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This article by Bart Jackson was prepared for the February 5, 2003 edition of U.S. 1 Newspaper. All rights reserved.

Doctoring Dotcom

You have exactly 200 seconds to present all your ills,

symptoms, and questions to The Doctor before he bolts from the


room and sprints on to the next customer, leaving you naked on the

stainless steel examining table. Long gone are the days when a


schedule permitted her to recall your name, let alone your health

history. Partly as a result of this de-personalization and time


more than 67 percent of all American patients seek at least some


advice on the Internet. The American Medical Association’s response?


Is this a sound prescription? Are healthcare websites practical tools

or just a misleading overflow of information?

This issue comes up at "Healthcare and the Internet," a


of the Princeton Chapter of the Society of Internet Professionals

on Wednesday, February 12, at 6 p.m. at Sarnoff. Cost: $10. Call


The featured speaker is Susannah Fox, research director for

the Pew Internet and American Life Project. Fox reveals exactly how

individuals seeking healthcare information are using the Internet,

and how businesses and information providers can best respond. Her

insights include issues of interest to healthcare professionals,


and salespeople, as well as to website designers.

The Society for Internet Professionals (SIP) is a good deal less


techie than it sounds. Its membership includes writers, web designers,

programmers, marketers, and a range of business folk who want to make

the best use of Internet technology.

Joseph N. Pew, founder of Sun Oil, along with his wife, Mary Anderson,

raised four handsomely endowed children. In loving memory of their

parents, the two boys and two girls created several foundations,


by 1979, they united into the Pew Charitable Trust. Designed to foster

citizen activity in health, culture, education, family, religion,

and the environment, the Philadelphia-based Pew Trust doles out $230

million annually from its $4.3 billion holdings.

Striving to keep up with the times, the trust in 1999 funded the


of board member Rebecca Rimel: the Pew Internet and American Life

Project. Its goal is to find out just exactly what the Internet is

doing to — and for — us Americans. Through a series of rigidly

controlled studies and surveys, the Project seeks to compile data

on Internet use and its effect in a host of areas, including


Fox, the daughter of U.S. 1 Newspaper’s senior editor, Barbara Fox, is

a graduate of Wesleyan University, where she studied literature and

anthropology. She did research at the Harwood Group in Bethesda,

Maryland, before helping to launch RealNetworks in 1994. Armed with

this Internet experience, she moved to U.S. News & World Report, where

she was the editor of the publication’s online edition. Now it is

Fox’s job to help uncover and relate the effects the Internet is

having on society.

Sixty percent of all Americans over the age of 18 use the Internet,

Fox reports. While that percentage is growing scarcely at all, the

types of use have exploded exponentially. "Simply put, people

are growing more bold in their use of the ‘Net," says Fox.


seniors who three years ago got online strictly to talk with the


are now shopping, selling, and checking out their latest medical


Like the public library, the Internet has now become a mainstream

information tool on which Americans depend. Additionally, trust in

the Internet has deepened enormously. Eighty percent of Americans

(greater than the actual number who use the ‘Net themselves) claim

that they expect to find — and do find — information vital

to their lives through the Internet.

In the face of this overwhelming usage, the American Medical


has shifted its stance on the benefits of Internet health advice,

albeit grudgingly. Its 2001 proclamation warning Americans to get

offline was roundly criticized, and the organization was characterized

as a group of turf-threatened wizards vainly preaching that an


patient was their best customer. This past year the AMA is addressing

the question of the quality of health information available online.

There is now a fairly even split between those patients who take their

initial health questions to a doctor, and those who turn first to

the Internet. Beyond looking at patient behavior, Pew’s research


the patient’s "zone of influence" — the family members

and friends who are trying to act as advocates for the patient.


and their advocates alike tend to be discriminating in searching for

health information online. Fox reports that three out of four


searching for medical answers online have rejected at least some of

the information presented them. Why? And what makes one site highly

valued while another is rejected?

Those damn ads. The absolute number one reason patients

give for rejecting medical advice provided online is their distrust

of commercial advertising. While this probably surprises no one, it

remains a blow to all the pharmaceutical and medical supply retailers,

whose intent is, very reasonably, to sell their products.

For years now website designers have answered the marketing


requests to pack their sites with more information. They want to sell

trust in themselves by making their web pages into learning tools.

Yet all those fascinating diagrams showing medication moving through

various organs can be quickly undermined by a commercial message.

Fox’s research show that the minute the company logo goes on and the

order slip appears, the effect of the advice is minimized.


notes Fox, "it’s not all that bad. People love fact-based sites.

All drug information is very popular. Designers must just remember

to keep the commercialism in balance. Pitch them at the end —

not at the beginning."

Says who? "They" say that four glasses of bourbon

daily will flush your kidneys just fine. Believe it? Probably not.

The Internet "information," while highly agreeable, cites

no author, no journal, no specified source of validity. Recently the

Medical Librarians Association came out with a list of three quality

checks for all Internet information. First, check the source and the

author. Second check the date. "If you log onto a website that’s

not been updated since l999," notes Fox, "you might find it

unreservedly recommending hormone replacement therapy." Finally,

discuss all Internet findings with your doctor.

The healthcare website that supplies information on its sources,


a current date, and suggests that patients check with their own


before taking action stands a better chance of getting read and


Feel of the familiar. If the medical advice agrees with

something the patient has already heard from either a doctor, print

publications, or radio and television, the patient is more likely

to agree. The four-bourbon regimen, standing pretty much alone, will

probably not attract many disciples. Conversely, so much of the


dietary advice finds ready acceptance because it involves eating the

way mom always told us to eat — lots of veggies and just a


of sweets.

Add backup, as any good propagandist will tell you, and credibility

gets a boost. One way to do this is to link to the websites of


medical authorities. As a warning to patients, however, the Medical

Librarians Association notes that medical information is often


so several sources may come from one study.

Tyranny of the search engine. Over 85 percent of those

seeking healthcare information online opt for standard search engines

over the medically validated search engines, including that of the

National Institute of Health ( Almost automatically


click on Google and type in "diabetes" and receive a flood

of unedited information.

The greatest quality problem with online healthcare research —

and the one the public hears the least about — is the fact that,

often, no one edits online material. Virtually all print media have

at least one editor who checks facts. The Internet itself has no


and a particular website may or may not have an editor. "This

quality control is definitely a problem," says Fox, "but when

web developers are armed with this knowledge, I feel they can design

around it."

Without a doubt, the Internet offers Americans greater access to


than they ever had before. Fox tells the story of one elderly woman

whose paralyzed husband required a specialized air mattress, with

a generator that died two days before Christmas. A phone call to the

supplier gave her only an "it’s out of date and Medicare won’t

pay for it" response. Undaunted, the woman logged onto eBay, got

a low-cost mattress generator, made a quick purchase, and had it sent

by FedEx and installed by Christmas. Such is the power of the Internet

to improve healthcare in unexpected ways.

Are we better or worse off for the Internet’s invasion into our lives?

With a sort of Buddha-like simplicity, Fox dismisses the black and

white and responds: "You might as well ask if children half a

century ago were better or worse for the ballpoint pen." For both

ages, it is simply a fact of life — something there. Be it Instant

Messaging or the pen, these are tools that our children find before


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