The Internet has become a valuable instrument for communication of the written word. In the past, direct oral speech and the written word were the principal means by which people communicated. The telephone and radio increased the opportunity for oral communication; now reinforced by cellular phones, oral communication has become nearly instantaneous, nearly always available and can include several persons separated by great distances.

The Internet has done the same with the written word. Being able to send a written message rapidly and at modest cost (providing both parties have the appropriate equipment) raises written messages to the same level of convenience and availability that has been achieved with oral communications.

In addition, the Internet is also beginning to have profound effect on the storage and retrieval of information, including medical and scientific information. Most new scientific and medical information before being published are "peer-reviewed." The information (generally a manuscript) is submitted for publication to a journal. The journal editor assigns the manuscript to several experts in the field and receives their comments about it. The reviewers' comments are shared with the manuscript's authors, who generally revise the manuscript to address the concerns of the reviewers. The journal editor is then able to decide whether to publish the revised manuscript or reject it. This process is call "peer-review" and is the method used by nearly all accepted scientific and medical professional journals. It assures the reader that experts in the field have found the manuscript scientifically acceptable, the new information can be relied upon, and it is of enough importance to be published.

A number of scientific journals are now using the Internet for publication of the abstracts of peer-reviewed manuscripts accepted for publication; sometimes for publication of the whole manuscript. But like publication in a written journal, the manuscripts or abstracts have been peer-reviewed and the information is considered to be reliable and significant.

However, anyone who subscribes to the Internet can transmit nearly anything he/she wishes --- without peer-review. Under these circumstances, the reliability of the information is uncertain and each Internet reader has to be his/her own judge.

Nearly all scientifically reliable authors would be very hesitatant to transmit a manuscript on the Internet without the benefit of the peer-review mechanism. For example: describing a clinical experience (e.g. a new treatment) may be interesting but can be misleading. The reliability of the description can be affected by several biases involved in patient selection and in the interpretation of the observations reported upon. A clinical observation or series of observations can serve as the basis for the development of a clinical trial, but very rarely qualify as the equivalent of a clinical trial. Thus, clinical observations described on the Internet generally would not be accepted by a peer-review journal as being scientifically acceptable for publication.

The Internet certainly improves communication and can serve as a useful means of sharing medical and scientific information. But the information can be very misleading unless the reader is either skilled in the field or has assurance that the information has been peer-reviewed. Just because someone has put information on the Internet does not mean it is true or reliable. Medical and scientific information that has not undergone peer-review can easily be misinformation. Before you believe, check it out with a reliable expert. The Internet is an excellent method of communication, but not necessarily an excellent source of reliable information.

United Cerebral Palsy Research and Education Foundation, November 1999