Consumer Health Information on the Internet

we applaud the intent of Fallis and Frické 1 in their recent attempt to provide the public with indicators of accuracy for health information on the Internet, we take exception to some of their methods and conclusions. The topic they have chosen to study is certainly an important one. There exists on the Internet a vast amount of health information , and much of it may be incorrect or easy to misinterpret. The authors' call for impartial valida-tors of such information should be cheered. Nevertheless, we have some methodological concerns with their recent study. The first concern involves their choice of clinical subject matter. The authors claim that managing childhood fever in the home was chosen " because there is a wide consensus among experts in this area. " 1 This issue is a point of significant contention among pedi-atricians. 2–4 Even the five topics covered in their methods are sure to spark many debates among health care professionals. 5–7 We consider it an important omission that the authors did not provide the " correct " answers or cite the experts who provide the consensus to the five topics set forth in the paper. We wonder how much of the information that was labeled inaccurate by the authors was merely a reflection of differences in practice. If this same topic were brought up in a pediatric journal, we believe that reaching a consensus on what is " correct " would be difficult. Without clear consensus, there can be no gold standard. Without a gold standard, there can be no measure of accuracy. The second concern is over the methodology used for selection of Web sites. The authors provide no criteria as to how they decided which 100 sites to analyze. Given the enormous number of possible sites, it would be critical to know who selected sites and how they decided which ones to select. Without such information, the study cannot be repeated or understood fully, nor can possible selection bias be ascertained. The third concern we have is the definition of " accurate " and " inaccurate " sites. The authors arbitrarily set the dividing line between accurate and inaccurate at the median of the sites' ratings. Although they did confirm their results using several different cutoffs , we are concerned with the use of these terms at all. Their accuracy scores range from 0.55 to 0.75, with the vast …