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I'm a medical writer so I can comment on the medical content of the sites in the Consumer Webwatch reports. I don't think they're good enough.

(Since I write for the web, I found the programmer comments very useful. OK, I'll change that code in my site RSN).

I agree completely that (my) content doesn't matter if you can't find it, and without good graphic design, backed up by good programming (thanks guys), you can't find anything on those web sites (which have thousands of pages). Everything you want to know about medicine is on the Internet many times over, but the problem is (1) finding it (2) in a form that you can understand and (3)evaluating its accuracy and validity.

Here's a good example: I went to a doctor for a checkup, and he didn't perform a digital rectal examination, although he did give me a guiac test. A DRE is a way of screening for prostate cancer and rectal cancer, and the American Cancer Society among other well-known organizations recommends it for everyone above 50, like me. A guiac test samples the stool for blood, which is often a symptom of colon cancer. Various organizations also recommend sigmoidoscopy (a fiber optic scope that goes through the rectum and up the colon about a foot) and colonoscopy (which goes up the colon even farther) as screening for colon cancer. My medical textbooks were either out of date or ambiguous on these issues.

So, here's my question for the medical web sites:

Should my doctor have performed a DRE on a 50-year-old man in a routine physical?

My first stop was the web site rated No. 1 by the experts National Institutes of Health. Once I got there, I realized that I had to refine the question. What I really wanted to know is,

would a DRE have lowered my chances of dying of cancer?

As it turned out, there are scientific studies with control groups that found that there was no good evidence that patients who had screening DRE, sigmoidoscopy or colonoscopy lived longer than patients who did not. However, patients screened with guiac tests did live longer (endpoint of death, they call it). I found this on the professional side of the site, not the consumer side, couched in technical language. Not easily accessible or understandable -- for something that your life depends on.

So when I read the Consumer WebWatch report, I decided to see how the expert's No. 2, MayoClinic.com handled it. To my surprise and dismay, the Mayo Clinic web site, in its extensive discussion of screening for colon cancer, did not make the point that only guiac testing had been shown to save lives. There is criticism in the medical literature that doctors don't provide enough hard information to their patients to enable patients to make an intelligent decision. I think the fact that the life-saving ability of 3 of those 4 screening tests is not supported by evidence-based medicine is an important fact for patients that the Mayo clinic should have provided for patients who are trying to decide whether to take an uncomfortable and (for the scopes) expensive test with a risk of perforating the bowel.

Evidence-based medicine, BTW, is a term of the art, and a good Google search. It means practicing medicine on the basis of scientific evidence, when it exists (the catch: you wind up saying, "science doesn't know" too much of the time).

EBM started when 2 doctors in Canada were having trouble keeping up with all their reading, and said, "Hey, let's just read the stuff that's supported by scientific evidence." That cut down the pile significantly.

A good explanation is on the Bandolier web site, from Oxford, UK. This will reduce medicine to the rationality that engineers and other geeks are used to thinking in.

What is series:
Evidence-based Medicine

Bandolier

Forms of evidence
Evidence is presented in many forms, and it is
important to understand the basis on which it
is stated. The value of evidence can be ranked
according to the following classification in
descending order of credibility:

I. Strong evidence from at least one
systematic review of multiple well-designed
randomised controlled trials.

II. Strong evidence from at least one properly
designed randomised controlled trial of
appropriate size.

III. Evidence from well-designed trials such as
non-randomised trials, cohort studies, time
series or matched case-controlled studies.

IV. Evidence from well-designed
non-experimental studies from more than
one centre or research group.

V. Opinions of respected authorities, based on
clinical evidence, descriptive studies or
reports of expert committees.

BTW, when people ask me where to find medical information on the Internet, I recommend peer-reviewed sources, starting with the Merck Manual Home Edition , then British Medical Journal, then Medicalstudent.com.

But you can't do it on the Internet alone without professional guidance -- medical librarians explained to me how to search the medical literature. And very often what you want to know is only available on paper.

I went into this in more detail when I taught a class in medical journalism. I interviewed a medical librarian and posted her explanation in an article on my web site. That's why brick libraries are so valuable -- they don't just have paper, they have librarians.

I was the original webmaster for Merck.com back in 1996 or so. I vaguely remember early on when we were putting up one of our first product sites, I got the thing up late one day and to test it, threw on a simple HTML page that said something like "It works, time for a coffee break" and a picture of a cuppa joe. My manager found it the next day and was livid. Had to take it down.

A little while later we were working with a long-dead state engine add-on for the Netscape web server (don't laugh, this was before either cookies or Apache were all that prevalent), and we had a couple fun things, including a scavenger hunt where people could pick up little tokens on web pages and a thing for changing the theme for the site. (We called them "flavors".) Not really secret Easter eggs, but they were fun. Likely won't find anything that non-corporate on the site anymore.

Microsoft trying to talk to students about "the source" is like your dad wanting to "rap" with you about drugs.

Hmm, what about those of us who have dads who design drugs?

The level of danger from any radiation exposure depends on at least three things: 1. dose (the article talks about that) 2. area 3. duration The fact of the matter is, whole body exposures are far more lethal and mutagenic, than concentrated ones. So, for instance, if you irradiate a person externally over most of his body with 6 grays, he has a high (something like 35% in Chernobyl) chance of dying. In radiation therapy, patients are often given 30Gy, to one spot, and do just fine (i.e. don't keel over). Note also, that different organs react very differently to radiation. As a rule of thumb, where cells divide often, radiation is most dangerous. Thus, skeletal muscle and such can deal with much more than core organs and reproductive organs. Check out Merck's page on the subject for a good initial overview (there are more nuances in reality, as always ... :))

Anyone taking advice from a web site and not their doctor gets exactly what they pay for. Of course, I have a slightly different view being in Canada where a doctor's visit doesn't cost me anything (except *@#%$! insane taxes). I'm all for sites that are a layman's version of the Merck Manual, but anything other than that, and you're being silly.

HOWEVER - I will concede that it would be an excellent idea to have some online general health pointers, explanations, tips, and such for less-developed countries. Only problem with that is why would you assume someone who doesn't have access to any sort of medical treatment would have access to a computer, let alone the Internet??

If this proposal does go through, I want to know: is the WHO going to certify and oversee my vet's website, or do we need a .vet, too? :-)

"There's a party," she said,
"We'll sing and we'll dance,
It's come as you are."