Editor's choice

The debate on whether the Internet might transform medicine is taken up in this first issue of 1996, and Enrico Coiera is convinced that it will (p 3). The biggest effect, he argues, will be to make information on health care available to everybody and so undermine central attempts to ration health care. "Will people who have an almost unlimited access to information but limited access to health care resources tolerate suboptimal care?" He also thinks that the Internet can help with communication within medicine, perhaps speeding up the implementation of new research; and "the recent controversy over the way in which the British government advised the public on the potential risks of some formulations of the oral contraceptive pill in advance of informing many doctors could have been avoided."

But not everybody is so positive. Professor Tim David from Manchester has wasted many hours trying to access the Internet from home and advises only "computer enthusiasts with plenty of spare time to bother" (p 55). David Sellu, a surgeon from London, describes two encounters with patients through the Internet but advises that "sensitive information must not be disseminated this way until there are better safeguards" (p 49). The Department of Health has issued guidance to doctors on computer security, but the BMA thinks that it has been premature with its advice (p 59).

The Internet is not the only technology that has the capacity to change medicine, and two others are mentioned in this week's issue. Michael Henning Andreae describes how virtual reality ("an interactive, computer generated environment that stimulates the real world") can be used in rehabilitation and envisages a world in which "telepresence" allows specialists to operate in remote hospitals (p 4). Less spectacular but possibly more useful are telephone interpreting services, which provide access within 90 seconds night ad day to interpreters who are fluent in more than 140 languages (p 53)

The problem of accessing information through the Internet may, however, be much less difficult for patients than the problem of knowing what it means once found. Debates in the journal over treating patients with atrial fibrillation with anticoagulants (pp 45, 51) or patients with chronic backache with spinal fusion (p 38) show how doctors cannot agree, raising the possibility that more information may lead to more confusion rather than less.