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BMJ. Aug 7, 1999; 319(7206): 385.
PMCID: PMC1127008

Rating information on the internet can empower users to make informed decisions

Gunther Eysenbach, researcher

Editor—Last year Diepgen and I proposed rating information on the internet with a standard vocabulary of machine-readable metadata.1 In his comment on our paper Whatling incorrectly implied that we intend to “dismiss the input of non-medical readers.”2 This is a misunderstanding—we merely aim to empower users to make informed decisions.

I would not call the efforts of physicians to evaluate information on the internet “arrogant.” Using that argument, it would be arrogant for peer reviewers for scientific journals to assess submitted papers or for a doctor to give health advice to patients in daily practice. We argue that physicians have the duty to guide patients through the information jungle. This can be done by evaluating printouts from the internet that puzzled patients bring with them. A smarter way, though, would be to distribute such evaluations on the internet, using an infrastructure such as medPICS.1,3

Whatling’s notion that everything on the internet can be falsified is incorrect. Raters of our med-CERTAIN project will be able to use digital signature labels, which allow end users to check the authenticity and integrity of ratings.3

Lastly, Whatling’s assertion that “patients have read and heard numerous reports of magical cures and cancer healers for hundreds if not thousands of years in one form or another and have given these the short shrift they deserve” is not supported by scientific evidence.4 Besides, to extrapolate from early times, when people did not have books, to the emergence of the internet—the most profound change in communication since Gutenberg’s inventions—and to predict that these developments have no effect on how people understand and digest information is absurd. McLuhan coined the aphorism “The medium is the message,” arguing that any new medium will impose a new environment and that the modes of disseminating data will cause culture changes, including the way we see, deal with, and assess the things around us: “We shape our tools and they in turn shape us.”5

The internet is the world’s largest library, shopping mall, business market, museum, university, health information provider, and entertainment vehicle. It facilitates the sharing of ideas, data, and tools, creating an ethos of cooperation and collaboration; has the potential to empower patients and to bring evidence into medical practice; but also creates an environment of chaos and information overload. Both sides have to be kept in mind and all possible measures should be evaluated to push the balance towards the beneficial effects.


1. Eysenbach G, Diepgen TL. Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information. BMJ. 1998;317:1496–1502. [PMC free article] [PubMed]
2. Whatling P. Having non-medical readers of papers on internet will enhance peer review. BMJ. 1999;318:1144–1145. . (24 April.) [PMC free article] [PubMed]
3. Eysenbach G, Diepgen TL. Labeling and filtering of medical information on the Internet. Meth Inf Med. 1999;38:80–88. [PubMed]
4. Passalacqua R, Campione F, Caminiti C, Salvagni S, Barilli A, Bella M, et al. Patients’ opinions, feelings, and attitudes after a campaign to promote the Di Bella therapy. Lancet. 1999;353:1310–1314. [PubMed]
5. McLuhan M. Understanding media–the extensions of man. Cambridge: MIT Press; 1994.

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