A spoonful of sugar makes the medicine go down, but when you are researching a medical problem on the Internet, you want more than a glitzy home page and a promise of sweet deals on health supplements. Here are some ways to evaluate health-related Web pages and some places to find information on diseases or conditions.
Evaluating the reliability of medical Internet sites is very important - a life may be at stake. Determine who is sponsoring each site, and why. Government agencies, university medical centers, and national health promotion groups such as the American Diabetes Association typically offer solid advice based on medical research. Look for the names and credentials of authors or advisors, and investigate how recently pages have been updated. Be wary of "dot.com's" that offer anecdotes or testimonials instead of research and intersperse medical news with invitations to buy various products. Chat rooms and online support groups can provide comfortable places to talk with other patients and families, but be very careful about revealing your full name and address. Web information should complement, not replace, medical attention, and readers should be encouraged to take materials to their physicians if they have further questions. The Health on the Net Foundation provides a code of conduct for health sites (www.hon.ch/HONcode/Conduct.html) and provides its HONcode seal to those in compliance, though some reliable sites have not formally subscribed.
When you have a medical question, where should you begin? Two sites that are extremely useful for locating information on a wide variety of medical topics are NOAH and MEDLINEPlus. Both of these are designed for the public.
NOAH, or New York Online Access to Health (www.noah-health.org/), is often my first stop when a client wants "the basics" on a topic. It is a bilingual site, so bookmark it for Spanish-speakers. Assembled by librarians and sponsored by major New York libraries, the New York Academy of Medicine, and the March of Dimes, it has subject categories with links to online brochures and resources from many organizations. Each category, such as kidney disease or headache, is subdivided to guide users to definitions and basic descriptions, care and treatment, related issues or concerns, and additional information resources. If you don't see the topic you need, try the word-search feature. Unexpected find: a new section added in March on "Foot (Hoof) and Mouth Disease," with information from US and foreign departments of agriculture and news briefs tracing outbreaks abroad. Experts have already sorted through many Internet pages and compiled the best, so save some time and hop aboard with NOAH.
MEDLINEPlus (medlineplus.gov) is one of the evolving National Library of Medicine/National Institute of Health sites. Intended as a portal for both health professionals and consumers, it is not as user-friendly as NOAH, but has features that will add depth to any search results. Search the Health Topics section by its alphabetic list, broad topic categories, or medical encyclopedia. Drug Information is a layperson's guide to more than 9,000 prescription and over-the-counter medications. Several medical dictionaries are listed, including one that is multilingual. Directories of both physicians and hospitals make it easy to check the license status of doctors and dentists, and to answer questions such as, "What's the address of that hospital in Selma?" The final section, Other Resources, is where you will need to spend some time - library staff should be prepared to guide readers through this section. Links to nearly 100 federal and other health organizations have been compiled, and there are connections to many health-related databases, including MEDLINE/PubMed which indexes and abstracts journal articles. (To locate libraries carrying particular medical journals, see www.sjvls.org/medlib/holdings.html for Fresno, or www.dbs.cdlib.org/?CSdb=pe for California.) NLM/NIH databases are most helpful for trained or truly dedicated searchers. A Publications division in MEDLINEPlus includes government-sponsored health information (some in Spanish), a few full-text health newsletters (the Harvard Health Watch series), and the Merck Manual.
What if one wants the very latest developments in a field? Checking Web sites of the major professional societies and research organizations is worthwhile, but a compilation site such as Medscape, geared for medical professionals, might be an even better place to begin. Medscape (www.medscape.com) requires free registration to use all its features, but is worth the minor inconvenience. Find late-breaking medical news, dates and summaries of important medical conferences (nice for following up teaser articles in newspapers), practice guidelines, a wealth of information in medical specialties (click on "more specialty pages" near the top of the home page), a series of e-journals such as MedGenMed, abstracts from other medical journals, and even a patient education section. Medscape is a commercial site and does advertise products to health professionals, but has a reputation for excellence when it comes to medical information.
There are many, many more Internet sites devoted to medicine or health, some that require paid subscriptions or payment for special features or services, and some free to browsers. UpToDate (www.uptodate.com) is one example of a hybrid site. Only subscribers have access to its full range of medical text and news, but it also has a free patient information section with solid information on diabetes, digestive and endocrine disorders, women's health, etc. A few special features on other free sites include Medical Tests Encyclopedia (with a link to Surgery Encyclopedia - health.discovery.com), a version of Gray's Anatomy of the Human Body with color illustrations (www.bartleby.com/107/), www.nnlm.nlm.nih.gov , and those always popular personal health calculators and wellness tips on Web sites such as DrKoop (www.drkoop.com/tools/calculator/).
This is just the tip of the iceberg when it comes to health resources on the Internet. Don't be overwhelmed! Define each question to avoid wasting time on side issues, work from basic information to the more complicated medical literature, carefully evaluate all sites used, and be sure that you or those you are advising realize that this is only part of the path to health - contact trained health professionals for further advice, interpretations, and prescriptions. And don't forget to check for supplemental books and audiovisuals at the library!
Nancy Crossfield, Saint Agnes Medical Library