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."