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 threatnot only to these professional prerogativesbut 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?