As a medical-legal consultant and Internet researcher I am asked every day to find authoritative medical literature references for a broad spectrum of topics. The information I am looking for may be used to support a claim, to debunk an expert theory, or to educate the attorney during the course of a case evaluation.
Changes in the way medical information is stored, accessed, and retrieved have created a wealth of health care information. The Internet provides free access to a great deal of the medical literature, either in full text or citation/abstract format.
Because anyone with access to the Web can establish a Web page, many medical sites contain little useful information, even though they may be visually appealing. For this reason, the quality of information available varies from very good to poor, and some sites even intend to mislead. It is important to search for peer reviewed information, from an authoritative source.
I. Define The Search
Before you start your search, be clear as to the specific type of information you are seeking. It may be a standard of care for a particular procedure, it may be the rate of occurrence for complications related to a specialized treatment, or it may be basic information defining a disease or particular injury. You must identify the main concepts in your topic and determine any synonyms, alternate spellings, or variant word forms for the concepts.
In order to define your search, you will need a grasp of basic medical terminology. The medical terms used in your search usually come from records showing a diagnosis or particular treatment. The terms may include the name of a medication or specialized medical equipment. It is a good idea to keep a medical dictionary and drug guidebook close at hand as references, because spelling of medical terms must be accurate in order to get relevant search results.
Because the Web is not indexed in any standard manner, finding information can seem difficult. Search engines are popular tools for locating web pages, but they often return thousands of results. Search engines crawl the Web and log the words from the web pages they find in their databases. Without a clear search strategy, using a search engine is like wandering aimlessly in the stacks of a library trying to find a particular book.
II. Performing the Search
Most of the major medical literature search sites have tutorials or help functions to assist you in customizing your search. It may take some time to learn how to master the specific commands and options offered by the various search engines, but it pays off by helping you avoid hundreds of hours fruitlessly searching.
Do not let the similarity between the appearance and function of medical search sites fool you into thinking they are all alike. They are not. They use different rules and procedures to analyze your queries and decide what results are seen.
If you have tried a query a few times and are not getting the results you are looking for, switch to another search engine. It is natural after searching for awhile to have “favorite” search sites.
In one way this is good, the more you use a particular site the more likely you are to master a particular tool. But, instead of relying on one search site for all your needs, try using several different sites on a regular basis. This way you will get a feel for which ones work best for specific types of searches. Over time, it will become automatic for you to select the “best” search site for each query from among the several that you know well.
Boolean operators (and, or, not) allow you to construct very precise queries that theoretically should give you very precise results. But this is not necessarily the case for two reasons.
First, search sites implement Boolean operators in slightly different ways. If you are going to use Boolean operators, be sure you understand exactly how each site implements them.
Secondly, despite the apparent simplicity, Boolean logic is anything but simple. A misused “not” or a poorly “nested” phrase can lead to wildly inappropriate results. For a good Boolean primer, with helpful illustrations and examples is Boolean Searching on the Internet from the University of Albany Libraries found.
Some search engines ignore certain words. They are never used to find a matching document, despite what amounts to a direct command when you type them into a search form.
These are called “stop words” because the search engine does not “search” when they are found in its index. This is because the stop words are either too common to generate meaningful results, or are parts of speech like adverbs, conjunctions, prepositions, or forms of “be” that mean nothing unless they are part of a phrase with more “important” nouns and verbs. If you use a stop word in a query you may get wildly irrelevant results.
How can you identify stop words? They are listed at the website: Most of the 300 Most Common Words in the English Language found.
Some search engines will tell you when they are ignoring a stop word at the very top of a results page.
Another problem for the net-searcher is whether to use capital letters in a query. Some engines are case sensitive, while others are not. As a rule of thumb, it is best to always use lower case letters when you search This will typically return results that contain both upper and lower case letters.
It is a good idea to bookmark or print out the information you find. It is easy to believe once you have found a page or site using a search engine that you will find it again. It does not work that way.
You may not get the same search results using the same terms if you repeat a search within an hour, let alone days or weeks later. The Web is in constant flux. Thousand of new pages are published to the Web every day, and thousands more moved to new “addresses”, or are removed entirely.
This means a particular “relevance” of a particular document for a specific search query also changes constantly, as it is compared to other documents added to or removed from the search engine index.
If you get stuck, and can not find what you are looking for on the Internet, do not stop looking. Sometimes your best bet for finding information is to log off and take a trip to your local medical library.
Libraries have many resources that are not available on the Internet. And, the librarians are trained experts who are usually more than willing to help you find what you are looking for. Effective searching requires a blend of learned skills, common sense, and a bit of clever intuition.
III. Where to Search For Medical Information
Medical Search Engines/Website Lists
Medical information on the Internet is growing and diversifying. Every month more information is added and it becomes more challenging to sift through the many sites to find the content you are looking for. Traditional search engines do not focus on medical sites, and therefore some very valuable sites are overlooked or not updated into the index.
To date, there is no all-inclusive engine for searching medical sites. Nor is there a single engine that adequately and throughly indexes just the most reputable sites. These are a sampling of sites that will search for and retrieve up-to-date, applicable and current postings from peer-reviewed sources.
National Library of Medicine
The NLM is a very large database and the efficiency of a search can be aided by a review of the MESH (medical subject heading) “trees” at http://www.nlm.nih.gov/mesh/
The mesh trees incorporate the specialized language of the NLM classification system. Failure to use the appropriate language will result in a null or irrelevant search. For example: the phrase kidney calculi should be used instead of kidney stones.
Medline (accessible from various sites)
MEDLINE is the NLM’s premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences. MEDLINE contains bibliographic citations and author abstracts from more than 4,300 biomedical journals published in the United States and 70 other countries.
The file contains over 11 million citations dating back to the mid-1960’s. Coverage is worldwide, but most records are from English-language sources or have English abstracts. Medline is free, and is accessible from various sites, such as Medscape, Pubmed, and Healthgate.
Pubmed
The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at web sites of participating publishers.
Publishers participating in PubMed electronically supply NLM with their citations prior to or at the time of publication. If the publisher has a web site that offers full-text of its journals, PubMed provides links to that site, as well as sites to other biological data, sequence centers, etc.
User registration, a subscription fee, or some other type of fee may be required to access the full-text of articles in some journals.
PubMed provides access to bibliographic information which includes MEDLINE as well as the out-of-scope citations (e.g., articles on plate tectonics or astrophysics) from certain MEDLINE journals, primarily general science and chemistry journals, for which the life sciences articles are indexed for MEDLINE.
Medscape
Medscape is a multi-specialty Web service for clinician and consumers that combines information from journals, medical news providers, medical education programs, and materials created for Medscape. Here you will find a combination of peer-reviewed publications, a free version of drug information via the “First Data Bank File” and free Medline. At the present time there is no fee to set up a user account which gives access to full text articles.
Healthfinder
Healthfinder is a free gateway to reliable consumer health and human services information developed by the U.S. Department of Health and Human Services. healthfinder can lead you to selected online publications, clearinghouses, databases, web sites, support and self-help groups, as well as the government agencies and not-for-profit organizations that produce reliable information for the public.
MD Consult
Founded by leading medical publishers, MD Consult integrates peer-reviewed resources from over 50 publishers, medical societies, and government agencies. From this site you can obtain full text from many respected medical reference books from a variety of specialties, as well as information from medical journals, and MEDLINE.
In addition you can obtain comprehensive USP drug information (beyond the scope of a PDR), and many clinical practice guidelines. This is not a free service, but for a small fee you can have access by the day, month or year. Also there is a free trial membership.
Medical Matrix
Medical Matrix is a source for a wide variety of online resources that include major journals, textbooks, disease and conditions, and patient education. To access this site you must complete an online registration form and fees are charged for some features.
Medical World Search
Medical World Search can aid medical practitioners, researchers, or anyone with basic knowledge of medicine, to formulate an optimally precise query to search the World Wide Web and find exactly the information they need. The major goals of Medical World Search are to provide a search engine that operates over a selection of the most high quality medical sites on the Web and to facilitate searching by using a medical thesaurus that understands medical terminology and can thus search for related terms automatically.
Medical World Search has three components: the Web crawler, the indexer, and the query processor. The Web crawler seeks out medical sites on the World Wide Web, starting from some of the major entry points for clinical medicine, then retrieves them and stores them on Medical World Search’s disk system. The indexer recognizes medical concepts in the pages retrieved by the Web crawler, and generates a large index of all medical concepts and words in the Web pages; this index shows in which pages each concept and word appears. The query processor allows the user to specify his information needs and then attempts to match the query optimally to Web pages using the index generated previously. Results are ranked and returned to the user. There is a small annual fee charged for use of this service.
MD Choice.com
This site is founded by academic physicians. Their goal is to make access to the Internet’s vast health and medical information as efficient and reliable as possible for healthcare professionals as well as consumers. MDchoice.com has combined the content of several award-winning medical websites including NetMedicine.com, Physician’s Choice, and EMBBS.com (The Emergency Medicine and Primary Care Home Page). A panel of board certified physicians in the U.S. evaluate the Web’s medical content.
Guidelines Clearing House
This site is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) in partnership with the American Medical Association and the American Association of Health Plans. A medical term search will retrieve objective, detailed information on clinical practice guidelines. Results in a search will obtain: structured abstracts (summaries) about the guideline and its development, a utility for comparing attributes of two or more guidelines in a side-by-side comparison, syntheses of guidelines covering similar topics, highlighting areas of similarity and difference, links to full-text guidelines, where available, and/or ordering information for print copies and, annotated bibliographies on guideline development methodology, implementation, and use.
IV. Where to search for information on Pharmaceutical Products
Institute for Safe Medication Practice
The Institute for Safe Medication Practices (ISMP) is a nonprofit organization that works closely with healthcare practitioners and institutions, regulatory agencies, professional organizations and the pharmaceutical industry to provide education about adverse drug events and their prevention. The Institute provides an independent review of medication errors that have been voluntarily submitted by practitioners to a national Medication Errors Reporting Program (MERP) operated by the United States Pharmacopeia (USP) in the USA. Information from the reports may be used by USP to impact on drug standards. All information derived from the MERP is shared with the U.S. Food and Drug Administration ( FDA) and pharmaceutical companies whose products are mentioned in reports.
Lawfirm Websites/Class Actions/Document Vaults
The lawfirm of Feldman & Rifkin, LLP has put together a good site of resources related to class actions and pharmaceutical related litigation resources. Another site link http://www.badproducts.com has a wealth of litigation resources including pleadings and exhibits. You can also do a search of the web and news services by using http://www.google.com for the drug in question.
Formulary Journal
Formulary is a monthly clinical journal for members of Pharmacy and Therapeutic (P & T) Committees (and others charged with drug management responsibilities) at hospitals, HMO’s and other managed care settings, PBM companies, and within the VA system.. This publication contains peer-reviewed clinical articles plus drug-related clinical news, drug-related regulatory news, meeting “pearl” reports, formulary trends, and clinical experience briefs.
The American Society of Health-System Pharmacists
Founded in 1942, this is the premier professional association for hospital and other health-system pharmacists. The Association publishes the IPA database, the American Hospital Formulary Service (the “Red Book”) and the American Journal of Health-System Pharmacy, as well as a number of books and continuing education publications. The site offers timely alerts on medications which have been recalled by the FDA or had warnings issued. The site also offers free MEDLINE access, as well as a directory of headquarters staff and the Association’s publications catalog. Information on purchasing publications is found at this website.
American Association of Pharmaceutical Scientists
The American Association of Pharmaceutical Scientists consists of more than 9,300 pharmaceutical scientists employed in academia, industry, government, and other research institutions worldwide. “Founded in 1986, the goal of AAPS is to improve human health through the development of better pharmaceuticals.” This site provides information about the pharmaceutical science profession, information for members, publications, and links to additional health and pharmaceutical sites.
The American Pharmaceutical Association
The American Pharmaceutical Association (APhA), the national professional society of pharmacists, was founded in 1852 and is the first established and largest professional association of pharmacists in the United States. The more than 50,000 members of APhA include practicing pharmacists, pharmaceutical scientists, pharmacy students, pharmacy technicians, and others interested in advancing the profession. The Association is a leader in providing professional information and education for pharmacists and an advocate for improved health of the American public through the provision of comprehensive pharmaceutical care.
International Society for Pharmaceutical Engineering
ISPE is the Society of choice for more than 13,000 healthcare technology professionals in more than 60 countries… ISPE [is] the leading global source of information, educational services, and forums providing knowledge and practical experience for technical professionals who develop, manufacture, regulate, and support healthcare products. This site includes a calendar of upcoming educational programs; information on ISPE publications; career development and student areas; contact information for affiliates and chapters; and Shared Interest Groups (SIGs) Bulletin Boards, plus information on Good Automated Manufacturing Practices (GAMP), Baseline Pharmaceutical Engineering Guides, and Clinical Trial Materials training tools.
Parenteral Drug Association
PDA is a non-profit professional/technical association whose mission is to support the advancement of pharmaceutical technology by promoting scientifically sound and practical technical information and education for industry and regulatory agencies. PDA is the recognized authoritative voice and leading technical organization in the field of parenteral science and technology. Through the development of technical reports, bulletins and responses to regulatory initiatives. Membership consists of over 9,000 individual and 250 corporate members worldwide. Conferences, meetings and open forums bring together pharmaceutical manufacturers, suppliers, users, academics and regulatory officials to discuss issues of mutual interest.
FDA – Electronic Orange Book – Approved Drug Products with Therapeutic Equivalence Evaluations
At this site you can search for drug information by active ingredient, drug applicant holder, proprietary name, or application number. If you have the trade name, search the Electronic Orange Book Rx or OTC section using the Proprietary Name search. This determines the ingredient(s). Then use the Ingredient Search for all approved products that contain the ingredient(s). The resulting list will provide approved products by dosage form and route. For each dosage form; route grouping, there will be a Reference Listed Drug (RLD) that is the innovator product. One or more strengths will have a Yes RLD. If there are approved generic products of another firm, the RLD will be No and all the products within the dosage form; route grouping will have a therapeutic Equivalence Code (TE Code). Products that have been discontinued are in the Discontinued Section and do not RLD or TE Codes. The OTC Section products are not evaluated for therapeutic Equivalence.
Information not found here can be requested from the FDA by going to CDER Freedom of Information Office
Pharmaceutical Research and Manufacturers of America
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading research-based pharmaceutical and biotechnology companies. You can search medication/pharmaceuticals in development by disease, drug name, or company name.
Biotechnology Information Directory
This directory contains well over 1500 URLs of companies, research institutes, universities, sources of information and other directories specific to biotechnology, pharmaceutical development and related fields. It places emphasis on product development and the delivery of products and services. It includes a listing of pharmaceutical companies and their associated websites, as well as a link to the European mirror site.
Hardin Meta Directory of Internet Health Sources: Pharmacy and Pharmacology
As a “metadirectory” this site provides a “directory of directories” on a variety of medical topics. The section on pharmacy and pharmacology provides links to 20 different directories on the World Wide Web.
Virtual Library: Pharmacy
This general site also includes links to information on pharmacokinetics and pharmaceutical chemistry. Included are links to schools of pharmacy throughout the world, community pharmacy web pages, and job information for pharmacists. Maintained by the University of Oklahoma College of Pharmacy.
PharmWeb
This site is maintained at the University of Manchester (England), and is “mirrored” by over a half-dozen sites throughout the world. It includes extensive links to Internet resources of interest to pharmacists and maintains numerous discussion groups.
University of Sydney Department of Pharmacy — Pharmacy Internet Guide
This site includes a thorough and logically organized guide with links to pharmacy resources on the Internet. The guide includes an extensive list of email discussion groups and electronic journals of interest to pharmacists.
FDA Bulletin Board/World Wide Web site
Includes FDA Federal Register Notices, Drug & Device Approvals, agency press releases, FDA Consumer Magazine. A search form is available for searching the FDA web site for information on a specific topic or drug.
U.S. Department of Health & Human Services
The DHHS is the parent agency of the Health Care Financing Administration MedicareMedicaid), Food & Drug Administration, Centers for Disease Control, Agency for Health Care Policy & Research, Agency for Toxic Substances & Disease Registry and others. Links to the agency web sites, as well as grant, research and policy information are available from this central site.
National Institutes of Health
Links to CancerNet PDQ Drug Information, the full-text of Clinical Practice Guidelines, grant information, and NIH sponsored research in progress.
National Library of Medicine
The National Library of Medicine (NLM) provides no-cost access to MEDLINE, a database which provides citations to the primary biomedical literature. MEDLINE can be searched via the World Wide Web from this website using either NLM’s “Internet Grateful Med” search engine, or the “Pub Med” search engine. Pub Med also includes links to a small number of full-text articles available on the World Wide Web.
V. General Information Searching
Search engines rely on computer programs called spiders or robots to crawl the Web and log the words on each page. With a search engine, keywords related to a topic are typed into a search “box.” The search engine scans its database and returns a file with links to websites containing the word or words specified. Because these databases are very large, search engines often return thousands of results. Without search strategies or techniques, finding what you need can be like finding a needle in a haystack.
General search engines are good for finding information and sites on a specific topic. The search results generally will contain many irrelevant sites, and you will need to “sift” through your results to find information that is useful.
There are many tutorials for web searching techniques on the Internet. One particularly good tutorial, which you may download and print for reference is Bright Planet’s “Deep Content” tutorial.
This is an in-depth Web searching tutorial, organized to proceed from the basics to more advanced topics. It has 12 parts containing over 60 topics.
Listed below are some of the more popular general search engines.
VI. General Information Search Engines/Website Lists
Google consistently turns up high-quality, highly relevant results. Google does well on specific queries such as American Pediatric Neurological Organizations, and broad-topic searches, such as Medical Professional Organizations. It’s also great at targeting a specific home page. Depending on your query, you may get stock quotes, or related news stories for example. My favorite feature is Google’s ability to view cached copies of results pages. When the page you want to access is no longer live, you can view a cached copy of the way it looked the last time Google crawled it. Google offers only basic query customization features, including phrase searching and foreign-language filtering. You can use plus or minus signs to include or exclude keywords, or you can head to the Advanced Search page for drop-down pick lists to construct complex searches. There is a similar page” feature as well as a translator for foreign language websites.
About
About.com uses “professional Guides” to research and collect over a million useful sites in over 700 topic areas. About.com is a great place to start a web inquiry as long as you’re not looking for anything to specific. Think of it as a resource library for popular subjects. Uses Sprinks (powered by the competent Inktomi) as a default search engine if it can’t find your query at about.com.
Dogpile
Dogpile uses a different concept to search the Internet than most other general content search engine. Rather than maintaining its own database of Web site addresses and their contents, Dogpile searches the databases maintained by the other general content search engines, such as Google, Ask, MSN-Search and Yahoo Search, as well as databases maintained by Usenet newsgroups, ftp sites, newswires, and business news sources.
Dogpile begins by searching the larger general content search engine databases and general purpose directories, and then gradually moves through smaller, more specific search engines. The user is permitted to alter the order of search, however.
Open Directory Project
The goal of this new engine is to produce the most comprehensive directory of the web, Similar to Yahoo, listings are organized by category and reviewed by editors. The ODP is a Web directory, not a search engine. Although they do offer a search query, the purpose of the ODP is to list and categorize web sites. They do not rank, promote or optimize sites for search engines. The ODP is simply a data provider.
WebFerret
WebFerret is free software that searches the internet for you. (This type of program is called a “bot.”) WebFerret uses several search engines, looking as deeply as you like to “ferret” out the pages you’re interested in. You can search the entire text of pages, their titles and descriptions, just their titles, or even just their URLs. What search features you select determines how fast WebFerret works.
In addition, WebFerret will eliminate duplicates by URL, title, or host. WebFerret will list the pages it finds by relevance, title, address or source, then you can save your search as WebFerret search results (an ASCII file or HTML). Since WebFerret is a small program, so it can work in the background.
VII. Summary
The Internet continually offers more opportunities to find information on medical and related topics. However, with the expanding resources comes a larger challenge for net-researchers to find the information they are seeking. The more experience the researcher gains the more proficient they become in finding pertinent data.
Janabeth F. Taylor, R.N., R.N.C. has a degree in Nursing from Oklahoma State University and a Litigation Paralegal Certificate from the University of Oklahoma Law Center. She was a nursing instructor for ten years and has been a medical legal consultant since 1990.
The American Trial LawyerÕs Association (ATLA) named Mrs. Taylor PARALEGAL OF THE YEAR 2002.
Mrs. Taylor is currently President/Owner of Attorney’s Medical Services, Inc. in Corpus Christ, TX. She provides litigation support for attorneys across the United States and specializes in case reviews and Internet information resources.
