These pages have some suggestions for judging the reliability and quality of health and medical information found via internet resources, from staff of the Food & Drug Administration (FDA), plus additional commentary by CMA Library staff.

Is this Site Reliable? [While written with drug information in mind, these points apply to health and medical information in general, too.] FDA staff and others familiar with Internet medical offerings suggest asking the following questions to help determine the reliability of a Web site:

• Who maintains the site? Government or university-run sites are among the best sources for scientifically sound health and medical information. Private practitioners or lay organizations may have marketing, social or political agendas that can influence the type of material they offer on-site and which sites they link to.
• Is there an editorial board or another listing of the names and credentials of those responsible for preparing and viewing the site's contents? Can these people be contacted by phone or through E-mail if visitors to the site have questions or want additional information?
• Does the site link to other sources of medical information? No reputable organization will position itself as the sole source of information on a particular health topic.
  On the other hand, links alone are not a guarantee of reliability, notes Lorrie Harrison of FDA's Center for Biologics Evaluation and Research. Since anyone with a Web page can create links to any other site on the Internet - and the owner of the site that is "linked to" has no say over who links to it - then a person offering suspect medical advice could conceivably try to make his or her advice appear legitimate by, say, creating a link to FDA's Web site. What's more, health information produced by FDA or other government agencies is not copyrighted; therefore, someone can quote FDA's information at a site and be perfectly within his or her rights. By citing a source such as FDA, experienced marketers using careful wording can make it appear as though FDA endorses their products, Harrison explains.
• When was the site last updated? Generally, the more current the site, the more likely it is to provide timely material. Ideally, health and medical sites should be updated weekly or monthly.
• Are informative graphics and multimedia files such as video or audio clips available? Such features can assist in clarifying medical conditions and procedures. For example, the University of Pennsylvania's cancer information site, called OncoLink, contains graphics of what a woman can expect during a pelvic exam.
  Bear in mind, however, that multimedia should be used to help explain medical information, not substitute for it. Some sites provide dazzling "bells and whistles" but little scientifically sound information.
• Does the site charge an access fee? Many reputable sites with health and medical information, including FDA and other government sites, offer access and materials for free. If a site does charge a fee, be sure that it offers value for the money. Use a searcher (see "Sources of Internet Health Information") to see whether you can get the same information without paying additional fees.
• If you find something of interest at a site - say, a new drug touted to relieve disease symptoms with fewer side effects - write down the name and address of the site, print out the information, and bring it to your doctor, advises Valencia Camp of FDA's Office of Information Resources Management. Your doctor can help determine whether the information is supported by legitimate research sources, such as journal articles or proceedings from a scientific meeting.
  In addition, your doctor can determine if the drug is appropriate for your situation. Even if the information comes from a source that is reputed to be reliable, you should check with your doctor to make sure that it is wise for you to begin a certain treatment. Specific situations (such as taking other drugs) may make the therapy an inadvisable choice. Your doctor can decide whether the drug is suitable for you and may be able to offer more appropriate alternatives.

• Who is providing the information? Is the site produced by a government agency, an academic institution, a watchdog organization, a professional association, a research foundation, an interested individual (who may be trying to drum up business, or may be purely altruistic), a managed care organization, a hospital system, a manufacturer or consultant group? Obviously, each of these entities has different reasons to provide health information, different biases, and different goals. Try to weigh the information received against what you think might be the intent of the information provider. If you are getting advice from word of mouth' sources like discussion groups or Newsnet postings, be particularly wary. First-hand experience from other people may be very useful; however, do treat it as the equivalent of casual conversation and check to see if other (non-anecdotal) sources confirm or reflect that information.
• A related note that deserves special emphasis - beware sites that don't indicate the source of the information. If you don't know who or where it comes from, you have no way to judge its validity.
• A similar question is - who is paying for the site? While some internet resources are home-grown and the result of numerous volunteer hours, many of the more elaborate or sophisticated sites look to various funding sources to pay for their Java applets and multimedia-enhanced web pages - or even just to pay for routine upkeep. Note the advertisers or sponsors for that site, and factor them in when judging bias or providers' intent.
• Don't rely on information that only appears in one source. News in the medical community travels quickly, and it's unlikely that even fairly obscure information will be reported in only one resource. Use the many indexes and internet search engines to find corroboration, additional details, or "second opinions" on the topic of interest. You may even have to go to indexes to printed medical information, since not everything is available yet online (by a long shot!).
• Take advantage of internet reviews and annotated links to other internet resources. For some health and medical topics, there are an overwhelming number of possible sources of information How can you tell which of the many sources are worth exploring? Good starting points are those sites which collect links to resources by topic; particularly useful are those which also review sites, using expertise from experts, practitioners, and/or librarians. Some examples of such collected and reviewed lists are Medical Matrix, HealthWeb, Health and Medical Informatics Digest, MedWeb, and some of the medical professional organization and academic sites. (Those "Top 5%" and "Site of the Week" awards you see on some home pages, however, are not reliable indications of the quality of their medical information.) Published guides, like the many Internet books now in print, may give useful pointers -- but can be out-of-date quickly, given the volatile nature of the Internet.
• While there are some ambitious projects in the works to create information "filters", for now the best ways to evaluate health and medical information on the Internet are common sense, consulation with experts (and your own health care partners, including medical librarians), and an open but questioning mind.

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