Health watch: Can eHealth keep you healthy?

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When Paul was diagnosed with hypertension, he wanted to know everything he could do to help manage his disease. So to supplement the information given him by his doctor, he went to the Internet.

When Marlene started getting menopausal symptoms, she went to the Internet to learn about safe and effective dietary supplements that might reduce the hot flashes that were keeping her up at night.

According to a recent Harris survey, 53 percent of Americans use the Internet to get health information - up from 27 percent in 1998. Dubbed as "HealthMed Retrievers" or "cyberchondriacs," these individuals have at their disposal more than 100,000 Web sites dispensing material ranging from medical journal articles to sales material.

Self-diagnosis and self-treatment are not recommended, of course, even for doctors. But, in an era of managed care and cost cutting, doctors have little time to give patients the detailed information they want and need.

Some writers have warned about material on the Internet that is inaccurate, misleading or unrealiable, but the same can be true for information from other media such as television, the daily newspaper, health-oriented magazines or leaflets picked up at the health food store. Whatever the source, it's up to the reader to make a critical appraisal regarding accuracy, reliability and relevance to that person's medical condition. Information from anyone trying to sell a product, of course, must be judged in light of its purpose.

Starting a search

Anyone who is familiar with the Internet knows how easy it is to get information. Merely typing in a word even closely related to your topic will get you hundreds of articles to choose from. The majority, however, will not be very relevant; many will be outdated or no longer available.

The first step should rather be to choose a good search engine and then to define your search terms as precisely as possible.

Metacrawler (www.metacrawler.com) and about.com (www.about.com) are useful because they search across other search engines, combining the results and presenting them in a more manageable form. Magellan (www.mckinley.com) rates sites and provides short summaries. Google ranks Web pages by how frequently they are used by others. According to Google, this search engine "crawls the Web scooping up hyperlinks and uses them to figure out how important a page is by how is pointing to it."

Healthfinder (www.healthfinder.gov) is a gateway site with user-friendly links to federal, state, local and nonprofit, university and other consumer health resources. If you're in a library, you can get additional search tips from a librarian.

For definitive searches, health professionals and researchers use MEDLINE, the online version of the Index Medicus, with abstracts of articles published in more than 4,000 international medical journals. Since 1997, consumers have been able to use the same database without charge through PubMed. You can go directly to the PubMed Web site (www.nebi.nlm.nih.gov/PubMed.com) or merely type PubMed into your browser.

PubMed searches are carried out using official medical subject headings (MeSH), and the results are mostly citations and abstracts. You need to have a medical dictionary handy and read abstracts carefully to see if you wish to obtain the full text for more detailed information. A health science librarian also can help you fine tune your search and make use of other reference sources.

Evaluating the source

For specific illnesses, there are numerous sites sponsored by groups such as the American Medical Association, the American Heart Association, the Centers for Disease Control and the American Cancer Society. CancerNet (cancernet.nci.nih.gov) gives reliable, up-to-date information on cancer.

The CDC has numerous disease-oriented sites such as www.cdc.gov/cancer and www.cdc.gov/diabetes. Travel information can be obtained from www.cdc.gov/travel.

When you're evaluating sites, it's useful to consider the suffix. Dot coms are commercial, for-profit sites; .org stands for nonprofit; .edu for educational and .gov for governmental organization. For further information about the sponsoring organization, click on the "about this site" or "who we are" button.

In judging the credibility of any information you find on the Internet, there are a few questions to ask:

• Authority: Who sponsors the site? Do they have a bias, a vested interest or something to sell?

• Credibility: Are the statements or claims backed by research from peer-reviewed scientific publications?

• Credentials: What are the educational and professional qualifications of the writers and sponsors? Can the authors be contacted to answer questions?

• Timeliness: Health information goes out of date in a hurry. When was the material last updated?

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