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The Web Also Wheezes FREE TO VIEW

William F. Bria, II, MD, FCCP
Author and Funding Information

Affiliations: Ann Arbor, MI
 ,  Dr. Bria is Medical Director, Clinical Information Systems, University of Michigan.

Correspondence to: William F. Bria II, MD, FCCP, Medical Director, Clinical Information Systems, University of Michigan, 1500 E. Medical Dr, 3916 Taubman Center, Ann Arbor, MI 48109–0360; e-mail: wbria@umich.edu

Chest. 2002;121(4):1015-1016. doi:10.1378/chest.121.4.1015
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The impact of the World Wide Web (WWW) on patient information gathering has been profound and wide reaching, the full implications of which are just beginning to be understood. Since the beginning of our profession, imparting information to patients has been part of our duty as physicians. Therefore, it comes as no surprise that we have become more interested and more concerned regarding the information our patients are seeing while touring the information superhighway. In this issue of CHEST (see page 1301), Croft and Peterson report on the quality of on-line asthma information. They find a rather wide variation in quality and application of medical journalism standards. Furthermore, they confirm a previously established conclusion from the printed medical literature that publications from academic centers do not guarantee quality. The authors also identify the paucity of asthma Web sites exhibiting the best of the WWW technology, including images, animation, and streaming multimedia. For those early adopters of broadband technology, there is a growing recognition that the best of the WWW is yet to come. Broadband technology truly transforms the on-line experience so that interactive-television video conferencing and virtual meetings become a reality.

The concerns addressed by the authors of this manuscript have previously been noted. The book, Silicon Snake Oil: Second Thoughts on the Information Highway,1 was among the earliest to express reservations as to the validity of on-line information. These authors suggested that the information superhighway was at a stage of development akin to the typical untamed frontier industries of pornography and gambling. However, as we transition from the infancy to the adolescence of the WWW, various organizations have appeared to propose quality standards and codes of on-line medical information in an effort to protect professionals and consumers alike from the sometimes disorienting hyperlinked environment of the WWW that may place conjecture next to tested fact with nary a sign of the distinction.

These growing efforts at an on-line Fleischner Report include the Health on the Net Foundation (HON) and the Internet Healthcare Coalition, and are worth the review of all clinicians. These codes of on-line medical journalism include the following elements: (1) authority, (2) complementarity, (3) confidentiality, (4) attribution, (5) justifiability, (6) transparency of authorship, (7) transparency of sponsorship, and (8) honesty in advertising and editorial policy.2 It is important to understand each of these elements.

The following definitions are from the HON principles of conduct.2Authority speaks to the need that any medical or health advice provided on a WWW site should be given by a medically trained and qualified professional unless clearly designated otherwise. Complementarity indicates that information provided on a health-care site is designed to support and not replace the patient-physician relationship. Confidentiality of data relates to individual patients visiting a Web site, including their identity, which must not be disclosed. Confidentiality standards vary between states and countries, therefore the Web site must meet or exceed the confidentiality standards of the patient’s region. Attribution means that where appropriate, information contained on a Web site will be supported by clear references as to source and hyperlinks to that source. Additionally, the date when that source was last updated must be indicated (ie, timeliness of data). Justifiability specifies that any claims relating to the benefits/performance of a specific treatment, product, or service will be supported by appropriate, balanced evidence in the manner outlined under the “attribution” element of the HON code. Transparency of authorship addresses that the Web site will clearly provide information including contact information for all authors and the Webmaster of the site. Transparency of sponsorship makes obvious the identities of commercial and noncommercial organizations that have contributed funding services or materials for a site. Finally, the honesty in advertising and editorial policy element of the HON code speaks to the need to have a brief description on a medical site of the advertising and editorial policies of the site explicitly stated.

Despite the “dot bomb” economic downturn in the past 6 months, it is very clear that the WWW will continue to grow as an essential information delivery technology.3 Furthermore, we would expect that over the next few years, traditional sources of authoritative printed medical information, such as the American College of Chest Physicians, will develop and promulgate on-line standards of medical information for the benefit of providers and patients alike. Finally, as patient advisors, it will remain our growing responsibility and challenge to understand, interpret, and guide our patients and colleagues to the best of the WWW, to both improve the quality of on-line communication and insist on the broad adoption of quality standards of on-line medical journalism.


Stoll, C (1995)Silicon snake oil: second thoughts on the information highway. Doubleday. Garden City, NY:
HON code of conduct. Available at: http://www.hon.ch/HONcode/Conduct.html. Accessed February 25, 2002.
Harris poll. August 5, 1999.




Stoll, C (1995)Silicon snake oil: second thoughts on the information highway. Doubleday. Garden City, NY:
HON code of conduct. Available at: http://www.hon.ch/HONcode/Conduct.html. Accessed February 25, 2002.
Harris poll. August 5, 1999.
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