The net doctor will see you now

TECHNOLOGY

Can the net find you a cure? Lisa Grossman

IF YOU regularly turn to a search engine to find out whether, say, you should put ice on a twisted ankle, you’re far from alone. Sixtyone per cent of American adults seek out health advice online, according to a survey published last month by the Pew Internet and American Life Project. Around a third of those surveyed admitted they changed their thinking about how they should treat a condition based on what they found online. Yet a growing body of evidence suggests that much online health information is unreliable. “My overall impression is that the quality of health information varies wildly, almost ridiculously wildly,” said Kevin Clauson, a pharmacologist at Nova Southeastern University in Fort Lauderdale, Florida. “If [a website] is treated as an authoritative source, and there’s evidence that it isn’t, then it’s potentially dangerous.” Several studies to be published in medical journals this year highlight the issue. Pia LópezJornet and Fabio Camacho-Alonso of the University of Murcia, Spain, found that information on oral cancers on the top websites gathered by Google and Yahoo searches was “poor” (Oral Oncology, DOI: 10.1016/j. oraloncology.2009.03.017). Among other things, the websites failed to attribute authorship, cite sources and report conflicts of interest. And a study by a team at the Charité University Medical Centre in Berlin, Germany, of 20 | NewScientist | 25 July 2009

googled advice on how to deal with heartburn found that “the evidence for most of the recommendations is weak to nonexistent” (European Journal of Integrative Medicine, DOI: 10.1016/j.eujim.2009.05.001). While these and other studies examined dozens of websites, most agree that the site to watch is Wikipedia. Popular and easy to browse, the user-generated encyclopedia is the eighth most visited site on the internet, and the first stop for many seeking health information. Wikipedia articles appear in the top 10 results for more than 70 per cent of medical queries in four different search engines, according to a study in this month’s Journal of the American Medical Informatics Association (DOI: 10.1197/jamia.M3059). It also gets more hits than corresponding pages on the US National Library of Medicine’s MedlinePlus service. This is worrying, and perhaps an indicator that some people’s search engine strategies may not

FRAZER HUDSON

We are increasingly going online for health advice, but it's hard to know which sites to trust

be up to scratch. A 2002 study found that most searchers use only one term in their searches and rarely look past the first page of results – though internet users may have improved the way they search since then (BMJ, vol 324, p 573). More disconcerting is the percentage of doctors who turn to Wikipedia for medical information: 50 per cent, according to a report in April by US healthcare consultancy Manhattan Research. How does Wikipedia fare as a medical reference? Its collaborative, user-generated philosophy generally means that errors are caught and corrected quickly. Several studies,

Some of the more reliable medical info sources Health websites you can trust:

Headline Picture Box here

■ MedlinePlus http://medlineplus.gov A directory of articles from the US National Library of Medicine ■ NHS www.nhs.uk The website of the UK National Health Service. Its other website, NHS Direct www.nhsdirect.nhs.uk, now focuses primarily on the swine flu outbreak ■ Mayo Clinic http://mayoclinic.com A not-for-profit medical practice with hospital and research facilities across the US ■ WebMD www.webmd.com Written by doctors and reviewed by an independent board

including one examining health information, another probing articles on surgery, and one focusing on drugs, found the online encyclopedia to be almost entirely free of factual errors. Better still, the articles improve significantly with time, according to a study Clauson published last December in the The Annals of Pharmacotherapy (vol 42, p 1814). “Wikipedia’s editing policy does work,” he says. But any Wikipedia page (beyond those locked to prevent vandalism) is vulnerable to malicious editing – and some drug firms have been caught removing negative information on their drugs from Wikipedia pages. The site’s other major flaw is its incompleteness. Wikipedia was able to answer only 40 per cent of the drug questions Clauson asked of it. By contrast, the traditionally edited Medscape Drug Reference answered 82 per cent of questions. “If there is missing safety information about a drug, that can be really detrimental,” Clauson points out. For example, Wikipedia’s page on the HIV drug Prezista makes no mention of complications when used alongside St John’s wort,

For daily technology stories, visit www.NewScientist.com/technology

Pain-inducing microwave weapon to fire from the sky

“Even more disconcerting is that 50 per cent of doctors turn to the user-generated Wikipedia for health info” to replicate it. For instance, specialty-specific wikis (editable web pages) such as RadiologyWiki and WikiSurgery can be edited only by doctors. A more general medical wiki called Medpedia, also written and vetted by medical professionals, launched in February. Medpedia was founded by San Francisco entrepreneur James Currier, who teamed up with several prominent medical schools and organisations to build a reliable medical

database – with a social networking site at its heart. It includes nonencyclopedic resources such as a section for user Q&As and debates. “Our goal is to be the place where physicians tell their patients to go educate themselves,” Currier told New Scientist. “Everyone can benefit from a more educated patient.” But it’s still always a good move to consult a professional before starting a treatment, he cautions. “Anything they see [on Medpedia] will be trustworthy stuff, but it’s not complete. Nobody is,” he says. It will take a long time for these smaller wikis to match the popularity of Wikipedia, however. “Ultimately, it will be easier to change the quality of information in Wikipedia than to change the search habits of an entire population,” Clauson says. The US National Institutes of Health is catching on. On 16 July, it hosted an event at its headquarters in Bethesda, Maryland, with the stated aim of teaching health professionals how to edit Wikipedia’s health pages and why they should think about doing so. The Wikipedia of the future, it seems, looks set to become a far more reputable place. ■

controversy. Jürgen Altmann, a physicist at Dortmund University in Germany, showed that the microwave beams can cause serious burns at levels not far above those required to repel people. This was verified when a US airman was hospitalised with second-degree burns during testing in April 2007. The airborne version will not make it any less contentious. “Independent of the mode of production, with this size of antenna the beam will show

“The new antenna will be steered electronically and is capable of generating multiple heat beams” variations of intensity with distance – not just a simple decrease – up to about 500 metres,” says Altmann. Shooting it on the move with any accuracy will be difficult, he adds. Dave Law, head of the technology division of the JNLWD, says the airborne weapon will operate at the lowest possible effective power level and will have a sophisticated automated target-tracking system. In a recent cost-benefit analysis, the US Government Accountability Office rated the ADS worst out of eight non-lethal weapons currently in development. David Hambling ■

AIR FORCE PHOTO

the herbal supplement used to treat depression. Their potent interaction can cause the HIV therapy to fail. On the other hand, the publicity Clauson’s research garnered has helped fix the shortcomings he highlighted. One error of omission – that pregnant women should avoid the painkiller Arthrotec – was fixed the same day Fox News ran a story on the study. The medical community has taken note of Wikipedia’s success, and has made several attempts

THE Pentagon’s enthusiasm for non-lethal crowd-control weapons appears to have stepped up a gear with its decision to develop a microwave pain-infliction system that can be fired from an aircraft. The device is an extension of its controversial Active Denial System, which uses microwaves to heat the surface of the skin, creating a painful sensation without burning that strongly motivates the target to flee. The ADS was unveiled in 2001, but it has not been deployed owing to legal issues and safety fears. Nevertheless, the Pentagon’s Joint Non-Lethal Weapons Directorate (JNLWD) in Quantico, Virginia, has now called for it to be upgraded. The US air force, whose radar technology the ADS is based on, is increasing its annual funding of the system from $2 million to $10 million. The transmitting antenna on the current system is 2 metres across, produces a single beam of similar width and is steered mechanically, making it cumbersome. At the heart of the new weapon will be a compact airborne antenna, which will be steered electronically and be capable of generating multiple beams, each of which can be aimed while on the move. The ADS has been dogged by

–Hot stuff, but cumbersome– 25 July 2009 | NewScientist | 21