Can we trust Dr. Google?

1. January 13, 2007 Can we trust Dr. Google? The importance of teaching student doctors how to evaluate medical websites Geoffrey Talmon, M.D. University of Nebraska Medical Center

2. A scenario… Learning issue: Describe the Schilling Test

3. The way it was…

4. The way it is now…

5. The way it is now…

6. Another scenario… “Doctor, I found this website that says that weasel saliva will cure my prostate cancer. What do you think?

7. The Internet has revolutionized information exchange • Depth and breadth of available information is staggering • The WWW is increasing in use, influence, and cultural importance

8. The Internet in medicine: statistics • WWW debuted in 1993 • In 2005, 1 billion people worldwide • In 2004, 202,000,000 Americans used the Internet (72%) • 112% increase from 2000 • 66% use the Web daily Pew Survey, 2007

9. The Internet as a medical information source • Access to support/discussion groups, primary literature, society websites, etc. • Growth in health resources • In 2000: 100,000 medical websites BMJ 2000; 321:136 • 2007 “medical websites” Google search: > 2,000,000,000 results • Online health ad spending: $662 M in 2010 • 79% of Americans use the WWW to find health information, the majority utilizing search engines (Google=55%) Wall Street Journal 3/21/2006

10. The Internet as a medical information source

11. The Internet as a medical information source

12. The Internet as a medical information source: caveats • Audience of websites varies • Patients/relatives to specialists • Complexity of information and language varies • Sponsorship (agenda) varies and disclosure not universal • Professional societies • Drug companies • Patient groups • Special interest groups

13. The Internet as a medical information source: caveats • No systematic means to remove outdated content • Web search engines not discriminatory • No systematic peer review of content (the “wikipedia syndrome”) • 2000: ~50% of content was reviewed by experts • 4-89% of information was “inaccurate” or “misleading” • Worst in nutrition, best in cancer • Worst in “private sector”, best in societies’ JAMA 2002; 287:2691-2700

14. How health information on the web will impact student doctors • Primary medical resource • Evaluation of patients’ information

15. The Internet as a primary m medical resource • Little data to quantify or characterize medical student/resident Internet use • 88% of 18-29 year-olds use the internet regularly • >80% of college students own a computer Pew Survey, 2006 • 94% of clinicians use the Internet with 81% using it at least several times per week • Personal experience: the WWW is ubiquitous • WebMD, eMedicine, UpToDate, pathologyoutlines.com, etc… • Access to online journals/texts • WWW searches

16. The Internet as a primary medical resource • Advantages: • Fast, convenient, inexpensive, easy to use • Wide variety of information from multiple sources accessible • Disadvantages: • Requires additional evaluation of content (“academic vigilance”) • Limit of research to material available online • Decrease in variety of sources used? • Digital plagarism

17. Patients and the Internet • 77% of consumers research health topics before and after seeing a physician • 54% discuss their findings • 64% get information from sites intended for professionals • 43% use WWW to seek second opinions • Online health information is trusted by public second only to that from clinicians • Average user looks for health related information 3x/wk HON survey, 2004-5

18. Patients and the Internet Health Affairs, Nov/Dec 2000

19. Patients and the Internet

20. What should educators do? • Understand that the Internet has and will continue to impact health care • Recognize the degree of current Internet use by students/residents • Foster conscientious use through teaching student doctors how to evaluate websites

21. Preparing student doctors for the Internet Age • Abundant experience with teaching the evaluation of primary/review literature • Web-based materials engender additional issues • Student doctors should be just as conversant in these as study design and selection of statistical methods • Medical research curricula should include these points • Learners and educators should encourage the empiric evaluation of all web-based materials

22. Evaluating medical websites • Additional criteria for evaluating websites: • 1. Audience • Intended audience should be clearly identified • 2. Accuracy • Cite the source(s) of published information • 3. Sponsorship/financial disclosure • Identify host organizations and funding sources • 4. Transparency • Identities/qualifications of authors, editor(s)/reviewers, and webmaster with accurate contact information • 5. Currency • Date created and/or last updated

23. Resources • Published guidelines for evaluating sites • Johns Hopkins University • Net.TUTOR • “The Good, the Bad, and the Ugly…” • Published guidelines for evaluating health-related websites • AMA Guidelines for medical and health information sites on the Internet (2000)

24. Resources

25. Resources • Health on the Net Foundation (www.hon.ch) • Non-governmental foundation in EU with published code of conduct for web publishing of health information (HONcode) • Accredits health websites • Downloadable toolbar • checks accreditation status of sites • Searches accredited sites

26. Resources

27. Resources

28. Resources • WRAPIN (www.wrapin.org) • Project of HON • Searches only “approved” websites • Searchable by keywords

29. Resources

30. Resources Arch Path Lab Med 2005;129: 742-6

31. Summary • The Internet has and will continue to be an important method of obtaining medical information for patients and clinicians • The Web is currently being heavily used by the public and student doctors • Medical education needs to recognize the importance of the evaluation of health-related websites and the information they contain • Published guidelines and useful web-based tools are currently in existence to aid educators

32. Questions?