Drawbacks of the information autobahn
t is difficult to pick up a magazine or journal these days without being confronted with the information superhighways. Everybody is talking or writing about them, so I have decided to join the crowd. It is not a bad idea to give this subject some thought before we are totally immersed.
The information superhighways allow all kinds of information to be shared, facilitate education, and provide access to libraries and galleries worldwide. The exchange of information is faster and dissemination of knowledge more widespread because by distant learning, and it is claimed that even the environment benefits because people do not have to drive to the office but can work from home.
Those using the superhighways are singing the praises of this new tool. Like highways for automobiles, the information superhighways or data autobahns are great, wide, fast roads that are free or inexpensive. In medicine, it seems that many problems can be eased by this technology.
Let us imagine one typical situation in radiology – or in clinical medicine at large – where the highways can contribute to the patient's advantage: A patient has been referred for a diagnostic follow-up, but the original hard copies are not in the hospital archives. They are somewhere in London, Paris, Amsterdam, or the building next door. In any case, they cannot be found. Everybody is familiar with this situation. Now, there are two possibilities: there is a backup on tape or disk (which usually cannot be retrieved), or the original examination was made somewhere else and cannot be retrieved.
Consider the future: you walk to the next computer with an internet or PACS (picture archiving and communication system) connection, log on, and within seconds you have the original images on-screen, regardless of where in the world they are being stored.
In another situation, a patient has Hotzenplotz disease and you want to know how many cases of the disease there have been in San Marino and how they have been treated there. You walk to the next computer with an Internet connection, log on, and within seconds the answer is displayed on-screen.
No quick fix
Attending conferences, reading magazines, or watching television can give the impression that computers and Internet will solve every conceivable question. In medicine, computers contribute to a patient's faster and better recovery. The patient's medical history is available on Internet. E-mail makes the health system cheaper.
There is no doubt about the benefits that information superhighways will bring, but the mental picture of the highway analogy contains not only fast-moving and smooth-flowing traffic but also pollution, noise, accidents, congestion, and a ruined landscape. Few people have thought about the drawbacks of the data autobahn. The overwhelming enthusiasm of today might soon give way to more sobering thoughts, and it is worth considering some of them in order to keep a sense of perspective.
Supporters of the information superhighways assert that medicine is one of the main areas of application and benefit.
A common example is of a small community hospital or clinic connected to experts in big faraway medical centers. With difficult or uncertain cases, all the data is sent to these experts via a telephone line or fiber-optic cable, and the experts then return the diagnosis. Ideally, this scenario implies that the patients will receive the right treatment faster than if it had first been necessary to transport them to the big medical center.
The main problem of many small hospitals is the lack of high technology equipment to obtain data, not the lack of an expert. It may well be the case that such small hospitals would spend valuable resources connecting themselves to the superhighway, thus using resources that could have been better used purchasing diagnostic equipment or educating and training a medical doctor to deal with the patients locally.
Beware of the superhighway barons
The next point concerns access, and the problem of haves and have nots. The promise is of easy and free (or, at least, very cheap) access to the information superhighways for all. A student of mine told me that it does not cost anything, but he is not in charge of paying the university's telephone bill; he did not have to buy the hardware and software he uses; nor does he read the business pages of the newspapers.
Just as the 19th century had its railroad barons, the late 20th century will have its information superhighway barons, making millions of dollars out of high technology telephone lines, hardware, software, and most importantly, fees.
Easy and free access is a public relations slogan. Access still depends on availability of equipment, connections and networks which are not necessarily cheap or easy for everybody. The concept of easy and free access assumes the prior availability and understanding of the supporting technology. The entire continent of Africa possesses less telephone lines than Sweden, so it is difficult to see how Africa can be connected to the superhighways.
Will all the world's information be accessible? Of course not. This is another marketing slogan.
The superhighways will convey only information from those computers linked to the system – if you can find it because the internet is chaotic. Other information will not be accessible. On the other hand, whatever information is on the highway can hardly be protected any more.
Copyright does not count, and intellectual theft will become increasingly widespread and cannot be punished because nobody is enforcing the laws. As soon as you are connected to the highways, it will become difficult to lock your garage and house doors. All the big and small brothers can – and will – watch you.
Is it really necessary for everybody to participate in the information society? It is claimed that if you do not become a member, you will be isolated.
However, there is another point of view: you become isolated as a member of the information society because you start living in an artificial world fenced in by computers and telephone lines. In other words, you degenerate into data autism. This leads to the next potential problem of dependency and habit, whereby the user becomes so used to or dependent on the technology that the options or alternatives are no longer considered.
The telefax addicts are a case in point. Many people have seemingly forgotten that mail and telephone exist, communicating only by telefax, to the extreme of sending a 50-page document by fax when it could have been sent by mail (or kept, because nobody will read it anyway).
Given easy and free access, is the point going to be reached where people only communicate through computer networks? Will, for example, congresses and other scientific meetings become obsolete? Users of the superhighways are able to order tickets for travel and entertainment from home, but will there really be any need for tickets? From their computers, users can connect to wherever they want to go to and to whatever they want to hear or see.
Will books or the printed media in general disappear, as some people predict? Will all scientific information be provided through the computer? Incidentally, journal articles published 10, 20, or 100 years ago can easily be read, but can a computer access and decipher diskettes that are 10 years old? Probably not, because reading them is as difficult as deciphering the Dead Sea scrolls.
Another point often overlooked is that the information society is based on permanent change. What was taken for granted yesterday will change today. The high-technology wonderland needs permanent change to earn money, and it is big business. It does not create new thoughts or new mental results, but it offers solutions for new vehicles to transport, transform and store information. These vehicles are consumer goods that will be obsolete in five years.
Depending in whom you talk to, the opinions about the information superhighways vary from “I do not really care because I do not understand anything about it” to “I can't wait until it is all set up and I can use it for everything”. In between these two extremes, one finds animosity, fear, excitement, and brainstorming to discover applications for the technology.
For users of technology and information, the prospects are mostly fascinating. Much has been said and written about the new possibilities, the irrelevance of distance and difficult access, and the dream future of democratic distribution of information. However, it is because we have been bombarded with propaganda and commercials about the advantages of the information superhighways that the possible drawbacks must be kept in mind. We must do this for our own good and to keep alive the different and independent cultures that are the backbones of our civilization.