St Bartholomew's and the Royal London School of Dentistry, Turner Street, London E1 2AD, UK
We would like to thank McNally et al. [1] and Armstrong et al. [2] for their interest in our study. They have made a number of important and helpful points relating to the use of rheumatology resources available on the World Wide Web (WWW).
Armstrong and colleagues [2] point out that the Internet is expanding rapidly and we agree there have been significant changes in the WWW since our study was done. The amount of information available has increased dramatically and as McNally and colleagues [1] have stated, there are now many different methods of surfing the WWW. The search engines we used in our study are certainly not the only method of accessing information on the WWW, and we agree that news groups and mailing lists are becoming a more popular way to use the Internet. However, we chose to use rather unsophisticated search techniques in order to see what a first time or naive Internet user might find.
The choice of the word `rheumatology' was used in a deliberate attempt to gain an overview of all the rheumatology information available on the WWW. Our objective was to analyse the breadth and variety of information available and therefore a more specific search term may well have skewed the results away from a cross-section of rheumatology information. We mentioned in our article that lay users and doctors might well use more specific key words to direct their search. We certainly agree with McNally and colleagues that the choice and method of search terms are therefore of great importance.
Our search generated a large number of sites, many of which originated from non-medical institutions. Our concern that some of this information may be misleading or poor quality is therefore quite valid. The use of a quality filter such as OMNI is obviously extremely useful in this context, however using this method and rheumatology as a search word, only 22 sites were found.
It was never our intention to discourage others from making use of the WWW, but merely to point out a few of the problems we encountered during our study. McNally's and Armstrong's helpful comments highlight some of the many ways that the problems raised in our paper are being addressed and hopefully more people will be encouraged to use the WWW in the future.
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