INTERVIEW WITH CHARLES CURRAN

Charles Curran is Director of Professional Affairs of Forest Pharmaceuticals. Interview by Anna Fata.

Q: In developing countries scientific journals donÄôt arrive and medical databases arenÄôt disposable. It would be necessary a big investment to bridge the informative gap, but, in real terms, what do you think we can do?

A: Low cost alternatives are available. Almost a thousand medical journals are now available online at no cost (1), (2) or at greatly reduced rates to institutions in developing countries (3). Dozens of reference books covering many medical specialties are now available online in 11 languages (4). Many medical dictionaries are also available online (5).

The rapid expansion of free medical books and journals available online suggests that this may be an important and enduring trend. However, the potential for increased worldwide access is limited by the reduced availability of computers and Internet service providers in developing countries.

Q: The biggest part (80%) of the medical literature is produced by the ten most industrialized countries, because, besides other factors, an article, with the same quality of information, written by researchers from poorest areas of the world, has less probabilities to be published. According to you, why does it happen? Do you think itÄôs possible to modify this situation? How?

A: Some bias appears to exist against authors from countries other than the country in which a journal is published in that reviewers may tend to recommend acceptance based on country of origin (6). It is possible to modify the review process by providing journal manuscript reviewers with masked manuscripts. These are manuscripts in which the identities of the authors and their institution and country of origin have been removed. The overall effectiveness of the masking process has been demonstrated (7) although it is difficult to effectively mask the manuscript of authors who are well-known (8).

Q: What are the risks for patients of using online medical resources by oneself?

A: Some websites have been developed by persons who wish to present particular viewpoints that are not scientifically well-founded. Because these sites lack professional guidance, some information may not only be useless, but also potentially dangerous (9). Websites that provide information about untested or unproven substances are often sufficiently attractive to cause patients to infer that their claims are factually correct.

Additional risks are posed in using online medical resources, because patients are often unable to determine how the information provided applies to their particular condition. Highly detailed and accurate information is available from many respectable medical websites, but if the information cannot be understood by patients, the information cannot be put to effective use.

In addition to the difficulty patients have in selecting sites that are free of obvious bias and that provide information based on good scientific facts and medical principles, most patients lack the sophistication to determine whether a particular site contains attributed information or shows evidence of frequent updating.

Q: As you maintained in your article, physicians, generally, are able to value the reliability of researches. What valuation methods patients can adopt to verify trustworthiness of information?

A: Validation services are available to help patients select reliable online information (10), (11), (12).

References

(1) bmj.com Archive of All Online Issues. http://bmj.com/contents-by-date.0.shtml Accessed 31 July 2002.

(2) Freemedical journals.com. http://www.freemedicaljournals.com/ Accessed 31 July 2002.

(3) The IDEAL^¬Æ Charter for Low-Income Countries Helps Researchers Cross the Digital Divide Through Reduced-Rate Access to Scientific, Technical and Medical Journals.http://www.academicpress.com/www/ideal/pressreleases/charter.htm Accessed 31 July 2002.

(4) Free Books for Doctors. http://www.freebooks4doctors.com/ Accessed 31 July, 2002.

(5) Link AM. US and non-US submissions. An analysis of reviewer bias. JAMA. 1998;280:246-7.

(6) Ceci SJ, Peters D. How blind is blind review? Am Psychologist. 1984;39:1491-4.

(7) Justice AC, Cho MK, Winkler MA, Berlin JA, Rennie D and the PEER Investigators. Does masking author identity improve peer review quality? A randomized controlled trial. JAMA. 1998;280:240-2.

(8) Curran CF, Oh KE. Sources of drug information available to consumers. Drug Informat J. 2001; 35:539-546.

(9) Medical Library Association. Consumer and Patient Health Information Section. Web Sites You Can Trust. Main Page. http://caphis.mlanet.org/consumer/ Accessed 31 July 2002.

(10) MEDLINEplus Health Information. Dictionaries. http://www.nlm.nih.gov/medlineplus/dictionaries.html Accessed 31 July 2002.

(11) Medical Sciences Library. SelectedMedicine Web sites. http://msl.tamu.edu/MSL/netrsrc/hlthweb.html accessed 31 July 2002.