Internet review:online health services

Citation

(2006), "Internet review:online health services", Health Education, Vol. 106 No. 6. https://doi.org/10.1108/he.2006.142106fag.001

Internet review:online health services

Internet review:online health services

After pornography, health information is the most sought after commodity on the Internet. Although Google has recently started censoring the information provided for users in China, for the most part content on the Internet is largely unregulated and therefore issues of reliability and quality, especially in the field of health, become paramount. Given that many people who are seeking health information turn to the Internet before their own doctor, what can be done to safeguard these people from the snake-oil salesmen and the quacks whose internet presence is already worryingly high? Fortunately, there are a number of Internet based organisations that can now help by offering health advice that consumers can be confident in using.

BestTreatments

www.besttreatments.co.uk/btuk/home.jsp

The BestTreatments web site is published by British Medical Journal publishing in association with Clinical Evidence, an “international source of the best available evidence for effective health care”. With a pedigree like this users can be confident that the central aim of BestTreatments, “Helping you to make better health decisions”, is very likely to be met. The web site is designed to be used by both patients and doctors and although the list of medical conditions available is the same, the information for patients is written for the lay person and the technical detail is kept to a minimum. The information for doctors is provided by Clinical Evidence and will include the results of research programmes, randomised controlled trials and journal articles. The designers of this web site have done a good job in simplifying its organisation with three sections on conditions and treatments, decision support, and operations and tests. The information on conditions, treatments, operations and tests can be found on many other web sites, but the section on decision support is innovative and really useful. Without this section there is a high probability that users might be left floundering in a morass of information, which often appears to be, conflicting. The decision support section in essence explains to users the basis of evidence based health care. It explains the need for research, how to evaluate risks, how to identify good studies, and how, with the help of your doctor, to select the most appropriate treatment for your particular complaint. Another interesting feature of this web site is that it has the ability to monitor just how users feel about the content of the web site. Where information is being provided, at the bottom of the page is a five-point scale that allows users to express how useful they felt the information was, and to submit this to the authors. This feedback feature is simple and something perhaps other web site designers might want to emulate. Overall, this web site is an excellent resource for both doctors and patients. One slight criticism is that mental health issues get only a limited mention, anxiety and depression are covered but there is nothing on schizophrenia, alcoholism or obsessive-compulsive disorder.

BUPA

www.bupa.co.uk/health_information/

BUPA started out in 1947 as an insurance company, the British United Provident Association, and even now when we think of BUPA most people probably associate the organisation with health insurance. However, BUPA has shown considerable growth and change since 1947 and now, as this web site shows, has is a lot more to offer including developments in the provision of health information. The Health Information home page is divided into several sections. The A-Z health factsheets is always available but the other sections are constantly updated in order to provide topical health information as appropriate. The list of factsheets is extremely comprehensive, probably more so than BestTreatments, though the information provided is rather more limited. Each factsheet follows a similar format with a description of the condition, causes, treatments, and self-help possibilities. The factsheets can be printed out online or there is an option of downloading in pdf format if a more professional looking factsheet is required. A further information section also provides links to other organisations that might be able to offer help with a particular condition.

Although the information provided isn’t as in-depth as that found in the BestTreatments web site, nevertheless the quality is high and the standard of web site design is excellent. For the lay person who wants a quick overview of a health problem this web site would be suitable. For the person who is suffering from a particular complaint and might want to discuss their problem with their doctor, then BestTreatments would be better.

NHS Direct: Self-help guide

www.nhsdirect.nhs.uk/selfhelpguide/index.aspx

Past readers of these reviews may recall the NHS Direct has not always been favourably reviewed. However, it has now had a revamp and has added a few interesting features that are worth exploring. In the past the user clicked on the name of the condition they thought they were suffering from and obtained a brief, and often unfathomable, description of the condition and possible treatments. While this hasn’t change very much, a new self-help guide is a considerable improvement. In this section they have listed many of the most common symptoms which people call NHS Direct about for advice. These can be accessed via an alphabetical key, or the much more user-friendly alternative of the body key. The body key allows users to click on that part of the body where they are experiencing symptoms. For example, if you have a pain in the chest, click on chest and you will be asked a series of questions and provided with one of three alternative courses of action. For example, if you click on chest and indicate that you have a pain in your chest you will be asked if you have had this pain before during a heart attack. If you click Yes the a flashing red “Dial 999” appears! If you clicked No to this question then you will be taken through a series of other Yes/No questions and depending on your responses you might be asked to telephone NHS Direct, or to opt for self-care, where you manage the condition yourself. The self-care advice is quite limited but there are also links for further advice. This self-help guide is a good idea and on the whole works quite well. Occasionally, some of the questions asked can be confusing for the user, especially where multiple questions are asked but only a single Yes or No response is possible; the user then has to make the best guess and might not feel comfortable with this. It is good to see these improvements to the NHS Direct web site, it now also has links to BestTreatments (see above) and together they do offer a valuable service to patients and I suspect to health professionals as well.

Quackwatch

www.quackwatch.org/

Unlike the other web sites in this review Quackwatch isn’t concerned with providing health information about specific conditions, rather its central aim is to identify those peddlers of the snake oil, the health fraudsters who are more concerned with separating people from their money than in looking after their health; in short Quackwatch is “Your Guide to Quackery, Health Fraud, and Intelligent Decisions”.

In design Quackwatch is quite crude by modern standards, simply a list of links categorised in various ways. The first category deals with Quackwatch itself, its mission statement, details of how it is funded (and how users can make a donation!), and useful tips for navigating the web site. The next section deals with the founder of Quackwatch, Dr Stephen Barrett, a retired psychiatrist resident in North America. So after establishing the credentials of this web site what else is on offer.

The important content of this web site is to be found in two sections, one dealing with “Quackery” and the other with questionable products services and theories. Again, these sections are made up of lists of links dealing with topics like how quackery is defined, ten ways to avoid being quacked, how quackery harms patients; I particularly liked the link explaining why health professionals become quacks (its not all about money!).

The next section on Questionable Products Services and Theories is again a list of links starting with acupuncture and finishing with wild yam cream! In between are listed a whole host of exotic sounding theories and “treatments”. Chiropractic, ear candling, homeopathy, iridology, magnet therapy, qigong, reflexology and many more all come in for scathing criticism from Dr Barrett. For each of these topics a brief description of the “therapy” is provided and then Dr Barrett reviews the research to establish if the therapy has any scientific foundation, which needless to say most do not! For each of the therapies listed a date of the last update is also included and this gives us a clue to the major problem associated with web sites of this sort. Research advances at an ever increasing pace and if the last update was in 1998 (Chiropractic) then the reader has the right to be sceptical about the validity of the research cited. It may well have been valid in 1998, but has nothing else been found since then?

For a little light relief spend some time looking at the section dealing with Questionable Advertisements, I particularly liked the one for Slim Slippers … . slippers that can help you lose weight!

The final sections of Quackwatch are rather more positive and focus on health education and promotion. Advice is available on cardiovascular disease, diet, fluoridation, hormone-replacement therapy, smoking and vegetarianism, to mention only a few. There is a section on how to find health care providers, i.e. doctors, dentists, personal trainers and the like. Although this is aimed mainly at the North American consumer market much of the advice is sound and will travel well to other parts of the globe. Finally, if you want to know what your Consumer Health IQ is there is a quiz. Unfortunately, it isn’t interactive, you simply read the questions and then click on a link to find out the answers and get a comment on the number scored correctly. For anyone who has an interest in the provision of health information via the internet, whether you are a patient or information provider, Quackwatch should be one of the first web site to be consulted.