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Biology 103
2001 First Web Report
On Serendip

It Was Bound to Happen: Medicine Meets the Internet

H.A.

In the world of medicine, where information definitely means power, the Internet's potential to revolutionize current concepts and facets of public health has been recognized through the workings of cybermedicine. Arbitrarily defined, this field "...encompasses the use of global networking technologies to educate, innovate, and communicate in ways that promote medical practice, commerce, scholarship, and empowerment" (1). Such claims primarily include the enhancement of health care services and resources, taking forms such as greater numbers of medical databases and publications, increased patient self-support, and conveniences such as purchasing prescription drugs over the Internet. Nevertheless, these new capacities inevitably come with a variety of risks that stem from insufficient preparation and education on society's part, particularly relating to problems with the quality/accuracy of online information, insufficient standards for relaying this medical information, and preserving advantages of traditional physician-patient relationships (2). Before any decision can be made about whether cybermedicine is an overall benefit or challenge to the medical world, these issues of debate need investigation.

With medical information being one of the most retrieved types of information online, it is no surprise that there are an estimated 100,000 medical sites on the Web (2). Consequently, there has been a significant increase in Internet use for the provision of direct patient care services, and these uses range from informal e-mail communications between physicians and patients, to more formal services involving fees for storing medical records online, physical consultations with diagnoses, formulating treatment plans, etc. Additionally, the Web hosts countless online forums for support groups, in which patients can become involved in global exchanges of clinical and non-clinical discussions of medical topics (3). In this sense, patients (as consumers of information) may increase their focus on "prevention" and "health promotion" by using the Internet for information, as opposed to the traditional face-to-face exchange of formal communication with a physician (2). With these few examples, the benefits and conveniences of cybermedicine are quite apparent. However, there is also the perspective that these new capacities are compromising the quality of medical care and the stability/importance of the physician-patient relationship.

First and foremost is the danger of the spread of medical misinformation on the Web, especially since anybody can be a publisher of online information and it is difficult to assess the credibility of these publishers. According to the American Cancer Society's statistics in August 2001, there was an abundance of non-peer-reviewed material, as well as a 6% fatal inaccuracy rate. Additionally, a CNN report in April noted a continuing increase in the number of online health scares (2).

Another aspect of this dilemma is the lack of established standards for cybermedicine; "...standardization on many higher levels (such as medical applications) still has to be achieved to reach interoperability of medical Internet resources" (2). One of the most controversial examples of this issue involves the sale of prescription drugs online, and whether or not there is sufficient legal standardization to regulate this activity. Despite the advantages of lower cost and convenience, the risks include consumer access to illegal or unapproved drugs, medication without a prescription, and drugs marked with fake health claims. Furthermore, in the case of illegal activity, the absence of clear and definitive cybermedicine laws make prosecution and regulation complicated. Since the practice of medicine has been traditionally governed by state medical/pharmacy acts, and the Internet allows for the importation of drugs into and throughout the U.S., the situation ends up within federal jurisdiction, ultimately creating confusion among state and federal regulators (4).

In the midst of this confusion, there also exists a threat to the physician-patient relationship. Many have warned against replacing the traditional medical communication methods with virtual doctor's visits; "As medical services continue to shift to the World Wide Web, that depersonalization may continue...the role of the individual doctor and the continuing personal relationship with the patient has declined" (5). Moreover, there is harsh criticism of online diagnoses, pointing out that forms and questionnaires on the Web cannot substitute physical exams. Without the face-to-face experience, patient warning signs that may easily detected by touch, could go unnoticed and pose as a risk to the patient (4). Ultimately, the fear is that a necessary trip to the doctor will be replaced by a visit to a database administered by non-physicians.

At this point, the increasing cognizance of the pros and cons of cybermedicine are leading to better assessments and developments in the world of online medicine. Medical services were quick to take advantage of the vast power of the Web, but must now focus on channeling efforts to make sure this power is used effectively and accurately. On the technology front, anticipated advancements in the Internet could lead to a "quantity leap," - significantly faster operation speeds, the integration of sight/sound/touch to allow videoconferencing with healthcare providers, resolution of security problems, etc. Equally important are the innovations and progress being made on the legal front, the results of which could include a "quality leap" (2). These efforts have involved bills such as the Internet Pharmacy Consumer Protection Act of 1999, which mandated the disclosure of online drug selling sites with relation to place of business, name/address of physician(s) working for the site, and a listing of all the states in which the physician(s) held a license. Furthermore, the National Association of Boards of Pharmacy launched a certification system called Verified Internet Pharmacy Practice Sites (VIPPS), which is a voluntary, 17-point rigorous examination ensuring that the site is in compliance with all regulatory, statutory, and licensure requirements of each state of operation (4). Steps such as these are the beginnings of a more comprehensive set of standards to accompany the rapid cybermedical progress.

Ultimately, the medical world has greatly benefited and stands to gain even more from the field of cybermedicine, with the understanding that there are inherent risks with current online practices. The crucial step of identifying these risks and increasing societal awareness is being effectively pursued, so that future technological, legal, and standardized developments may reduce any danger to physicians and patients. At this point, the medical world is merely in a transitional phase, during which it is important to note that the existence of complications is many times a common symptom of advancement. Furthermore, considering the inherent risks relating to accuracy and identity associated with the Internet, it is realistic to say that there will never be a time when medical online activity will be perfect. The key is to recognize and properly address the new needs that rise from new abilities. Currently, it is the case that "old rules don't make sense any more and the new rules haven't been defined yet..." (5). "Yet" being the operative word...

WWW Sources

1)cyberMedicine.org , site that defines, promotes, and discusses cybermedicine

2) Shopping Around the Internet Today and Tomorrow: Towards the Millennium of Cybermedicine, - comprehensive article about positive and negative implications of cybermedicine

3)Using the Internet to Empower Patients and to Develop Partnerships with Clinicians, extensive discussion of realistic outcomes/potential for online medical practices

4)Cybermedicine: The Benefits and Risks of Purchasing Drugs Over the Internet, detailed paper by David Mills on the legality of online prescription drug sales

5) Professor at School of Law Issues Warnings About 'Cybermedicine' , Saint Louis University Professor of Cyberspace/Healthcare Law talks of risks with cybermedicine




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