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February 03, 2003

the "gold standard" for medical information

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."

Posted by peterlevine at February 3, 2003 04:53 PM