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The Journal of Clinical Endocrinology & Metabolism
Copyright © 2001 by The Endocrine Society
Vol. 86, No. 7
Printed in U.S.A.
HOT TOPIC
Endocrinology Resources on the Internet
MATTHEW I. KIM
AND
PAUL W. LADENSON
Division of Endocrinology and Metabolism, Department of Medicine, The Johns Hopkins University
School of Medicine, Baltimore, Maryland 21287
Endocrinologists and other medical subspecialists are increasingly turning to the Internet as a resource for use in
clinical practice. The latest American Medical Association
Study on Physicians’ Use of the World Wide Web reported
that 37% of physicians have used the Internet, a substantial
increase from the number identified on a similar survey
completed 2 yr earlier (1). Market research surveys report
that most practitioners use the Internet to search for information about specific diseases, to look up prescribing information, and to read online versions of medical journals (2).
According to these sources, a significant number of practitioners also use e-mail to communicate with patients on a
regular basis (3).
Endocrinologists using the Internet in clinical practice face
a number of challenges. The process of finding information
involves sorting through an enormous quantity of content
dispersed among an estimated 100,000 web sites containing
health care information (4). The problem of identifying appropriate information is compounded by the fact that it is
often difficult to distinguish physician-oriented resources
from patient-oriented sites on summary review. Another
formidable challenge lies in assessment of the quality of
information available on the Internet. As an open-access
resource, the Internet does not require any validation of
information posted on individual web sites. The lack of enforced standards of documentation makes it difficult to determine whether specific content is reliable enough to be
used as reference material.
Among medical subspecialties, endocrinology is relatively
well represented on the Internet, as evidenced by the number
of topical pages retrieved with different search engine queries (Table 1). By way of demonstration, a search performed
with a popular search engine using the general term “thyroid” returned a count of 465,000 indexed pages (5). A similar
search performed using the specific term “diabetes mellitus”
returned a count of 135,000 indexed pages (6). Common
endocrine topics are highly visible on most of the major
consumer-oriented web sites. A number of active online inReceived January 5, 2001. Revision received February 26, 2001. Accepted March 7, 2001.
Address all correspondence and requests for reprints to: Paul W.
Ladenson, M.D., Division of Endocrinology and Metabolism, The Johns
Hopkins University School of Medicine, 1830 East Monument Street,
Suite 333, Baltimore, Maryland 21287-0003. E-mail: ladenson@welch.
jhu.edu.
terest and support groups focus on discussion of specific
endocrine disorders. This level of representation probably
stems from the fact that clinical practice centers on the evaluation and treatment of chronic disorders incorporating specific knowledge, specialized diagnostic testing, and use of a
wide variety of pharmacological agents and treatments.
A selection of freely available, nonsubscription resources
that may serve as useful starting points for exploration of the
Internet are listed below. These include general and medical
search engines, reference resources, and compilations of
practice guidelines that have been selected based on their
potential utility in real-time clinical practice. A home page
address is provided for each site.
General Search Engines
General search engines are programs that are used to
perform wide-ranging searches of the Internet. Web sites
that include general search engines are among the most
frequently used resources on the Internet. Each engine
generates an index of web pages by deploying a program
called a web crawler that travels throughout the Internet,
scanning the contents of pages located on different servers.
As text words are retrieved from scanned pages, they are
collected, collated, and listed in an index of terms. When
a user logs on to the site and enters specific terms to
perform a search, another program scans the index of
terms to identify pages containing those text words. Strategies are used to weight the relevance of pages based on
the frequency and proximity of the terms entered in a
search. Based on these criteria, a list of pages is generated
and displayed in order of decreasing relevance. Entry of
different combinations of specific terms may lead to wide
variation in returned search results. Furthermore, search
results may change substantially from day to day, as indexes are continuously updated to track changes in the
organization and content of listed pages.
In practice, general search engines can be used to perform
basic searches that provide a broad overview of the resources
available for a given topic. Quick skimming of search results
often suggests the distribution of commercial, nonprofit, and
personal web sites that reference a given term. Basic searches
can be refined with the addition of selected terms combined
with Boolean logic to perform targeted searches for specific
information.
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ENDOCRINOLOGY RESOURCES ON THE INTERNET
TABLE 1. Number of web pages returned with searches using
endocrinology and metabolism search terms
Search term
Yahoo!
AltaVista
FAST, All the
Web, All the
Time
Google
Osteoporosis
Diabetes mellitus
Hypothyroidism
Hypercholesterolemia
Graves’ disease
Hyperparathyroidism
Polycystic ovary
syndrome
Cushing’s disease
Hypopituitarism
Aldosteronoma
70
450
24,600
7,600
7,300
5,800
1,100
77,900
19,800
10,500
3,000
3,000
2,500
3,000
395,700
130,000
51,400
19,100
15,300
12,200
6,200
485,000
135,000
87,700
27,200
25,200
20,900
7,500
1,400
900
130
900
700
30
5,000
3,500
180
6,200
6,000
190
Keyword search was performed on November 20, 2000.
FAST, All the Web, All the Time
www.alltheweb.com. FAST web search is a unique general
search engine that uses several programs operating in tandem to index web pages. This parallel approach speeds up
the process of indexing pages, enabling users to perform very
rapid, wide-ranging searches of the Internet. FAST indexes
a large number of full-text pages and provides a simple, easy
to navigate interface that allows for direct entry of search
terms without special conditions or modifiers. Quotation
marks can be placed around terms to direct searches toward
pages that contain exact phrases (e.g. radioactive iodine treatment). For sophisticated users, FAST provides a number of
advanced search capabilities that can filter results with increased precision.
Google
www.google.com. Google is a general search engine that
employs a unique method of rating web pages. In the process
of compiling its index, its web crawler takes note of the links
to other web sites that appear on each page. It uses this
information to map out an abstract network of the links that
connect different pages and sites to one another across the
Internet. By tracing through this network, it is able to rate
each page based on the number of highly linked sites that
connect to it in turn. When search results are displayed, listed
pages are ranked according to this rating. This method of
ranking yields searches that return highly relevant results.
Google indexes a large number of full-text pages and provides a remarkably accessible interface that allows for direct
entry of search terms. It also provides advanced search capabilities, including a function that enables users to search
for other pages that link directly to a designated page. Google
has recently started to index files that are configured in the
Adobe Portable Document Format (also known as pdf files).
At this stage it is unclear whether this type of indexing
will cover files listed by subscription journals and publications (7).
Medical Search Engines
Medical search engines are programs that have been specially adapted to seek out medical information on the Internet. They use sophisticated web crawling and indexing pro-
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grams to evaluate the medical relevance of pages located on
different servers. This screening process enables users to
limit searches to indexes of selected pages that have been
identified as medically relevant. In practice, these search
engines are good at finding pages that serve as entry points
to reputable sites warranting further exploration. They may
not perform as efficiently as other resources when used to
search for answers to specific clinical questions. One study
has demonstrated that online textbooks and general search
engines provide the quickest answers to questions encountered in general medical practice (8).
Health On the Net (HON): MedHunt
www.hon.ch. MedHunt is a medical search engine developed by the HON Foundation, an organization of medical
and information technology professionals dedicated to promoting a code of conduct for the development and operation
of health care web sites. MedHunt assigns estimates of medical relevance based on identification of 12,000 terms in a
medical dictionary. Its program counts the number of highly
relevant terms that appear on each page and generates an
index of web pages with concentrations of highly relevant
terms. MedHunt also indexes sites that have been evaluated
by HON members along with sites that subscribe to the HON
code of conduct.
MDchoice: Ultra Web Search
www.mdchoice.com. This commercial medical search engine
limits searches to a range of preselected health care web sites.
According to its model, medically relevant health care sites
are identified, evaluated by an editorial board of academic
physicians, and listed in a database. Although the range of
returned results is relatively narrow, this site incorporates
some unique display features that set it apart from other
medical search engines. Results are displayed in ranked order with categories of pages that have been peer-reviewed,
are targeted toward consumers, contain images, or include
CME resources. Selecting the link for one of these categories
regenerates a list of pages in ranked order. Searches can also
be customized with different combinations of filters to select
for pages that have been peer-reviewed, include CME resources, contain specific types of information, or include
specific types of images or media. With registration, selected
web pages can be saved to a password-protected personalized page.
Specialty Guides
In an effort to bring some order to the profusion of health
care information available on the Internet, a number of sites
have been established that provide listings of links organized
under headings of medical specialties and subspecialties.
The quality of these specialty guides depends on the frequency with which their links are reviewed and updated.
Carolinska Institute: Diseases, Disorders and Related
Topics
micf.mic.ki.se/Diseases. This web site, developed by the
Carolinska Institute, was one of the first comprehensive spe-
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JCE & M • 2001
Vol. 86 • No. 7
KIM AND LADENSON
cialty guides available on the Internet. Its layout is based on
the National Library of Medicine’s Medical Subject Heading
(MeSH) disease classifications. A separate page of listings is
maintained for each of 24 major disease categories, each of
which provides an extensive list of MeSH classifications
linked to topical web sites. This site also provides an alphabetical list of diseases with related MeSH categories. Most of
the endocrinology and metabolism links are listed on the
pages devoted to Endocrine Diseases and Nutritional and
Metabolic Diseases. These listings, which appear to be updated on a regular basis, include links to a wide array of high
quality informational and educational sites. Most of the listings include links to physician and patient-oriented
resources.
in separate print versions. The site is in the process of compiling extensive directories for 31 different medical specialties. Each directory will list over 1000 web sites grouped
according to general content. Each site will be rated using a
system of 1–3 stars. An Endocrinology and Metabolism guide
is currently under development. The eMedguides home page
provides free access to a general medicine guide that includes
a comprehensive listing of physician, student, and patientoriented resources. An access code is required to view each
online specialty guide. Subspecialists can obtain print versions of directories with access codes from designated pharmaceutical representatives. Print versions and access codes
can also be purchased directly.
Drug Information
Cliniweb International
www.ohsu.edu/cliniweb. Cliniweb, originally developed at
Oregon Health Sciences University as an experimental indexing program, allows users to search a delimited, but
extensive, database of approximately 10,000 web pages. It
displays returned search results in a unique format. As medically relevant pages are identified and entered into the database, they are indexed according to MeSH disease and
anatomy classifications. This indexing is performed manually with the assistance of a program that scans pages to
automatically assign approximate MeSH classifications.
When a user performs a search, a program matches each
entered search term to the closest MeSH classification, locating pages that are listed under that classification. Returned links are displayed in a hierarchical listing of associated MeSH classifications. This allows users to explore
additional links listed under related classifications without
performing additional searches. This site provides another
feature that enables users to link to topical PubMed entries
to search for related journal articles. A separate function
allows users to browse directly through the MeSH hierarchy,
although this tends to be a less efficient means of locating
specific information.
Medical Matrix
www.medmatrix.org. Medical Matrix, a commercial specialty guide that requires registration to obtain a password,
includes a wide array of listings in eight separate sections.
Under the specialties section, pages of links are maintained
for each of 57 different medical specialties. Most of the endocrinology links are listed on the pages devoted to endocrinology and Metabolic Medicine and Nutrition. On each
page, links are grouped according to general content. In
contrast to most other sites, clear distinctions are made between links to physician and patient-oriented resources.
Each site that is listed is rated by a board of participating
physicians using a system of 1–5 stars based on an assessment of its point of care clinical utility.
eMedguides: Endocrinology and Metabolism
www.emedguides.com. Established with support provided
by major pharmaceutical companies, eMedguides produces
online directories for physicians that are also made available
A growing body of prescription drug information is available on the Internet. Most major pharmaceutical companies
maintain active web sites for brand-name medications (usually listed as www.[trade name].com) that provide product,
prescribing, and consumer information. For reference purposes, there are a number of established sites that provide
reliable drug information.
Physicians’ Online: Clinical Pharmacology
www.pol.net. Physicians’ Online is a comprehensive commercial web site that makes a number of informational resources available to physicians who register to obtain access.
It provides links to several drug information resources, including Clinical Pharmacology, an online index of full-text
monographs with entries for common medications, investigational drugs, combination preparations, and nutritional
supplements. Within Clinical Pharmacology, a search function
can be used to locate drugs by generic and trade names. An
alphabetical listing of generic and trade names is also provided. Each medication appears on a separate page that lists
the generic name, trade names, description, mechanism of
action, and pharmacokinetic properties. Most pages also include product photos. For each medication, links are provided to separate pages that list indications and dosage,
contraindications and precautions, drug interactions, adverse reactions, cost, and identification information. This
layout allows for easy navigation between sections. As an
additional feature, each medication listing also includes a
link to a printable patient information page that outlines
administration and side-effect information in a question and
answer format.
PDR Online
www.pdr.net. This online version of the standard Physicians’ Desk Reference provides access to the complete set of
indexes and full-text monographs in the familiar print version of the PDR. Each monograph appears on a separate page
with a list of links that allows for direct navigation to different subsections. Associated tables, figures, and product
photos are included with each monograph. This site also
provides access to the PDR MultiDrug Interaction Report, an
online resource that allows users to enter selected medications into a list, submit the list for analysis, and view a display
ENDOCRINOLOGY RESOURCES ON THE INTERNET
that details any potential interactions. PDR Online also provides access to an online version of the PDR for Herbal Medicines. Use of this site requires registration with a DEA number to obtain access.
Laboratory Tests
Given the wide array of currently available laboratory tests
used to diagnose and monitor endocrine and metabolic conditions, there are surprisingly few informational resources
available on the Internet. In particular, there is a striking lack
of reliable information about the performance and interpretation of dynamic tests.
ARUP Laboratories
www.arup-lab.com. Originally established by the Department of Pathology at the University of Utah Health Sciences
Center in Salt Lake City, ARUP Laboratories serves as a
clinical reference laboratory for a wide array of teaching
hospitals, community hospitals, clinics, government facilities, and pharmaceutical companies. For consumer purposes,
it has developed a web site that includes an online version
of the ARUP User’s Guide. This is a comprehensive alphabetical listing of more than 2000 available laboratory tests.
Within the site, a search function can scan for full or partial
test names. Each test is listed on a separate page with a
detailed description of its methodology, reference intervals,
collection and transport requirements, turnaround time, and
associated CPT codes. Some of the listings provide cursory
information about the performance and interpretation of dynamic tests. A separate section of the guide outlines a limited
number of diagnostic testing algorithms.
Practice Guidelines
A number of professional societies and government agencies have made versions of published clinical practice guidelines available on the Internet.
National Guideline Clearinghouse
www.guideline.gov. This online collection of evidencebased clinical practice guidelines has been developed by the
Agency for Healthcare Research and Quality, the American
Medical Association, and the American Association of
Health Plans. Guidelines articulated by government agencies
and professional societies are organized by diseases, types of
interventions or treatments, and issuing bodies or organizations. A search function can be used to scan for full or partial
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terms within guidelines. The section labeled Endocrine Diseases lists 80 sets of practice guidelines divided into subsections under the headings of diabetes mellitus, adrenal gland
diseases, gonadal disorders, thyroid diseases, breast diseases, parathyroid diseases, and endocrine gland neoplasms.
Each guideline is listed on a separate page that includes a
description of the issuing organization, primary source, release date, major recommendations, and development and
endorsement information. Each page also includes links to
available full-text and printable versions of the guideline
located on the web sites of different issuing organizations.
Organizations with practice guidelines available on
the Internet
The following organizations have practice guidelines available on the Internet: American Association of Clinical Endocrinologists (www.aace.com), American College of PhysiciansAmerican Society of Internal Medicine (www.acponline.org),
American Diabetes Association (www.diabetes.org), American
Thyroid Association (www.thyroid.org), Institute for Clinical
Systems Improvement (www.icsi.org), National Heart, Lung,
and Blood Institute (www.nhlbi.nih.gov), National Osteoporosis Foundation (www.nof.org), Society of Nuclear Medicine
(www.snm.org), and United States Preventive Services Task
Force (text.nlm.nih.gov).
Efficient use of the Internet as a resource requires a certain
degree of familiarity with the layout of frequently visited
web sites. Endocrinologists who take the time to explore
sites, track links, and bookmark useful pages will find that
the Internet can be a valuable tool in clinical practice, providing quick access to an ever-expanding range of current
information.
References
1. 2000 AMA study on physicians’ use of the world wide web.
2. 2000 Facts file. In: Pharm.com. 28 February, 2000. http://www.inpharm.com/
facts.html. 28 July.
3. 2000 5th HON. Survey on the evolution of internet use for health purposes. Health On the Net Foundation. http://www.hon.ch/Survey/
ResultsSummary_oct_nov99.html. 28 July.
4. Eysenbach G. 2000 Consumer health informatics. Br Med J. 320:1713–1716.
5. Google. 2000 search using “thyroid.” http://www.google.com. 21 September.
6. Google. 2000 search using “diabetes mellitus.” http://www.google.com. 20
November.
7. 2001 Google extends search engine’s reach to a popular file format. The New
York Times on the Web. 22 February. 2001. http://www.nytimes.com/2001/
02/22/technology/22GOOG.html. 23 February.
8. Graber MA, Bergus GR, York C. 1999 Using the world wide web to answer
clinical questions: how efficient are different methods of information retrieval?. J Fam Pract. 48:520 –524.