For the last two issues, we have focused on ways in which the Web can provide the lay public with timely, accurate, and unbiased medical information presented in an attractive, well-referenced format. We also have raised the questions about what the Web needs in order to become a relevant and reliable information source for our patients. Discussion is a two-way street, so this month I am sharing the floor with two of our readers, with their responses edited for space.

Brad Tanner, MD, runs Clinical Tools, an online medical education company in North Carolina. His response:

“I hate the networks and AOL. I think they stand in the way of growth and creation of new novel ideas. The last thing I want is a stronger MSN, AOL, CNN, or Yahoo. I’m a fan of Google, Amazon, eBay, NetFlix, and other ‘specialists’ that can give me what I want when I want it without worrying about how to build their empire. I still see the Internet as revolutionary and not just inevitable. The potential of the Internet to tear down what was and replace it, eliminating the concept of the ‘network’ in the process, would be a good thing.”

Mike Burns of Nationwide, a Fort Lauderdale company specializing in high-end IP voice and data systems, wrote:

“I don’t sense any zeitgeist militating against bad information on the Web. In fact, as the Web matures, I see this as less and less an issue. The notable exception may be the access of medical information via the Web. Obviously, bad information in this area can have serious effects if applied. “Nonetheless, market forces will be brought to bear on this, and I see a trend toward the use of reliable sites like WebMD for those who tend toward standard Western medical ideas. People will go there, search engines will put them on the top of their lists, and for clear reasons: better information, better presentation. As long as they keep their information clean, they will garner a reputation that will cement them in users’ minds. There will always be faith-healers and shamans by whatever name, and correct information will never be important to these types.

“How does the new Internet medium affect age-old questions about reliable information? My answer would be ‘Not much.’ The same questions were asked, no doubt, by Church fathers in the advent of the printing revolution, by Boss Tweed in the age of Yellow Journalism, by hand-wringing liberals reacting to the spread of talk radio...the answer is usually the same, to wit, get Daddy to stop that guy from saying things I don’t like. You have to stay away from that answer, and to your credit, censoring bad information is not presented by you as a solution. You are on the right track in taking the approach of providing better information in a competitive environment...you know the answer is better information, better marketing, better education. Forget about ‘parent’ organizations making the Web safe. SurfWatch, Net Nanny, etc. are already here. They are less concerned about guiding you to reliable sites than guiding you away from prurient sites, but the concept of oversight is the same.

“I don’t think it will ever happen in the way you envisage. There will always be a spectrum of sites running the gamut from a malicious liar’s blog to the OED’s online dictionary, just as in any medium.”

Tanner and Burns both address, without quite saying so, the strengths of the Internet as an empowerment vehicle for the individual, something I hadn’t addressed. And they’re right. When, in 1985, the affordable laser printer first became part of an individual home office, we all suddenly had the power of the printing press. With only a little design work, a one-person office could look like a much larger firm. The Internet takes that to the next level, again allowing a single individual with some Web-authoring skill to present himself or herself on a comparable level as a larger group. Both correspondents appear to enthusiastically support this very important aspect of the medium.

I think we are all in agreement that censorship is not the way to go, but let’s not ignore that option entirely. For many years, biased direct-to-consumer advertising of pharmaceuticals was not allowed in the United States. A few years ago, such advertising was introduced; there has been continued discussion in the press as to whether it should continue to be permissible. Banning biased information is clearly a well-argued topic that at times appears to be culturally and socially acceptable. I think we also would agree that incorrect medical information in an online format can be more hazardous to an individual in the community than can, say, incorrect specifications regarding a vacuum cleaner.

Open discussions regarding a medication or treatment modality can contain significant bias, and that too is something we haven’t addressed in past columns. Take a look at Epinions.com and you will find a site where people post their experiences with new products. If you look up a new washer/dryer or a new digital camera, you will find a series of personal opinions based upon actual use of the device. I have used the site many times when trying to decide between product A and product B, and it sounds like the type of site Dr. Tanner would support. What would you think if Epinions included an area for pharmaceuticals? Imagine if you could look up Zoloft® and Paxil®, then go to your physician and tell her which antidepressant you wanted to start based upon your review of personal opinions? Or imagine if you could look up Dr. Smith and Dr. Johnston, then pick the physician to see based upon personal opinions and discussion? Certainly these are empowering types of sites; they empower the posting individual to share his opinion, and they empower the reader to take a more active role in choosing course of action. Is this necessarily a good thing, with specific focus on whether it is inherently good within the medical information field?

Next month we will return to focus on addictions and the Web, but we may yet take another look at the topic of these last three articles.

Stuart Gitlow, MD, MPH, is the author of Substance Use Disorders: A Practical Guide, from Lippincott Williams & Wilkins. He spoke at the Psychiatric Congress in Orlando in November 2003 on e-mail and the psychiatric patient.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2004, v.5, n.5, pp. 58-59.

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