TO THE EDITOR:
We congratulate Golladay et al. for their fine job of reviewing Internet resources in "Current Concepts Review. Internet Resources for Orthopaedic Surgeons" (80-A: 1525—1532, Oct. 1998). The description of the origin and the current status of the Internet and, more importantly, the review of the resources available at the time of writing were both informative and thorough.
Inevitably, several of the trends mentioned in the review have worked to make information in it incomplete or out of date. PubMed, the free Medline service of the National Library of Medicine (www.ncbi.nlm.nih.gov/PubMed/) was introduced after the article was submitted and has revolutionized the work of reviewing the literature. Collaboration between orthopaedic sites has reached the stage that seven of the ten selected orthopaedic Web sites in Table V post the same links collection (Orthopaedic Web Links, OWL, now at owl.orthogate.org). Indeed, such is the pace of change on the Internet that two of the sites, Link Orthopaedics and Orthopaedic Information Service, are no longer maintained or updated even though the pages are still on the Internet.
One of the major barriers to the use of the Internet for serious academic activity is this fluidity and the sense that finding what one needs is enormously difficult. The authors correctly identified the 1998 Annual Meeting of the American Academy of Orthopaedic Surgeons as a turning point because of the foundation of Orthogate (www.orthogate.com) and the nonprofit Internet Society for Orthopaedic Surgery and Trauma (ISOST) (www.isost.org). The Society aims to provide the international academic backing for the Orthogate Project. The fundamental aim of Orthogate is to provide a clearinghouse for orthopaedic information on the Internet so that anyone who wants up-to-date pointers to orthopaedics can find them in the form of links, search engines, case presentations, reviews, materials for continuing medical education, and databases. Orthopaedics is leading world medicine in this process of amalgamating and organizing Internet resources at the international level.
The authors alluded to potent forces drawing medical research journals onto the Internet, such as costs, distribution problems, and the decreasing budgets of health-science libraries. Their own article highlighted another reason to welcome the Internet and to promote the movement of academics and journals such as The Journal of Bone and Joint Surgery onto the Internet. It is hard to stay current in the real world and impossible to reflect Internet reality in the static medium of print. We, the members of the Orthogate Project, believe that such reviews belong on the Internet where they can be easily and frequently updated and remain valuable. We cannot imagine the academics of the twenty-first century taking place at the speed of print media; we believe that it is only a question of time before all orthopaedic information is on the Internet, and the sooner the better. We are setting up Orthogate as a clearinghouse so that this process is expedited and comfortable for all concerned, and we urge all orthopaedic surgeons to support this endeavor.
J. F. Myles Clough, B.A., B.M., B.Ch., D.Phil., F.R.C.S.(C): 303-321 Nicola Street, Kamloops, British Columbia V2C 6G6, Canada
Magdy Anwar Abdelmaksoud, M.D.: P.O. Box 331, Tanta, Egypt
Peter E. J. Kamstra, M.D.: Department of Orthopaedics, Scheper Ziekenhuis, Boermarkeweg 60, 7824 AA Emmen, The Netherlands
Mangal Parihar, M.D.: Mangal-Anand Hospital, 48 Swastik Park, Chembur, Bombay 400071, India
Randale C. Sechrest, M.D.: 2831 Fort Missoula Road, Suite 106, Missoula, Montana 59804
David L. Nelson, M.D.: 56 Delmar Street, San Francisco, California 94904
Eugene Sherry, M.D., F.R.A.C.S.: Department of Orthopaedic Surgery, University of Sydney, Penrith, New South Wales 2750, Australia
Jan Van Der Bauwhede, M.D.: Department of Orthopaedics, AZ Groeninghe, Houtmarkt 33, B-8500 Kortrijk, Belgium
Charles Eaton, M.D.: 1000 45th Street, 2, West Palm Beach, Florida 33407
Mel Heiman, M.D.: 15215 Foxchase Lane, Abingdon, Virginia 24210-7741
Dr. Golladay, Dr. Kirschenbaum, Dr. Matthews,and Dr. Biermann reply:
We appreciate the comments by the members of the Internet Society for Orthopaedic Surgery and Trauma. That some of the orthopaedic Web sites that we listed have changed or are no longer being updated does indicate the dynamic fluidity of the Internet as a source of medical information. Still, we firmly believe that there is a place for information about the Internet in printed journals and a place for printed journal information on the Internet, particularly during this period when both resources are viable.
While many Web pages are updated frequently, others are not maintained in such a current manner. As stated in our review, the confusion that is created by these frequent changes can be relieved if authors clearly indicate when their pages were updated and attempt to maintain some constancy with regard to location or at least to provide a forwarding link if their pages need to be moved. Indeed, the medium is at a formative stage and currently is considerably less consistent than conventional sources of medical information. While some authors suggest that printed journals will become obsolete, we believe that the current system offers many advantages. The peer-review process ensures that medical literature has been scrutinized. Articles published in historically respected printed medical journals carry with them the assurance that the material is presented fairly, the data are interpreted correctly, and the appropriate conclusions are drawn. Peer review on the Internet is in its early stages1. Printed literature implies permanence that is not subject to the whims of an author who may choose to alter or withdraw his or her work at any time, as is possible on the Internet. The Internet is a great equalizer, allowing every group or individual with a computer and Internet access to have their say. However, the quality of unregulated electronic medical information currently is, and may always be, in question.
While conflicts of interest are possible in both media, such conflicts are clearly identified in printed journals, allowing the reader to recognize the possibilities of bias and to draw his or her own conclusions. In contrast, medical information on the Internet may be subject to the influences of self-promotion or financial interest without disclosure.
The Internet is an expanding tool for the timely dissemination of credible medical information. However, until there is better regulation for quality assurance, peer review, indexing, and constancy in accessing medical information on the Internet, conventional printed means of disseminating information, such as The Journal of Bone and Joint Surgery, will remain important, reliable, and timely medical media.
Gregory J. Golladay, M.D.; Larry S. Matthews, M.D.; J. Sybil Biermann, M.D.: Section of Orthopaedic Surgery, Department of Surgery, University of Michigan, 2912 Taubman Center (G. J. G. and L. S. M.) and 7304 CCGC (J. S. B.), 1500 East Medical Center Drive, Ann Arbor, Michigan 48109
Ira H. Kirschenbaum, M.D.: Westchester Bone and Joint Associates, 7 Reservoir Road, White Plains, New York 10603