THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 13, NO.4, 2000 193 Review Article

Medicine and the Internet: A survey of the information highway

I. K. INDRAJIT, S. NANGPAL, NOBHOJIT ROY

INTRODUCTION www.thebestmedicalcare.comldoctors/doctorsguide.htm and The Internet is here to stay. It is an extensive network of computers Hitchhikers web guide at http://www.hitchhikers.netlguide.phtml. spanning the entire globe. From entertainment to applied science Related to the Internet is a working knowledge of computers. A and technology, critical case scenarios to digitized concise and informative online basic primer of Computers in radiology images, the Internet has become increasingly useful for Medicine is available from the British Medical Journal group of medical practitioners. Designed initially to suit the requirements publications: ABC of Medical Computing at http://www.bmjpg. of the military in the USA, it has now broken all barriers and has comldatalabcmc.htm. been seamlessly integrated into the personal computer, at home or in the office. This article outlines the quintessential features of AN OVERVIEW medicine on the Internet and comprehensively maps the sweeping The unprecedented growth of the Internet presents a defining range of medical websites on the Internet. moment at the dawn of the millennium. The information age, long predicted, seems at last to be upon us.' The Internet has approxi- HISTORY OF THE INTERNET mately 800 million web pages at the moment, with an extraordi- The Internet was created in 1969, when the Advanced Research nary tendency to grow further. Of these, it has been estimated that Projects Agency of the United States Department of Defense there are more than a million websites dealing with medicine. funded an experimental long-distance telecommunication net- Medical information is often said to be one of the most retrieved work consisting of only four computers. In the 1980s, ARPANET types of information on the web. In fact, according to a survey in was superseded by NSFNET, a series of networks created by the October 1998, Internet users (27% of women and 15% of men) say National Science Foundation, which established the current struc- that they access medical information weekly or daily. An interest- ture of the Internet. I Since then, there has been an exponential ing observation from this and other surveys is that health and increase in the number of computers added to this network. The medical content seems to be one of only a few categories online Internet has now reached a stage of being so vast that practically that women are more likely to use than men.' Thus it is not every aspect of human interest including medicine, communica- surprising that the long established and traditional medical teach- tions, commerce, science, media, law, art, etc. are represented in ing is shifting gradually and dramatically to the electronic library." some form. To this end, telecommunications on the Internet are There are a variety of services available on the Internet. They standardized by a set of communications protocols, the TCP/IP comprise commercial and non-commercial information brows- protocol suite, that describe routing of messages over the Internet, ing, electronic mail, file transfer and newsgroups. Furthermore, computer naming conventions, and commonly used Internet ser- the Internet is a superb tool for defined collaborative research vices such as e-mail. groups. By using e-mail, chat rooms, file transfer protocol (FTP), file distribution, or even general websites, geographical limita- A GUIDE TO THE INTERNET tions of such collaborations are eliminated.' To learn about the Internet, there are many basic books available. Nevertheless, for those who wish to learn about the Net on the THE BASIC ISSUES IN 'SEARCH TECHNIQUES' Internet itself, there are a host of websites. These include: Doctors The cardinal issue influencing medicine and the Internet is infor- guide to Internet at http://www.pslgroup.comldocguide.htm. mation retrieval. At the moment, a variety of techniques such as Beginners guide to Internet at http://www.silverlink.netlpoke! medical search engines, general purpose search engines, medical IIP/, Learn the net at http://www.learnthenet.comlenglish! meta-lists, and commercial websites are used to access medical index.html, Intelligent Doctor's guide to the Internet at http:// information from the Internet. However, the best method of information retrieval from the Web is not known. Broadly, two search technique strategies present themselves to simplify the INHS Asvini, Colaba, Mumbai 400005, Maharashtra, India process of information retrieval. The first strategy employs search I. K. INDRAJIT Department of Radiodiagnosis engines. Search engines are comparable to yellow pages, deliver- S. NANGPAL Institute of Naval Medicine ing a list of websites appropriate to any medical topic. Most of the Bhabha Atomic Research Centre Hospital, Anushaktinagar, search engines require typing a topic in a blank field followed by Mumbai 400094, Maharashtra, India clicking of a search button to derive a large list of websites. NOBHOJIT ROY Department of Boolean algebraic operations facilitate searches in most search Correspondence to I. K. INDRAJIT [email protected] engines by the innovative use of words such as 'and', 'or', 'not', © The National Medical Journal of India 2000 194 THE NATIONAL MEDICAL JOURNAL OF INDlA VOL. 13, NO.4, 2000 etc. Search engines which are currently popular include Yahoo, at http://www.medmatrix.org, Medscout Yellowpage Links at AltaVista, Excite, etc. http://www.medscout.comllinks/index.htm. Galaxy Guide to In recent times, the evolution of search engines into the newer Medical Topics at http://galaxy.einet.net/galaxy/Medicine.html fascinating metasearch engines has led to a refinement in the and Virtual Hospital Major Links at http://www.vh.org/Provid- process of searching. Metasearch engines function as 'yellow ers/Providers.html. In addition, there are medical engines and pages of yellow pages' and query multiple search engines, echo- resources that can locate health-related information (Table I). ing the oft-repeated opinion 'Why search when you can meta- search!'. The popular metasearch engines include All the Web at THE RANGE OF WEB SITES http://www.alltheweb.coml, Google at http://www.google.coml, Rather expectedly, the Internet contains medical topics ranging Dogpile at http://www.dogpile.coml, Metacrawler at http://www. from 'the history of medicine' to 'new medical websites' that are metacrawler.coml, Surfwax at http://www.surfwax.comland added every week. The history of medicine is depicted at engaging SavvySearch at http://www.savvysearch.coml. The list of search sites such as History of medicine at http://www.asap.unimelb.edu. and metasearch engines is growing every day and exhaustive aulhstmihstm_medicine. htm. At the other end of the spectrum are directories are available which list them. For example, Beaucoup a host of new and updated websites that are added to the net. These at http://www.beaucoup.comis a website that has 1600 search and can be scrutinized at websites such as New medical site today at metasearch engines and Search Engine Watch at http://www. http://medwebplus.comlwhatsnew/today.html, New medical sites searchenginewatch.com is a comprehensive resource with in- of the week at http://www.pslgroup.comlmedsites.htm. New sites depth information on search engines. of the year http://www.hon.chlMedHuntlNew/981016.html. Few Paradoxically, while using a search engine certain obstacles medical journals such as the BM] and regularly give present themselves. To begin with, there are numerous search a review of new websites such as the Webwatch section at http: engines and therefore the selection is a personalized choice. In //www.thelancet.coml. addition, a typical search often results in obtaining 20%- 30% of The Internet is a rapidly developing and useful tool for emer- useful material, with the bulk of listed websites not specifically gency physicians. There is a website for emergency medicine related to the topic asked for. To overcome some of these prob- aptly titled E medicine at http://www.emedicine.comlemerg/ lems, the second strategy-the use of medical directories--can be index.shtmli To cater to the needs of medical students there is a resorted to. Medical resources or medical directories deal with a 'lounge' where common topics, interest, chat topics, job opportu- huge catalogue oftopics by categorizing them, usually by special- nities are dealt with comprehensively: IMS lounge http://www. ties. The largest and most comprehensive medical directories are medstudents.netl. Further, there are websites dedicated to Basic accessible at Medmark at http://www.medmark.org, Medmatrix clinical skills at http://www.medinfo. ufl.edulyear 1Ibcs/index. html,

TABLEI. Some important general medical websites*

Medical websites URL/Web address Medical websites URL/Web address

4 Physicians www.4physicians.coml Clinical Calculator www.intmed.mcw.eduic/incaLc.htmL Accumedlnfo www.accumedinfo.com/ Clinical Center-(NIH) www.cc.nih.gov Achoo www.achoo.com:801 Clinidata www.clinidata.comlJrames_e.htm Active First Aid Online www.parasoLemt.com.aulaJa/index. htmL CliniWeb www.ohsu.edulciiniweb ADAM www.adam.coml CME Courses Online www.cmesearch.coml Advocate Health Care www.advocateheaLth.comlhome. htmL Colorado Medical Rounds Aegis www.aegis.com www.uchsc.edulsmlpmblmedroundslindex.htmL Agency for Toxic Substances www.atsdr.cdc.govl Complete Home Medical Guidewww.cpmcnet.coLumbia.edultextslguidei All Health www.aLLheaLth.coml Conditions of Skull and/or Face American Red Cross www.redcross.orgl www.arhinia-cranioJacial.orglconditionslindex.htmL America's Health Care Source www.heaLthcaresource.coml Conferences and Courses AmericasDoctor.com www.americasdoctor.coml www.home.worLdonLine.nLI-knmg}588lconJerences.htm Antigoni-Greek Medical Site www.med.auth.grl Conversion of Units Argonauta www.kmeijn.me.kp.dLr.de:8080Iargonauta/index.htmL www.chemie·fu-berLin.delchemistrylgeneraLlunits3n.htmL Australian Health Online www.health.abol.net/abolhlth/ Critical Guide Inet www.internetmedicine.comltoc.htmL Best Medical Info the Net Cuidese www.geocities.com:80IAthensI5352lcuidese.htmL www.sau.eduicwislinternetlwi/diMajorsIMedicaLlmedindex.htm Derm/cinema lobby page www.skinema.com Biosites Medical Library Dick Bowyer's Surgery Resource www.Library.ucsfeduibiositeslheLplguideLines.htmL www.ds.dial.pipex.comlr.bowyer/MedSurg.htm Black Stump Medical Page www.werpLe.net.aul-lionslmedical.htm Dictionary of Measures Bookmarks2Go www.ex.ac.uklcimtldictunitldictunit.htm#prefixes www.sidecLick.switchboard.comlSideCLickl}lnavtopicsLinks Diet www.cyberdiet.coml British Healthcare Association Digital Medical Information www.huizen.dds.nl/i-mtebbes/ www.bhia.orglpubLicireJerenceirecommendationslmedpubstandards.htm Diseases Topics-Karolinska www.mic.ki.seIDiseaseslindex.htmL Cancer Guide www.cancerguide.orgl Docguide www.docguide.com Cancer News on the Net www.cancernews.coml DocNet www.docnet.org.ukl CDC A to Z Health Topics www.cdc.gov/health/diseases.htm DocsOnline www.docsonLine.coml CDC Links www.cdcnpin.orgltblstart.htm Docsweb www.docsweb.coml CDC Resources www.cdcnpin.orgltopiclstart.htm Doctoranywhere www.doctoranywhere.com Chicago UnivMedical Links Doctorline www.doctorLine.coml www.uhs.bsd.uchicago.edul-dliebovilhomepage.htmL Doctors' Page www.doctorspage.netl Clerkship Resources www.teLeport.coml-abusharrIcLerk.htmL Doctors' Page www.members.aoi.comlDrsPagelindex.htm INDRAJIT et at. MEDICINE AND THE INTERNET 195

TABLE 1. Some important general medical websites* (continued)

Medical websites URUW eb address . Medical websites URUWeb address

Dr Gil Med Links www.Lander.es: 801-j gilleng Lish.htmL Housecall Medical Resources www.housecall.coml Dr Greene's Pediatric calls www.drgreene.coml iBionet symptoms search engine www.ibionet.comlibio. html Dr Greenson 's Liver Pathology DIP Medical Links www.ihpnet.orgI4health.html#behavioral www.pds.med.umich.eduluserslgreensonl DIP Net Health Resources www.interaccess.comlihpnetlhealth. html Dr Rose's peripheral brain Inet Washington Medical Centre www.JacuLty.washington.edulmomusIPBltabLeoJc.htm www.washington.edulmedicalluwmcluwmc_clinicslgimcl DynaMed www.dynamicmedical.com InfoMedical Dictionary www.home.ipoLine.coml-guoLilpinJoldictO.htm ENT-Patient Information Center www.netdoor.comlentinJol InfoMedical.com Search www.inJomedical.comlnindex.htm Ed's Pathology Notes www.worLdmall.comleifILectures.htm InfoSeek Health Sites netsearch.inJoseek.comfTopiclHeaLth?tid=1207 Explorer's Medical Links www.Lafn.orglmedLinks.htmL Infosheet Medical Resource www.infosheet.comlresourceslmedical.htmL Family Doctor·AAFP www.Jamilydoctor.org InteIliHealth www.inteLihealth.comll HlihtlH ?t=408 Family Health on the Net www.fhradio.orgl InteIliHealth of Johns Hopkins www.inteLihealth.com Fast Search Medical Siteswww.Lonestar.texas.netl-santosIMedSites.htmL Medical Students Lounge www.come.to/med-lounge/ First Aid Online www.prairienet.orgl-cicely/firstaidl Interactive Patient Home Page www.medicus.marshall.edulmedicus.htm Foot and Ankle Web Index www.JootandankLe.coml InterLinks Medical Networks List www.nova.edu/Inter-Links/ General Family www.smiledoc.coml International Medical Journal www.consuLt.iperweb.comlweLcome.htm Gills Medical Links www.arrakis.esl-jgiLzlenglish.htm Internet Guide for the Doctors www.NewWindPub.comlmedguide Global Health Network (GHNet) Internet Health Resources www.ihr.coml www.pitt.edulHOMEIGHNetIGHNet.htmL Internet Professional Resourceswww.ipL.orglrejlRRfstaticlhea9900.htmL Global MedNet www.gLobaLmednet.coml Internet Medicine Website watch www.internetmedicine.comltoc.htmL GlobalMedic www.gLobaLmedic.com Internet Medical Resources www.pslgroup.comlMEDRES.HTM Greatest Medical Tutorials List Internet Mental Health www.mentaLheaLth.coml www.medwebpLus.comlsubjectfTutoriaLs.htmL Internet Pathology Laboratory Growth House www.growthhouse.orglaward.htmL www-medLib.med.utah.eduIWebPathlwebpath.htmL Guide to Health Resources www.healtheconomics.com Internet Resources Workshop Guide to Medical Information www.bcm.tmc.eduiradioLogylworkshop.htm www.geocities.comlHotSpringsllSOSlguide.htmL Jane's Brain Page www.aLoha.netl-jmslbrainuse.htmL Handbook of Lab Tests John Dosseter Health Ethics www.pathweb.pds.med.umich.edulhandbooklindex.htm www.gpu.srv.uaLberta.cal-ethicslbethics.htm Hardin Meta directory www.lib.uiowa.edulhardinlmdl Journal Club on the Web www.webcom.comlmjljwebljrnlclb Harvard Medical Web www.med.harvard.edul Just BerriesFamily Physicians www.theberries.ns.cal Health A to Z www.HeaLthAtoZ.coml Karolinska Institute-Sweden www.mic.ki.selDiseases Health Answers www.heaLthanswers.com KidsDoctor www.kidsdoctor.coml Health Canada-Bienvenue www.hc-sc.gc.ca/ Koop www.koop.dartmouth.edu Health Connection www.crha-health.ab.calhLthconnlhlthconn.htm Listservs www.geocities.comlHotSpringsl lSOSIListservs. htmL Health Finder www.healthfinder.orgldeJault.htm M.D. Multimedia www.mdmultimedia.coml Health Homepage www.webmd.com Mayo Clinic Oasis www.mayoheaLth.orgl Health Info Services www.ndchealth.com McGill University Health Health Information Awards www.hii.orgljudging.htm www.health.Library.mcgiLl.calresourcelcriteria.htm Health Library www.healthlibrary.comli Mcmaster Health Resources www-hsl.mcmaster.caltomJlemltop.html Health Network www.ahn.com MD Consult www.mdconsuLt.com Health on the net foundation www.hon.chl MDAdvice www.MDAdvice.com Health Square www.heaLthsquare.coml MDLink www.mdLink.coml Health Topics FAQ www.imaginiscorp.comlsearchltopics.htm MDNetGuide www.mdnetguide.comlenews.cfm#6 Health Web www.healthweb.orglwglcontentlpaperslguidelines.htmL Med Education Online www.med-ed.online.com Health World Online www.health.net Med Help www.medhLp.netusa.netlindex.htm HealthAnswers www.healthanswers.coml Med Nexus www.mednexus.comlhtml HealthCare Professional www.hcpro.coml MedAccess www.medaccess.coml Healtheon www.healtheon.com MedConnect www.medconnect.coml Healthfinder www.heaLthfinder.govlaboutuslselectionpolicy.htm MedEc Interactive www.medecinteractive.coml HealthGate www.healthgate.coml Medem www.medem.com HealthLink Resources www.healthLink.com.aulbody_index2.html MedEngine www.fastsearch.com/med/index. htmL HealthLinks.net www.healthLinks.netl MedExplorer www.medexpLorer.coml HealthScout www.healthscout.coml MedGuide www.medguide.netl HealthSeek www.healthseek.com MedHunt www.hon.chlMedHuntl HealthStatus.Com www.healthstatus.com Medical Breakthroughs www.ivanhoe.coml HealthWeb www.ghsl.nwu.edulhealthweb Medical Chats www.geocities.comlHotSpringsllSOSlmedicaLchats.htmL HealthWorks Online www.healthworks.co.uk Medical Education Server www.medinfo.ufl.edu/ HealthWorld Online www.healthy.net Medical Engine www.geocities.comfTheTropicsIS320IindJrame.htm Healthy.com www.healthy.com Medical Imaging Resources HealthyWay www.sympatico.calhealthywayl www.mipgsun.mipg.upenn.edul-VnewsluseJuLwww.htmL Heartlnfo-Heart Information www.heartinJo.orgl Medical Information Guide Hippocratic Oath www.montchoisi.chlradiologieiSermentE.html www.geocities.comlHotspringsl lSOSlguide. html HospitalWeb www.mgh.harvard.edulhospitalweb.nclk Medical Interactive Tutor www.medconnect.comlmaindirlintacedu.htm Hotbot www.Looksmart.comlr?comeJrom=ize-eS3940&ize&eS3940 Medical Links-Linkaway www.atlantic.netl-bdarllmedical.html#med (continued) 196 THE NATIONALMEDICALJOURNAL OF INDIA VOL. 13, NO.4, 2000

TABLE I. Some important general medical websites* (continued)

Medical websites URUW eb address Medical websites URUWeb address

Medical Matrix www.medmatrix.orglindex.asp OB/GYN Net www.obgyn.netl Medical Meeting Place www.opennet.comlmedicall OMNI www.omni.ac.ukl Medical Patients Network www.medpatients.com OnHealth www.onhealth.comlchllindex.asp Medical References www.medrefcoml Online Medical Dictionary www.graylab.ac. uk/omd/index. html Medical Residency Page www.webcom.coml-woominglresidenc.html Online Medical Reference System Medical Source www.medsource.coml www.kumc.eduldykeslrefassistldisetlseslmedtextslmedtexts.html Medical Student www.medicalstudent.coml Online Medical Resources Medical World Search www.mwsearch.coml www.medfarm.unito.it:80Ieducationllearnini. html Medicare-Official Site www.medicare.govl Outdoor First Aid Kit www.princeton.edul-oalsafety/firstaid.html Medicine and Internet www.users.otenet.gr/i-pontikis/ PaperChase www.paperchase.coml Medicine on the Internet PharmInfoNet www.pharminfo.coml gopher:llpeg.cwis.uci.edu:7000Iiilgopher. welcomeipeglMEDiCiNE PharmWeb-Pharmacy www.pharmweb.netl Medicine Online--Germany www.medicineonline.de/ Physician and Sports Medicine www.physsportsmed.coml Medicine OnLine www.meds.coml Physician's Choice www.mdchoice.com Medicine Online Inc www.mol.netl Physicians' Desk Reference www.pdr.netl Medicine Resources on the Web Physician's Guide to the Internet www.webcom.comlpgi www.lrs.austin.cc.tx.uslresearchlw3Ihealthlmedlmedsites.htm Physicians Online (POL) www.po.com MedicineNet www.medicinenet.comiScriptIMainlhp.asp ? Physics Unit Conversion Page www.net-24-42.dhcp.mcw.edulphysics.html MedicineNet www.medicinet.com Pocket Guide to Diagnostic Tests Medicon www.medicon.cz www.med. virg inia. edul% 7Ewmd4n1PGDT2e-toc. html MediConf Conferences www.mediconfcoml Praxis.MD www.praxis.md MediConsult.com www.mediconsult.coml Primary Care Internet Guide www.uib.no/isf/guide/guide.htm MedicusLinks-Japanese www.medicusl.inks.com/ Provincial Health Ethics Network www.phen.ab.ca Medis www.docnet.org.uklmedislsearch.html Rescue 411-Basic First Aid www.library.thinkquest.orgli0624lindex.html MedNet-UCLA www.mednet.ucla.edu/ Resident Education Materials MedNet Interactive www.mednet-i.com www.views.vcu.edulhtmllpmrlresidentslres_ed.html MedNets www.internets.comlmednetslindex.html Reuters Health Services www.reutershealth.coml MedNets www.mednets.com Romania Medicine Online www.rotravel.comlmedicine Med-Ped ourworld.compuserve.comlhomepageslandurillmedicine.htm RX List www.rxlist.coml MedScape www.medscape.coml RxTV Prescription www.rxtv.coml MedSearch www.medsearch.com Sciencekomm directories Links MedSeek www.medseek.coml www.sciencekomm.atILinkslmedicine.html MedServ www.medserv.dk/index.html ScienceWeek www.scienceweek.com MedSite www.medsite.com Sick.com www.sick.com MedSite Navigator www.medsitenavigator.coml Silver Platter www.silverplatter.coml MedSmart www.lb.comlmedsmart Six Senses Review www.sixsenses.coml MedSource www.medsource.com/indexil. html Stanford Medical www-med.stanford.edulhealthLinki MedSurf www.medsurfcom:801 Stanford MedWorld www-med.stanford.edulmedworldlhomel MedTap www.medtap.com/Links.html Texas Medical Association www.texmed.org MedTech Corporate Link www.medtechcon.comlcorpsite.html Three Rivers Endoscopy Center www.gihealth.coml MedUniv Yellow page index www.meduniv.lviv.ualinformiLinks.htm U.S. Dept. of Health Services www.os.dhhs.gov MedViIIe www.medville.coml UKMedW3 www.ncl.ac.ukl-nphcarelGPUKJa_herdi MedWeb-Emory www.medweb.emory.eduIMedWebl US medical referral www.usmedihelp.net MedWeb Plus www.medwebplus.com Virgil's Prostate-Online www.prostate-online.com/ MedWeb UK www.medweb.co.uk/ Virtual Medical Library www.ccspublishing.comlindex.htm MedWorld-Stanford University Virtual Naval Hospital www.vnh.org www-med.stanford.edulmedworldlhomel Virtual Pharmacy Center Multimedia MMRL: Library www.med-library.comlmedlibrary www-sci.lib.uci.edul-martindaleiPharmacy.html Harvard University www.golgi.harvard.edulbiopageslall.html Virtual Ref Health Multimedia TIAC Library www.tiac.netlusersljtwardlindex.html www.dreamscape.comlfrankvadlreference-health.html Multimedia Medical Library www.med-library.comlmedlibraryl Vision Therapy www.vision3d.coml My Virtual Reference Desk www.refdesk.comlhealth.html Webcrawler www.webcrawler.com/Health/ National Cancer Institute www.nci.nih.govl WebDoctor www.gretmar.com National Institute for Diabetes www.niddk.nih.gov WebMD www.webmd.com NDEX www.ndex.comlhome.htm Weekly Medical Bloopers www.ep-publishing.comlbloopers.html NEMA Medical Resources www.nema.netlresourceslresources.htm Well-Connected www.well-connected.com Nephron Information Center www.nephron.comlindex.shtml Wellness Interactive Network www.stayhealthy.comlindex. html NetHealth www.healthwatch.coml Wellness Web Home Page www.wellweb.coml NetMedicine www.netmedicine.coml World Health Network www.worldhealth.netl Newsfile search www.homepage.holowww.coml World Health Organization www.who.orgl Newsgroups bulletin boards World Medical Resources www.oup.co.uklscimedlmedintlworld2.html www.geocities.comiHotSpringsl 1505lnewsgroups. html WWW Stanford Medicine www.vlib.stanford.eduiOverview.html NOAH: NY Health Access www.noah.cuny.edu/ WWW Virtual Library www.ohsu.edulcliniweblwwwvll Normal Body Values www.members.aol.comiCatsPajamaibloodval.htm Yourhealth www.yourhealth.com * These websites have been accessed and verified by the authors on 28 March 2000 INDRAJIT et al. MEDICINE AND THE INTERNET 197

Rare genetic diseases in children at http://mcrc22.med.nyu.edul MULTIPLE SPECIALTIES LINKS murphpOlltexthome.htm, Rare diseases in adults at http:// A huge list of specialty-related websites are emerging (Table II). rarediseases. info. nih.gov/org/ and Syndromes at http:// There are also special medical websites that catalogue the best of www.kumc.eduiAMA-MSS/study/pd:csyndromes.htm. each specialty and link them directly from a single page. These can

TABLE II. Some important specialty medical websites*

Multiple disease index Obstetrics and Gynaecology Disease Link Page Gynaecology and Obstetrics page www.womens-health.com/ .www2.mc.duke.eduideptslptotICurrent-SiteiLinksIJC-Bookmarks.html GynaeOncology Links www.oncolink.upenn.edulspecialtylgyn_oncl Disease Links www.sun3.lib.uci.edul-sclancylmedlmed2.htm Gyne Oncology Tutorials Multi topic Medical & Nursing Links www.seaox.comlnurse.html www.gynoncology.obgyn.washington.edulTutorialslindex-3.html Speciality Links www.mtsinai.orglmsites.html Infertility resources www.ihr.comiinfertiIitylindex.html. Cancer Orthopaedics Breast Carcinoma Links www.med.umich.edulllibrlcancerlbreast06.htm Classification Criteria for Rheumatic Diseases Cancer Links www.ncl.ac.ukl-nchwwwlguideslclinks21.htm www.rheumatology.orglresearchlclassificationlclassifi.htmI Cancer Links www.ncl.ac.uklchild-heaithlguideslclinks2d.htm Gateway to Orthopaedic Teaching sites at Internet Cancer types www.cancer-info.comlcantypes.htm www.owl.orthogate.orglteach.html Largest Oncology Links www.micfmic.ki.selDiseaseslc4.html SLE Links www.lupus.comlancientlsle.html Oncology Links for patients www.ahandyguide.comlcatllclc766.htm Spine Links www.spine.orglother_sites.html UK resources for Cancer www.ncl.ac.ukl-nchwwwlguideslclinks44.htm Wheeless Textbook of Orthopaedics www.medmedia.comlmed.htm. Infectious disease list Pathology Infectious Disease Links www.home.idac.orglidaclidlinks.html Clinical Genetics Malaria www.geocities.comiHotSpringsIResortI5403IMalaria.htm www.vh.orgIProviderslTextbooksIClinicaIGeneticsIContents.html Parasite Atlas www.cdfound.to.itIHTMUatlas.htm HemoSurf-An Interactive Atlas of Hematology TB Links www.serum.dklenlforskningltbimmunituberculosis_links.htm www.aum.iawfunibe.chlvlzlBWUHemoSurjlIndexe.htm TB Lupin Links www.lupingroup.comlindexl.htm Pathguy www.pathguy.comllectureslguts.htm TB WHO www.who.orglgtblindex.htm www.who.orglgtbl Pathmax www.pathmax.com Weblab www-medlib.med.utah.edulWebPathlwebpath.html. Cardiology Cachnet Cardiology Links www.cachnet.orglsites.html Paediatrics Healthlinkusa Cardiology Links www.heaithlinkusa.coml79.htm OMIM Online Mendelian Inheritance in Man Littlehearts Cardiology Links www.littlehearts.comllinks.html www3.ncbi.nlm.nih.govIOmiml Tchin Cardiology Links www.tchin.orgl Paediatric Disease Database Welcome to Cardiology Compass www.cardiologycompass.coml www.pedianet.comlnewslillnessldiseaseldisease.htm Paeds Links www.med.jhu.edulpedslneonatologylpoi.html Cardiorespiratory audio links The Pediatric Database (PEDBASE) 550 childhood illnesses Atlas of Murmurs www.icondata.comlhealthlpedbaselpedlynx.htm www.kumc.edulinstructionlmedicinelcont-edlinfotechlcar-mur.htm Auscultation Assistant www.med.ucla.edulwilkeslintro.html Pharmacology Auscultation Tutorials www.xs-tall.nl/i-medicine/ Acid Base tutorial Cardiac Auscultation Links www.westernu.edullib_hrtsound.html www.tmc.tulane.eduldepartmentslanesthesiologylacidlacid.html Cardiac Medlib Murmur directory www ..comispilcoolstuJj2.htm Antibiotic Guide www.intmed.mcw.eduiAntibioticGuide.html Cardiology Multimedia files Drug Search Lists www.rxlist.coml www.gretmar.comlwebdoctorlcardiologymm.html Pharminfo Net www.pharminfo.com ECG Library www.homepages.enterprise.netldjenkinslecghome.html Radiology' ECG Tutor www.bioscience.igh.cnrs.frllatlaseslheartlekglekg.htm Christopher USG site home.att.netl-don.christopherlultrasound.htm McGill Auscult Atlas www.music.mcgill.cal-tkatsialauscultation.html CT Fly Thrus www.crd.ge.comlesllcgsplprojectslmedicall Virtual Stethoscope www.music.mcgill.cal-tkatsialauscultation.html George Simon's Plain Film Collection www.sbu.ac.ukl-dirtlmuseumlg-topics.html Dermatological Online Atlas www.derma.med.uni-erlangen.de Joewoo USG Overview www.home.hkstar.coml-joewooljoewoo2.html Dermatology Image Index www-medlib.med.utah.edulkwlderml Virtual CT Detailed notes www.nlm.nih.govlresearchivisiblelvhpJonflrobblrobb-pap.htm ENT ENT Links www.users.interport.netl-jsherrylentlist2.html Surgery Medmark ENT www.medmark.orglorll Atlas of Diagnostic Laparoscopic Surgery OtoLinks www.infocom.coml-djetmorelotolotolinks.htm www-surgery.med.ohio-state.edulatlasl Online ENT Textbook www.bcm.tmc.edu/oto/studs/toc.ht Brain tumour www.abta.orglprimerltypes.htm Dr Bagga's Surgery Links Gastrointestinal tract www.members.wbs.netlhomepageslblalglbaggaslmedicine.html Medmark Gastroenterology Links www.medmark.orglgastrolgas.html Online Atlas of Surgery www.bgsm.edulsurg-scilatlaslatlas.html Gastrointestinal Endoscopy Links www.vub.vub.ac.be/r-leo/ Organ transplantation Links www.asforglother.html. Endoscopic Studies www.eus-online.orglstudiesframe_studies.html Surgery Links www.207.226.184.98lcatllsls561.htm What's new in Gastro Transweb www.transweb.orgl www.dir.yahoo.comlHeaithiMedicineiGastroenterologyl Q and A Hepatitis Vaccine www.cdc.govlniplvacsafelfslqhepb.htm Urology Atlas of GI Endoscopy www.mindspring.coml-dmmmdlatlas_l.htmi Nephrology www.medmark.org/neph/. Feeding Gastrostomy Page members. iinet.net.au/i-scarffam/gtube. html Urology www.medmark.orglurol

* These websites have been accessed and verified by the authors on 28 March 2000 198 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 13, NO.4, 2000 be viewed as a 'one-stop' page, making a difficult task easy. The the clinician does not choose the topic, the pace ofthe programme, popular websites are Galaxy Guide to Medical Topics at http: or the place of learning, and the CME material cannot be easily Ilgalaxy.einet.netlgalaxyIMedicine.html, Lancet Links at http:// delivered to the point of care where the clinician needs the www.thelancet.comlnewlancetlanylarcade!links. html, Medical information. Computer networks have the potential to accomplish Students Links at http://som.flinders.edu.auIFUSAlFMSSI these goals. CME has begun to appear on the Internet; however, NAMSAlmedicine.html, Internet Medical Search Guide at http: there have been few evaluations of its usefulness, acceptance Ilwww.pcom.edullibrarylclinical.htm. Nursing and Medical and effectiveness. Several obstacles to its wider use remain. These Links at http://www.seaox.comlnurse.html. Disease Link at include issues regarding training in using the Internet forphysicians, http://www2.mc.duke.edu/depts/ptot/Current-Site/Links/JC- reluctance of physicians to participate in online commerce, Bookmarks.html. and the current unavailability of CME to be delivered in small- grained quantities to the point of care. While these issues are being NEWSGROUPS addressed, online CME can be experienced from the following Newsgroups are forums where news and views on a variety of websites at CME Medscape List at http://www.medscape.coml subjects can be exchanged. There are a growing number of groups Home!CMEcenterICMECenter. html, CME Web at http://www. dedicated to medical topics. Although they are mainly of interest cmeweb.coml and CME at http://ahsn.lhsc.on.ca/ce!. to specialists, they are all open to the general public, and it is not uncommon to see a question posed by a patient with a problem." TELEMEDICINE The largest collection of newsgroups is USENET, which contains Cybermedicine is distinctive from telemedicine, although there several thousand news groups covering almost all imaginable are overlapping issues, especially as the Internet can also be used topics, from alcohol to Zen. USENET newsgroups are arranged in as a medium for telemedical applications. While telemedicine a hierarchy, which originally had seven top-level categories: sci focuses primarily on a restricted exchange of clinical, confidential (science), comp (computing), soc (social), talk, misc (miscella- data with a limited number of participants, for the most part neous), news, and rec (recreational). The addition of the alt between patient and physician or between physician and physi- (alternative) category to this original list triggered an explosion of cian, in cybermedicine there is a global exchange of open, non- bizarre newsgroups. Each top-level category is further subdivided clinical information, by patients and medical practitioners. Tele- many times, with each group conforming to a hierarchical naming medicine for the most part is applied to diagnostic and curative convention-sci.med is a general medical newsgroup within the medicine, while cybermedicine is applied to preventive medicine sci category, and sci.med.aids is a newsgroup dealing with the and public health. II Telemedicine, the delivery of health care with medical and scientific aspects of AIDS. Medical newsgroups are the patient and at different locations (,medicine comprehensively categorized and indexed at Medical Newsgroup at a distance'), covers the whole range of medical activities, database at http://www.sciencekomm.atladvicellists.html. Johns including treatment and education. 12 Hopkins University at http://world-health.netlnewsgrou.html It is important to understand that Telemedicine is a process, not and Med-Info.Com Newsgroup database at http://www.med- a technology. Telemedicine activity around the world is practised info.comlmed-newsgroups.html. by virtue of it being either 'better' than traditional medicine ordue to the presence of no other alternative means of health care ELECTRONIC MEDICAL TEXTBOOKS delivery. Its driving force has been developments in communica- Online access to medical textbooks is a unique feature of the tions technology, and as new communication systems are devel- Internet. Some of the most popular e-medical books include AIDS oped health applications are proposed, such as those supporting at http://hivinsite.ucsfedulakbI19971,9 e Dermat at http:// the delivery of primary health care to geographically remote www.emedicine.comldermlindex.shtml. Pediatric Critical Care areas or regions underserved through the maldistribution of pro- at http://pedsccm.wustl.eduIAll-Netlmain.html, Telemedicine fessional expertise. Textbook at hup.r/www.coiera.com/, Textbook of Virtual An- The dramatic impact of the growth ofTelemedicine in recent esthesia accessible at http://www.usyd.edu.aulsulanaesIVATI times has resulted in the emergence of specialized areas such as VAT.html, Wheeless' Textbook of Orthopaedics at http:// Telecardiology, Teleradiology, Telepathology, and so on. Tele- www.medmedia.comlmed.htm, Yale Univ Heart Book at http:// medicine is not a panacea and its disadvantages include possible www.med.yale.edullibrarylheartbkl, Online Merck's Manual legal implications, depersonalization and overdependence on accessible at http://www.merck.comlpubslmmanuall and Harrison technology that may be unreliable, and a clinical risk." Tele- Online at http://www.harrisonsonline.coml. There are websites medicine is comprehensively analysed at websites such as Tele- that periodically update a list of medical textbooks available medicine glossary at http://tie.telemed.org/links/pubs. online on the Net. These are sourced as Online Textbooks at asp#glossaries, Telemed Links at http://www.telemedmag.coml http://emedicine.comlcgi-shllfoxweb.exe!onlinebooks@d:/emlga, links.shtml, Tie Telemed Links at http://tie.telemed.orgllinksl, HeaIthcare Multimedia Textbooks at http://www. vh.orgIPro- IOWA Telemedicine Links at http://www.lib.uiowa.edulhardinl viderslTextbooksIMultimediaTextbooks.html, and an electronic mdltelemed.html, and Telemed Today athttp://telemedtoday.coml textbook with a remote control gadget as Emergency Medicine at http://emedicine.comlemerglstyle2.html. MEDICO-LEGAL ISSUES AND ETHICS A precarious implication of medicine on the Internet is that CONTINUING MEDICAL EDUCATION doctors may be potentially exposed to more frequent legal chal- Continuing medical education (CME) is meant to bridge the gap lenge. While patients may be motivated to seek out the most recent between new scientific observations and clinical practice. 10 How- literature for their condition and can invest considerable effort in ever, the traditional CME has not been effective at altering the that search, most practising doctors cannot. If the law were to behaviour of physicians. One reason for this failure of traditional judge a doctor negligent for failing to institute recognized best CME programmes may be their inflexibility. In traditional CME, practice, the continuation of an informed patient population and INDRAJIT et al. : MEDICINE AND THE INTERNET 199 an overworked clinical community provides a recipe for increas- popular websites such as Medical Center Libraries Journal ing litigation." Stemming from these areas of concern are a Index at http://scilib.ucsd.edulbmllmedLnz.htm, Medwebplus number of websites dealing with medicine and the law (albeit Medical Journals at http://medwebplus.com/subject/, being relevant to the developed countries) at Health law http:// Sciencekomm Medical Journals at http://www.sciencekomm.at/ www.mwbb.comlserviceslhealthI2.htm. Intrepid Medical Legal journals/medicine/med-bio.html. Another excellent compilation Links at http://www.intrepidresources.com/html/links.html. of medical journals on the net is located at UNICA Biomedical Medical Law at http://www-sci.lib.uci.edu/-martindalel Journals list at http://pacs.unica.it/period.htm, Stanford Legal.html, Medical Law on the Net athttp://www-sci.lib.uci.edul Medical Journal Site at http://highwire.stanford.edul, Teleport HSG/Legal.html, Medical malpractice, professional liability, Medical Journal at http://www.teleport.coml-hestonljournal/ and health care Links at http://www.afss.com/medlinks.htm. chat.htm, Mednets Journal Links at http://www.internets.coml Medical Law Links at http://www.takayasu.org/pageJ4.html, mednets/obgyn.htm, Webmedlit at http://www.webmedlit.coml. Patient's Medical Safety at http://www.ama-assn.org/med- Utah Online E-Journals List at http://medstat.med.utah.edul sci/npsfllit.htm, The Health Law Resource at http://www. database/ejournal.html and Science Direct Medical Journals at netreach.neu--wmanning/, The Physician's Guide to Medical http://www.sciencedirect.com. There are certain popular medical Liability Litigation at http://www.afss.com/physguid.htm.In journals which comprehensively cater to a wide group of medical recent times, law websites related to medicine have sprung up in professionals, merging the barriers between various disciplines. India such as Healthlaw India from the National Law School at As an illustrative example, a small select group of popular http://www.healthlawindia.com. medical journals comprises British Medical Journal at http:// Medical ethics is an area of crucial purport in the practice of www.bmj.com/, JAMA at http://www.ama-assn.org/publicljour- medicine. Inasmuch as it deals with the crux of moral medical nals/jama/jamahome.htm, The Lancet at http://www. practice, medical laws and values, codes of right and wrong, of thelancet.coml, NEJM Online at http://www.nejm.orglcontent/ late much interest has been generated on issues such as death and index.asp, and Canadian Medical Association Journal at http:/ dying, confidentiality, electronic medical record privacy, eutha- /www.cma.ca/cmaj. nasia, organ transplants and ethical aspects of human cloning. These can be accessed at Issues in Medical Ethics at http:// INDIAN MEDICAL RESEARCH AND JOURNALS www.healthlibrary.comlreading/ethics/index.htm. Medical Eth- In recent times, many websites related to biomedical research in ics Online at http://aristotle.philosophy.msstate.edulMedEthl, India have sprung up. Foremost among them is the website located Downloadable Papers in Bioethics and Medical Ethics at http: at IndMed at http://indmed.delhi.nic.inl. Equal to the challenge //www.bu.edu/wcp/MainBioe.htm, Medical Ethics at http:// and effort, a large compendium of medical journals of India www.medicalethics.com/, DoctorNET Medical Ethics Links at indexed both by Medline and National Informatics Centre (NIC) is http://www.comedserv.comlethics.htm. Medical Ethics Online available at QMed http://www.qmedin.comlmedsites/indianweb Links at http://aristotle.philosophy.msstate.edu/MedEth/ journals.htm. Other websites that offer a list of medical journals resources.htm and Bioethics at http://lrs.austin.cc.tx.us/researchl based in India include IndMedica at http://www.indmedica.coml w i/health/ethics/medethic.htm, journal.htm and IndMed at http://indmed.delhi.nic.inljrnl.html.

SEARCHING MEDICAL LITERATURE AND ARTICLES INDIAN MEDICAL COLLEGES, DOCTORS AND Searching medical literature has become easier and more acces- HOSPITALS sible for most medical practitioners. The Medline is a comprehen- A large list of medical college websites are available from the sive, cross-referenced premier bibliographical database of cita- following sites-MCS India at http://www.mcsindia.org/ tions to the medical literature from 1966 to the present. Medical college.html, Ministry of Health and Family Welfare at http: articles from Medline can be conveniently accessed and derived //mohfw.nic.inlkkl95/book95.htm, http://www.allaboutcollege. from the National Library of Medicine's database covering the comlcolleges/asia/india.htm and displayed in a map form at http: fields of medicine, nursing, dental medicine, the health care //www.mapsoJindia.comlmaps/india/h3i22.htm. There are many system, veterinary medicine and the preclinical sciences. It is websites dealing with medical practitioners across the country. available free on the Internet through many agencies including Generally the sites are categorized specialty-wise as in IndiaOrtho Publvled." Pubmed is accessed through the portal Pubmed at at http://www.indiaorth.orglkemradl, Indian Dentists at http:// http://www.ncbi.nlm.nih.gov/PubMedi. Another popular website www.dentalindia.com/, Radiology Education Foundation at utilized for searching the net is Internet Gratefulmed at http:// http://www.reJindia.net, ENT India Online at http://members. igm.nlm.nih.gov/. There are websites that compare the various tripod.com/-entindia/index. html, or geographical region-wise such web agencies that offer Medline. These include Medmatrix as Doctors Delhi at http://www.doctorsdelhi.comland TN Doc- Medline Comparator at Dr Felix's Free Medline Page at http: tors Online at http://www.tamilnadudoctors.coml. or sometimes /rwww.docnet.org.uk/drfelix. Medline Comparators Links at comprehensively as in Indian Doctors Network at http://www. http://ww2.med.jhu.edulpeds/neonatology/medline.html#medline, indiandoctors.coml and 123 Doctors Network at http://www. Stanford Medline Comparator at http://www-med.stanford.edul J23india.comlhealth_and_medicineldoctorsl. Doctors looking out laneidatabaselmedJomparison.html, and Invivo Medline List for jobs overseas may benefit from websites such as http://www. http://www.invivo.net/b g/medline2. html. overseasdoctors.com. Hospital lists in India are available at http://www.indmedica. MEDICAL JOURNALS com/hospitals. htm, http://www.J23india.com/business_and Medical journals undoubtedly form the backbone of scientific _economylcompanies/hospita/s/ and http://www.qmedin.coml learning and effective medical practice. There are websites that medsites/hospital.htm. Some of the premier hospital websites can have been compiled across the globe, which display a list of be accessed at Amritha Institute Cochin at http://www. medical journals. The various medical journals are catalogued at aimsproject.org/hospital.site.htm, Apollo Hospitals at http:// 200 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 13, NO.4, 2000 www.apollohospitals.com/, Madras Medical Mission at http:// books at http://www.vh.org/ProviderslTextbooks/Multimedia www.icvd.org/, and Hinduja Hospital at http://www.hinduja Textbooks.html. hospital.coml. Recently, online prescribing has begun in India with information available [email protected]. SHORTCOMINGS AND DRAWBACKS Internet and information and communication technologies may HEALTH NEWS AND RESOURCES FROM INDIA help reduce health disparities through their potential for pro mot- HELP (Health Education Library for People) is a consumer ing health, preventing disease and supporting clinical care for all. health library for patients available at http://www.healthlibrary. Unfortunately, there are shortcomings. Many patients with health coml. The mission of HELP is to empower patients with informa- problems are least likely to have access to such technologies. tion by providing it directly to them, encourage them to make Barriers to access include cost, geographic location, illiteracy, their own decisions, evolve the patient to a status of an educated disability, changing nature of many website URL addresses (links partner, and ultimately serve as a resource centre for doctors. present today; gone tomorrow scenarios l), and factors related to HELP was modelled on the Planetree Health Library in Califor- the capacity of people to use these technologies appropriately nia 15 and efforts are on to build up a sizable collection of material and effectively .16 in regional Indian languages. Q Med is a one-stop direct access In addition, only a few websites provide complete and accurate to Indian medical websites available at http://www.qmedin. information on health-related topics. To objectively illustrate this com!. The classification of sites has been done with a view to viewpoint, Biermann et al. 17 systematically evaluated the infor- make browsing really easy. They are comprehensively catego- mation available on the Internet for the condition Ewing's sar- rized into blood banks, Indian polyclinics and clinics on the web, coma. The accuracy, completeness, and consistency of the results medical conferences, educational institutions, foundations, non- was significantly influenced by a host offactors that included the governmental organizations, trusts and health associations. type of search engine used (first -generation search or metasearch Health news from India is offered in a variety of websites such engines), the spelling of key word typed (Ewing, Ewings, Ewing's, as MCS India at httpt//www.mcsindia.org/, HELP at http: etc.), the type of medical information sourced (anecdotal, testimo- //www.healthlibrary.comlnews/index.htm. Apollo Health online nial, alternative medical therapy, medical case report, general at http://apollohealth.satyamonline.coml. In addition, there is a information, primary treatment information, etc.), the rating of large index of health news groups of India at http://www. peer review status (posting from a non-peer reviewed journal, indonet.net/news/newsgroupslhealthl. Importantly, extensive re- posting without reference to publication or presentation, posting sources on Indian health are located at websites such as List from a printed textbook, posting with reference to a medical or of health organisation at http://www.idealist.org/india.htm. scientific presentation, etc.) and the 'net appeal' factor (graphics, IndiaFocus Links at http://indiafocus.indiainfo.comlhealthl, sound, colour, etc.). In addition, the information ranged from http://indias .comlH ealth/, India Health Links at http://dmoz. org/ near-accurate and mildly misleading statements at one end, to Regional/Asia/India/Health/, IndiaView Links at http://www. clearly erroneous information and factually incorrect web pages. indiaview.com/make.html, Q Med at hupr/www.qmedin.com. Expectedly, this study showed that a variety of web pages reported http://www.qmedin.comlmedsites/index.htm. HELP at http:// survival rates for Ewing's sarcoma sweeping from as low as 5% www.healthlibrary.com/index.htm, IndMedica at http:// to as high as 85%. This suggests an urgent need to check public- www.indmedica.comland http://www.indmedica.comlindex.htm. oriented health care information on the Internet for accuracy, Health net India at httpr/rwww.healthnetindia.com/, WebIndia completeness and consistency. 18 at http://www.webindia.comlcategorylhealthcare.html. Indian Medical Association at http://www.imal928.coml. Non profit THE QUALITY FACTOR Indian health organization at httpi/Zepore.mit.edu/s-tgowrish/ Recurring concerns relate to the quality of information on the tgowrishiindiaiindia_non....[Jrofhtml and Public health profes- Internet. The quality of medical information is particularly impor- sionals at http://education.vsnl.comlpublichealthtoday!. tant because misinformation could be a matter oflife and death. 19 The health resources and information from the Government of Quality is defined as 'the totality of characteristics of an entity India can be sourced from the following locations: Ministry of that bear on its ability to satisfy stated and implied needs' . For Health and Family Welfare at http://mohfw.nic.in/, National quality to be evaluated, these needs have to be defined and AIDS Control Organization at httpt/Zwww.naco.nic.in/, translated into a set of quantitatively or qualitatively stated National Health Policy at httpt/Zwww.cbu.edu/r-aross/ requirements for the characteristics of an entity that reflect the Links.H'FM, Ministry of Health and Family Welfare at http:/ stated and implied needs. Given the evolving state ofthe Internet, /mohfw. nic.inlkkl95/book9 5. htm, and National Health Programs it may be difficult or even inappropriate to develop a static tool at http://mohfw.nic.in/kkl95/i9itoc.htm. or system for assess-ing health-related websites. 20 The quality of information varies widely, from the most up-to- POTPOURRI OF WEB SITES date practice guidelines produced by leading clinical bodies to In addition to the websites described above, there are a few which out-of-date or inaccurate recommendations." Though there is cover the spectrum of topics that influence our 'day-to-day' poor quality health information on the Internet, no one has yet medical practice. Some of these sites are Nursing Links at http: shown whether it has a positive or a negative impact on public //www.publist.com/indexes/M ED05 8000_02. html; Clay health outcome. 22 Similarly, it has not been shown that the quality Helbers Statistics Links at http://www.execpc.coml~helberg/ of information on the Internet is different from that in other media statistics.html, Electronic Statistics Tutor at http://www.statsoJt. or that it leads to different health decisions by the public. 19 An com/textbook/stathome.html, Medical Quotations at http://www. important outcome of the availability of quality medical informa- doctorspage.net/quotes.asp, Medical Slides at http://www. tion on the Internet is the delivery of effective health care to medslides.com/, Multimedia Medical Reference Library at patients. Exemplifying and underscoring this issue of quality are http://www.med-library.comlmedlibrary/ and Multimedia Text- the illustrative case reports featured in The Lancet as 'Medline INDRAJIT et al. : MEDICINE AND THE INTERNET 201 solutions' , wherein dilemmas in clinical management are ratio- available at present. Second, the Internet, e-mail, www and the nally solved by the use of quality medical information on the information superhighway will have a dramatic impact on medi- Internet. 23 cine. Medical teaching, research as well as clinical practice will be affected in many different ways by these advances. Expectedly, THE FUTURE there is an ongoing broader shift from the conventional methods It is difficult to predict the future of medicine on the Internet. The of medical teaching and practice into the world of dotcom and Internet will change radically in the coming years with a 'quantity Internet. Third, the fundamental issue influencing medicine on the leap', freeing today's Internet from some of its technicallimita- Internet is 'quality information retrieval' .There is an urgent need tions. The next-generation Internet will operate at speeds up to to qualitatively calibrate all medical information so that the a thousand times faster than today, will be integrated more desired data is focused, accurate, updated, relevant and reliable. intensely with multimedia capabilities and facilitate effective Clearly, this will be the most challenging area of concern in the video-conferencing by patients and physicians and resolve secu- future. rity problems. Besides the 'quantity leap', there will be a 'quality leap' with the emergence of 'machine understandable informa- REFERENCES tion' and evolution of a global medical knowledge base that is Glowniak J. History, structure, and function of the Internet. Semin Nucl Med 1998; browsable and searchable across languages and continents. 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