I spent some time writing my article about Medline

as a "gold standard" of medical advice and information of the

Internet. No individual knows enough about medicine to make a direct assessment

of the information presented on this huge portal, which adds half a million

new scientific references every year. To decide if the material on Medline

is reliable and useful, we cannot apply what my friend Anton Vedder calls

"primary epistemic criteria," such as "consistency, coherence,

accuracy, and accordance with observations." But we can use what

he calls "secondary epistemic criteria," and they are all in

Medline’s favor. We can easily see that it is well-funded, separated from

profit-seeking companies, and run by distinguished professional organizations

and bodies.

So should every American who goes online for medical information consult

only Medline and those sites to which Medline links? One problem is that

government officials, including medical doctors, may have political agendas.

In 2002, various agencies of the United States Government removed information

about condom use and abortion from their Websites, allegedly because elected

politicians favored sexual abstinence before marriage and opposed abortion

on moral or religious grounds. For example, the National

Cancer Institute had posted information denying a link between abortion

and breast cancer until an anti-abortion Member of Congress objected,

calling it "scientifically inaccurate and misleading to the public."

Another federal Website

removed its positive assessment of condoms’ role in preventing the transmission

of disease. After the removal was criticized, similar material reappeared

online with the following additional text (in bold): "The surest

way to avoid transmission of sexually transmitted diseases is to abstain

from sexual intercourse. …" A liberal Member of Congress said,

"We’re concerned that their decisions are being driven by ideology

and not science." The President of the Planned Parenthood Federation

of America put the charge more strongly: "They are gagging scientists

and doctors. They are censoring medical and scientific facts. It’s ideology

and not medicine." [See Adam Clymer, "Critics Say Government

Deleted Sexual Material From Web Sites to Push Abstinence," The

New York Times, November 26, 2002, p. A18; and Adam Clymer, "U.S.

Revises Sex Information, and Fight Goes On," The New York Times,

December 27, 2002, p. A15.]

There is controversy about the reasons behind these particular choices

to post, remove, and revise online information. However, we need not resolve

the facts in these cases to see that government Websites may be written

on the basis of "ideology and not medicine." Actually, all

science is thoroughly imbued with normative choices about what is

important to study, what outcomes should be valued, and how much risk

to tolerate. Thus a more sophisticated critic might say something like

the following: "The Federal Government presents its medical websites

as a ‘gold standard’ and claims that nothing but dispassionate science

determines decisions about what to include. In reality, all medical advice

involves an element of normative judgment, whether deliberate or unconscious.

However, because government Websites are lavishly funded and linked to

the organized medical profession, they threaten to monopolize discourse

about important topics. Hence, we demand that these Websites disclose

their normative or ideological leanings and refer explicitly to alternative

perspectives."