What does your client know about medicine?

Our clients know more about medicine than we think. Given all
the data that can be discovered online, it is important for us
to know what our clients know (or can find).
There are good reasons to consider the web sites that aim
medical information at consumers. The discovery of medical
information by consumers is one of the major reasons they go
online. The consumer- oriented databases offer various kinds
of data that can be understood by the informed lay person; the
exposition of data allows us to see how complex facts may be
communicated to informed lay people. Another reason to look at
consumer-oriented medical web sites is that we must manage
client expectations; one way to do that is to know what our
clients know.

Medical Information Standards

Health On the Net Foundation (http://www.hon.ch/) is a Swiss
organization that has articulated eight standards for health
information on the Internet. Although these standards are not
requirements, they are useful measures to use when evaluating
web sites for credibility and reliability. These standards
include:
1. Authority - the identity of sources is identified;
2. Complementarity - the offering supports the doctor-patient
relationship;
3. Confidentiality - the data exchange is confidential;
4. Attribution - the sources relied on are cited with
hypertext links or citations to published literature and the
date the web page was modified appears on the page;
5. Justifiability - claims are supported with citations to the
Web or the literature;
6. Authorship transparency - contact addresses for authors and
web masters are available on the site;
7. Sponsorship transparency - those who pay for the site are
identified clearly; and
8. Honesty in advertising and editorial policy.

Mental Health

Psychological issues are becoming more important in damage
cases. Planet Psych (http://www.planetpsych.com/) explains
many mental health issues, has a self-help section, and offers
a chance for an electronic-mail consultation with a therapist.
There is an online newsletter as well. Go to the site map and
review it to get a sense of what is available on the site.

Drug Information

The Pharmaceutical Information Network
(http://www.pharminfo.com/) has several different indexes. The
data are searchable by disease. The offerings include
information centers that target particular diseases- providing
possible leads for expert witnesses. There is cross-index
between generic and branded drugs. Of special interest to
lawyers may be the drug press-release database and the online
discussion groups concerning specialty areas, pharmaceutical
marketing, and medical web masters. There are hypertext links
to web sites discussing research and development,
associations, schools, and pharmaceutical companies.

MEDLINEplus

The U.S. National Library of Medicine's consumer-oriented site
MEDLINEplus (http://www.nlm.nih.gov/medlineplus) is organized
by disease or condition. It offers hypertext links to
organizations dealing with particular medical problems so it
is a lead to possible experts. It also offers a direct link to
the National Library of Medicine's nine-million-plus-citation
MEDLINE database. If you do use that link, check on the
MEDLINE search strategy MEDLINEplus creates for you-
sometimes, it does not reflect what you are really seeking.
Cross-check that selection of search terms with the printed
Annotated Medical Subject Headings (MESH) list or the online
version of MESH that you can access from the PubMed home page.

Dr. Weil

Recently profiled on CBS News "60 Minutes," Dr. Andrew Weil
has a substantial archive of alternative medical information
available at http://www.drweil.com/. Indexing is by remedy,
treatment, disease, or condition. His answers to questions are
searchable, helpful, and understandable.

Quackwatch

Quackwatch (http://www.quackwatch.com/) is one of a series of
web sites by a physician (Dr. Stephen Barrett, M.D.) who takes
a skeptical view of many alternative medical modalities. These
sites include Chirobase (http://www.chirobase.org/), on
chiropractic; MLMWatch(http://www.mlmwatch.org/), on
multilevel marketing, and Nutriwatch
(http://www.nutriwatch.org/), on nutrition. This material is
particularly useful for cross-examination purposes.