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I appreciate Dr. Monaco's comments regarding my recent study of clinical trial resources on World Wide Web (“the Web”) sites.1 I appreciate even more—and applaud—the analysis regarding the accessibility and readability of clinical trial information that she and her colleagues have completed and to which she refers in her comments. Completing such studies are pivotal to maximizing the use of the Web as a platform for the exchange of information. I very much look forward to seeing the full report.

The data concerning comprehensive cancer centers summarized by Dr. Monaco reinforces the perspective that, in general, the state of clinical trial information published on the World Wide Web is sorely lacking. The study by Dr. Monaco and her colleagues adds to the growing body of evidence indicating that even if a visitor can locate clinical trial information on an institution's Web site, it is more likely than not that the information will be incomplete or not understandable by the average reader.

Therefore, what steps might be taken to correct the problems that have been identified with regard to the presentation of clinical trial information on Web sites? The following are three of the more obvious solutions: 1) involve more patients, more actively in writing and reviewing website content; 2) incorporate research staff earlier and more actively in the process of developing and maintaining site content; and 3) define a minimum data set for clinical trial information (e.g., phase, sponsor, patient category, etc) that must be included in any Web site information regardless of the trial sponsor and site sponsor.

Centralized clinical trial databases are an obvious and available way with which to improve the presentation of information. A major advantage of the centralized database approach is the economies of scale they offer. In an era of ever tighter resources it appears a bit absurd that hundreds of institutions around the country are programming and maintaining much of the same Web infrastructure and trial information (and often in a substandard manner) when they could pay less money to utilize a clinical trial site that offers comprehensive, readable and up-to-date information. Another advantage is that most of these systems now utilize automated processes to download trial information, enter data, and perform database maintenance.

When the goal is enrolling more patients in better trials, researchers and institutions should be willing to do whatever is necessary to aid that process, either by taking all necessary steps to improve their Web site content or outsourcing the process if that represents the best solution.

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