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Paul C. Coelho, MD

JAMA. 1998;280:1454.

In 1994, roughly 3 million people worldwide were estimated to be regular users of the Internet.¹ More recent surveys estimate the number of Internet users at more than 80 million in North America alone.² As recent events have demonstrated, the Internet and its graphical counterpart—the World Wide Web—are becoming the preferred medium for rapid access to new information.³ Internet use will continue to increase as new technology makes access easier. It is expected that within the next 10 years a variety of inexpensive non-personal computer devices, such as digital television, will emerge to surpass the personal computer as the primary means of Internet access. This will fuel even greater information consumption.

This robust consumption of electronic information has, in turn, set off an unending cycle of supply and demand. New software and other tools have made electronic publishing convenient for many organizations and individuals. Consequently, the tremendous growth in Internet use has been paralleled by an equally impressive increase in Internet content. One measure of content is the number of registered domain names, or Internet addresses, which have increased by a factor of 50 between 1993 and 1997. Some have gone so far as to suggest that the Web has the potential to become "the world's largest vanity press."⁴

Given the ease of electronic publishing, many within the medical community are concerned about the validity, quality, and consistency of medical information on the Internet.^5-6 As important as the quality of information is, we must not overlook the implications of the quantity of information. Classic informatics theory shows that as information increases, the amount of irrelevant and inaccurate information (often referred to as "noise") also increases.⁷ Therefore, as more information is placed on the Internet, the probability of a patient finding relevant and accurate information decreases. This paradox of information theory has led one analyst of the Internet to comment that when "there is noise and someone assumes that there isn't any, this leads to all kinds of confusing philosophies."⁸

Medicine is no place for confusing philosophies. As society makes a transition to a digital economy, physicians must be prepared to assist in the process. Whether we like it or not, our patients are turning to electronic resources as their primary source of medical information. This trend, coupled with an expansion of nonphysician clinicians, is decreasing our role in decision making. We must take the lead in setting standards for medical information on the Internet to prevent further erosion of this role and to ultimately protect the health of our patients and our profession.

Department of Rehabilitation Medicine
University of Washington
Seattle

REFERENCES
1. The emerging digital economy. Washington DC: US Dept of Commerce; 1998. Available at: http://www.ecommerce.gov/emerging.htm. Accessed September 23, 1998. 2. Nielsen Media Research. Internet Demographic Study, June 1998. Available at: http://www.nielsenmedia.com/interactive/commercenet/S98/. Accessed September 22, 1998. 3. Macavinta C [CNet News Web site]. World rushes to Net for Starr report. September 11, 1998. Available at: http://www.news.com/News/Item/0,4,26265,00.html. Accessed September 22, 1998. 4. Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the Internet. JAMA. 1997;277:1244-1245. Accessed September 22, 1998. FREE FULL TEXT 5. Kassirer JP. The next transformation in the delivery of health care. N Engl J Med. 1995;332:52-54. FREE FULL TEXT 6. Jadad AR, Gagliardi A. Rating health information on the Internet. JAMA. 1998;279:611-614. Accessed September 23, 1998. FREE FULL TEXT 7. Shannon CE. A mathematical theory of communication. In: The Bell System Technical Journal. Murray Hill, NJ: Bell Laboratories. 1948;27:379-423. 8. Schneider TD. Information theory primer. Bethesda, Md: National Cancer Institute; 1995. Available at: ftp://ftp.ncifcrf.gov/pub/delia/primer.ps. Accessed September 23, 1998.

Edited by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.

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