the internet world of vinod scaria

Vinod Scaria
Cybermedicine19 October 2002

Correspondence:  vinodscaria@yahoo.co.in

Abstract:

The mid 90s witnessed a huge overhaul in the volume of Health information available on the Net. This raised concerns about the absolute quality of health information available to the consumers and the potential implications of accessing controversial, substandard, or fraudulent information on the Net. To solve this problem, many rating and trust marking organizations evolved and continue to do so.

The Internet is an anarchic and chaotic volume of information. With a somewhat exponential growth of Health information on the net, the problem rises to huge proportions

There is a wide range of conceptual disparity among different rating organizations. While some organizations prescribe ethical guidelines/principles for self-imposition, others actually rate the contents. The problem of trust marking /rating health information continues to be a problem not just for consumers, but also for health care workers and providers

Keywords: Internet, Health, Quality, Rating, Evaluating, Trust marking.

Introduction:

The Internet has evolved into a huge storehouse of information. The boom that occurred in the 90s, both in terms of the volume of content and the number of users had its impact on Health related activities too.

The mid 90s witnessed a huge overhaul in the volume of Health information available on the Net. This raised concerns about the absolute quality of health information available to the consumers and the potential implications of accessing controversial, substandard, or fraudulent information on the Net. To solve this problem, many rating and trust marking organizations evolved and continue to do so[1],[2]. Despite the fact that Rating organizations continue to evolve to meet the challenges, the anarchic structure of the Internet, which is the prime source of concern, continues to operate unabated, with profound influences on trust marking organizations too[2],[3]. The present paper deals with the potential problems with trust marking health information on the Net.

Problems inherent to Net Structure:

The Internet is an anarchic and chaotic volume of information. The basic characteristic of Internet being transparency and openness is the most prone to abuse. Anybody could post virtually anything on the Net, maintaining his anonymity. Though many countries have brought legal frameworks to tackle this problem, there is no uniform framework universally applicable. This makes these laws toothless tigers.

Another major problem is the absolute volume of health information on the net. With a somewhat exponential growth of Health content on the net, no single trust marking organizations will be able to trust mark all the Health related information on the net.

Search engines evolved to categorise the chaotic volumes of information on the Net. Though many search engines have developed their own technologies to categorise and present information to the consumers, these technologies work on analytical logic rather than commonsense. Anyone could fool crawlers and ranking[4] technologies and have their contents top the list.

Another characteristic of the Net is the ability to hyperlink. Unlike bound volumes of books which are discrete entities, information on the net is a continuous and endless. This could mean one could be taken away from an apparently rated source of information to an apparently fraudulent or controversial source without perhaps the consumer being aware of it.

The anarchic structure of the net, which is the major source of concern, continues to operate unabated. A recent study[2] demonstrated that many of the trust marking organizations that evolved in the earlier years either have disappeared or were incompletely developed to meet the challenges. This poses a major problem: who would rate these raters?[6]

Problems Inherent to page design and/or presentation

HTML (Hypertext Markup Language) which was the lingua franca of the world wide web, which provided static contents have now given way to dynamic Languages like DHTML, XML and ASP. Moreover, technologies like Java have come to the picture. This extreme level of dynamism makes it difficult to trust mark the absolute content posted on a particular website. Moreover, many conventional search engine robots do not recognize contents posted using technologies like java.

Many of the Health websites support interactive technologies like Chat, E-mail etc to interact with consumers and offer Health advice . The major problem as far as Interactive communication is concerned is the absence of any published guideline to directly assess the quality of information provided.

Problems with disparity in the criteria for rating/trust marking

There is a wide range of conceptual disparity among different rating organizations. While some organizations like Health On the Net (HON)[1] prescribe ethical guidelines/principles for self imposition without actually rating these websites, others like HealthAtoZ[7] actually rate the contents. There is also a wide range of disparity among organizations that actually rate websites. While some actually rate the content, some resort to indirect parameters[8] for judging the quality of information.

The present state of affairs is that there is no hard and fast rule that is universally applicable for trust marking Health information on the net. Though both these conceptual frameworks have its own advantages, the lack of a uniform guideline makes comparisons impossible.

Another problem is perhaps the illegal use of trust marks on apparently fraud websites[9]. The rating organizations do not have the adequate capabilities to find out and impose restrictions to their use. However, new generation trust marking organizations like MedCERTAIN[10] have plans to provide dynamic trust marks, which are loaded from a third party server. Time has always taught us that there is absolutely no technology on earth that can be free from abuse.

Conclusions:

The problem of trust marking /rating health information continues to be a problem not just for consumers, but also for health care workers and information providers. Though there are many designs based on varying concepts, there is no single guideline for rating health information on the net. New generation rating techniques are emerging to meet the challenges, but it is for time to prove their worth.

References:

[1]Health On the Net foundation available at: http://www.hon.ch HON code of conduct: available at http://www.hon.ch/HONcode/Conduct.html [both accessed on 28 Feb 2002]

[2]Gagliardi.A,Jadad A.R.Examination of Instruments used to rate Quality of Health Information on Internet: Chronicle of a voyage with unclear destination BMJ 2002 Mar9: 324(7337): 569-573

[3]Risk.A, Dzenowagis.J Review of Health Information Quality Initiatives J Med Internet Research 2002 Oct-Dec; 3(4): E28

[4]Google Page Rank available at : http://www.google.com/technology/index.html [accessed on 28 feb 2002]

[5]Craigie M, Loader B, Burrow R, Muncer s Reliability of Health Information on the Internet: An Examination of Experts' ratings J Med Internet Research 2002 Jan-Mar; 4(1): E2

[6]Terry N.P Rating the "Raters": Legal exposure of Trustmark Authorities in the context of Consumer Health information. J Med Internet research 200; 2(3): E18

[7]HealthAtoZ available at: http://www.healthatoz.com [accessed on 28 Feb 2002]

[8]Don Fallis, Martin Fricke Indicators of accuracy of Consumer health Information on the Internet Journal of Am Med Informatics Asso 9:73-79 (2002)

[9]Nater T, Boyer C, Eysenbach G, Debate about Evaluation and Monitoring of sites Containing HON Logo J Med Internet Research 2000 ; 2(12): E13

[10]MedCERTAIN available at http://www.medcertain.com [accessed on 28 Feb 2002]

Acknowledgements:

I express my gratitude to all my colleagues and friends for guiding and 'suffering' me throughout the period of this study.