Much of the sports medicine information available on the Internet is incorrect or incomplete — or both — according to a study that appears this month in the Journal of Bone and Joint Surgery.
Nonprofit websites offer the most comprehensive and unbiased information, the study found, while commercial sites tended to be the most incomplete, often failing to mention the risks or complications of the treatment associated with the site’s sponsor.
Yes, yes, at first glance this finding seems to fall under the “duh” category. After all, everybody knows the Internet is full of bogus and biased health information, right?
Actually, no, they don’t know that. Or perhaps it’s more accurate to say they don’t know how to recognize the bogus and biased information. As Consumer Reports found in a 2002 study, people tend not to use very rigorous criteria when judging the credibility of a website. “[T]he average consumer paid far more attention to the superficial aspects of a site, such as visual cues, than to its content,” that study found.
For this new study, three-person teams of orthopedic surgeons evaluated how 154 websites presented information about 10 of the most common sports medicine diagnoses (such as tennis elbow, shoulder separation, knee pain and rotator cuff tear). The websites were chosen because they appeared in the top 10 Google and Yahoo search results for each diagnosis. To evaluate the quality of the sites, the researchers used criteria established by the Health on the Net (HON) Foundation, a Swiss-based nonprofit organization established in 1996 to encourage quality content and ethical practices in the dissemination of health information on the Internet. To evaluate the thoroughness of each site’s content, the researchers devised a 100-point system (10 points for mentioning all diagnostic tests, 30 points for mentioning all treatments and complications, and so on).
The researchers also categorized the websites according to their information sources. Almost half (74) of the sites were commercial, which meant they were either industry-funded, displayed ads, or promoted the sale of devices or other products. This group included such sites as WebMD and eMedicine. The rest of the sites were sorted as follows: academic (32), physician and physician group (22), news-related (7), nonprofit (which included Wikipedia as well as such sites as the National Institutes of Health) (7) and personal (3). Nine websites fit none of those categories.
When it came to content, the nonprofit sites scored the highest, followed by the academic sites and then some of the non-sales-oriented commercial sites (such as WebMD and eMedicine). The sites with the poorest content were the personal and news-releated websites. (Okay. I’ve got to come to the defense of my news colleagues here. As someone who’s written for both online and in-print media, I’m not sure how fair it is to compare the thoroughness of a newspaper article with that of a website article. Newspaper reporters are much more limited by space, i.e., word counts.)
In terms of HON scores (“transparency of information and purpose”), personal websites also scored the lowest and nonprofit sites scored the highest. HON scores varied widely within all the other categories, but the study found one disturbing trend:
The potential bias of information and lack of accountability on certain commercial sites is of concern. Some sites were directly selling diagnosis-related products or were sponsored by companies that sold products related to the diagnosis and included (unsupported) content that suggested that these products were a preferred approach to treatment. Furthermore, approximately 20% of the total web sites retrieved with our searches were ‘‘sponsored’’ commercial sites. This may result in the most biased information being at the top of the search results for any given topic.
Buyer (online reader) beware
This study is a good reminder for all of us (yes, even those of us who consider ourselves Internet savvy) about the informational landmines hidden beneath the surfaces of many websites, no matter how attractive and/or authoritative they look and sound. (A further warning: Just because a site is sponsored by a nonprofit doesn’t mean it’s untainted by commercial bias. The sites set up by the nonprofit Center for Consumer Freedom, which is essentially a front group for the alcohol, tobacco and other industries, are cases in point.)
“[I]t is clear that although the Internet is a potentially powerful tool for patients to search for health-related information, there are many sources that, when encountered, may mislead them about their diagnosis, treatment, and potential outcomes,” conclude the study’s authors. “In the extreme, patients may feel a false empowerment to self-diagnose and treat, leading to potentially disastrous results. Despite these concerns, it is likely that use of the Internet by patients will continue to increase in the future. It is therefore important to proactively inform patients to exercise caution when relying on the Internet for health-related information. Patients should be counseled to avoid commercial web sites, with the exception of the most reputable sites, such as WebMD and eMedicine, and look for the HONcode seal of compliance for transparency and accountability.”