MedSpain

DRUG THERAPY RESOURCES ON THE WORLD WIDE WEB

Cándido Hernández-López

Unitat de Farmacologia, Institut Municipal d’Investigació Mèdica (IMIM)-Hospital del Mar, Barcelona, Spain

INTRODUCTION

Health care professionals have adopted slowly Internet like/as a new working and training tool¹ . There are three obstacles to routine integration of the Internet (the net) into the mainstream of health care practice. First, the minimum requirement of hardware (computer, telephone connection, modem, etc) and the procedure for obtaining internet connection (software, providers, etc) mean an expense that not every country (undeveloped countries), institution (national health system, medicaid) or professional (residents) can afford it. The second is the reluctance or animosity of some to novelties, specially when traineeship is required to understand and use them. Third, frustration that exists in attempting to locate relevant informative sites in the vast abyss of cyberspace^2,3 . Therefore Internet is still so far to become a comprehensive, indispensable and everyworld accepted tool for clinical practice. In spite of it, a small number of professionals are now/already faced up to expressions like quality and impact of the health information on the net. Even they dare to define criteria for measuring quality and impact of the world wide web (the web)^4,5,6,7.Such audacity is born from groups and individualities who knew the "dizziness" induced by navigation on the net, but they have learnt to manage it and now begin to ask theirself Why? and What for? about the vast information on the web concluding " good for quantity but better with quality ". We follow closely the interesting task of these investigators, who possibly are founding a new topic (Net-metry? ,in the manner of Bibliometry) .

In the present article we would like to show what offers the Internet. In particular, and because clinical pharmacology is our main interest, offering a description of drug therapy resources availables in the web. This article is not addressed for beginners, although provides enough web sites that only need to be typed. Thus, it will not describe general information about Internet (connecting, glossary of terms, basic facilities, etc) because previous articles already have devoted to this matter^8,9,10 .

SOME PREVIOUS QUESTIONS: WHAT ? HOW ? QUALITY ?

If the problem, for health care professionals, is not too little information but too much, first they should wonder what are searching on the net. Second, they should know the tools – when there are – or websites that facilitate for locating inquired information (how). And third assessing, controlling and assuring the quality of requested information.

What searchs the health care professional about drug therapy

on the web ?

In general professional interests in drug therapy information could include: drug use and related problems – guides of prescription, drug databases, glosaries of pharmacological terms, adverse drug interaction lists, etc -, knowledge about scientific basis of drug use – pharmacokinetics and pharmacodynamics, evidence-based pharmacotherapy resources, etc -, or about legal basis of drug utilization and marketing – new drug approvals lists, system for drug licensing, clinical trials, pharmacoeconomics, etc -.

Even promptly supply can exceed demand and extends the wealth of information, for example, to doctorate programmes or continued medical education, scientific and professional organizations, congress information and others resources.

However it could be interesting to assess objectively what search professionals on the web about pharmacotherapy, by means of some methods that could be: (1) Surveys to health care professionals about their interests in drug therapy information. These surveys also would serve to evaluate users’ access to the web, their knowledge, needs and requeriments. Besides, these field studies also would identify steps users take to locate websites, the subset of websites and their assessment. Information about impact on clinical practice and effect of the web on users could be studied with the results. There do not seem to be any published trials of the access and requeriments of professionals, not neither of the effects of the web on clinical practice^5,11 .

(2) Visitors meters that many addresses on the web have to count number of accesses to webpages. It can use them to estimate what look for and find professionals about drug therapy. It would be an indirect implement to mesure which results would require to be compared with websites devoted to others different fields, and always confiding in veracity of amount indicator. (3) Rating System for websites: these rating systems are available from some addresses on the net[ ] , where users can participate scoring for their favourite websites. This is also an indirect and generic instrument since are scored addresses but not concrete subjects or resources within the vast field of drug therapy.

(4) Internet appearance in medical journals: MEDLINE and other bibliographic databases offer an indirect method to assess health professionals interests on the net and its impact on clinical practice. Thus, we used Internet keyword to search by means of Medlineâ (KR OnDiscâ for Windowsâ ) articles indexed since 1991 to november, 1997, arranged by years (see table I). We observed no articles published in 1991, while between 1992 and november 1997, were obtained 876 articles. However, attaching to Internet word search other keywords related to drug therapy (drug, drugs, pharmacy, pharmacology, pharmacotherapeutic, pharmacovigilance, therapeutics and toxicology) only 35 records were achieved (see table I). Careful analysis of these data should be another indirect method to assess what search on the web health professionals about pharmacotherapy.

Table I. Results by means of MEDLINE for each search strategy arranged by years.

1997* : untill november

How search drug therapy information on the World Wide Web ?

Searching by subject, name or keyword is carried out using Internet tools called "search engines" (s.e.). There are two kinds of s.e.: Indexes and Directories, although it is possible to have both functions in the same search engine.

An Index consists in one or more keywords which/that users typed. Index will search keywords typed within words list included in every webpage. Those lists, named metaelements or HTML META tags, are not visible/perceptible by users and consist of head and body. Within both there is all information about webpage filed in : title, description, identifier, date and keywords. Thus, Index turn us webpages that contain typed words. They suppose each Index follows a different search standard because each one has a different arrangement and ordering information criterion, therefore results will be dissimilar (see table II).

Directories list outcomes in categories which tend the data base to related and sometimes useful sites. Categorization and subcategorization applied in several Directories are not the most appropiate/suitable and how explain table II, follow/arise a different systematization in each Directory.

Indexes are inefficient but comprehensive. Directories are efficient but limited. Because of these do not discriminate between clinical and nonclinical information or someone’s personal web page and that of a prestigious institute or journal, a number of clinically focused indexes and Directories have been developed. Anyway, to search applying some Indexes and Directories is an excellent strategy^9,13 .

Is reliable/trustworthy and accurate the information achieved on the web ?

Any health care professional is able by himself to carry out a first and intuitive assessment of web information obtained in a search. Nevertheless, some authors have developed criteria for assessing the quality of health information on the web. More of these criteria are available in medical journals or webpages^14,15,16 . In short, the core standards that can help to assess and assure the quality of medical information on the Internet have been outlined by Silberg⁴ et al and by Wyatt⁵: Authorship and Credibility (web site authors ,affiliations and credentials, web site owner or sponsor), Structure and Content of webpages (references to sources, copyright, accuracy, currency and readability of material, quality of links to other sites, media used to communicate material), Functions of web site (accesibility of site: easy access by means search engines, short URL address to memorize, navigability through material, interactivity: comment to webmaster, e-mail to exchange remarks and informations, update webpages). In that respect, a simple strategy for users " to minimize the possibility of accessing inaccurate or erroneus data, should limit their searches to webpages of reputable sources (universities, government agencies), those created by health professionals, and those that provide references to the primary literature "³ .

SEARCHING DRUG THERAPY INFORMATION WITH THE MOST COMMON SEARCH ENGINES

We evaluated seven search tools, whether as Index function, or as Directory application, when it was possible. As Index, typed keywords were: drug, drugs, medicaments, medicines, drug therapy, pharmacotherapy, therapeutics, pharmacology and clinical pharmacology. As Directory application, we analized systematization of categories related to drug therapy (see table II). Search was done in october of 1997 but taking into account previous searches during september of 1996 and 1997¹⁷ .

As a consequence from net navigation we identified and assessed a considerable number of websites (more than 300 addresses) with the purpose to achieve a pharmacotherapy resources list arranged by subjects. Resources systematization that we propose with other published reviews^3,18,19 , and more else for publishing, jointly could be the basis of a round Directory devoted to drug therapy resources.

Table II. OUTCOMES FOR SEVEN SEARCH TOOLS FOR DRUG THERAPY RELATED KEYWORDS :

Table II shows that search engines evaluated as Index offer a gap in results between almost 40,000 and more the million of documents. The more quantity of documents does not mean the best search tool, since in his turn/in this sense quality is variable, and moreover/furthermore documents can repeat²⁰ .. Usually, documents or records that Index returns us (for example, twenty by twenty) follow quality criteria of ordering rested/based on times that keywords typed are held/contained within the document. Even, in accordance with ordering criteria, differences are observed between search engines.

Directories could offer a clear and suitable categorization, but we don’t find unanimity about systematization of drugs and pharmacotherapy information. Thus, we are amazed at Yahooâ , the most popular search tool, that places category Pharmacology and its/hers subcategories (see table II) within Biology section, while Pharmacy is included in Health section. A coherent Directory devoted to pharmacotherapy information could be one that followed categorization in subjects just as we propose bellow.

DRUG THERAPY RESOURCES ARRANGED IN SUBJECTS

This list of Universal Resource Locators (URLs) or websites is intended to be a launching point for busy clinicians, researchers and academicians, whether to obtain information via the Internet (receivers) or whether to share it (emitters) with other professionals. List is arranged in seven general subjects, each one divided into other issues.

TABLE OF SUBJECTS:

2. DRUG INFORMATION SITES.

• HEALTH BODIES AND MEDICINES REGULATORY AGENCIES.

• RESEARCH, ACADEMIC AND EDUCATIONAL RESOURCES OF DRUG

THERAPY RELATED FIELDS.

• PUBLICATIONS AND JOURNALS RELATED TO DRUG INFORMATION.

• PHARMACEUTICAL INDUSTRY

• EVIDENCE-BASED PHARMACOTHERAPY RESOURCES.

• SCIENTIFIC SOCIETIES AND PROFESSIONAL ORGANIZATIONS.

• DRUG INFORMATION SITES:

For some time now web sites as Pharmweb (stablished in 1994) or Pharminfo were the Directories more common and used on the net. Recently other Directories and Databases have born under the auspices of universities -generally from USA- , pharmaceuticals industry and mass media companies. Some of them need subscription and payment. Sometimes, professionals from non-USA countries have problems to access to resources hosted in USA, because these websites request them identification number of the American Medical Association (Examples are PDR on line Drug Database [ www.pdrnet.com] and MedEC Interactive Online Drug Databse [ www.medecinteractive.com] . Both industry supported).

• GENERAL DATABASES AND DIRECTORIES:

Several sites on the Internet provide general health and pharmaceutical information. General health Directories as Medical Matrix (http://www.medmatrix.org/Index.asp) or MedWeb (http://www.cc.emory.edu/ WHSCL/medweb.html) include drug information related subcategories. For example, in MedicalMatrix are available subcategories as Pharmacotherapeutics, Prescription Assistance Resources, or Clinical Trials, which allow us to obtain an acceptable number of websites with a brief description. Contribution of the American Medical Informatics Association in website maintenance is noticeable/evident. MedWeb offers through/by means of Pharmacy & Pharmacology subcategories a list of websites organized under relatively narrow subject headings that allows information can be extracted at a fast rate. This site is hosted by the Emory University Health Sciences Center Library. Besides, both search engines can use as Index. Others directories specifically pharmaceutical are Pharmweb (http://www.pharmweb.net) and Pharminfo (http://www.pharminfo.com) that tender numerous links and resources filed in a consistent order. Both are essential tools to add in our bookmark, although not to be recommended for exclusive use. Others addresses, as Martindale’s Health Sciences Center (http://www-sci.lib.uci.edu/HSG/Pharmacy.html) and World Wide Web Virtual Library (http://www.cpb.uokhsc.edu/pharmacy/pharmint.html), complement/supplement previous directories, let us to cover three common codes: .net (network), .com (commercial) and .edu (educational), with only four URLs⁸.

• DRUG DATABASES AND GUIDELINES OF PRESCRIPTION:

The three most representative drug databases are (1) the Clinical Pharmacology , Drug Monograph Service (http://www.cponline.com) , (2) Rx List (http://www. rxlist.com) and (3) Iowa Drug Information Service (http://www.uiowa.edu/~ idis), all three provide wide clinical information with useful monographs. Payment is required for some services. Pharminfo also provides a drug database: DrugDB, a generic and trade name database.

On the other hand, day by day new guides of prescription arise, with general interests or devoted to definite/particular medical specility or disease. Authors and sponsors’ guides overspread different fields. More vademecums, formularies and some national prescription products guides are available by pharmaceutical industry. Sometimes these resources are supported by the National Health Service or a medical association. Finally and most often/frequently, an university hospital provide its own guide of prescription on the net. In this respect antibiotic guides are prevailed/preponderated.

It should very useful on the web a complete/round and updated list devoted to these resources, which authorship and sponsor data were available. Some addresses that provide guidelines of prescription are shown in table III.

Table III. A number of universal resource locators (URL_s) about Guidelines of Prescription in different fields

• ADVERSE DRUG EFFECTS (ADEs), DRUG INTERACTIONS AND TOXICOLOGY RESOURCES:

A considerable wealth of ADEs information is hosted by health bodies, medicines control agencies (see below), or specifically, by regional-national centres of pharmacovigilance (table IV). There is not a complete Directory of worldwide centers of pharmacovigilance, what hinders health professional access to spontaneous reporting systems and ADEs information. Besides that, there are a few databases specifically devoted to ADEs and drug interactions, with the exception of/except for the DIDX’s adverse drug interaction search engine (http://csmctmto.interpoint. net/didx/public.html).

Table IV. Some centres, institutes or groups devoted to pharmacovigilance over the world

Regarding toxicology resources there is an assorted inventory: samples are (1) EXTOXNET (http://ace.ace.orst.edu/info/extonext), the EXtension TOXicology NETwork is a cooperative effort of University of Carolina-Davis, Oregon State Univ., Michigan State Univ., and Cornell Univ.; (2) the Agency for toxic substances and disease registry (http://atsdr1.atsdr.cdc.gov:8080 /atsdrhome.html) sponsored by U.S. Department of Health and Human Services, that provides numerous links and databases devoted to hazardous substances, (3) the Toxicon Multimedia Project (http://badger.uih.uic.edu) , at Univ. of Illinois in Chicago; and (4) HyperTox (http://www.ozemail.com.au:80/ ~ ouad/toxi0002.htm) a programm generated by the Department of Clinical Toxicology in the Hunter Regional Mail Centre, Australia.

• HEALTH BODIES AND MEDICINES CONTROL AGENCIES:

Significant amount of drug information are available in the web pages about regulatory health bodies and health agencies: legal information, system for licensing, medicinal products approved, treatments recommendations and guidelines are provided.

• HEALTH BODIES AND INTERNATIONAL ORGANIZATIONS:

The World Health Organization (http://www.who.ch) and the Panamerican Health Organization (http://www.paho.org) have their own webpages. Numerous countries, and exactly its health institutes, are on the net. But with respect to quantity and quality of these resources, highlight hosted in USA: National Institute of Health (http://www.nih.gov), the National Library of Medicine (NLM) (http://www.nlm. nih.gov) and the Center for Disease Control (http://www.cdc.gov). Outside the USA are the Canadian Health Network (http://www.hwc.ca/) and the National Institute of Health (http://www.nih.go.jp/), in Japan. All previous are source of pharmacotherapy information, although within a wide range of resources that sometimes makes difficult to find a specific kind/type of data. An undeniable wealth of drug therapy information is MEDLINE, the most used bibliographic database hosted by the NLM (see table I). Free access to this secundary source of information is available from June 26, 1997, although with some limitations. We propose connection through: PubMed (http://www.ncbi.nlm.nih.gov/pubmed) , what is tantamount/equal to the NLM itself, or else Healthgate (http://www.healthgate.com/healthgate/ medline/).

• MEDICINES CONTROL AGENCIES:

A resource to take into account is the Intenational Conference on Harmonisation-ICH (http://www.ifpma.org/ich1.html), a project that brings together the regulatory authorities of Europe, Japan and the United States and experts from the pharmaceutical industry in the three regions to discuss scientific and technical aspects of products registration. In addition, there are the national medicines agencies, which organize the vast information available in their webpages by means of Directories or sometimes, even Indexes (see before).

The Food and Drug Administration (FDA), in the USA, and the European Drug Regulatory Agency (EUDRA) that includes the European Agency for the Evaluation of Medicinal Products (EMEA) are the institutions with more quantity of information, more quality of presentation (structure and content), and better accesibility and navigability (functions of websites)⁵. Both allow to access on line and download of legislative material, information about medicinal products commercialised and news products approved, systems of pharmacovigilance and others databases , guidelines of drug investigation and links. Their potential users cover a wide range: from health professionals, researchers, pharmaceutical industry staff, health system managers, politicians, to even any citizen. In spite of this, complexity and specialization of information provided by those resources, become them tools for skilled/qualified personnel.

URL_s or websites of the most common medicinal and biological products agencies on the net are showed in table V.

Table V. Medicines Control Agencies

• RESEARCH, ACADEMIC AND EDUCATIONAL RESOURCES OF DRUG

THERAPY FIELDS:

These resources boom is yet. Thus, every day less/fewer university departments and less/fewer research institutes remain without their own webpage. Most medical schools and many hospitals have web sites, which, in part, serve as marketing devices, but also serve important community service needs, such as helping patients find special programs and providing public health information²⁰ . Authorship and credibility standards^4,5 of these resources are an advantage, that relatively assure quality of medical information. On the other hand, a not uncommon fault detected refers to update webpage. Thus, other quality criterion to consider in these web resources is this: updating degree/state.

2. INSTITUTES AND CENTRES FOR DRUG INVESTIGATION:

New drugs research and development, thus as new therapeutic indications are carried out in university departments, research institutes, medical centers and CROs (Contract Research Organizations), every day more present/current on the net. Access to those is possible through general Directories (see table II) or Directories devoted to clinical trials, as CenterWatch (http://www.centerwatch. com) that provides details profiles of more than 150 clinical research centers (all in North America). Information achieved include general and staff information, list of departments and laboratories, research interests and main research programs, publications and links to other resources. Day by day, Internet facilities/opportunities grow, and thus some firms/companies offer web-based investigator data capture tools, strategies to recruit potential/possible volunteers for clinical trials, or job opportunities for investigators.

Some websites of drug research institutes and CRO_s are shown in table VI.

Table VI. Institutes and Centres for drug investigation web sites

• UNIVERSITY DEPARTMENTS OF PHARMACOLOGY:

A wide of university departments devoted to drugs and drug therapy (pharmacology, clinical pharmacology, therapeutics, pharmacy and toxicology) are availables on the net, by means of lists of links ordering in geographic regions. Among the best catalogues there is the achieved by Department of Clinical and Experimental Pharmacology in Graz University, Austria (http://www.kfunigraz. ac.at/ekpwww/links.html) with more than 120 links to USA departments and as many in Europe, and the rest of the world. These websites are achieved and ordering by area, country and city, and continuosly update. Even this resource offers to users possibility of let us know via electronic mail (e-mail) when an address is moved or new resources are located. University of West Ontario, in Canada (http://www.uwo.ca/pharm/pharmtox.html) hosted other schedule of links, but less exhaustive.

• PHARMACOKINETICS AND PHARMACODINAMICS RESOURCES:

A brief number/amount of URLs with useful pharmacokinetics (PK) and pharmacodinamics (PD) resources include (1) the University of Oklahoma that provides links to PK/PD resources and an interesting course in PK and Biopharmaceutics (http://www.cpb.uokhsc.edu/pkin/pkin.html), or (2) the Anesthesiology Department of Stanford University offers PK and PD software including NONMEN and others (http://pkpd.icon.palo-alto.med.va.gov), and (3) the University of Auckland in New Zealand (http://www.phm.auckland.ac.nz/ pkpd.html) with a Pharmacometric home page with links and information about PK/PD data analysis. Recently, use/using Internet as a pharmacokinetic information resource arose/was arisen in a prestigious journal with a squeeze/crowd and pleasing review that provided more than twenty WWW sites with useful PK/PD information and teaching resources²¹ .

• PHARMACOEPIDEMIOLOGY AND PHARMACOECONOMICS :

These resources are provided through differents websites as (1) School of Public Health in Harvard University (http://www.hsph.harvard.edu/ Organizations/DDIL/ddilhpge.html), (2) the Univ. of North Carolina at Chapel Hill School of Pharmacy (http://sunsite.unc.edu/pharmacy/Cepor/cepor.html), or (3) the Univ. of Bayreuth in Deutchland (http://www.uni-bayreuth.de/ departments/vwliv/hec.html). All they provide links to associations, courses, databases, institutions, journals, sofware and topics in Health Economics, with emphasis on the two most common pharmacoeconomics tools: cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA).

• EDUCATIONAL RESOURCES:

Limited free access and subscription are need to navigate through many of these web resources. Perhaps, because potential users (university students and teachers) are not considered by some sponsors, which are more disposed/prone to finance resources aimed/addresses at clinicians. However, wealth of educational resources could be more extensive for health professionals, because physician’s need for objetive, concise, and well organized information on drugs is obvious²² .

The Pharmacology Higher Education Network is a pharmacology educational resource, pionner on the net. It was established in 1994 with Employment Department (UK) funding, to establish a cohesive network of pharmacology teachers in differents institutions "to enhance co-operative improvements in the quality, effectiveness and efficiency of pharmacology teaching and to provide for improved dialogue between teachers and employers". Others resources on the web include pharmacology technical vocabulary, problem solving techniques, lecture notes, exam questions, drug lists and guide to good prescribing or even a complete course of pharmacokinetics. Most common websites devoted to educational resources related to drug therapy are filed in table VII.

Table VII. Educational resources devoted to drug therapy

• PUBLICATION AND JOURNALS RELATED TO DRUG INFORMATION:

Different scientific and clinical publications are available in Internet (CD, books and journals).Medical publications present in the Internet increased from 0 in 1992 to more than 100 in 1995²⁰ , some of them have general interest (BMJ, NEJM, The Lancet,..) and others speciall interest in pharmacology or pharmacotherapy (British J Clin Pharmacol, Clinical Pharmacokinetics, Drugs, Eur J Clin Pharmacol, The Medical Letter, etc..), offering the opportunity to consult their tables of contents with or without abstracts, but rarely allow full text. Subscription or pay-per-view is already possible on the net. An advantage of the Internet, and about medical publications presence, bases on its widespread availability and reduced publishing and mailing cost . Therefore issues related to copyright, economics, and peer review are not still resolved²³ and even begin to arise problems when drug advertisers/publishers take website texts, for example recognized medical publications, from others and wrap their own advertiser’s material around them⁷ .

2. SITES THAT PROVIDE LINKS TO PUBLISHERS AND JOURNALS:

3. Department of Clinical and Experimental Pharmacology in Graz University, Austria, also provides a complete and update catalogue of links to journals (more than 100) and publishers (39) related to pharmacotherapeutic fields (http://www.kfunigraz.ac.at/ekpwww/linkzsch.html). Other Directories to consider/take into account are MedWeb (Categories: Pharmacy & Pharmacology® Electronic Publications) and Yahoo (categories: HealthÕ Pharmacy® Journals).

    

4. PUBLISHERS AND JOURNALS RELATED TO DRUG THERAPY:

Some of publishers and journals devoted to drug therapy field are filed in table VIII.

Table VIII. Addresses for some publishers and journals related to therapeutics.

• PHARMACEUTICAL INDUSTRY:

Connection to more than eigthy pharmaceutical companies and manufacturers associations. Frecuently they offer a profusion of graphics with messages from their chairman, financial reports and growth strategies. They also provide information about product and research areas, but only in few occasions provide useful pharmacological information and other links.

2. MANUFACTURER ASSOCIATIONS:

More significative addresses of manufacturers associations are showed in table IX. Contents are related to aims, association members, and offering links to other addresses related to pharmaceutical industry.

Table IX. Manufacturers Associations websites

• PHARMACEUTICAL COMPANIES:

Registers of links to pharmaceutical companies are available through websites such as: Pharmweb (see 1.1.), or Yahoo (categories: HealthÕ Pharmacy® Companies). Several of these laboratories provide interesting resources as (1) The Merck Manual (http://www.merck.com/!!rhhQd3PVkrhhQy3Rgd/pubs/ mmanual/html) , with different sections, one of them entittled Clinical Pharmacology devoted to PK and PD information, Drug Toxicity, Placebos, etc or (2) The Glaxo Wellcome pharmacology guide (http://www.glaxowellcome. co.uk/science/phguide) with contents about in vitro and in vivo pharmacology, molecular pharmacology, molecular basis of drug action , neurotransmitter systems, etc.

• EVIDENCE-BASED PHARMACOTHERAPY RESOURCES:

Evidenced-Based Medicine is for somebody the new paradigm in clinical practice. This new approach is developing actively through the Internet[ ] , offering interesting websites: (1) The Health Information Research Unit maintained by the Mc Master University in Canada (http://hiru.mcmaster.ca/), provides resources as the Cochrane Collaboration, the Evidence-Based Medicine Project and Journal and others; in the UK (2) the University of Oxford supports the Centre for Evidenced-Based Medicine (EBM) (http://cebm.jr2.ox.ac.uk/ index.extras) and important related resources as the journal Bandolier. Regarding to catalogues of resources related to EBM is (3) the AuRACLE Project, Automated Retrieval Assistant for Clinically-relevant Evidence (http://panizzi.shef.ac.uk/auracle/aurac.html), created by the Univ. of Sheffield. Other resources, specificaly devoted to EBM information on drug therapy are: (4) the Therapeutics Initiative (http://www.interchg.ubc.ca/ jauca/index.html), created by the Univ. of British Columbia in Canada; and (5) the Centre for Evidence-Based Pharmacotherapy (http://www.ccc.nottingham. ac.uk/~ paxjc/clinphar.htm), sponsored by the Univ. of Nottigham, in UK.

• SCIENTIFIC SOCIETIES AND PROFESSIONAL ORGANIZATIONS:

Every year more proffesional associations or societies, devoted to drug therapy fields, have their own webpage. In these pages they describe its aims and objetives, membership, meetings, scholarships and awards, publications and additional information. In many cases access to journals, databases and others pharmacology related links are also available. Links to societies and organizations related to pharmacotherapy fields are arranged in table X.

Table X. A number of scientific societies and professional organizations devoted to drug drug therapy field.

CONCLUSION

When Johann Gutenberg invented in the 1400’s the first movable type/printer, a wide range of uses and applications would cross his mind: from Holy Bible edition to classical texts. At that time, this novel engine would cause/create an anxiety estate compared to present time with Internet. However nowadays, there is no dubt that unsuitability of inquisitorial attitudes, as formerly happened, but now it`s necessary a favourable predisposition. At present we are on the cusp of a revolution in computer technology²⁴ which means that information will tend to carry through the Internet. As in the past with Gutenberg’s invention, who no adopt/assume new technology runs the risk of to be removed/to fall into oblivion, due to inherent/intrinsic dynamism of the new communication networks. But there is a remarkable difference between the printer and the Internet. Thus, there is not a permanent/stable substratum/support, as books were and follow being, that remain at time. In the future, it will be difficult/hard to assess how happened/ occurred the historical evolution/development health information through the Internet, unless we use secondary sources: newspapers, journal articles, books and handbooks about this matter. We believe short efforts/tasks like present article can display/show what there is and what there was about the new engine at the end of the XX century.

About what now there is in the World Wide Web devoted to pharmacotherapy, we confirm the vast information achieved on the web. Besides, that information amount tend to increase even more, what day by day makes harder to locate specific/particular information in that tangle well-named net. With regard to quality of information, the web has a fluctuating value. Thus, access to original and quality information in the Internet is not yet like conventional channels/ networks (journals, books etc) except for scarce resources, and as usual only by payment. Up till now, easiness to achieve articles in a wide range of medical journals keeps greater in our educational and hospital libraries, than on the web. This situation is compensated when by means of ciberspace it’s possible, for example, to know table of contents of next journal issue, even before that new edition was distributed, or accessing to spontaneous reporting systems that provide update information (regarding that remember when FDA announced withdrawal of Fenfluramine and Dexfenfluramine in september, 1997)²⁵ , or even else, to download free material and software on the net that allow us to improve congress presentations or academic/university lessons.

Therefore, actually the World Wide Web is probably the most powerful and simplest method of providing and retrieving drug therapy information on the Internet. Lacks of the WWW – scattered information, questionable/dubious quality and others – are failed subjects that can be mended. WWW potency – freedom of speech, quick and cheap information distribution, intercommunication, "worldwideness" – could safeguard extremely.

Advice

It’s not impossible some addresses were moved when you try connect. There is more than 100 websites in this article achieved in september-october, 1997. Some websites provide, at the same time, links to other sites achieving an amount of more than 300 addresses related to drug therapy. A complete list of these resources could be send to interested readers addressing to authors.

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Correspondence and requests: Candido Hernandez-Lopez, Pharmacology Unit, Institut Municipal d’Investigacio Medica (IMIM), Dr Aiguader 80, 8003 Barcelona, Spain. URL: http://www.imim.es/imas/

E-mail: clopez@imim.es

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