Spine is expanding on the Internet

Minimally Invasive Spine Surgery: Analyzing Internet-based Education Material

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVE

The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS).

SUMMARY OF BACKGROUND DATA

Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability.

MATERIALS AND METHODS

The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified.

RESULTS

Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company.

CONCLUSIONS

Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.

Threats to scientific advancement in clinical practice

STUDY DESIGN

Point/counterpoint.

OBJECTIVE

To facilitate debate regarding conflicts of interest and ethical considerations in physician/industry relationships.

SUMMARY OF BACKGROUND DATA

We find ourselves working in a health care system in which nearly $2 trillion are spent, only to rank 37th in world health. That much money at stake piques peoples' interest, and various parties, without loyalty to the Hippocratic principles, will find opportunities to gain financially. Clearly, current health expenditures do not always coincide with better outcomes. Yet some believe that over 20% of the gross national product will be necessary to maintain our health care system in the future. Medical liability causes a paradoxical situation: physicians are at times driven to use the newest technology and perform many diagnostic tests, for fear of litigation. This practice is often independent of the best evidence.

METHODS

Literature search and experience.

RESULTS

The nature or magnitude of conflict(s) of interest influences the risk of bias in research. It is important to acknowledge and disclose these potential conflicts while recognizing that the existence of such conflict does not necessarily adversely affect the quality of the research.

CONCLUSIONS

Conflict of interest need not be a conflict of the mind and is not an evil. Physicians need to disclose all relationships to industry and/or other potential conflicts in order to maintain the trust of one's community, and in order to advance the best science.