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The New York Times has today published a pair of articles on Internet health sites.  One tells how dangerous some of the information on the sites may be.  The other tells how useful some of the better sites are to those who use them properly.

Below and side by side are excerpts from both articles, along with a list provided by the New York Times of health web sites which they recommend.  These sites and other sources of valuable health (and other) information are also included in ASH's Newslinks web page: Newslinks From Action on Smoking and Health (ASH)

ASH's policy is to report only news from major new sources, well-recognized scientic and medical journals, and reports from governmental agencies.  In many case the text of the report and/or a link to the report itself is included so that readers can judge the value of the information for themselves.
 
 

The Health Hazards of Point-and-Click Medicine By JANE E. BRODY   Looking for a cancer treatment? Which statement do you believe?   *Shark cartilage "appears to work through the activity of at least four complex proteins contained in the cartilage. The proteins appear to inhibit the development of new blood capillaries needed to feed a fast-growing tumor. Without a feeding network, a tumor can't grow."   *"Shark cartilage is worthless against cancer."   Both statements appear on the World Wide Web, amid dozens of sites turned up in an Internet search for references to shark cartilage, a diet supplement trumpeted as a remedy for breast and prostate cancer. And while the second statement is clearly closer to the truth, at least as documented by clinical research, the first is among scores of misleading, inaccurate "facts" about cancer and other diseases -- references accessible in moments to anyone with a computer and an Internet connection.   The misinformation does not stop at unproven remedies. As a team of researchers from the University of Michigan reported this month in the journal Cancer, the Internet is rife with basic, and perhaps life-threatening, factual errors.   In their study, the researchers analyzed 371 Web sites with references to Ewing sarcoma, an uncommon bone cancer that typically afflicts children and young adults. The search revealed errors that the authors called "shocking," with about a third of the references lacking any indication that the information had been deemed accurate by independent experts through the time-honored process of peer review.   Six percent of the Web pages that were not peer-reviewed contained "clearly erroneous" information. In other cases, the information was seriously outdated or misleading.    In their report the team, led by Dr. J. Sybil Biermann, called the Internet the great equalizer and added: "Experts, specialists, authorities, professionals, alternative therapy promoters, interested lay people, charlatans and hucksters all may set up sites."    "Although it has enormous potential to educate the public and to comfort individual patients, the Internet in some cases may actually lead to adverse medical care by spreading misleading or even fraudulent information," Dr. Henson wrote. "On the Internet, there is no separation of peer-reviewed, scientifically proven conclusions from anecdotal information or personal reflections."   When information from the Internet conflicts with recommendations from physicians, patients may become confused and uncertain, resulting in a delay in treatment or inappropriate choice of therapies, he said. And when information found on the Internet contradicts what patients learn from their physicians, they may lose confidence in their doctors, which could compromise their willingness to accept necessary treatments, the Michigan team suggested.   This is by no means the first time that a significant percentage of Web sites dealing with health matters has been found to be filled with inaccuracies. Last year, for example, pediatric specialists from Ohio State University College of Medicine and Public Health examined 60 Web sites established by major medical institutions, medical schools and hospitals and found that only 20 percent of them gave up-to-date advice for treating childhood diarrhea. The remaining 80 percent of sites had inaccurate information, with advice that conflicted with the authoritative guidelines established by the American Academy of Pediatrics.    "It can be confusing, controversial, inaccurate, ill-advised, even deadly if the advice is followed," Ms. Ryer added.   Dr. Maurie Markman, chairman of hematology and medical oncology at the Cleveland Clinic Cancer Center, says that cancer information on the Internet "has the potential to cause tremendous harm through erroneous, misleading and deceptive information."    In an editorial on the benefits and risks of cancer information on the Internet published last year in the Cleveland Clinic Journal of Medicine, Dr. Markman wrote, "Of greatest concern is the complete lack of quality control for any information or advice provided. Well-recognized and highly respected health care organizations and experts have no more inherent authority when viewed on a computer screen than a misinformed member of the public attempting to help others, or than individuals or groups engaged in health care fraud."    They added, "Better health care results when patients are more involved with their treatment choices, more informed regarding their disease and more invested in their health care." They urged health care providers to maintain open minds and be willing to explore new information, including information about alternative and complementary therapies, that patients glean from the Internet.   Noting that the Internet was here to stay and is expanding rapidly, the Michigan team also suggested that doctors help to identify or create accurate patient information Web sites and teach the public how to evaluate information about cancer and other health matters found on the Internet.

On-Line Health Care for the Savvy Surfer  By JANE E. BRODY      What do you want to know about health? How to treat your arthritis? Which vitamins to take? How to quit smoking? How to find the best cardiac surgeon? What to do about your anxiety attacks? Are there any promising new cancer drugs? How to join a clinical trial? Or are you looking to join a support group of people who share your health problems? Perhaps you want to buy a prescription drug or consult a physician about a pressing medical matter without ever having to leave your home.   You name it, and chances are you'll find it on the Internet. This year some 25.5 million Americans are expected to turn to computers for answers to their health questions. When the Federal Government established an on-line health information initiative several years ago, 4.8 million people visited the site in its first 30 days of operation. Health issues, not weather or stock reports, are a major reason people now log on to the Internet. But chances are that much of the information and advice they glean from the computer screen will be biased, inaccurate and, in some cases, downright dangerous.   Typical Internet users have no assurance that medical advice dispensed on the Web has been properly tested for effectiveness or safety, and most people lack the expertise to assess the validity of what they find.   Unlike peer-reviewed reports in medical journals, information on the Web is not screened by independent experts who can determine whether the conclusions and recommendations are warranted by the available evidence. There are no quality standards for statements posted on the Web, and anyone with some computer savvy -- from ordinary patients and purveyors of products to top medical experts and government agencies -- can set up a Web site and promulgate "facts" for you and me to find.   As the editors of The Journal of the American Medical Association put it: "When it comes to medical information, the Internet too often resembles a cocktail conversation rather than a tool for effective health care communication and decision making. The problem is not too little information but too much, vast chunks of it incomplete, misleading, or inaccurate."   At the same time, the Internet can be an invaluable source of facts and guidance for people with all kinds of health problems, including rare diseases that have baffled their personal physicians.    Many of the Web sites uncovered when searching for useful health information have been established by commercial sources, especially pharmaceutical companies and producers of vitamins, herbals and homeopathic remedies. While this does not automatically mean the information is biased, Web browsers must be constantly on guard against being steered toward this or that product, which may or may not be appropriate for the condition in question. As the medical magazine Patient Care recently noted, "Web sites are used by unscrupulous marketers to sell various medications, books and devices."   Another common danger is information that is outdated. Unless Web sites are continually updated with the latest facts and findings, what you download may be too old to be useful.   While there is no guaranteed route to quality information on the Web, there are some guidelines that can increase the likelihood that what you are finding is both factual and useful.   First and foremost, check the source of the information. Who put it together? Whom does that person work for? What are his or her credentials? Who is the sponsor of the site? If it is a business, what kind of business? Might the tail of potential profits be wagging the dog? You are most likely to get reliable information from leading medical centers, university hospitals and government health agencies, like the National Institutes of Health, Centers for Disease Control and Prevention or the Food and Drug Administration. But keep in mind that even these sources have potential biases.   Next, check whether the information is based on reports published in leading medical journals. If all the references are to foreign or obscure publications you never heard of, be suspicious. And, of course, if there are no references, the statements may be based more on opinion than on fact.   Try to assess the objectivity and comprehensiveness of the information presented. Keep in mind that there is no way to stop someone from posing as a medical expert and dispensing erroneous advice. How many opinions does the advice reflect? A reliable source is likely to present various perspectives on a health matter. No one organization has all the answers, and even reputable sources reflect opinions that may be disputed by other experts.   Is the information current? A Web site on health should be updated monthly and should state the date of the most recent update.   Don't believe everything you read. Maintain a healthy skepticism. Check out Internet advice with your doctor, and don't start taking remedies recommended on the Web without first consulting your doctor.   Be very careful about the growing practice of on-line medicine. A doctor who cannot see or examine you physically necessarily lacks vital information about the state of your health, and is totally dependent on what you choose to report. This can easily result in misdiagnosis or improper or even dangerous treatment recommendations. The same caution should apply to ordering drugs on-line. Unless someone is checking you out for potential contraindications or interactions with other drugs you take, the consequences can be disastrous.   Last but not least, Jeanne C. Ryer, author of "Health Net" (Wiley, 1997), urges, "Use your common sense. If something sounds too good to be true, it probably is."

These Web sites on health rely on peer-reviewed information and reports published in reputable medical journals.

MEDSCAPE (www.medscape.com) is used by more than 200,000 physicians, says its chairman, Peter Frishauf.

HEALTHFINDER (www.healthfinder.gov).
A Government-sponsored site with links to more than 1,400 health sites.

MEDHUNT (www.hon.ch). A medical search engine that allows users to type in key words to find appropriate sites.

NATIONAL INSTITUTES OF HEALTH (www.nih.gov/health). A gateway to the extensive resources of Federal agencies, including a list of diseases being studied by the various institutes.

CENTERWATCH (www.centerwatch.com) lists clinical trials on various diseases, including a summary of the research and information on whom to contact.

NATIONAL LIBRARY OF MEDICINE (www.nlm.nih.gov) provides access to the world's largest biomedical library, including notice of important findings issued before studies have been published. For general health information, try the library's easy-access site: www.nlm.nih.gov/medlineplus

MAYO CLINIC (www.mayohealth.org). This famous clinic's Web site provides accessible health information and allows users to E-mail questions to clinic physicians.

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