A Dose of Caution Required

With experts predicting that some 30 million Americans will go online for health information by year’s end, it’s clear that the Internet is becoming a staple in the lives of many. I think of my neighbor who tells me he found a recipe for lentil salad on the Web.

But while there’s no apparent controversy in lentil salad, health-care Web sites are attracting critical scrutiny these days. Congress recently held hearings about issues involving Web sites that let you order prescription drugs online, and a number of sites have come under fire for questionable ethics or faulty information.

The problems stem at least in part from the two main ways these sites are created. The more “altruistic” sites, which don’t accept advertising and boast of a mostly informational or educational purpose, often don’t have the resources (read: little or no advertising) to keep critical information updated. Commercial sites (read: lots of ads and sponsors) run the risk that business considerations will influence content.

But sometimes the distinctions between the two may not be so clear-cut. A noncommercial site may be biased toward a particular opinion or philosophy, even though it doesn’t feature ads. A chiropractor’s Web site, for example, may have a different view of how to treat back pain than an acupuncturist’s site. So how do you know whom to trust and what information is reliable?

To help sort out some of these issues, I’d like to suggest five questions to ask when evaluating health-care Web sites. These are, in fact, the questions I ask myself as I review sites for this column.

* Who is the site’s owner, sponsor or author? Are they familiar to you? If you don’t recognize the names, try contacting them directly for more information.

* When was the site last updated? This is important if having current information is important to the subject you are interested in, such as the latest medical research.

* Does the site have a medical advisory board? Do you recognize any of the individuals or institutions listed? Does the advisory board or other “experts” get involved in discussion groups, chat rooms or reviews of the sites’s content?

* Does the site include clearly stated policies on ethics, advertising or privacy policy?

* What does my health care provider have to say about this information?

If those tips aren’t enough guidance, perhaps you’ll want to follow the efforts of Web sites themselves to develop self-policing guidelines. This effort got a kick-start after the Web site started by former U.S. Surgeon General C. Everett Koop (https://www.drkoop.com) was blasted in a New York Times article in September for not fully disclosing sponsorship arrangements. The article also criticized Koop for not disclosing his own personal financial arrangements with the site’s commercial sponsors.

Now representatives from Drkoop.com and 15 other prominent health sites have formed an alliance called Hi-Ethics or Health Internet Ethics. (At first, I thought this cleverly named group was named “hi” as short for Health Internet; it later dawned on me that the “hi” was also meant to suggest “high” ethical standards.) The group is working on guidelines on content, advertising and privacy issues for Web sites.

Another watchdog in cyberspace is the Federal Trade Commission, which has published consumer guidelines intended to limit the use of the Internet in health fraud schemes.

The agency’s tips include being wary of products advertised as “a quick and effective cure-all.” Also watch out for words like “scientific breakthrough,” “miraculous cure,” “exclusive product,” “secret ingredient” or “ancient remedy.” The FTC also cautions against health sites that use “impressive-sounding terminology to disguise a lack of good science.”

Medscape, (https://www.medscape.com) a popular health and medical Web site headed by former Journal of the American Medical Assn. editor Dr. George Lundberg, recently adopted a comprehensive advertising policy. The site has published precise guidelines for the type, placement and labeling of advertising and “advertorial” content.

Want to learn more about the subject? The Internet Healthcare Coalition (https://www.ihc.net), a nonprofit organization formed by Internet companies and medical and consumer groups, among others, is hosting an Internet health ethics summit Feb. 1-2 in Washington, D.C. The group also offers consumer tips to help evaluate Web sites (https://www.ihc.net/content/tips.html).

While these various efforts should help consumers to better evaluate the credibility of health Web sites, they won’t tell us with certainty which to trust.

As with any goods or services, the ultimate responsibility in making a selection rests with you, the consumer. Think of the Internet as a virtual second opinion. Use it to supplement, not replace, the advice you get from your doctor or other health-care professional.

And, of course, use your common sense and your best judgment. My neighbor did, and that lentil salad was one of the best I’ve ever had.

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Marla Bolotsky is managing editor and director of online information for the Henry J. Kaiser Family Foundation. She can be reached by e-mail at marla.bolotsky@latimes.com.

* Cathy K. Purcell contributed to this article.

* Your Health Online runs on the first and third Monday of the month in Health.