Kitemarking the west wind

Editor—We disagree with several of the ideas expressed by Delamothe in his editorial—for example, that we cope without the help of kitemarks and gateways in the real world.¹,² Book reviews, television programmes, even the BMJ are all counterparts of “infomediaries.” There is also consensus that any gateway, kitemark, or trustmark cannot and does not intend to guarantee the “accuracy” or completeness of information,³ as implied by the editorial. Instead, they should be seen and used as tools to increase transparency.

The European Union project MedCERTAIN (MedPICS Certification and Rating of Trustworthy and Assessed Health Information on the Net) will use the concept of a third generation of trustmark, which must be discriminated from traditional kitemarks. The approach can best be explained by drawing an analogy to food labels. In order to direct consumers to a healthy diet we are not telling them which products to eat specifically; instead we educate consumers about healthy constituents of a diet, encourage food providers to use clear labels telling consumers important facts—for example, how much fat and sodium the food contains—and regulate how these labels are displayed, and what they must contain. Together, these measures empower and encourage consumers to make informed choices. We hope that the MedCERTAIN trustmark will play a similar part on the world wide web, by educating users and encouraging information providers to label their services, but also by monitoring and evaluating these labels to prevent misuse and by making transparent what others say about the service. Information providers certified by MedCERTAIN will display electronic labels using a standardised vocabulary (MedPICS), containing all relevant information allowing consumers to judge the quality of an information provider themselves and to select information that is relevant and appropriate for their individual needs. Moreover, users may set their own preferences by using a special browser add on to get automatic alerts and advice if a site does not meet their individual requirements. This concept of “downstream filtering” is different from attempts of upstream filtering such as the dot.health proposal of the World Health Organization.⁴ Our decentralised system depends on building a network of developers, users, information providers, and evaluators, much as the Cochrane Collaboration built a network in its field. The Heidelberg Collaboration for Critical Appraisal of Health Information hopes to be an initiative to help lay people, patients, and professionals to identify health information useful to them—for example, by developing and sharing methods with an international network of colleagues.⁵