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To the Editor.—What is the applicability and quality of information on the World Wide Web for answering questions generated by clinicians during practice? This new medium has lowered the bar for publishing, allowing anyone with access to a Web server to distribute words, images, and other media to a worldwide audience. While this may be a positive trend for a democratic society, whether it is beneficial for professional fields such as medicine in which peer review and the deliberate editing process in general serve as filters (albeit imperfect) is unclear. Information used to make the most personal decisions, ie, those concerning an individual's health, should be of the highest quality.
We performed an observational study to assess the ability of an experienced medical librarian using an Internet search engine to find pages and rate them for applicability to the clinical question and quality based on credentials and affiliations of authors, attribution of sources and copyright, disclosure of findings and conflicts of interest, and currency of content. Since our focus was to determine the quality of the best information that could be retrieved, we chose to use a medical librarian experienced in searching the Internet and a "meta" search engine that sends search statements to multiple other search engines (Metacrawler, http://www.metacrawler.com). For assessing applicability and quality of retrieved pages, we developed an instrument based on attributes from a published quality standard,2 although as others have noted, there is no "gold standard" for this sort of quality assessment.3 Fifty questions were selected from a database of clinical questions captured ethnographically during observation of clinical practice,4 searched using Metacrawler, and rated based on our instrument.
A total of 629 pages were retrieved for the 50 questions (average, 12.6 pages; range, 2-20 pages). Table 1 lists the attributes from the instrument and how often they occurred. Most of the retrieved pages were neither clinically applicable nor of high quality. Sixty percent of pages retrieved were not oriented to an audience of health care professionals. Eighty-nine percent of the retrieved pages were not applicable to the question that prompted the search. Only 26 (52%) of the 50 searches had 1 or more applicable pages. About 58% of pages were subject reviews, but fewer than 1% consisted of "evidence-based" resources (original research or systematic reviews). Only 1 quality measure (site affiliation) was present in a majority of pages. Sixty-nine percent of the pages did not indicate an author, and more than 80% did not give the author's credentials. Disclosure of financial or other conflicts of interest was present in only 1%. Fewer than 18% of pages gave the date posted or updated.
We conclude that the bulk of information on the World Wide Web, ie, the "HTML" pages, is of low applicability and poor quality for answering clinical questions. Users may be better off relying on online versions of traditional information sources, eg, medical literature and textbooks, an increasing number of which are available in World Wide Web format.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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