California. Researchers found the information provided on English-language sites was completely correct 75%-91% of the time for the 4 conditions studied. On Spanish-language sites, the accuracy measurements ranged from 53%-96%.
Berland says it's important to note that the study examined health content on the Internet and looked at what consumers might find, but it didn't actually use consumers in the study. Instead, researchers used a panel of medical experts who evaluated the information provided after performing standardized searches for the terms obesity, breast cancer, depression, and asthma on 14 major search engines (10 English language and 4 Spanish language).
"The thing that surprised us the most was that there was the striking deficiency of coverage on Spanish-language sites," says Berland. For example, 53% of the major clinical elements for each of the conditions studied were not covered on Spanish-language Web sites.
Researchers also determined that much of the health information found on the Internet required a high-school level of reading or better, which may make it less accessible to large segments of the population who may benefit from it.
"The Internet has the potential to be a very powerful resource for both patients and healthcare providers, but right now it may not be as useful to all the populations that many people would like it to be useful to," says Berland.
But some Internet medicine experts say the study was unfairly designed.
"If the authors had chosen to scientifically address their study in a fair way, it would have been necessary to have a control group," says George Lundberg, MD, editor in chief and executive vice president of Medscape, Inc., which operates two Internet health portals, http://www.medscape.com and http://www.cbshealthwatch.com.
Lundberg says that as he understands the study, it contains a fundamental flaw: It did not use another medium as a control, "of which the only possible comparison groups would be radio, television, and paper."
Berland says it would be very interesting to do another study to compare the quality of health information across media with a control group that looks at the "bricks and mortar" traditional types of information, but "we were just unable to do that."
The study also found that although the level of accuracy of information was generally high, the presence of conflicting information could confuse some readers rather than educate them. Lundberg and Berland both acknowledge that conflicting health information on Web sites reflects both the enormous size of the Internet and the scientific process, which is constantly evolving.
"If you were to go to a standard medical textbook that's 1,000 pages long, chances are you might find conflicting information," says Berland.
Jon Eisenberg, senior program officer at the National Research Council, was the study director of a report published earlier this year by the National Academy Press entitled The Internet's Coming of Age. He says it's important for consumers to remember that the Internet is just the conduit through which information is transmitted, and no one organization regulates it or runs it — as is the case for any other type of media.
Information found on the Internet, Eisenberg says, should be judged and evaluated based on the same standards that apply to other sources of information, such as the qualifications of the person who wrote it.
Eisenberg also says there seems to be a misconception among the public to the effect that search engines are smarter than they actually are.
"What you get from a search engine is not something an expert has evaluated and thinks you should get, and you do not always get something you were hoping to get," says Eisenberg.
Lundberg agrees. "The search process is both one of the greatest strengths and one of the greatest weaknesses of Internet technology," he says.
Lundberg refers to a 1997 JAMA editorial on the subject that he coauthored. "There are probably hundreds of thousands of health information sites on the Internet. A few are wonderful, many are terrible, and many are in between," he says.
The study by Berland and colleagues was conducted by researchers at RAND Health and financially supported by the California Healthcare Foundation.
[Full text of article - http://jama.ama-assn.org/issues/v285n20/rfull/joc02274.html]
Jennifer Warner is news editor with CBS Healthwatch, Medscape's sister site for patients.
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