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Study: Web a Rocky Road for Health Info

Content sparse, dense and lacking in Spanish

TUESDAY, May 22, 2001 (HealthDayNews) -- When it comes to delivering health content, the Internet is more of a twisting mountain road than an information superhighway.

People who tour the Web to learn about specific medical conditions are likely to get a thin dose of generally accurate but fairly technical content that's often lacking important clinical material, says a new study.

And far from being a worldwide clearinghouse, health information on the Internet is heavily biased toward people who speak -- and seek -- English.

"What surprised us the most was the really striking deficiency and lack of comprehensive coverage provided by Spanish language sites," says study leader Dr. Gretchen Berland, a consultant at the Los Angeles-based research group RAND Health. "I think the Internet has the potential to be a powerful resource, but we don't think it's quite lived up to its expectations." The findings appear in the May 23/30 issue of the Journal of the American Medical Association.

An estimated 60 million Americans look online for health information, and more than 70 percent say what they find influences their treatment decisions, say the researchers.

Berland, who also is a Robert Wood Johnson Scholar at the University of California at Los Angeles, and her colleagues conducted three experiments with online health information. In the first, they used 14 search engines (10 English and four Spanish) to find Web content for four conditions: breast cancer, depression, childhood asthma and obesity.

They also asked a panel of 34 medical experts to review the results from one search engine, rating 18 English and seven Spanish links for their relevance, accuracy and inclusion of 100 important clinical topics. A site about breast cancer, for example, had to include who should get a mammogram and how often, the benefits of early detection of tumors and the importance of a family history as a risk for the disease.

The English sites included news sources, like WebMD, CBS HealthWatch and Dr. Koop, government-sponsored links, such as the National Library of Medicine and the National Institute of Mental Health, and other outlets, like, the American Cancer Society and MyAsthma. Spanish links included Salud, Graciasdoctor and Salud Latina.

Only one in five first links in the English-language searches, and about one in eight Spanish queries, produced relevant content, the study says.

When key information was available, it was more than cursory and accurate on 45 percent of English links but on only 22 percent of Spanish sites. English sites were missing 25 percent of the key clinical elements, while Spanish sites didn't have 53 percent.

"We were very pleased to see that if information was covered, it tended to be accurate most of the time. That's great news," Berland says. "The less great news is that if you're Spanish-speaking it's going to be difficult for you to find complete online health information."

When good content was presented, it appeared in language most Web users would find challenging. Sample paragraphs from every English site, and 86 percent of the Spanish sites, required at least a high-school reading level to understand, say the researchers, who used a standard, bilingual literacy tool to assess complexity. Since the average American reads at the eighth-grade level, "health information materials are being written at a level that is not useful," Berland says.

In addition to these significant barriers to medical materials, the study revealed more subtle obstacles that might trip up Web surfers.

More than half the English content pages had conflicts of fact or other contradictory information. An asthma site, for instance, said steroids don't stunt the growth of children, but later said they do.

Fifty six percent of the English-language links had advertisements, while the rest had other forms of promotional material, the researchers say. Pitches were also common on the Spanish pages, though somewhat less so.

Berland says the study's "systematic, rigorous" approach might be useful as a template for sites or reviewers who want to evaluate other aspects of Internet health information. "You can interchange diabetes for breast cancer" and perform the same analysis, she says.

John Mack of the Internet Healthcare Coalition, a Washington, D.C., non-profit group, says the journal article may be holding online health information, at least those fished up by search engines, to an unreasonably high standard.

"Using general purpose search engines like AltaVista and Yahoo -- that's like finding the best qualified physician by looking in the Yellow Pages," says Mack, whose coalition represents more than 1,000 patients, academics, industry representatives and government agencies. "Obviously consumers use these search engines to find health information, but we don't think that's a good way for people to actually find high quality health information."

Sites like, which is run by the U.S. government, are probably better at pointing Web users to accurate content, Mack says.

Berland says the Internet in general may be no worse than other mass media in its presentation of medical information.

Mack supports some form of review process for Internet health sites, but not a mandatory system akin to peer review for medical journals. "If you're providing health information [online] there should be some sort of review to make sure it's credible and properly referenced, but to have an independent review is not really practical."

Mack says policing must therefore be chiefly internal, which means people who post content, in addition to those who consume it, need to be educated about what constitutes solid information.

What To Do

The American Medical Association has tips to make your search for health information on the Web as effective as possible:

Look out for bias. Sites selling something may present one-sided material. If possible, try to find out who's posting the content. Providers who openly provide that information may be more trustworthy.

Make sure the information is timely, clearly sourced and well referenced. The endorsement of a site by noted health experts and reputable institutions is another sign of quality.

And finally, Mack says never make any treatment decision or act on Internet advice without first checking with your doctor.

For more tips on how to maximize the effectiveness of your online health experience, check the Internet Healthcare Coalition.

If you'd like to look up a medical topic, try healthfinder or Medem, which has material from several medical societies.

Read other HealthDay articles about the Internet and medicine.

SOURCES: Interviews with Gretchen Berland, M.D., RAND Health, University of California, Los Angeles, and John Mack, president, Internet Healthcare Coalition, Washington, D.C.; May 23/30, 2001 Journal of the American Medical Association
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