UB Professor Oversees Emergency Medicine Content of eMedicine, Online Medical Journal

BUFFALO, N.Y. -- The electronic realm has, at first click, made daily inconveniences convenient.

Like email and ecommerce. And emedicine.

Type in the keywords "health" or "medicine" using any search engine and the results turn up in the multi-millions. But given the informality and immediacy of the medium, users may be reluctant to give credence to much of the World Wide Web's medical content. Sites that provide medical guidance may serve the dual purpose of pushing a new product or therapy, confusing the truth with salesmanship. And individuals expecting to meet the whole of their medical needs via the Internet could be displaying symptoms of foolhardiness.

So who -- or what -- can you trust?

Thousands of medical professionals are taking steps to build both health consumers' and practitioners' confidence in this burgeoning medium for dispensing medical information with eMedicine Journal, an online library of continuously updated medical textbooks at http://www.emedicine.com that caters primarily to medical professionals, but also provides texts for consumers.

As part of that contingent, Richard Krause, residency program director for the Department of Emergency Medicine in the University at Buffalo School of Medicine and Biomedical Sciences, has contributed to eMedicine since 1999, a year after its founding. Recently named managing editor for the section devoted to emergency medicine, he says the lack of confidence in online medical publications is due, in part, to the perception that print publications are more credible.

"I don't know that when this site was started, people took it as seriously as they would have something in print," adds Krause, UB clinical assistant professor of emergency medicine. "A lot of what's on the Internet is of questionable quality."

eMedicine provides textbook-quality articles on topics ranging from dermatology to sports medicine with one distinct advantage over the print variety: the information is truly current.

"They have come up with a way to keep textbooks, in effect, continuously up to date," Krause says about eMedicine's creators. Leafing through a bulky textbook and stopping at a chapter on bone marrow disorders, he notes that by the time the books are published, the information is at least two years old. For this current edition, published in 1998, the most recent article referenced in this particular chapter is from 1996. "That is clearly the problem," he says.

One of 21 managing editors for eMedicine, Krause has edited nearly 20 sections of the emergency medicine text, and as many for the site's consumer-oriented American Academy of Emergency Medicine Emergency Medical and Family Health Guide. He has authored two chapters -- on anaphylaxis and renal failure -- for the emergency medicine text, as well as co-authored with his residents several chapters for the family guide.

None of the authors -- all of whom are physicians and culled from top medical schools, societies and institutions worldwide, according to the site -- simply can post his or her work as is. Each article must pass muster with four editors before it is posted as new or updated, Krause explains. Even with this peer-review process, he continues, updating information may take only a days versus the years it can take a publishing company to come out with a new textbook edition.

Krause says consumers should be cautious about medical information presented on the Web or in a textbook, noting that it shouldn't be taken as "gospel" or substituted for advice from one's health-care provider.

That information, he adds, should be used "as a way of better understanding a condition that they or family members have. They should use the information so they can ask intelligent questions. I think the way the average consumer should use it is to develop a list of questions that they can talk to their doctor about in terms of their specific circumstances."

And given that patient-physician time is at a premium these days, Krause adds, coming to an appointment prepared can yield a much more fruitful interaction.

"People can really make more use out of a medical encounter if they've done some research first," he says. "And physicians not being perfect, you may find some information a physician doesn't know."