Grandpa has a stomach ache.  He does not use the internet much, but Grandma does.  She even knows how to post photos of her grand-kids onto Facebook, much to the envy of her Bunco group.  Confident in her web savvy, she springs to the laptop.

If Grandma is like most internet users, however, she will only visit the top 10 returns following her search for “stomach pain” on Google (yielding M_Twainapproximately 15 million options).  And those coveted top spots are no guarantor of sound counsel.

In my last post I considered the overall quality, or lack thereof, to be found on the internet when querying health-related information.  The broad and somewhat intuitive conclusion; some of it is good, much of it good enough, and some of it dreadfully misinformed.

So how can one determine if what they’ve found is any good?

In the broadest sense a website is judged on three criteria: the accuracy of information, how current it is, and the completeness of that information.  A search of the professional literature reveals that a number of tools have been proposed to evaluate different aspects of these criteria using a variety of schemes; at least 273 such tools, and counting.1

The oldest of these tools is the Health on the Net (HON) Code of Conduct, an 8-point code of conduct established in 1995 by the Health on the Net Foundation.  Approved websites can display a badge that looks like this.  Rather than signifying accurate information, however, HON_Codethe “HONcode” certification means that a site adheres to a specific code of ethics in regards to such issues as content attribution and transparency.  It is better than nothing, and does speak to noble intent.

Another interesting tool, DISCERN, has been designed to help consumers of health information rate what they have found without the need for any specialized knowledge.  The site itself ( provides a stepwise questionnaire to help evaluate the quality of a webpage.

Across all of these tools, common themes emerge that may be used as a quick gut-check when perusing web-based health information:

  • Says Who:  Are statements or claims supported by referenced sources, such as a research study or an expert opinion?  Are those references listed somewhere (often near the bottom of the page)?  If you do not find citations, your confidence should be diminished.
  • Since When:  How old is the information?  Does the website give a date, or perhaps a date of last revision?  If there are references given, when were they published?  Content that is trailing many years behind the state of the art should be regarded with caution, as should something of indeterminate age.
  • Slant:  Does the content seem focused on the advantages of a single therapy, without any mention of alternative approaches?  Seldom is medicine one-size-fits-all, and well-balanced information should acknowledge gaps in understanding.
  • Hyperbole:  Claims of a 100% cure rate should immediately raise red flags, as should alarmist language.  If what you are reading seems designed to frighten you, or speaks to a secret that “doctors don’t want you to know!” it is probably best to find another source.
  • Looking Good:  None of the most accepted tools consider items such as layout and graphics.  It is a common finding that visual appeal of a site is no guarantee as to its relative accuracy, though in some cases it might lend unearned credibility in the eyes of the user.  Even site domains such as .gov or .edu are imperfect as indicators of quality.2

Concerns about health-related content on the web have been present since the days of dial-up, when sites were comprised largely of static text, and maybe a link or three.  Today, an internet user is bombarded with an amalgam of text, audio, video, photos, and newsfeeds, all of which combine to form a nearly impenetrable jungle of facts, conjecture, opinion, and ads.

Is it even possible to untangle all of that?  The problem seems intractable to the extent that some literature states, “The time has likely come to end our Byzantine discussions about whether and how to measure the quality of online health information.”2

That feels a bit pessimistic, but in a way, it also acknowledges a reality; that the quality of content rests firmly in the hands of its creators.  There is a singular layer of control, at the source, and ideally, a certain sense of responsibility ought to come with that.

As generators of content, particularly in the realm of healthcare, our standards for quality should be exacting.  The timeliness and rigor of our work must always be top-of-mind.

Anything less seems irresponsible.  After all, Grandma might be reading.


  1. Fahy E, et al. Quality of patient health information on the internet: reviewing a complex and evolving landscape. Australas Med J. 2014;7:24-8.
  2. Deshpande A. Trying to measure the quality of health information on the internet: is it time to move on? J Rheumatol. 2009;36:1-3.