The harshest criticism comes from a study by Funda Meric, MD, and colleagues at the University of Texas MD Anderson Cancer Center. Meric, a breast cancer specialist, evaluated breast cancer information on the first 200 sites provided after typing "breast cancer" into a popular search engine.

"The big concern is that there is so much information available — anyone who can create a Web site can put out information," Meric told WebMD. "Unfortunately, the public is unable to evaluate the quality of this information. In print media, we know who is responsible. You know where it comes from and how current it is. Online you don't always know this, or how current the information is."

Meric's team compared the most popular sites — those to which people are most often sent by hypertext links on other sites — with the least popular sites. They found that popularity was no guarantee of quality.

This means a person has to look for some signs of quality. Meric suggests that a person look for the answers to several key questions:

• Who is presenting the information? Who are they affiliated with? What is their background?

   

• When was the information last updated?

   

• Is this web site linked with other companies? Is there disclosure of sponsorship, advertising policies, and conflicts of interest?

   

• Where is the information coming from?

Another research team, led by Heinke Kunst of the University of Maastricht, Netherlands, found that even when Web sites seem credible, they aren't always accurate.

"I don't recommend that patients don't look at the Internet," Meric says. "Many of our patients come in already having read things on the Internet.…I am impressed by how savvy they are. It is getting more and more likely that patients will have a lot of information."

Not all physicians are comfortable with patients who ask too many questions. Some older doctors feel threatened when their patients surf the Web for medical information, says Dino W. Ramzi, MD, assistant professor of family medicine at Emory University in Atlanta, Georgia.

"This is a big practice issue. I find that whether you see it as a bane or a boon depends on your style," Ramzi told WebMD. "For me, it has been good. I like it when patients are more involved, when they come in with more information. We can have a more productive dialog and I know where I can focus my efforts."

Ramzi says that he sometimes sends patients to the Internet for more information. While he warns them to "stay away from people trying to sell you things," he trusts their common sense.

"Patients tend to know when they should take something with a grain of salt," Ramzi says. "We encourage people to be critical and not to simply believe everything they read on the Internet."

Meric says that breast cancer patients are searching the web for 3 things: information on clinical trials, information about new studies, and message boards where they can find support.

"That third item says that doctors aren't doing as good a job as they should at referring patients to support groups — and that is a very important thing," Meric says. "From Web sites we can learn what we as doctors aren't doing."

BMJ. 2002;324(7337):577-581, 581-582, 582-583

Reviewed by Michael W. Smith, MD

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