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Videos, photographs, and patient consent

BMJ 1998; 317 doi: (Published 28 November 1998) Cite this as: BMJ 1998;317:1522

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Medical educationalists can free themselves from constraints of “real world” images

  1. Mark Pallen (, Senior lecturer,
  2. Nick Loman, Web resources development officer
  1. Department of Medical Microbiology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London EC1A 7BE
  2. Department of Neurology, Queen Elizabeth Hospital, Birmingham B15 2TH
  3. Department of Physiology, Birmingham University, Birmingham B15 2TT
  4. Department of Radiology, Royal Hospital Haslar, Gosport, Hampshire PO12 2AA
  5. Regional Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU

    EDITOR—Hood et al rightly emphasise that “the internet and electronic publishing are powerful tools for the dissemination of medical information and have created a demand for medical images” and that images of patients should, in most circumstances, not be used without consent.1 In the digital age, however, the links between images and individuals are complex and non-intuitive. With appropriate software it is easy to create images that do not reflect a true likeness of any real individual—cover girl images are commonly touched up, O J Simpson can be turned into a blond,2 and Ronald Reagan can be given AIDS, complete with multiple Kaposi's lesions.3 Thus manipulation of digital images means that the potential of the internet in medical education need not be frustrated by ethical issues.

    MorphMan was used to combine faces of both authors (left and centre) and then Photoshop was used to create a rash on the “combination” face (right)

    We wished to see whether we could, in a single afternoon, create fictional images of near-photographic quality illustrating medical conditions; we are interested amateurs and know that professional illustrators with more time and skill could achieve better results. We began by creating a malar butterfly rash such as one might see in systemic lupus erythematosus on a face that does not exist …

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