What if medicine in the US is just like the internet? What if it is just as difficult to separate the chaff from the wheat in medicine as it is on the web?
Both the curse and the blessing of the web is its accessibility. This means that anyone's voice can be heard. And it also means that anyone's voice can be heard. So, we are just as likely to stumble upon drivel as we are on information gold. And what takes time and skill is separating the two into neat piles, one to be ruthlessly discarded, and the other cherished for how it enriches us. To be sure without the web we might not have had access to either, and it is the egalitarian nature of the internet that gives us such a variety of sources in our information diet.
Now, let's look at medicine. Every day we hear about how much noise there is in the field, and this noise is difficult, if not impossible, to separate from the signal. Some signals are becoming much clearer, and they tell us that by being too egalitarian in medicine, we have likely been causing great harm. Take, for example, PSA and mammography screenings. The drumbeat of harm associated with these highly non-specific tests and the resultant chase after false positive results, is getting deafening, and rightfully so. Every day we hear that researchers have uncovered a breakthrough mechanism or treatment, and we hear with increasing frequency that a treatment previously thought to be sacrosanct is a bunch of rubbish. What gets lost among all this noise is the possibility of a true breakthrough in disease management or treatment or cure.
Think how hard it is to separate general valuable content from bunk on the web. Now, think of the logs of increase in the levels of difficulty of this task in medicine, where difficult concepts are further shrouded in the opaque cloth of arcane and obfuscating terminology. In fact, it is so difficult, that the class previously designated as the interpreters of this information for the lay public, physicians, are unable to keep up. There is a need for a whole new class of interpreters now -- researchers and patient advocates. And while this is good for the market and the economy, since it creates jobs that had not existed before, it begs a more critical evaluation vis a vis its impact on public's health. It also begs the question of the value of this gadgetry and information glut in medicine -- what is truly the wheat and what is the chaff? And what happens when you continuously try to drink from a fire hose? And do we turn down the stream, or is there another way?
Is it feasible to limit this stream of idea and information generation? Furthermore, is it sensible to do so? Many worry that putting limitations on this is tantamount to stifling innovation. But what is innovation? The most pertinent definition to the current discussion in the Merriam-Webster dictionary is "a new idea, method or device." Nowhere does the definition incorporate the value of this idea, method or device. Perhaps it is left to the free market to determine this value and ultimate use of such innovation. Well, in a market that claims to be free, but is filled with cynical machinations in the form of favoritism, subsidies and pricing games, is objective value really what is valued? And indeed, given the complexity of these "innovations", is it even possible for the end-user to judge their value, even if the market were free?
Yet, even despite all these challenges to establishing the value of innovation on the back end, I am not sure that centrally limiting idea generation is either feasible or right. In the case of ideas on the web, I have come to the conclusion that such microblogging platforms as Twitter can be invaluable filters of information, where my network of favorite tweeters whom I follow faithfully provides me with the wheat that has already been cleaned, yet not always overprocessed. Is this possible in medicine? I know that the FDA and CMS are supposed to provide some filtration for such medical information and interventions, but each is statutorily handcuffed and gagged not to stray beyond their legislative agendas. Therefore, a value filter should not be a body beholden to the letter of the law, or to political or financial interests. It needs to be driven by the spirit of scientific curiosity, objective evaluation and pragmatism. Most importantly, it must be open to a conversation that incorporates respectful dissent and many different perspectives.
Twitter arose out of the drive to share information, and it has shaped itself as a tool for developing value in the gargantuan and ever-growing world of yottabytes. Perhaps it is citizen bloggers and tweeters, including e-patients and clinicians and researchers and writers and others, who will ultimately solve this information glut in medicine by extracting the kernel of usefulness from this morass of vegetation. Harnessing this power systematically and accurately is the next challenge of our information age.
Because ultimately, for human cognition and health, less is more. And we are still human.