There are really two aspects to this question: how do I find credible sources and where do I go to do it? We're going to take a look at both of them.
Evaluating what you read
Maybe this seems out of order, discussing your search results before you do the searching, but on the other hand, you can eliminate a lot of sources without even reading them if you know what you're looking for in terms of reliable, credible information.
The first, most important quality of information you read relates not to who is saying it but how they got it. The truism goes that on the internet, nobody knows you're a dog. Huh? Well, just because you say you're an expert that doesn't make you one. Subvarieties of this include people who title themselves "doctor." There are many types of doctors, and only some of them have any legitimate, clinically-earned credentials within the health practice field. We have all kinds of respect for anyone who can earn a PhD. or, really, anyone who can get themselves and their funds together to order a PhD. from a mailorder vendor. But that's the rub: we can't tell them apart and we can't tell a PhD. in 16th century Estonian literature from an M.D. when they simply refer to themselves as doctor. If all we see cited is Dr. Jane Somebody as the source of information, we don't have a reliable source or at least, it's not credible on those grounds alone.
But that doesn't mean a site attributed to Jane Somebody, MD is any more credible. There are lots of doctors who have lots of opinions, but just because they've earned (or lied about) a medical degree doesn't mean they're licensed, legitimate, or even sane. If it's one doctor speaking, you still only have one person's opinion. That may be an educated opinion and their synthesis of the available medical knowledge may be impeccable, but you can't tell just from their name and title. We won't necessarily rule them out, but we'll hold their comments aside to see if additional research validates at least the information upon which their opinions are based.
As for other titles, the same thing applies if we even recognize the title: we have a fair idea of what a nurse's nominal background and licensing involve; ditto a Registered Pharmacist. But how about a Certified Lab Manager, Biomedical Researcher, or Joe Sombody, M.S.J.L.? Since we just made all of those nice-sounding credentials up, maybe they're not a good source of authority. A title needs to be verifiable, not just impressive-sounding when it's spelled out with capital letters.
If an individual is suspect, how about an institution? Now we're making progress. Reputable, major institutions may also be expressing opinions in how they summarize and present information, but at least they are opinions held by a group and subjected to the personnel selection/affiliation guidelines of that institution. On the list of fairly trustworthy institutions we would include most government agencies, professional medical groups, and major educational institutions. While their information may be biased, it will typically lead you astray only in the direction of being excessively conservative, not, generally speaking, wholly delusional.
One of the most important research reading skills is reading not only what is said, but what is not said. After the above paragraph, you could be wondering: what is a disreputable institution? Who should I not believe? First of all, if you haven't heard of them before, they may not be first-tier. Reading names carefully is important, here. The American Heart Association is a well-known and credible, if conservative, source of information. The American Heart Research Association, which only gets one google hit, probably doesn't exist and they should not be confused with the AHA. It takes some careful reading into the "about us" pages and some secondary searching to sort out just who is behind many groups, which is why they have a higher index of suspicion.
But first and foremost, an institution or group immediately puts us off if it's selling something, whether a specific product or simply the promotion of a class of products (think: National Institute for Hormone Health, American Society of Radish Fanciers). If we so much as sniff a profit motive, we're taking everything they say with a grain of salt. They may be telling the truth so far as it goes, but it may not be the whole truth because, by definition, they want you to buy what they're selling and if it needs selling, there's more to the story. That's why we look not at drug company publicity pages or ads, but at the licensed prescribing information (which is still subject to politics, but you have to draw the line somewhere). This means that pharmaceutical companies, vitamin mailorder houses, individual medical clinics, and testing labs are all on our "I'll believe this only if it's corroborated elsewhere" list. As soon as a profit motive comes into it, our faith in them as an unbiased source goes out of it. Harsh, but we're very suspicious of being led astray.
Well then, how about books? If someone's a published author or entertainment celebrity, we can believe them, right? Uh, no. In fact, there are all sorts of rubbish published every day in books, and it's important to remember that publishers are in the making-money-from-selling-books trade, not the publishing-truth trade. We could say that we've published a book, too—give us a moment and we can work up a nifty cover graphic and a few enthusiastic fake review quotes as well. Just because it's a familiar face you've seen "everywhere" doesn't mean that they have any greater insight or well-researched knowledge than you do: they just have a better publicist and are selling that familiarity in every market they can.
Sometimes it's really hard to evaluate what you're seeing, though. If you don't know the right answers when you begin, how will you recognize them when you see them. There is an excellent presentation of The Seven Warning Signs of Bogus Science that may help you out with this.
So what is it that we do like for information sources? Hard scientific research. Research that conforms to standard practices, uses blind controls, and is statistically analyzed, replicable, and published in peer-reviewed format. Discussion based on research, comparisons of research, summaries of research, speculations (where clearly identified as such) taking off from research-demonstrated premises—all of these are good things when they cite their sources and justify their science. Why does it matter what their sources are if there are a lot of them? Because not all sources are equally valid. To take a broad example, a study of 20,000 women over 20 years has one kind of predictive weight for human science while a study done in 20 rats over 2 days has another. Where a discussion follows primarily from small, obscure, animal-only research, we're less inclined to give them quite as much weight as a well-designed human study with a large population, a long timeline and good controls (note that last one, though—it can sink a lot of otherwise good-looking results).
But what about all of the anecdotal information we've presented on this website? What about the reports by women like us who are actually experiencing these things? What about what we can read every day on the message lists and forums all over the internet? Surely we can believe the women themselves? Sorry, no. Where we've presented comments on things women have told us, we've specifically identified that as the source of that information just because we know that this is less reliable. The level of simple physiological misunderstanding and lack of knowledge we women have about our bodies and how they work is astounding (the same is true of men, so don't think there's a sexist aspect to this). Further, we are all bad reporters; we miss things; we misrepresent things; we have biases we don't even know about; and worst of all, we are individuals. Nothing that happens to one person ever constitutes science that can be extended to a population, especially when something as hideously complex as hormones is involved. A lot of women talking about the same thing may mean there's a common thread, but it doesn't sort out correlation from causation. And any forum is inevitably going to be biased towards the negative: those who would express the positive, those without problems, those presenting the "typical" are vastly under-represented because they're not online talking about it; they've gone on about their lives. Even if "everyone" online is talking about how the latest hrt made their left legs fell off, we have to remember that this is incomplete data because we're not hearing from the whole user group and we don't have any way to get in touch with those whose left leg didn't fall off.
One other point we'd like to make: look at the dates. The whole field of menopausal health and HRTs is rapidly changing. There are sites that were put up five to eight years ago that reflect prevailing opinions at the time that have become totally outmoded by subsequent developments. That doesn't mean we have to reject everything more than a few years old, but it does mean that we need to make sure that it hasn't been negated by more recent work.
For a different look at evaluating online information, including some technical details to do with really looking at where a website comes from, we found this from the library at the University of California at Berkeley.
Where to look
Google is pretty much the default search engine these days, and it's a fine one to use. For many initial searches, the basic page is fine although the advanced search may be needed to home in on some more complex concepts with greater discrimination. Be advised that the links in the righthand column and those at the top with the colored background on all Google search results pages are sponsored (paid) links and thus are not likely to meet our non-commercial test. Google Scholar is a separate service that "provides a search of scholarly literature across many disciplines and sources, including theses, books, abstracts and articles" and may return a usefully different set of search results because it . Try a basic search on something like "estrogen" on Google Scholar and compare it with the same term on Google Search: you'll be surprised at how different the results are.
Depending upon how you write your search, you may find that the first few pages of hits are almost exclusively sales-related. For example, if you are searching for a particular hrt, you are likely to find the manufacturer's site up in the colored results at the top of the list. The first page of hits is also likely to contain a number of hits for overseas drug sources, and domestic mail order pharmacies, and nutraceutical vendors. In with them may be some useful sites, however, like drugs.com and rxlist, which are reference sites that republish the information in the prescribing information sheets that the FDA requires for all prescription drugs.
As you plumb deeper into the results (or rewrite your search to eliminate these sorts of hits), you'll begin to come across mentions of your topic in discussions or in forums. Depending upon whether you are looking for discussion or research, you may want to explore some of the most reliable-looking (look at the url, not the topic title or summary, to tell who has posted the information) discussions as you go. Often, though, if you are looking for research, you will have to go pages and pages into the hit results. Don't despair, though—you're skimming the available topic range while you do so, and sometimes that can be helpful in itself: you're getting acquainted with the general body of knowledge while you're on your way to the specific. And sometimes we've picked up better ways of wording our searches, just from looking at how the hits we did get turn out to be phrased.
Once you get down to the research, you may find that you're up against the wall of proprietary, subscription-based content. Before you shell out your hard-earned cash for articles that might not be what you hope, you should know that in many cases free abstracts, or executive summaries, of articles are available for free. When you click on a "full version" link and it takes you to a login for subscribers, back up and try the "abstract" link, which is often free. With time, you may notice that this link often takes you to a different site. This is the PubMed database, and you can in fact go there and search directly (either simple search or advanced) courtesy of the National Institutes of Health. We've had good luck searching not only on topics or specific terms, but by research article title or even journal date and name.
Do make sure that when you are reading study results or summaries that you're at PubMed or a real medical journal site. Just the other day one of us was researching and found a very interesting statement that seemed just what was being looked for in a quote from a study that was part of a set of references on a sales site. Hoping to find out more detail on that statement, she went looking for the original study, which turned out to be online in a full copy from the original publisher. And, lo and behold, that single statement that brought the study into support of the sales site's premise was nowhere to be found in the original study, even though the rest of the quote was valid. See: it pays to be suspicious.
Some other sites we have found useful not just for research but for generally keeping current are:
- Medscape: This medical news and continuing education site is aimed at health care professionals but subscription is free once you sign up and we have never been spammed by them. They have specialized pages for women's health, which is where they cover menopausal topics, but there are other special sections for things like osteoporosis and cardiovascular disease and cancers. You can also sign up for a free emailed summary that comes out on a weekly basis or subscribe to an RSS feed of news items. This is the source of many useful summary articles as well as pointers to medical journals, and their archive links are good longer than those of the news services.
- Reuters: Although limited to press notices and coverage, this service will provide good pointers for further research. You can also subscribe to it in RSS format.
- Eurekalert: Another medical news service, they don't have a breakout for women's health they way they do some mens' topics (hrmph) but they too offer an RSS feed.