Op-Ed: Online use research falls short

June 8, 2001

By Howard Wolinsky and Dr. George D. Lundberg

Last year, 100 million Americans went online to get health care information, up from 70 million the previous year, according to Harris Interactive.

Only Web sites devoted to weather and sports received more visitors than those devoted to health. Traffic at health sites last year for the first time exceeded porno sites. That's saying a lot.

With the rapid and impressive ascendancy, health care Web sites have become a major target for scrutiny. That is as it should be.

RAND Health is the latest to come up to the plate. In a study published in the May 23rd issue of the Journal of the American Medical Association, RAND took online health sites to task.

The researchers' main complaints were that health sites are incomplete and often presented material at reading levels difficult for people who were not college educated to understand.

RAND appears to have expectations for health Web sites that would be impossible to meet in the world of print books, newspapers, magazines and medical journals.

RAND doesn't define what it means by complete. Articles on health in the Journal of the American Medical Association, New England Journal of Medicine, the New York Times or Newsweek magazine are not ''complete.''

Time-crunched readers have varying levels of interest in a particular subject. Online and offline editors make the judgments on how comprehensive articles should be. A reader curious about a particular condition diagnosed in a friend will have different information requirements from the person who has the condition. Different sites, just like print resources, offer different levels of information.

As to reading levels, RAND researchers note that nearly half of all adults read at an eighth-grade level or below, so they will find it difficult to understand information presented at many health sites. However, the typical online reader today is more highly educated and may not have the same problem.

Readers can find sites that meet their interest and reading levels.

For example, CBSHealthWatch at www.cbshealthwatch.com and its affiliate Medscape.com at www.medscape.com ranks its articles based on its level: basic, advanced or expert. This rating system includes reading level and topic considerations.

RAND griped that search engines are an inefficient way to find information.

They didn't need to conduct a study to discover that. The Web is a huge and growing body of information.

There are, however, strategies for more effectively using search engines to find health information or any other sort of information. If users read the help screens at search engines, such as Google at www.google.com , they would learn tricks--such as judicious use of quotation marks and plus and minus signs--that will help them conduct searches.

They also should consider using search engines and directories specializing in health topics, such as the National Library of Medicine's MEDLINEplus at www.medline plus.gov and healthfinder at www.healthfinder.gov , as well as the targeted Medscape Select search engine.

RAND gave a negative spin to its findings, which it titles ''Proceed with Caution: A Report on the Quality of Health information on the Internet.'' And RAND's own Web site at www.rand.org hypes the study by saying that it points up the ''potholes'' and ''problems'' created by the Web.

Yet, RAND found the health information online generally to be accurate. It found some contradictory information within sites. We hope RAND informed the sites so they can be fixed. Still, medicine is a contentious area in which there is plenty of debate.

The goal of online information should be to provide information for self-care when appropriate, but also to complement the doctor-patient relationship.

The fundamental--almost fatal--flaw in the RAND study was the failure of researchers to recognize that the nature of the Internet is that it is simply a medium just as paper is a medium. The researchers failed to use other media (paper, broadcast or telephone) as control groups. The researchers, intent on picking nits, missed the grandeur of the vision and promise of this new technology, which we consider the biggest communications breakthrough since the printing press.

Howard Wolinsky is co-author with Judi Wolinsky of Healthcare Online For Dummies (2001 Hungry Minds) and Dr. George D. Lundberg is Editor in Chief of Medscape and author (with Jim Stacey) of Severed Trust (2001, Basic Books).