On a recent weekday afternoon, Nital Sheridan of the Ochsner Clinic Medical Library laid down the law to a group gathered for a workshop on medical information on the Internet. "A fifth grader can put something up on the Internet, and they can make it look good. So you have to be careful."
One of the recurring themes of the Ochsner workshop, held at the Jefferson Parish Eastbank Regional Library, was that the wealth of medical information online needs to be carefully evaluated. Over the course of two hours, Sheridan carefully taught the 10-person class methods of evaluating Web sites and steered her students toward several reliable databases.
Anyone who's ever typed in a phrase to the popular search engine Google knows that the available information ranges from the dependable to the highly dubious. In a search for multiple sclerosis, for example, the top link is the National Multiple Sclerosis Society, a valuable resource for patients and families coping with the disease and looking for support. However, the search also returns a series of sponsored links with aggressive sales pitches for herbal supplements and ionized water that promise to cure the incurable disease. These sales pitches, when followed to their conclusion, ask patients to pay hundreds, sometimes thousands, of dollars for their products.
"People take advantage on the Web," says Sheridan, "companies are getting slick in the way they package information." A common device used by drug company Web sites is an online quiz that tests for the symptoms of the disease treated by that company's product, such as depression or adult ADHD. While it's carefully stated that the quizzes are not meant as a diagnosis, the results usually strongly suggest that the quiz taker could benefit from the drug and encourage the person to ask their doctor for a prescription.
Of greater concern are the host of Web sites that have recently sprung up offering discount prescriptions for pharmaceuticals. These sites don't require a doctor's prescription; instead, visitors fill out a brief questionnaire about symptoms and medical history. Some unseen doctor then reviews the questionnaire and signs a prescription, and the drugs are sent by mail.
This system is wide open to abuses. Some of the anti-depressant and diet pills available in this way can be dangerous if taken in improper doses, and others are addictive. Sheridan worries that people may end up with the wrong medicines if the doctor who reviews their purchases isn't properly qualified. "Who knows if that doctor is an OB/GYN, and they're like, 'Oh yeah, this is good for the heart.' A lot of those sites will have a group of doctors -- they want to get the best overview of the different specialties, but they submit [the application] to the group as a whole and whoever's there will take it. That's scary."
Medical resources on the Web are best used to supplement advice from a physician, says Sheridan. "Online health information can't replace a doctor," she stresses, "and it's more useful after your diagnosis or your visit to the doctor. That way you know the right questions to ask and can find the proper information."
The supplemental role of online information is increasingly important in light of the harried pace of modern medicine. Most people have experienced a doctor visit that left them breathless and bewildered: there's a flash of white coat, a few questions and the patient is left holding a scrap of paper with an indecipherable scrawl on it.
Now patients have an easy way to seek information for themselves, which both empowers them and leads to better doctor-patient communication. Beverly Harper, one of the participants in the workshop, says she decided to get better informed "so that if something does come up, you know the right questions to ask when [the doctors] tell you something."
Carol Cargel of Metairie was taking the class "so the doctors won't treat me like I'm an idiot," she explains. "I'm at an age where I need medical attention. Sometimes the doctors start talking at you and it goes right over your head. And they rush out, and you're thinking, 'What?' This is just to prevent that."
"There's just about anything and everything on the Internet," says Sheridan. "You can find information on diseases, conditions, surgeries, procedures, medications, chronic illnesses, and also different lifestyle issues, like nutrition and fitness."
For free, all-purpose medical information, Sheridan recommends Medlineplus (www.medlineplus.gov), a comprehensive service provided by the National Library of Medicine and the National Institutes of Health. The INFOTRAC Health Reference Center, a Louisiana Library Connection Database, provides a searchable database of articles from newspapers and journals, as well as medical and alternative medicine encyclopedias. INFOTRAC is available at www2.state.lib.la.us/databases/ through the Gale Group of Databases under the "Health and Wellness Resource Center" link. The Ochsner Medical Library homepage (www.ochsner.org/medical-library) also has a variety of health and reference links. "Those specific sites you don't have to do the evaluation process on because the library staff has already done all that for you," says Sheridan.
The evaluation process isn't hard, says Sheridan, once you get into the habit. "At each Web site there are certain things you need to ask. First of all, ask yourself, what's the purpose of the Web site? Are they trying to inform you about the disease? Are they trying to explain something? Or are they trying to persuade or sell you something?" If the Web site is supported by a brand name, says Sheridan, be aware that the primary purpose of the Web site is to push the product.
Pay close attention to who's writing the articles and other content on the site. "Are the authors' qualifications stated, and do they match with the content? For example, if it's a heart procedure you're reading about, is the person who's writing it a cardiologist or are they OB/GYN? Also, you'd be surprised how many articles are written by somebody with a master's in science, not necessarily a physician." Always check for both credentials and contact information, says Sheridan. If either is missing, move on to another site.
It should also be made clear where the articles and information on the site come from and what year they were published. "You want current information," says Sheridan. "How often is the site updated? Medical information changes so quickly, so you want something published in the last three years. Anything before then is a little bit outdated." Check the "last updated" date, which appears at the bottom of many Web pages, she says.
The idea of constantly performing these evaluations is daunting, says Sheridan. "Say you are in Google, and you put in the word 'diabetes.' You'll get over a million hits. A good way to take out 60 to 70 percent of them is to look at the domain extensions (that end every Internet address)," she explains. If an address ends in ".com," you know the site's stated purpose is to make money, and the information is sometimes suspect. For sites dedicated to providing information and research, try addresses ending in ".edu," ".org," or ".gov" for educational institutions, nonprofit organizations and government sites.
Medlineplus offers an excellent range of information, including the latest medical news, interactive tutorials about diseases and conditions, a medical encyclopedia, and a drug information section that explains drug uses as well as any side effects and negative interactions with other drugs. If you want to find out about a drug, whether it's Prozac or Tylenol, Medlineplus' database is a more reliable source than the drug company's Web site, says Sheridan. On some company sites, she says, "when you go into some of their drug products they put all the good stuff about it, but they don't put the side effects. That's something to be wary about."
The site also includes a directory of physicians of all specialties, dentists, and directories of hospitals and clinics, and it includes links to sites that rank hospitals. Another physician directory is found on the American Medical Association's Web site (www.ama-assn.org/aps/amahg.htm). This directory can be searched by the physician's name, location or medical specialty, and it lists the physicians' educational and professional experience, as well as verified credentials.
Another service offered by Medlineplus is a directory of ongoing clinical trials around the country, which can help adventurous patients find experimental treatments that haven't yet hit the market. Links to clinical trials represents just one of the ways the Internet has facilitated connections. Most medical information Web sites include links to support groups that have sprung up for every conceivable topic or condition, from cancer survivor groups to "messies anonymous," which helps people deal with excessive clutter in their lives.
Some support organizations list regional chapter meetings, while others offer interactive online group sessions, using message boards and instant messaging to carry on conversations. WebMD (www.webmd.com), the most popular commercial site for medical information with an average of 20 million visitors per month, is building an online community through specialized message boards and weekly live events where medical experts answer questions. Some sites even offer 24-hour online counseling sessions using instant messaging or chat rooms, although at a cost. These services should be held up to the same scrutiny as any other Web site or service, says Sheridan.
The Ochsner Clinic Foundation offers its Internet workshop four times a year at the Brent House -- the next date is Feb. 17 -- and may continue to offer the classes in the public libraries. "The classes at Ochsner are usually full, and we have a waiting list," says Sheridan. "There's a need for this as people are becoming more computer savvy. They know they can research things on the computer and they want to do that."
- Donn Young
- Ochsner Clinic Medical Library's Nital Sheridan instructs workshop participant Jeanne Fant. "A fifth grader can put something up on the Internet, and they can make it look good," Sheridan says. "So you have to be careful."