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January 21, 2003

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?

January 21, 2003 5:11 PM | category: Internet and public issues | Comments


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