Letters

Editorial made extravagant claims

Coiera states that, as a result of the Internet, the provision of information on health will no longer be the exclusive remit of health care professionals. This statement is obviously false: other well known providers of information on health include grandmothers, busybodies, sick people, magazines, and libraries--and all of them have been around for much longer than the Internet. Other features of the Internet that Coiera identifies--accessibility, uncontrollability, lack of confidentiality, and variability with regard to the quality of information provided--apply equally well to the sources I have listed. There is nothing new here.

The author suggests that the Internet will introduce a "free market in information" (the implication is that, until the Internet came along, health professionals were able to monopolise the information). Since there is already a free market in health information, this hardly seems a possibility. Grandmothers, busybodies, and the other sources I mentioned, including libraries, participate in an existing free market in health information. What, if not a free market, is the vast global enterprise of medical publishing with which we are so familiar? It seems to me that if you make claims like "the changing nature of information delivery brings with it enormous implications" then you should be able to show that the nature of information delivery has changed. My view is that it has not changed: email is not different in principle from an ordinary letter; putting the BMJ on the Internet only provides another avenue for people who wish to read it. This may give the BMJ a wider readership, but it hardly constitutes a "challenge to health care provision."

The really big impact of computing on information delivery, which was never so widely heralded as the Internet, resulted from a much more important innovation than a mere communications system. This was the introduction by librarians of computerised indexes such as Medline, which provide access to information through the use of search tools based on multilevel thesauruses and boolean logic (neither of which can readily be used in a printed index). This occurred 30 years ago.

Medical librarian Geelong Hospital, PO Box 281, Geelong 3220, Australia

Stephen Due 

1. Coiera E. The Internet's challenge to health care provision. BMJ 1996;312:3-4. (6 January.) [Free Full Text]