Library Grand Rounds

Guiding your Patients to Reliable Health Information Resources: Hints for Clinicians

Introduction: Health Information on the Web

The movement to increasingly involve patients in treatment decisions, the pressure to reduce the length of office visits, the growth in interest in alternative medicine, the proliferation of self-help and support groups, and the growing distrust of the managed care industry have all fueled a tremendous increase in the consumer and patient demand for health information. The Web has proved both a boon and a curse in providing a tool for easy, widespread dissemination of health information.

An article in the August 1, 1999, issue of Cancer that pointed out some problematic health information on the Web also pointed to the benefits of the vast amount of "appropriate, accurate, and peer-reviewed information" available on the Web. The authors stated that "the Internet can be a powerful, positive partner to the health care provider in patient education. 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." (Biermann JS. Golladay GJ. Greenfield ML. Baker LH. Evaluation of cancer information on the Internet. Cancer. 86(3):381-90, 1999 Aug 1.)
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In a day when people turn to the World Wide Web for everything from airline reservations to stock purchases, it is only natural that they would turn to the Web for health care information as well. Various studies of Web usage have tried to estimate how many people are accessing health care information on the Web:

• A recent Harris poll found that 60 million American adults, 68% of those who use the Internet, have used the World Wide Web to find health information. (Patrick K. How patients use the web for second opinions. Western Journal of Medicine. 170(6):332-3, 1999 June.)
  
  
• One survey in the USA showed that nearly half of adult internet users have recently accessed health and medical websites. (McLellan F. "Like hunger, like thirst": patients, journals, and the Internet. Lancet. :SII39-43, 1998. Click here for full text*)
  
  
• It is said that 40% of the traffic on the Internet today is in search of medical information. (Huntley AC. The need to know: patients, e-mail, and the Internet [editorial]. Archives of Dermatology. 135(2):198-9, 1999 Feb. Click here for full text*)
  
  
• Media Metrix reported that there were 18.5 million unique visitors to 25 top health web sites, reaching over 35% of total Internet users in August 1999. Click here for full text.
  
  
• Just one of those sites, drkoop.com, reached over 2 million unique users or approximately 3.5% of total Internet users in the same month. Click here for full text.

An article in the February 1999 issue of Archives of Dermatology (Click here for full text*) tried to explain why people are turning to the Web instead of to their own health care practitioner. A group of German physicians who run a dermatology website - not aimed at patients - analyzed over 200 unsolicited e-mails received from patients seeking teleadvice. They concluded that patients are turning to the Web for the following reasons:

• Most of the patients had chronic or long-standing illnesses, and many of these expressed some frustration with or disappointment in their current provider.
  
  
• Many had experienced treatment failures and were seeking new therapies.
  
  
• Some patients wanted to be anonymous, perhaps out of fear of seeming stupid.
  
  
• Their physician did not give adequate information or the patient felt ill informed. The patient may have forgotten to ask their physician a question during a visit and then felt ashamed to contact them again.
  
  
• Some people are looking for information about diseases that actually do not concern themselves but friends or relatives, so the patient-provider relationship doesn't exist.
  
  
• There were also some irrational hopes expressed, such as person of German ancestry thinking a German doctor might have more insight in their problem.

Other articles have stressed the anonymity of the Web and the comfort many patients find in connecting with communities of people with similar diseases. An interesting sidelight of this is a new variety of the Munchausen syndrome in which people join chat rooms and describe fictitious illnesses to gain attention and sympathy. When caught they simply move on to a new chat room with a new name. (Feldman MD, Bibby M, Crites SD. "Virtual" factitious disorders and Munchausen by proxy. Western Journal of Medicine. 168(6):537-9, 1998 June.)

Guy MacNeill of drkoop.com was quoted as saying, "Most people come to the Web [for healthcare information] because they want a second opinion. And they're the kind of people who will also want a third and fourth opinion as well." (Stevens L. Consumer sites stir up the surf. Medicine on the Net. 5(6):6-8, 1999 June.)

Web sites have proliferated in response to this level of interest. An Alta Vista search for "breast cancer" on December 20 came up with over 218,000 hits. The first 10 postings included a page from the Shark Cartilage Information Center, another from "Tennis Against Breast Cancer", and a notice that Avon's Breast Cancer Awareness Crusade page has moved. It took quite a few clicks to get to anything that you could call reliable patient education material.

Wall Street has taken note of the growing interest in Web-based health information and health-oriented Web sites have proved profitable, or at least potentially profitable. The Wit Capital eHealth Index of 16 publicly held stocks related to health Web sites indicates that the value of these stocks rose 222% in 1999. Four eHealth companies completed initial public offerings over the last two weeks of 1999 and raised over $325 million in proceeds. (Click here for full text)

It would be naive to think that all that money had no effect on the content provided by these sites. One of the top 15 sites, WebMD, made a recent $220 million deal with DuPont in which DuPont will sponsor physician subscriptions to the site in return for DuPont providing WebMD's content on drugs and nutritional supplements and WebMD promoting DuPont products. (Medicine on the Net, December 1999, p. 9) When you are doing a search for a word or phrase in a search engine, such as Alta Vista, the order in which the sites ("hits") appear may be influenced by contracts between businesses and the search engine company.

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