Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor--Let the reader and viewer beware

Health care professionals and patients alike should view with equal parts delight and concern the exponential growth of the Internet (the Net), and especially its graphical, userfriendly subset, the World Wide Web (the Web), as a medical information delivery tool (Lundberg, 1995; Kassirer, 1995). Delight because the Internet hosts a large number of high-quality medical resources and poses seemingly endless opportunities to inform, teach, and connect professionals and patients alike. Concern because the fulfillment of that promise remains discouragingly distant. Technical glitches aside, when it comes to medical information, the Internet too often resembles a cocktail conversation rather than a tool for effective health care communication and decision making. The problem is not too little information but too much, vast chunks of it incomplete, misleading, or inaccurate, and not only in the medical arena (Achenbach, 1996; Consumer Reports, 1997). The Net-and especially the Web-has the potential to become the world's largest vanity press. It is a medium in which anyone with a computer can serve simultaneously as author, editor, and publisher and can fill any or all of these roles anonymously if he or she so chooses. In such an environment, novices and savvy Internet users alike can have trouble distinguishing the wheat from the chaff, the useful from the harmful. This should not be terribly surprising. After all, the Internet is a new and exciting communications medium and, therefore, highly attractive to those whose agendas range from the sublime to the ridiculous (Lundberg, 1989). At first glance, science and snake oil may not always look all that different on the Net. Those seeking to promote informed, intelligent discussion often sit byte by byte with those whose sole purpose is to advance a political point of view or make a fast buck. And naive viewers may be lulled by technological brilliance into placing more value on the content than it deserves, simply because they get it from the Net. In fact, effective use of technology can be an important indicator of quality-and especially utility-in communicating medical information on the Net. The best digital destinations will employ designs and tools that facilitate navigation through large quantities of information, provide appropriate mechanisms for feedback and interactivity, monitor and maintain the links they've chosen to provide to other sites, and generally commit the resources needed to maintain a useful presence in an increasingly crowded electronic landscape. But the bedrock on which these technical tools rest is content. And in this regard, the basic issues involved in presenting information on the Internet have changed little since Gutenberg first pulled the lever on his printing press. In the case of traditional print publishing, of course, the rules of engagement have been worked out over five centuries. There are standards by which to judge the quality of editorial content, to differentiate author from shill, editorial from advertising, education from promotion, evidence from opinion, science from hype. Those who follow these conventions develop a respected brand identity, establish a level of trust with their readers, and serve as a forum for the kind of informed, intelligent discourse that advances the scientific process and benefits the public health (Journal of the American Medical Association, 1990). Not everyone in the print world plays by these well-established rules. More than a few presses produce little more than empty pages. Nor are the rules under which even the best-known and most-trusted purveyors of medical information function by any means final or foolproof But at least they provide a base, tested by lengthy experience, on which to operate. The same set of quality moorings that helps users of medical information navigate in print should apply in the digital world. We believe the time has come to discuss vigorously how such a set of basic quality standards can be developed and applied in an electronic context. …