The Wild, Wild Web

* Readers should be warned that The Post's new health Web site, www.washingtonpost.com/ health, launched April 13, included potentially dangerous drug information. Information on the site, provided by Inteli-Health, Inc., in association with Johns Hopkins, is out-of-date and inaccurate. Here are just three examples:

For the nighttime heartburn drug cisapride (Propulsid), The Post's Web site advises for "Infants and children: No special problems are expected if the drug is used exactly as prescribed." There have been 38 reports of death from heart rhythm disturbances, including several in children, associated with the use of cisapride during its first five years on the market. The June 1998 revised labeling for this drug states the "safety and effectiveness [of cisapride] in pediatric patients under the age of 16 years have not been established for any indication."

Second, The Post's Web site incorrectly states that the short-acting form of nifedipine (Procardia capsules) is used to treat "high blood pressure." This form of the drug has never been approved by the Food and Drug Administration for the treatment of high blood pressure. In fact, short-acting nifedipine was relabeled in 1997 to say "Procardia capsules should not be used for the control of essential hypertension" because of its association with an increased risk of heart attack and death when used to treat high blood pressure.

Third, the Web site still contains information on the painkiller bromfenac (Duract), a drug banned in June 1998 because of liver toxicity, and makes no mention of the fact that this drug should not have been used for longer than 10 days. Bromfenac was relabeled in February 1998 with the following warning: "Duract is a nonsteroidal anti-inflammatory drug (NSAID) indicated only for the short-term (10 days or less) management of acute pain and is not indicated for long-term use."

Abigail Trafford's Health section commentary claims the quality of the Web site information is up to the "standard you have come to expect from The Washington Post." For now, these standards are not being met.

Larry D. Sasich, Pharm.D, MPH

Sidney M. Wolfe, MD

Public Citizen's Health Research Group

Washington

Scott L. Sherman, assistant dean of the Johns Hopkins University School of Medicine, sent the following reply to Sasich and Wolfe:

"I am writing to assure you that Inteli-Health and Johns Hopkins are taking immediate action to respond to the problems you identified.

First, we are having Duract removed from the database. Second, we have edited the listings for Propulsid and Procardia to make them up-to-date and accurate and have transmitted those changes to The Post.

A word of explanation regarding the deficiencies you identified is in order. The Post's Web site initially included an electronic download of a book, "The Johns Hopkins Complete Home Encyclopedia of Drugs," which was up-to-date at the time of printing. The Post should have received instead a separate online database, which has been regularly updated to reflect changes (including the recall of Duract). Thanks to you, we discovered this problem and are taking steps to correct it.

Johns Hopkins is committed to medical accuracy in all we do. Your questions have promoted a thorough review of our procedures for online publishing of drug information. We therefore appreciate the fact that you brought these matters to our attention."

Health section Editor Abigail Trafford adds:

The World Wide Web is a new universe of news and information--and its use can lead to questions of accuracy online, as the letter from Public Citizen illustrates.

The problems here occurred on the Inteli-Health Web site created by Johns Hopkins University and Health System and Aetna U.S. Healthcare. The Washington Post newspaper forms the backbone of Washingtonpost.com, but it does not account for all the material on the site. Once online clickers move from the stories that also ran in the newspaper, they leave the traditional territory of journalism. It is not possible for The Washington Post Co. to verify all the data available on the Web the way a reporter evaluates information in a story. In some ways, Web surfers have to make their own evaluations when they click on non-Post material.

At the same time, there is a common commitment to accuracy and excellence on the health site among Washingtonpost.com and its partners, including Newsweek, Inteli-Health, the Associated Press and Reuters. The editors at Washingtonpost.com want to hear from users about their experiences on the site.

The editors at Washingtonpost.com pulled the three drugs in question off the site after receiving the letter from Sasich and Wolfe.

Officials at Johns Hopkins have agreed to update the entire Inteli-Health database on drugs by the end of the month. After that, editors at both Inteli-Health and Washingtonpost.com will monitor action by the Food and Drug Administration that changes the status of any drugs and they will update the online database.

Corrections

* A May 4 answer in the Patient's Advocate column about qualifying for Medicaid coverage had an error. If a husband or wife needs to move into a nursing home or other institution and is seeking Medicaid coverage but the other partner can remain at home, the partner at home can keep at least $2,050 of income per month. That amount could be even higher if some or all of the income is in the name of the spouse who is not institutionalized. Medicaid is a complicated program and people with specific questions about their personal situation should seek further information from Medicaid officials.

On May 11, the column talked about how a spouse of a federal employee who dies can get insurance through the federal health plan. It correctly stated that survivor coverage is allowed if the employee was enrolled in family coverage before death. However, there are no other conditions necessary to guarantee survivor coverage.

* An illustration with the Bodyworks column on May 25 should have been credited to Davy Liu.

Letters intended for publication must be signed and include the writer's home address and home and business telephone numbers. Letters may be edited. Send letters to Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071 (Fax: 202-334-6471). Our Internet address is health@washpost.com.