The invention of talk

BMJ 2002; 324 doi: (Published 09 March 2002) Cite this as: BMJ 2002;324:j

Somebody has just invented talk. We humans have so far communicated entirely through the written word, signs, smell, and touch. This new medium seems to have devastating power. It is probably a “transformational” technology. Everything will change. Individuals can exchange large amounts of information rapidly, far more rapidly than with the written word. People can ask questions to check that they are understanding and are understood. Up to a dozen people can use talk to interact at once. Using amplification and broadcasting, it may be possible for one person to talk to millions. People can whisper, shout, curse, brainwash, and cast spells. Derivatives of talk—poetry and song—may be even more powerful than talk itself: they are like crack to cocaine.

This new medium has powerful therapeutic potential. Some visionaries have even suggested that talk alone, unaided by drugs or surgery, may be able to heal. Unfortunately there is also huge potential for harm. Terrorists have already begun to talk. There is growing evidence that most talk is not based on evidence. In short, most of it seems to be rubbish. Worse, there often seems to be a gap between what people mean and what they say. The opportunities for misunderstanding are immense. These anxieties have naturally led to calls for regulation, and the World Health Organisation, the American Medical Association, and the European Union have already produced quality scales which, it is hoped, will allow potential listeners to identify high quality talk.

Nonsense, all nonsense. But is our reaction to the internet any different? Speak to any group of doctors about the internet, and the first question is usually: “But there's so much rubbish. What can be done to distinguish high from low quality material?” The answer from this theme issue seems to be: “A great deal, but not much of it works or is used.” Quality scores are proliferating—and dying—at a tremendous rate (p 569), and authorities in Geneva (p 566), Brussels (p 567), Britain (p 566), Spain (p 567), the Netherlands (p 567), and no doubt many other countries are busy trying to regulate health information on the internet. Many individual organisations in the United States have also joined the quest (p 602), but the usual American view of “let the market and the customer decide” seems to be prevailing.

New evidence presented in this issue shows that few of the quality scores have been validated (p 569) and that sites that might be thought credible do not anyway contain more accurate information (p 581). But these failures may not matter because those using the internet are not paying attention anyway to these scores (p 573), and sites are popular for reasons other than quality (p 577).

If I was in the business of trying to regulate the web I would after reading this issue give up. It is truly like trying to regulate the West Wind or talk. Instead, we should concentrate on doing great things on the internet to transform health care (p 555).


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