Be careful about reading health books. You may die of a misprint.-Mark Twain CHRONICLING THE JOURNEY The Internet has forever changed the way we access and obtain health information. In 2006, the Pew Internet & American Life Project estimated that almost 80% of Internet users had searched for online health information, with medical diseases, health problems, medical treatment, and nutrition being the most popular topics 1. Yet, for almost 2 decades, ever since Tim Berners-Lee introduced the World Wide Web to the public, there has continued to be an underlying concern about the quality of health information available online. The natural assumption is to believe that there exists a link between the quality of information on the Internet and harm. However, a systematic review attempting to evaluate the number and characteristics of reported cases of harm in the peer-review literature determined that for a variety of reasons, there was little evidence to support this notion 2. Nonetheless, considerable resources continue to be spent on developing and disseminating quality assessment tools to evaluate online health information. Five broad categories could be used to classify assessment instruments to evaluate the quality of online health information: codes of conduct (e.g., American Medical Association), quality labels [e.g., Health On the Net Foundation (HON)], user guides (e.g., DISCERN), filters (e.g., intute.ac.uk), and third-party certification [e.g., Utilization Review Accreditation Commission (URAC)] 3. It has even been suggested that the nature of the site domain (i.e., .gov or .edu) could be associated with higher quality rankings 4. However, others have questioned this assumption 5. In fact, the debate as to what determines quality is so tenuous that the sheer number of instruments to accomplish this task has exploded from 58 to over 270 in less than a decade 6-8. Measurement of the quality of health information on the Internet, some have argued, might be a futile pursuit after all 9 .
