A bad day for blogging, because I’m very busy with the technical details

of preparing our joint report with the Carnegie Corporation, the Civic

Mission of Schools. Choosing paper stock is not interesting to write

about. I did quickly email the National

Library of Medicine to ask about the budget and mission statement

for Medline. The reason

is that I am supposed to work with some Dutch colleagues on a project

concerning "the reliability of medical information on the Internet."

(We are funded by the Netherlands government, which is one reason I took

the job.) The tension I hope to explore is between medicine as a standardized

discipline and the Internet as a wide-open medium. Medicine has been standardized

because there is supposed to be "one best treatment" for a given

condition (when fully described), based on the best scientific evidence

available at the time. Although physicians still have great discretion

and often offer divergent advice, powerful forces work to standardize

medicine. It is illegal to practice medicine without a license or to use

or sell regulated drugs without a prescription. To gain a medical license,

one must pass through an elaborate training and socialization process,

including graduation from an accredited medical school and apprenticeship

under experienced physicians. One then bears marks of membership in an

exclusive body: diplomas on the office wall, a white lab coat, an expectation

that one is to be addressed as "doctor." The Internet, poses

a threat—not only to these professional prerogatives—but also

to the "one best treatment" ideal. Someone who wants to locate

medical information or advice online can easily find herself looking at

a mix of official recommendations and highly eccentric ideas promoted

by laypeople. It is considerably harder to tell the difference between

official and unofficial advice than it was in the old days, when the main

sources of information were people in white coats and refereed journals.

In response, the National Library of Medicine, a $250 million/year federal

agency, has created a single Website that lays out the "one best

treatments." I am going to try to assess the result. To put my basic

question boldly: should we hope that everyone who goes online for medical

advice goes to Medline? If yes, what policies can the government adopt

to channel people there? If no, why not?

A little more than two weeks ago, I moderated a panel at the Association

of American Law Schools Conference. Two of the panelists were famous bloggers

(so I’ll use their full names): Glenn

Reynolds and Eugene Volokh.

I had not selected the panel—Amitai

Etzioni had arranged the whole event—and I was so ignorant about

blogging that I failed to mention their blogs when I introduced these

two panelists. (Meeting them may partly explain why I got into this business.)

In any case, I have continued to think a lot about the discussion that

evening.

First of all, I’ve been thinking about public engagement. Professor

Volokh graduated from UCLA with a BS in computer science at the age of

15, and then worked as programmer for some time before he became a law

school professor. I asked him why he made the switch, and he explained

that he wanted to lead a "public life" by testifying, writing

opinion pieces for newspapers, etc. This kind of opportunity has a certain

appeal for me, too, although I’m not sure that I could break into the

mass media even if I tried—and I don’t try very hard. The reason

I don’t try is that I want to lead a different kind of "public life."

My goal is to help build and sustain public institutions or communities.

That is quite different from expressing opinions (even informed and interesting

ones) on broad matters of national or international concern. Institutions

don’t primarily need people to express opinions; they need organizational

work and products appropriate to their mission. Also, the institutions

within which someone like me can have an impact are necessarily limited

in scope. They either work in particular geographical locations or else

they deal with fairly narrow issues. Unless you’re the Pope or the president,

you can’t work through institutions and deal directly with all the great

issues of the world. So I think that there is a trade-off between addressing

a big audience and working within organizations. I seem to have chosen

the latter course.

Second, the panel was populated by First Amendment lawyers, and for them

the Internet is primarily interesting as a venue for cheap speech.

It’s extremely expensive to communicate through media like print or television,

but it’s cheap to operate a Website or to send out bulk emails. Thus the

Internet is supposed to be very good for freedom of speech. I find myself

unpersuaded. The more people communicate on the Internet, the more they

have to split the available audience, to the point that the average online

"speaker" (that’s me) probably talks to two or three people.

Being able to communicate to such a small number is no great advance over

the olden days, when you could put up a poster. Also, "cheap speech"

often turns into the blather of chat rooms. That is because people abuse

common spaces by dumping ill-informed or uncivil speech into them. So

I have realized that I am interested in the possibilities of the Internet

for "affordable speech," not "cheap speech." Given

the new digital technology, we can now create such goods as streaming

videos, interactive online maps, local newspapers, and structured deliberations.

These goods cost thousands of dollars instead of hundreds of thousands.

The result is a great advance for the First Amendment, as many more people

can participate in creating things of value. However, "affordable

speech" is not free—indeed, it’s out of the reach of most community

groups and non-profits. Which is why I am so interested in creating institutional

support for public uses of the Internet.