standardizing medicine

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?