- Email: [email protected]
Veracity in in vitro fertilization Web pages
Veracity in in vitro fertilization Web pages Bryan D. Cowan, M.D. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
Huang et al. described compliance of IVF websites against the American Medical Association online health information guidelines and reported that IVF websites scored poorly. We describe a protocol for IVF websites that would inform readers about truthfulness of the page, develop standards for page construction, and establish a review process. (Fertil Steril威 2005;83:548 –9. ©2005 by American Society for Reproductive Medicine.)
Over the past several years the World Wide Web (WWW) has grown far beyond everyone’s expectations. It has been described that the WWW has taken the Internet by storm. Curiously, the application of this technology is not a “storm” but a tidal wave of epic proportions that transmits information from computer to computer. The WWW model makes distributing and accessing any form of digital data easy and inexpensive (for company or consumer), with a profound emphasis on business, culture, and society. At this time, we are beyond the “birth” of a new technology. We are now embroiled in a new technology that makes electronic communication seemingly effortless (a key stroke) and can offer transmittal and front-line access to information and database storage.
Thus, with easy access to browsers that encode the HTTP protocol, each user can now quickly publish or derive data on the Internet. With this inexpensive technology for worldwide publication, it is not surprising that searches with the term “infertility” in Google (or other search engines) reveal 1,840,000 Web pages (1).
As cited in the article by Huang et al. (1), surveys of WWW use indicate that 60% of women and 45% of men obtain information on medical conditions. Of keen interest to those practicing reproductive medicine, patients indicate that they seek fertility treatments and, more importantly, search for alternative opinions on the Internet.
It is the question of the veracity of information on the Web that prompted Huang et al. (1) to analyze IVF websites and to apply the American Medical Association (AMA) online health information guidelines (2). In their analysis they used two bifurcated classifications: hospitals vs. clinics or university-affiliated vs. non– university-affiliated centers. They evaluated each website in terms of three concepts: ownership, site content, and navigation. Differences existed in the bifurcated analyses in all three concepts applied to IVF Web pages. However, it is difficult on the basis of this information to determine veracity, the most important feature for our patients and physicians.
In brief summary, there are four tools or concepts that currently drive the WWW on the Internet. The hypertext transfer protocol (HTTP) is a client–server program designed to distribute hypertext documents. The client HTTP program (program on your computer) can call any server HTTP protocol using the uniform resource locator (URL). Once the HTTP protocols are installed, the URL is the entry point for access to all WWW-derived information. Information presented to your client HTTP program is principally text or graphics embedded with a hypertext mark-up language (HTML). These HTML “pages” allow you to see data, establish links, complete fill-in forms (database entry), and view images. Finally, robust search engines have evolved to provide WWW content with URL locators. These search engines have evolved in past years and now list information in descending order based on criteria (e.g., author-derived HTML content, meta-field).
Received November 3, 2004; revised and accepted November 3, 2004. Reprint requests: Bryan D. Cowan, M.D., Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216-4505 (FAX: 601-984-6904; E-mail: [email protected]).
548
It is intuitive that there are two principal types of Internet use: profit (advertisement) and nonprofit (information). To focus specifically on IVF (1), several authors of WWW pages have constructed documents to attract patients to their clinic (to advertise). In our society, both information and advertisements are accepted, provided both contents are factual.
Focusing on website content is probably the best attestation to truthfulness on Web pages. Huang et al. (1) found that only 8 of 236 websites had content reviewed by an editorial board, and only 6 of these had a description of the editorial process. In addition, the source of content was more frequently identified on the websites of hospitals or universityaffiliated centers compared with those of clinics or non– university-affiliated centers. With so many acronyms posted to the WWW, I would offer another abbreviated concept: IVF websites are in a World of Hurt (WOH). Well, what’s next? If we are faced with a WOH to establish veracity on IVF server Web pages, how can we fix this? Several items come to mind, and probably others are important as well. First, the reader should be informed of the strength of the evidence posted on the Web pages. For example, “the best doctor in the world” cannot be measured.
Fertility and Sterility姞 Vol. 83, No. 3, March 2005 Copyright ©2005 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/05/$30.00 doi:10.1016/j.fertnstert.2004.11.025
Second, professional organizations (e.g., the American Society for Reproductive Medicine [ASRM], the Society for Assisted Reproductive Technology [SART]) should develop policies and procedures for Web-based information about IVF and require all IVF Web sponsors to comply. Finally, the reliability and credibility of information should be reviewed by an independent agency. Although I applaud Huang et al. (1) for using the AMA guidelines for medical and health information sites on the Internet, documents by the AMA are principally derived to give an AMA position, and go further to discuss advertising on the AMA website. However, the AMA does not investigate sites nor provide information concerning the reliability and credibility of information. As an alternative, the Health on the Net Foundation (http://www.hon.ch) has defined alternative standards for the reliability of medical and health information on the WWW. This inspection is free and uses eight principles for site evaluation (less intrusive than the AMA codes). Unfortunately, the Health on the Net Foundation does not rate the accuracy, validity, or appropriateness of medical information. Thus, Huang et al. (1) have initiated a detailed analysis of IVF websites in the United States and on the basis of these
Fertility and Sterility姞
data suggest that IVF sites are in a WOH. They do not comply with the AMA guidelines on medical information on the Internet, and viewers cannot determine the veracity of information on Web pages. If we are to overcome this, the producer of Web pages must comply with acceptable medical information standards, professional agencies (ASRM, SART) must verify medical accuracy, and independent agencies must investigate each site to determine the adequacy of benchmarks that assure readers about the site. These features should inform patients about the truthfulness of the page, establish standards that website builders will follow, and ensure inspection by a governing agency. Access to the Internet, both in users and URLs, will continue to grow. The best electronic service we can provide to ourselves and to our patients is truth on the Web pages.
REFERENCES 1. Huang JYJ, Discepola F, Al-Fozan H, Tulandi T. Quality of fertility clinic websites. Fertil Steril 2005;83:538 – 44. 2. Winker MA, Flanagin A, Chi-Lum B, White J, Andrews K, Kennett RL, et al. Guidelines for medical and health information sites on the internet. JAMA 2000;283:1600 – 6.
549
Huang et al. described compliance of IVF websites against the American Medical Association online health information guidelines and reported that IVF websites scored poorly. We describe a protocol for IVF websites that would inform readers about truthfulness of the page, develop standards for page construction, and establish a review process. (Fertil Steril威 2005;83:548 –9. ©2005 by American Society for Reproductive Medicine.)
Over the past several years the World Wide Web (WWW) has grown far beyond everyone’s expectations. It has been described that the WWW has taken the Internet by storm. Curiously, the application of this technology is not a “storm” but a tidal wave of epic proportions that transmits information from computer to computer. The WWW model makes distributing and accessing any form of digital data easy and inexpensive (for company or consumer), with a profound emphasis on business, culture, and society. At this time, we are beyond the “birth” of a new technology. We are now embroiled in a new technology that makes electronic communication seemingly effortless (a key stroke) and can offer transmittal and front-line access to information and database storage.
Thus, with easy access to browsers that encode the HTTP protocol, each user can now quickly publish or derive data on the Internet. With this inexpensive technology for worldwide publication, it is not surprising that searches with the term “infertility” in Google (or other search engines) reveal 1,840,000 Web pages (1).
As cited in the article by Huang et al. (1), surveys of WWW use indicate that 60% of women and 45% of men obtain information on medical conditions. Of keen interest to those practicing reproductive medicine, patients indicate that they seek fertility treatments and, more importantly, search for alternative opinions on the Internet.
It is the question of the veracity of information on the Web that prompted Huang et al. (1) to analyze IVF websites and to apply the American Medical Association (AMA) online health information guidelines (2). In their analysis they used two bifurcated classifications: hospitals vs. clinics or university-affiliated vs. non– university-affiliated centers. They evaluated each website in terms of three concepts: ownership, site content, and navigation. Differences existed in the bifurcated analyses in all three concepts applied to IVF Web pages. However, it is difficult on the basis of this information to determine veracity, the most important feature for our patients and physicians.
In brief summary, there are four tools or concepts that currently drive the WWW on the Internet. The hypertext transfer protocol (HTTP) is a client–server program designed to distribute hypertext documents. The client HTTP program (program on your computer) can call any server HTTP protocol using the uniform resource locator (URL). Once the HTTP protocols are installed, the URL is the entry point for access to all WWW-derived information. Information presented to your client HTTP program is principally text or graphics embedded with a hypertext mark-up language (HTML). These HTML “pages” allow you to see data, establish links, complete fill-in forms (database entry), and view images. Finally, robust search engines have evolved to provide WWW content with URL locators. These search engines have evolved in past years and now list information in descending order based on criteria (e.g., author-derived HTML content, meta-field).
Received November 3, 2004; revised and accepted November 3, 2004. Reprint requests: Bryan D. Cowan, M.D., Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216-4505 (FAX: 601-984-6904; E-mail: [email protected]).
548
It is intuitive that there are two principal types of Internet use: profit (advertisement) and nonprofit (information). To focus specifically on IVF (1), several authors of WWW pages have constructed documents to attract patients to their clinic (to advertise). In our society, both information and advertisements are accepted, provided both contents are factual.
Focusing on website content is probably the best attestation to truthfulness on Web pages. Huang et al. (1) found that only 8 of 236 websites had content reviewed by an editorial board, and only 6 of these had a description of the editorial process. In addition, the source of content was more frequently identified on the websites of hospitals or universityaffiliated centers compared with those of clinics or non– university-affiliated centers. With so many acronyms posted to the WWW, I would offer another abbreviated concept: IVF websites are in a World of Hurt (WOH). Well, what’s next? If we are faced with a WOH to establish veracity on IVF server Web pages, how can we fix this? Several items come to mind, and probably others are important as well. First, the reader should be informed of the strength of the evidence posted on the Web pages. For example, “the best doctor in the world” cannot be measured.
Fertility and Sterility姞 Vol. 83, No. 3, March 2005 Copyright ©2005 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/05/$30.00 doi:10.1016/j.fertnstert.2004.11.025
Second, professional organizations (e.g., the American Society for Reproductive Medicine [ASRM], the Society for Assisted Reproductive Technology [SART]) should develop policies and procedures for Web-based information about IVF and require all IVF Web sponsors to comply. Finally, the reliability and credibility of information should be reviewed by an independent agency. Although I applaud Huang et al. (1) for using the AMA guidelines for medical and health information sites on the Internet, documents by the AMA are principally derived to give an AMA position, and go further to discuss advertising on the AMA website. However, the AMA does not investigate sites nor provide information concerning the reliability and credibility of information. As an alternative, the Health on the Net Foundation (http://www.hon.ch) has defined alternative standards for the reliability of medical and health information on the WWW. This inspection is free and uses eight principles for site evaluation (less intrusive than the AMA codes). Unfortunately, the Health on the Net Foundation does not rate the accuracy, validity, or appropriateness of medical information. Thus, Huang et al. (1) have initiated a detailed analysis of IVF websites in the United States and on the basis of these
Fertility and Sterility姞
data suggest that IVF sites are in a WOH. They do not comply with the AMA guidelines on medical information on the Internet, and viewers cannot determine the veracity of information on Web pages. If we are to overcome this, the producer of Web pages must comply with acceptable medical information standards, professional agencies (ASRM, SART) must verify medical accuracy, and independent agencies must investigate each site to determine the adequacy of benchmarks that assure readers about the site. These features should inform patients about the truthfulness of the page, establish standards that website builders will follow, and ensure inspection by a governing agency. Access to the Internet, both in users and URLs, will continue to grow. The best electronic service we can provide to ourselves and to our patients is truth on the Web pages.
REFERENCES 1. Huang JYJ, Discepola F, Al-Fozan H, Tulandi T. Quality of fertility clinic websites. Fertil Steril 2005;83:538 – 44. 2. Winker MA, Flanagin A, Chi-Lum B, White J, Andrews K, Kennett RL, et al. Guidelines for medical and health information sites on the internet. JAMA 2000;283:1600 – 6.
549