| How to Search the Web |
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by Michael Castleman Introduction Health sites rank among the most abundant--and most visited--on the World Wide Web. As a group, they have also become quite controversial. Various experts have warned that "some" or "much" of the medical information on these sites is questionable, or even possibly hazardous. Recent scandals, for example, the selling of the potentially dangerous erection pill, Viagra, over the Web with little or no regard for the buyer's medical history, have increased the general anxiety level about Web health information. And while sites with "brand names," such as the American Heart Association, or the National Cancer Institute, or the Mayo Clinic, carry the imprimatur of credibility, you have to wonder about the quality of information on the hundreds--thousands!--of sites that turn up when you key the name of a medical condition into a search engine. No guide to health information on the Web can review all sites for content and credibility. There are simply too many. This guide presents a step-by-step approach to finding health information that's current, credible, and does no harm. Fundamentally, there is no qualitative difference between health information on and off the Web. You can find authoritative information and inaccurate, possibly hazardous information on the Web and everywhere else: in newspapers, magazines, books, newsletters, and on radio and television. The major difference between health information on and off the Web is quantity. Go to your local library, and you might find a half-dozen books on coping with diabetes. But key "diabetes" into any major search engine, and you're likely to be directed to hundred of sites. As the number of rises (100, 500, 5,000), it becomes impossible to visit them all. In addition, you begin to suffer from that uniquely Web malady, "information glut," the dazed, confused feeling that there is simply no way to digest all the information you can retrieve from cyberspace. Another difference between health information on and off the Web is that the Web is comparatively new and has a "wild West" reputation that "anything goes." When other media deal with health subjects, they generally feature experts with credible-sounding affiliations that help consumers feel comfortable with the accuracy of the content. But many health Web sites publish information devoid of such anchors of credibility, and as a result, visitors might feel that they are adrift in a choppy sea of questionable health information. Finally, it's important to remember that medicine is as much an art as a science. Many questions don't have definitive answers, rather they require judgment calls. Doctors and other experts often disagree. That's why, before consenting to surgery, or cancer treatment, or many other procedures, it's a good idea to solicit "second opinions," to take your situation to a number of doctors, to try to come up with a consensus view. Medical information on the Web is similar. Sites may disagree, yet both be "right," in the context of their own points of view, especially when one site focuses on mainstream medicine, and another deals with alternative therapies. As a result, for anyone interested in health or medical information, the Web provides both opportunities and pitfalls. Here's how to make the most of this marvelous new medium, without getting bamboozled by unreliable information in the process. Step 1: Start with Off-line Resources It may sound odd for a guide to health information on the Web to begin with an endorsement of off-line resources, notably, home medical guides and books devoted to the specific problem that interests you (cataracts, insomnia, gallstones, etc.) But off-line resources are an easily accessible source of introductory, broad-overview information that can help you get a handle on the subject(s) that interest you. Visit your local library. Talk with a reference librarian. Most libraries contain a great deal of health and medical information that can provide basic, ground-floor knowledge that forms an excellent foundation as you subsequently investigate other information resources. At a time when people increasingly believe that any information worth having is available on the Web, some people have turned away from the public libraries they relied on for years. This is a mistake. Public libraries are still excellent information resources. In fact, they're better than ever because, as a group, librarians have become extremely Web-savvy, and can help you locate valuable information both off and on the Web. Step 2: Contact Organizations and Support Groups A librarian can also help you find the name and contact information for the organization (or possibly more than one) that relates to the condition that interests you. Virtually every condition, even rare ones, have information-support organizations. Some are familiar, among them: The American Heart Association (heart disease and stroke), the American Cancer Society (all cancers), the American Lung Association (asthma, quitting smoking, emphysema, etc.), the American Diabetes Association (diabetes and its many complications), the American Dietetic Association (nutrition issues), and The Arthritis Foundation (joint problems of all kinds). However, many are smaller, less widely known, and more specialized, for example: the National Psoriasis Foundation (the skin disease), the National Organization for Seasonal Affective Disorder (winter depression), the Association for Macular Diseases (macular degeneration), and the American Tinnitus Association (chronic ringing in the ears). Condition-specific organizations and support groups are tremendously valuable resources. They typically can provide a great deal of background information, and can point you toward more specialized information, experts, and news about treatment advances. Most of these organizations have Web sites that allow easy access to their information. And some host online support groups so you can discuss your concerns with others who have faced the same challenges you're facing. If you can't find an organization that relates to your area of concern, contact the New Jersey Self-Help Clearinghouse (www.njshc.org). Although this group focuses on New Jersey, it also functions as a national clearinghouse of self-help and support groups. It can even help you start one. Step 3: Visit "Brand Name" Web Sites The brand-name sites overwhelming deal with mainstream medicine. There are far too many of these sites to provide a comprehensive list here, but to the left is a sampling of credible sites that can be expected to provide authoritative information. Step 4: Sample Other Widely Recommended Sites While not exactly "brand names" on the order of the CDC, Harvard, or The American Cancer Society, an enormous number of sites feature credible information, that have earned kudos from physician reviewers and consumers. An idiosyncratic listing is also to the left. Step 5: Try a Search Engine It's easy to key the name of a condition into any of the major search engines--almost too easy. You're likely to get hundreds--perhaps thousands--of matches. Many of these sites may provide excellent information. But be careful that you don't get misled. Here are a few suggestions: Beware of conflicts of interest, sites that sell products their content also endorses. This isn't necessarily a bad thing. Many vitamin and herb sites do this. But before you buy products touted on such sites, try to verify their effectiveness on sites that have no commercial interest in making sales. Beware of sites that tout explanations or treatment regimens much different from those you've already discovered. If you've obtained basic information at your library, contacted the organization that deals with the condition that interests you, checked the information on brand-name Web sites, and followed links to a few others, you can feel reasonably assured that you're well-informed about the condition you're researching. Now, it's possible that all these sites have overlooked some important element that a particular site focuses on. But it's not all that likely. At this stage of your research, it would be wise to be skeptical of information that differs greatly from what you've already found. Consider it if you like, but don't make major changes in your life or treatment plan before discussing it with your physician. Step 6: If You Want Information Direct From the Medical Literature.... All the sites discussed so far have been created FROM the findings in the medical research literature, but the information has been predigested for presentation in an accessible, consumer-friendly manner. What if you want to get behind the explanations and delve into the medical literature itself? It's easier than you might think. Amazing as this may sound, summaries (known as abstracts) of the entire world medical literature going back to 1966 are available at one Web site, MEDLINE, the medical literature online at www.igm.nlm.nih.gov (Internet Grateful Med at the National Library of Medicine at the National Institutes of Health). These abstracts are written in medical jargon, but if you have a good dictionary, particularly a medical dictionary, it's not terribly difficult to search and retrieve a great deal of state-of-the-art information. Here's how: Go to www.igm.nlm.nih.gov. Click on MEDLINE. When the search screen appears, simply type in a subject, for example, osteoarthritis. MEDLINE allows up to three subjects. Suppose, for example, you've read that glucosamine helps treat osteoarthritis (it does) and you want to see abstracts of the studies that have investigated this issue. Then key in two subjects: osteoarthritis and glucosamine. If you know the author of any study or any title words, you can also search by them. Then scroll down to the search delimiters. It usually helps to limit the search to English-language journals. You might also want to limit your search to human studies, as opposed to animal and human. Unless you specify the year range, MEDLINE searches from 1966 to date. You may want to limit the search to a narrower range, say, 1985 to date. Then scroll down and click: Perform Search. What comes up are titles of articles, without the abstracts. If you want just one abstract, click the box that says View Full Citation. If your search produces multiple studies whose abstract you would like to view, or click the box to the left of the title, then at the bottom of the search screen, click: Fetch for Display. That command retrieves and displays all the abstracts. Another box, Related Articles, can locate other articles you might be interested in. While MEDLINE is a wonderful resource, it can also be challenging. The language is medical jargon. And you often find that studies disagree with one another, which is why expert interpretation is often necessary to make sense of the findings. But for those who want to delve deeper than most health sites allow, MEDLINE is accessible and often very helpful. Step 7: If You Want An Expert to Perform a Detailed, Personalized Search for You.... Sometimes you may not want to be bothered researching medical conditions. Sometimes you'd rather have an expert researcher do it for you. That's what you get at The Health Resource (www.thehealthresource.com). This unique medical research service was launched long before the Internet in 1984 by Jan Guthrie, of Conway, Arkansas, after she developed ovarian cancer. Her oncologist recommended a certain treatment program. But before submitting to it, Guthrie, who had a background in medical research, decided to check for herself--and discovered that for her subtype of ovarian cancer, another treatment regimen produced better longterm survival. She presented her findings to her doctor, who opted for the treatment Guthrie had uncovered. After she recovered, Guthrie quit her job and launched The Health Resource to give others the benefit of her research skills. Guthrie and her staff now research hundreds of conditions and specific health questions every year. A basic background packet of information on any noncancer condition, typically a few hundred pages of material, costs $275. A basic background packet on any type of cancer costs $375. Search the Web Below are a list of Internet resources, including "Brand Name Sites", a sampling of credible sites that can be expected to provide authoritative information, and an idiosyncratic sampling of others which are not exactly "brand names" on the order of the CDC, Harvard, or The American Cancer Society, but which feature credible information, and have earned kudos from physician reviewers and consumers. Brand Name Sites
Other Reputable Sites
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