by Lisa Grossman, New Scientist Magazine

Sixty-one percent of American adults seek out health advice online, according to a recent survey.
Seeking out health advice online

If you regularly turn to a search engine to find out whether, say, you should put ice on a twisted ankle, you're far from alone. Sixty-one percent of American adults seek out health advice online, according to a survey published in June by the Pew Internet and American Life Project.

Around a third of those surveyed admitted they changed their thinking about how they should treat a condition based on what they found online. Yet a growing body of evidence suggests that much online health information is unreliable.

"My overall impression is that the quality of health information varies wildly, almost ridiculously wildly," said Kevin Clauson, a pharmacologist at Nova Southeastern University, Fort Lauderdale, Florida. "If (a website) is treated as an authoritative source, and there's evidence that it isn't, then it's potentially dangerous."

Several studies to be published in medical journals this year highlight the issue. Pia Lopez-Jornet and Fabio Camacho-Alonso of the University of Murcia, Spain, found that information on oral cancers on the top websites gathered by Google and Yahoo searches was "poor" (Oral Oncology).

Among other things, the websites failed to attribute authorship, cite sources and report conflicts of interest. And a study by a team at the Charite University Medical Center in Berlin, Germany, of googled advice on how to deal with heartburn found that "the evidence for most of the recommendations is weak to nonexistent" (European Journal of Integrative Medicine).

While these and other studies examined dozens of websites, most agree that the site to watch is Wikipedia. Popular and easy to browse, the user-generated encyclopedia is the eighth most visited site on the Internet, and the first stop for many seeking health information.

Wikipedia articles appear in the top 10 results for more than 70 percent of medical queries in four different search engines, according to a study in July's Journal of the American Medical Informatics Association. It also gets more hits than corresponding pages on the U.S. National Library of Medicine's MedlinePlus service.

This is worrying, and perhaps an indicator that some people's search engine strategies may not be up to scratch. A 2002 study found that most searchers use only one term in their searches and rarely look past the first page of results -- though Internet users may have improved the way they search since then (BMJ).

More disconcerting is the percentage of doctors who turn to Wikipedia for medical information: 50 percent, according to a report in April by U.S. healthcare consultancy Manhattan Research.

How does Wikipedia fare as a medical reference? Its collaborative, user-generated philosophy generally means that errors are caught and corrected quickly. Several studies, including one examining health information, another probing articles on surgery, and one focusing on drugs, found the online encyclopedia to be almost entirely free of factual errors.

Better still, the articles improve significantly with time, according to a study Clauson published last December in the The Annals of Pharmacotherapy. "Wikipedia's editing policy does work," he says.

But any Wikipedia page (beyond those locked to prevent vandalism) is vulnerable to malicious editing -- and some drug firms have been caught removing negative information on their drugs from Wikipedia pages.

The site's other major flaw is its incompleteness. Wikipedia was able to answer only 40 percent of the drug questions Clauson asked of it. By contrast, the traditionally edited Medscape Drug Reference answered 82 percent of questions. "If there is missing safety information about a drug, that can be really detrimental," Clauson points out.

For example, Wikipedia's page on the HIV drug Prezista makes no mention of complications when used alongside St. John's wort, the herbal supplement used to treat depression. Their potent interaction can cause the HIV therapy to fail.

On the other hand, the publicity Clauson's research garnered has helped fix the shortcomings he highlighted. One error of omission -- that pregnant women should avoid the painkiller Arthrotec -- was fixed the same day Fox News ran a story on the study.

The medical community has taken note of Wikipedia's success, and has made several attempts to replicate it. For instance, specialty-specific wikis (editable web pages) such as RadiologyWiki and WikiSurgery can be edited only by doctors.

A more general medical wiki called Medpedia, also written and vetted by medical professionals, launched in February. Medpedia was founded by San Francisco entrepreneur James Currier, who teamed up with several prominent medical schools and organizations to build a reliable medical database -- with a social networking site at its heart. It includes non-encyclopedic resources such as a section for user Q&As and debates.

"Our goal is to be the place where physicians tell their patients to go educate themselves," Currier told New Scientist. "Everyone can benefit from a more educated patient."

But it's still always a good move to consult a professional before starting a treatment, he cautions. "Anything they see (on Medpedia) will be trustworthy stuff, but it's not complete. Nobody is," he says.

It will take a long time for these smaller wikis to match the popularity of Wikipedia, however. "Ultimately, it will be easier to change the quality of information in Wikipedia than to change the search habits of an entire population," Clauson says.

The U.S. National Institutes of Health is catching on. It hosted an event at its headquarters in Bethesda, Maryland, with the stated aim of teaching health professionals how to edit Wikipedia's health pages and why they should think about doing so.

The Wikipedia of the future, it seems, looks set to become a far more reputable place.

HEALTH WEBSITES YOU CAN TRUST

- MedlinePlus http://medlineplus.gov. A directory of articles from the U.S. National Library of Medicine.

- NHS www.nhs.uk. The website of the UK National Health Service. Its other website, NHS Direct www.nhsdirect.nhs.uk, now focuses primarily on the swine flu outbreak.

- Mayo Clinic http://mayoclinic.com. A not-for-profit medical practice with hospital and research facilities across the U.S.

 

 

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