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Government health web sites; a primer

By Gary Bryant

All significant medical research has one thing in common: government participation in the form of regulation or funding, or often both. Consequently, the Federal government should be your first stop for health information. Most of the health information provided by the government will come through agencies of the Department of Health and Human Services (HHS). Through any of its major health information gateways, you can get information on clinical trials, research centers, medical devices, and background information on virtually all diseases and conditions. Below is a list of the more significant Federal sites.

FirstGov.gov
http://www.firstgov.gov/

With more than 186 million Web pages, FirstGov.gov is the gateway to every agency, database, publication, and policy that the federal government intends the public to see. FirstGov.com. is operated by the General Services Administration (GSA) The home page includes a welcome message from the President. Content is organized under four tabs. While not specifically a medical or health site, FirstGov.gov can provide you with resources for Medicare and Medicaid as well as an ample supply of consumer education material. FirstGov.gov has been in operation since September of 2000. One sub-site to note is FirstGov for Science. It is one of several portals into the health activities of the federal government. Be sure to check out this link. http://www.science.gov/browse/w_127.htm

National Library of Medicine (NLM) Gateway
http://gateway.nlm.nih.gov/gw/Cmd

Developed by the Lister Hill National Center for Biomedical Communications (LHNCBC), the NLM Gateway is part of the National Institutes of Health (NIH). More than a health portal, the NLM Gateway is a meta search engine that will provide access to a number of "retrieval systems". (At the time of this writing, integration of the system was not yet complete.) From the NLM Gateway you will be able to search the following databases: MEDLINE/PubMed, OLDMEDLINE, AVs LOCATORplus, AVs LOCATORplus, ClinicalTrials.gov, DIRLINE, Meeting Abstracts and HSRProj.

Medlineplus
http://www.nlm.nih.gov/medlineplus/

Medlineplus is operated by the NLM and should be considered your first stop for any medical investigations. Working in cooperation with the NIH, Medlineplus provides one stop access to a wide range of health education and medical information services including medical literature databases, direct access to research studies through ClinicalTrials.gov, an illustrated medical encyclopedia, full text access to detailed drug information, a medical dictionary, and a large resource directory to help you locate hospitals, doctors, societies, nonprofit support groups, and other health resources.

PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

PubMed is a cooperative effort of the National Center for Biotechnology Information (NCBI), the NLM, and the NIH. PubMed uses a search retrieval system called Entrez, which is also used by a number of other science databases. It is an extremely powerful text-based search engine that can access citations in medical journals. A feature called Linkout connects the user with the full articles of cooperating journal publishers. In addition, PubMed provides access to the Medline citation database of more than 4,500 journals from more than 70 countries. 

ClinicalTrials.gov
http://www.clinicaltrials.gov/

Clinical trials are extremely important to medical research. They are required to determine whether or not a specific drug or treatment is safe and effective. Clinical trials are usually managed by the sponsoring agency, which can be a university, non-profit research center, the federal government or a private pharmaceutical company. ClincialTrials.gov exists to provide medical professionals and health consumers with access to clinical trial information. The site currently lists more than 8,000 clinical trials from more than 70 countries. Participation in a clinical trial has advantages and responsibilities. It is an opportunity to contribute to the body of science that may lead to health benefits for many people. Each clinical trial listing a ClincialTrials.gov includes a summary of the study's purpose, the status of the study, whether it is accepting participants, the criteria for acceptance, and specific contact information.

On ClinicalTrials.gov, there are a number of ways to create a search query. You can browse through listings by disease, treatment, and location. Your best bet, however, is to use the 'focused search' option which provides a pre-formatted search form allowing you to quickly hone your search results.

TOXNET - Toxicology Data Network
http://toxnet.nlm.nih.gov/

Wouldn't it be great to have a single Web site where you could learn about the impact of various chemicals on our environment, our food, and our medicines? TOXNET is just that and more. An outgrowth of the NIH Toxicology and Environmental Health Information Program (TEHIP) , TOXNET aggregates the data from a number of chemical databases under one Web site. The site includes links to consumer information, and tutorials bibliographies. It also integrates with the following databases.

"The Hazardous Substances Data Bank (HSDB) contains records on over 4,500 toxic or potentially toxic chemicals.

"TOXLINE®, with over 3 million entries, lays out the effects of drugs and other chemicals.

"ChemIDplus is the chemical database version of MeSH, providing nomenclature information to identify chemical substances cited in NLM databases.

"The Integrated Risk Information System (IRIS) includes Environmental Protection Agency (EPA) health risk assessment and regulatory information on over 500 chemicals.

"The Chemical Carcinogenesis Research Information System (CCRIS), sponsored by the National Cancer Institute (NCI) includes evaluated data and information derived from short- and long-term bioassays on over 8,000 chemicals.

Other accessible databases include the Toxic Chemical Release Inventory (TRI), GENE-TOX, a toxicity database of more than 3,000 chemicals created by the EPA y, and the Developmental and Reproductive Toxicology/Environmental Teratology Information Center Database (DART®/ETIC) covering toxicology literature collected since 1950.
Users may search all databases at once or individually. Additional resources are available including an extensive help system.

National Center for Biotechnology Information (NCBI)
http://www.ncbi.nlm.nih.gov/

The days of a single gray-bearded scientist working in a flask-filled basement laboratory are long gone. Today, computers, software, and large communications networks have become integral parts of the health landscape. From DNA sequencing to stem cell research, mountains of medical data require Herculean efforts to organize, track, and apply. The NCBI is the government's hot bed of scientific discovery. The Web site opens on a rich collection of databases, tools, and resources that can help any serious student of medical research. Home to PubMed Central, the NCBI Web site provides links to GenBank, a database of nucleotide sequences from more than 130,000 organisms, a number of molecular databases, genomes, literature databases, science tutorials, and a download area.

Genetics Home Reference
http://ghr.nlm.nih.gov/

This easy to use Web site provides information on genetic diseases and conditions caused by genetic disease. As of this writing, the site has cataloged 58 genes and 72 genetic conditions. The site also has a very comprehensible primer on genetic science, a genetic glossary, and links to additional genetic resources.
 
Genetics and Rare Diseases (GARD) Information Center
http://rarediseases.info.nih.gov/index.html

The NIH is offering healthcare professionals free assistance on two fronts in the form of its recently established GARD Information Center. Funded by the NIH's National Human Genome Research Institute (NHGRI) and the Office of Rare Diseases (ORD), the center provides healthcare professionals and their patients with immediate access to experienced information specialists who can furnish current and accurate information about more than 6,000 genetic and rare diseases. According to the Web site administrators, the GARD Information Center was established in February 2002. Since then GARD has responded to nearly 4,000 inquiries on rare and genetic diseases. The requests include many queries from physicians, nurses and other healthcare professionals, as well as patients and their families who have been directed to the site by healthcare professionals.

Medical Subject Headings (MeSH)
http://www.nlm.nih.gov/mesh/meshhome.html

This is a helpful site if you are planning detailed research using PubMed.gov. The MeSH Web site does not have any articles, reports or other medical data per se, but it does provide a resource for using correct terminology to formulate your search. All of the citations used in Medline/PubMed are indexed according to MeSH standards.

Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/

The CDC is another mega-resource for health researchers. An HHS agency, the CDC is focused primarily on public health issues. On your first visit, you will notice an immediate emphasis on infectious and emerging disease. The pages offer a wealth of statistics on every health topic imaginable. CDCWonder, a search tool deployed on the site, allows visitors to query a large collection of reports, publications, and health data. While CDCWonder does have a registration option, like all federal health Web sites, it does not require any type of login or registration. Additionally, all services, Web pages, and online tools are available at no cost.

Food & Drug Administration (FDA)
http://www.fda.gov/ 

More than any other government agency, the FDA is directly involved in the regulation of those things that affect our health. Thus, the FDA Web site is a major source of health information. Here is a quotation from their Web site: "It's FDA's job to see that food is safe and wholesome; that cosmetics won't hurt us; that medicines and medical devices are safe and effective; and that radiation-emitting products are not harmful."Like many other government agencies, the FDA has gone to great lengths to provide as much information as possible on its Web site. Although you may occasionally find yourself on a page that was last updated several years ago, the good news is that responses to questions are provided in fairly short order. Make sure you visit the 'about' section of the FDA Web site. There is a free Web-based course that provides an excellent overview of the agency's activities and responsibilities, which are addressed through an organization of 'centers'. Below is a list of the most important centers related to consumer health issues.

Center for Drug Evaluation and Research (CDER)
http://www.fda.gov/cder/

The most important responsibility of the CDER is to monitor clinical trials. Their mission is to protect the rights of participants and maintain the integrity of the resulting data from those trials. CDER reviews the results of clinical trials and if the benefits outweigh the risks, they approve the drug.
The CDER Web site provides links to a number of useful resources including:

"The Electronic Orange Book  a valuable resource for obtaining patent information on pharmaceuticals

"The National Drug Code Directory  primarily a universal identifier mechanism for prescription drugs

"Consumer Resources  a well stocked shelf of electronic brochures and other consumer-oriented information about the safe use of drugs

"MedWatch  a service of the FDA designed to keep the public  informed about safety alerts on medicines and medical products that have already entered the marketplace

Center for Devices and Radiological Health (CDRH)
http://www.fda.gov/cdrh/

Whether it is a drug or a new procedure, the process usually involves a delivery mechanism, which usually takes the form of a medical device. These devices fall under the jurisdiction of the CDRH. Medical devices play an important roll in diabetes, vision treatments, including LASIK, CT scanning, breast implants, and more. It is easy to see why the information provided on this site is so important.

Center for Biologics Evaluation and Research (CBER)
http://www.fda.gov/cber/

Through the CBER, the FDA addresses its responsibility for the safe supply of blood and blood products. The CBER is also involved in vaccines, allergens, genetic research, tissue transplantation, and host of other health-related biological activities.

Office of Special Health Issues (OSHI)
http://www.fda.gov/oashi/home.html

With primary focus on HIV/AIDS and cancer, OSHI provides a clearinghouse for medical information on these diseases. OSHI also offers a patient representative program through which patients and their families can provide a unique perspective to the FDA regarding specific diseases.

Excerpt from Searching the Web for Health © February 2004

 

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