Pharmacists need to know how to access useful information from the internet
Our profession appears to be moving into the 21st century, if not the New Age, now that the first on-line internet pharmacy has opened in Britain (PJ, November 27, 1999, p849). Internet trading seems to be here to stay and is already making its presence felt. Members of my family have purchased clothes and household items by mail order for many years, and the use of the internet is just a further step.
However, apart from being potentially a shopper's paradise, the internet is also a vast repository of information and a ready means of global communication. As a communications medium, the net is unrivalled. I can e-mail a friend in Japan and get a response very quickly and incredibly cheaply - just the cost of a local telephone call. There is a vast array of newsgroups, discussion groups and chat-lines covering every imaginable interest. As an example, the protests against the state visit of the Chinese president last year were co-ordinated over the internet, as I found out when I inadvertently became involved in a demonstration at the Cambridge university library. Of course, the net is totally anarchic, with few controls, and this means that there can be some very undesirable forms of contact available. This can pose significant dangers for, say, children surfing the net unsupervised by a parent.
One of the most popular reasons for surfing the net is to find out medical information. How many community pharmacy colleagues (or hospital for that matter) have been visited by patients afflicted with IPS (Internet Printout Syndrome)? According to one of the "free" general practitioner newspapers, this is becoming very common in primary care. The typical IPS patient is well educated, middle class and appears to know what he or she is talking about. They possess, of course, a home computer with internet access, and enough medical knowledge to scare themselves but not enough to be reassuring. In my work as a health authority pharmaceutical adviser, I have had numerous calls from GPs who have been consulted by patients bearing wads of print-out, with the request (or demand) that the poor doctor prescribe some weird treatment or other on an FP10. But how good is this kind of information? Has this ever been examined?
A recent paper in Nature1 examined whether search engines (programs which will search for specific information, matching the key-words entered by the user) located information reliably. The authors estimated that the world wide web contained about 800 million pages of information at the time of writing (presumably early in 1999). They carried out a series of tests with different search engines to locate pages on specific scientific topics and concluded that no search engine they tried had identified more than 16 per cent of the information available on any one topic on the internet. Thus, the results of a search for information will depend heavily on which search engine one uses.
I recently had reason to search the internet for specific medical information for a query. A group of sixth-formers had been using a teenage chat-room on the internet which had given information on the possible increased risk of breast cancer with the use of some types of under-arm antiperspirants. Not unreasonably, they were worried, and it fell to me to check out the story for them. I used one of the more popular search engines which is sponsored by advertising and which kept flashing up irresistible offers on personal finance, new cars, holidays and menswear while I was working on the problem. The search quickly picked up a site from the American Cancer Society which totally refuted the story and gave much reassuring information. I was able to print this out and pass it on to the young people concerned. My search also revealed the various sites which were spreading what turned out to be old wives' tales. Many other sites connected with breast cancer were also indexed. Some of these were from self-help groups and I felt that they might be very valuable and reassuring to sufferers. Some sites indexed had no obvious connection with breast cancer at all, or even with health care. I also came across a site called "Teentits" (which I did not examine!) and which indicates how easy it is to pick up inappropriate and perhaps downright nasty stuff quite inadvertently. It is possible to obtain special programs which screen out this kind of material but these are dependent on the authors of adult sites putting a special marker on their sites which is picked up by the protector programs.
As a result of this query, and after reading the Lawrence and Giles paper in Nature, I decided to do my own test. Using, again, the three keywords "antiperspirant breast cancer", I checked how many sites were indexed. The numbers ranged from 32 on Lycos to 1.8 million on Infoseek. All the sites produced the relevant information from which I could have answered my query, and most produced them in the early stages of the search. However, with the search engines producing the larger numbers of sites, it was difficult to know whether to go on looking. After all, it would take rather more time than I could spare to examine 1.8 million sites!
Now that pharmacy (like everything else) has entered the information age (our New Age?), pharmacists need to know how to access useful information on health care issues from the internet. Not all of us are experts at surfing the net, nor do we necessarily wish to become experts on it, but we do need to know how to use it reliably. We need two things. One is a good survey of the search engines, to see which produces the best range of health care information without too much irrelevant junk. (Wake and Lisgarten made a start last week.2) The other is a list of specific sites on the net which give reliable information on health care topics, and perhaps a list of sites to avoid because the information given is of dubious quality. Ideally, we need a sort of BSI Kite Mark for good sites. Now here is a challenge - who will take it up on behalf of the profession? Someone should carry out an exhaustive test of the search engines and find out which is most useful for pharmacists.We also need a list of good websites published in The Pharmaceutical Journal. There could be a "Website of the Week" column, where we could give a list of sites on similar topics and give them a star rating from one to five. I will start it off this week:
John Wilson is a pharmacist based in Arnold, Nottinghamshire, who has retired and now works part time (e-mail john@ginadog.demon.co.uk)