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CMAJ - November 16, 1999JAMC - le 16 novembre 1999

Developing a code of conduct for the Web

Michael OReilly

CMAJ 1999;161:1301

| On_the_Net@cma.ca  /  Sur_le_Net@cma.ca |

The proliferation of health information on the Web has many people worried. Although abundant material is available, study after study is pointing to a decided lack of quality information.

For instance, physicians at the University of Michigan did an Internet search to find information on Ewing's sarcoma, and their findings provide cause for alarm. Nearly half of the pages that contained treatment information included unproven techniques or practices. About 6% provided nothing but incorrect information, and many more were misleading. The search also turned up hundreds of frustrating dead ends, bad links and pages that contained no medical information.

"For the public's sake, we should work to improve the quality of health information on the Internet and to increase public understanding of how important it is for medical data to undergo scientific verification," stated the lead researcher, Dr. Sybil Biermann.

This is not an isolated case. Last year, the American College of Gastroenterology found that a significant proportion of sites dealing with GI diseases offered unproved remedies. An analysis of sites dealing with childhood diarrhea indicated that only 20% of them used the most recent medical guidelines. Unfortunately, many of these sites had been developed by traditional medical sources such as hospitals and clinics.

As the federal government stated in its recent Advisory Council on Health Info-structure report (www.hc-sc.gc.ca/ohih-bsi), "Canadians need to be able to trust the information they receive through the Canada health infoway."

That report, Paths to Better Health, was delivered to federal Health Minister Allan Rock last February. It recommends that Health Canada, in partnership with the provinces, "take the lead in ensuring development of standards or guidelines to distinguish between objective, evidence-based health information and information intended to promote a product. These guidelines could be developed into criteria for rating Web sites."

As Canada studies the question, plenty of action is taking place around the world. The US government has taken action by creating a Web site called HealthFinder (www.health finder.gov/) that acts as a clearinghouse for solid health care resources on the Net. And the Health Education Authority (www.hea.org.uk/) in the United Kingdom has created a Web site called QUICK: QUality Information ChecKlist (www.quick.org.uk/). It is designed to help young people make a critical analysis by helping them analyse any information found on the Web.

The issue of quality has become so important that a conference was devoted to the subject last month. The second annual Quality of Healthcare Information on the Net Conference (www.ihc.net/community/conf.html) explored topics such as online interactions between patients and providers and ways to help patients make sense of what they find. The keynote speaker was Dr. George Lundberg, former editor of JAMA and current editor-in-chief of an online health site, Medscape (www.medscape.com).

In 1996, following the recommendations of an international conference on telemedicine, a new organization was born to try to deal with the growing quality problems facing the Web. The Health on the Net Foundation (www.hon.ch/) was born and is trying to bring some quality standards to the "wild west" part of the Net. It has established a code of conduct (www.hon.chHONcode/Conduct.html). The code has 8 principles. Sites that use it must include a listing of the author's credentials, the dates the clinical documents it cites were last modified, source references, and funding and advertising policies. Sites following this code can apply for membership in the foundation; if the application is approved, the site can then post the HONcode logo.

This "stamp of approval" is the type of thing needed to bring some sense to what can be a decidedly wacky Web. Dr. Alejandro Jadad, an epidemiologist at McMaster University Medical Centre, describes the situation this way. "The Internet is giving us an unparalleled opportunity to improve the way in which we access and use information. However, it is uncontrolled, overwhelmingly vast and full of material of variable quality and relevance. Most users have been left unaided to search for, access, interpret and use health information on the Internet." — Michael OReilly, mike@oreilly.net

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