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The Internet has brought the spirit of global communication and collaboration to nurses and other healthcare professionals in ways never before thought possible. These resources are offered to expand your opportunities for discussion, reference, education, and research.


According to the Pew Internet and American Life Project, "Fully 80% of adult Internet users, or about 93 million Americans, have searched for at least one of 16 major health topics online. This makes the act of looking for health or medical information one of the most popular activities online, after email (93%) and researching a product or service before buying it (83%)" (


As healthcare professionals we must be able to review health-oriented Web sites both for ourselves and our patients to determine whether the information available is credible. Many tools have been developed and certifying bodies created to assist both consumers and clinicians, but are they used? A Google search on any healthcare topic will yield thousands, if not millions, of hits. How many people are convinced of a site's credibility based on convincing language and official sounding names?


A few months ago I heard of the DHMO Web site (, whose goal is to inform concerned citizens about dihydrogen monoxide. On the Web site's FAQ sheet is the question "Should I be concerned about dihydrogen monoxide?" The answer is a resounding "Yes, you should be concerned about DHMO!! Although the U.S. Government and the Centers for Disease Control (CDC) do not classify Dihydrogen Monoxide as a toxic or carcinogenic substance (as it does with better known chemicals such as hydrochloric acid and saccharine), DHMO is a constituent of many known toxic substances, diseases and disease-causing agents, environmental hazards and can even be lethal to humans in quantities as small as a thimbleful."


The site is well designed, seems to be affiliated with the "United States Environmental Assessment Center," and has links to such reputable organizations as the NIH, CDC, EPA, and American Cancer Society. There is a link at the bottom of the page to send e-mail to your congressman and it was last updated only a few days ago. There is a small print line that says "Note: content veracity not implied" but I suspect many might gloss over that. On the page titled "Dihydrogen Monoxide and Cancer," the reader is informed after a list of different types of tumors that "what is known about these cancers is that Dihydrogen Monoxide is found in detectable and biologically significant levels in virtually all tumors and other cancerous and pre-cancerous growths."


A further Google search on what seems to be a most distressing agent brings us to the Web site of Dr Joseph Mercola ( and a page titled "What Are Some of the Dangers Associated with DHMO?" Inhalation of DHMO can be deadly and is found in biopsied tumor tissue. Dr Mercola's picture is on the site, he looks trustworthy, and his credentials seem impressive. He has been interviewed on national news shows and is board certified in family medicine.


The Ban Dihydrogen Monoxide site ( lists "Symptoms of DHMO ingestion can include excessive sweating and urination, and possibly a bloated feeling, nausea, vomiting and body electrolyte imbalance. For those who have become dependent, DHMO withdrawal means certain death."


There are pro-DHMO sites as well such as DHMO- Your All Natural Friend ( This Web site informs the reader that "It has been shown that hydrogen hydroxide enhances the functionality, growth, and health of many forms of life-including humans!!-and current research suggests that it has become an integral part of our planet's ecological balance."


On National Public Radio's Web site is a page with the heading "Dihydrogen Monoxide Sparks Global Concern" ( There is an interview with Professor Tom Way of Villanova University, surely a reputable institution and an impressive title.


What are the readers to do? Whom should they believe?


Yes, I know dihydrogen monoxide is water and thoroughly enjoyed the play on words and the wonderful way the site has been constructed. Everything is true. Yes, inhalation of water can be fatal and overhydration can cause electrolyte imbalance.


I showed these sites to several professional individuals who did not recognize the terms. When I discussed this site with some entry-level nursing students as part of a class on using the Web for health information, about 30% of them thought the site was credible. I suggest an important criterion for evaluating Web sites should be whether or not the reader actually understands all the terms used on the site.


The DHMO Web site was developed by Thomas Way, PhD, who is professor of computer sciences at Villanova University (, to illustrate a point about information literacy and critical thinking. It's a great place to begin a class or inservice about evaluating healthcare information available on the Internet.


Contributed by William Perry, MA, RN