Medicine on the Net

Writing in the The Boston Globe, reporter Wendy Lee discusses the internet and the changing face of medicine in North America.

When a 32-year-old patient with rapid heart palpitations showed up in the emergency room at Massachusetts General Hospital saying she suffered from Holt-Oram Syndrome, Dr. Jonathan Adler had no idea what this syndrome was. But he knew he had to work quickly. Using his computer, he looked up a comprehensive description on, a Nebraska-based Web database of various diseases and conditions. He got his answer in minutes — an inherited disorder that causes abnormalities of the upper limbs and heart.While he still uses textbooks to review content, Adler said he tends to look at eMedicine when it comes to making clinical decisions for patients. “A textbook can’t take the space to go into it,” Adler said, but eMedicine can “because it’s a bigger hard drive somewhere.”In fact, 64 percent of all US practicing physicians use online technologies for pharmaceutical-related products and services, according to a study released last week from New York market information firm Manhattan Research. The majority of these physicians — 87 percent — believe the Internet is a critical resource on information for prescription drugs and treatment options, with three-fourths admitting their behavior is sometimes or often changed as a result of what they found online, according to the study. In addition, about 39 percent of all US adults rely on the Internet for health information, according to the 2003 study by Manhattan Research.

Should we be worried about this trend? There is something seemingly reassuring about that big blue book sitting on the physician’s bookshelf — one can imagine hours of work going into compiling the information and even more hours of work proofreading it before publication. On the other hand, try to visualize putting a web page together, even one containing medical or pharmaceutical information, and what comes to mind? The familiar figure of Dr. Marcus Welby, the ever-present stethoscope draped around the shoulders of his white lab coat, hunched over a keyboard two-finger typing the information into a WYSIWYG web page program? Or some geeky kid with a grilled cheese sandwich holding open the pages of a book while, music blaring through his speakers and sipping on a jolt cola or Mountain Dew, he slams together page after page of medical or drug data?

Organizations like HONCode (Health-on-the-Net Code) certify that medical and health websites conform to certain standards in the presentation of medical-health information, and they do repeatedly visit certified sites to ensure that they remain in compliance with the code, but is that enough? And is there a difference in the medical-health information provided by commercial versus non-profit versus government websites?

I worry sometimes that the growth of the net has taken us all by surprise, that we didn’t have time to think ahead about what we were going to do with all this technology and information. The problem becomes particularly apparent in the case of medication side-effects. Pick a drug, any drug, and there exists a forum or website somewhere with one anecdote after another describing the horrors of the drug and disparaging the ethics of the drug companies who produce it and the physicians who prescribe it. And yet, armed with a little knowledge of the medication, normal symptoms of the conditions it is used to treat, and information about such factors as control groups, placebo effects, and statistical significance, it isn’t difficult to conclude that most of the alarmist information available on such sites isn’t valid or accurate.

There is a need not only for organizations like HONCode to expand their presence on the net but also to do a better job of publicizing what it is they do and don’t do. In essence, it needs to become a Better Business Bureau of medical-health information websites, and it needs to have the familiarity and to inspire the confidence in consumers that the BBB worked hard to establish.

health information, HONcode, Internet Behavior, internet health information, medical information

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