LDI Health Policy Seminar Series and
Provost's Interdisciplinary Seminar on Health Informatics

George D. Lundberg, M.D.

Editor in Chief

"The Current Status of the Medical Internet"

November 17, 2000, 2:00 p.m.
Class of 62 Auditorium, John Morgan Building
(3620 Hamilton Walk)

Summary Biosketch
The always provocative Dr. George Lundberg gave his views on the past, present and future of the Medical Internet at a seminar at the Leonard Davis Institute of Health Economics on November 17, 2000. Dr. Lundberg served as editor-in-chief of JAMA for 17 years, and is now editor-in-chief of Medscape.com.

"Obviously, computers are great for the practice of medicine, if we could figure out how," Dr. Lundberg declared. After working with computers for the first time in 1963, Dr. Lundberg said that he had predicted that "physicians would use computers, big-time." And every decade since, he added, "I've been wrong." However, recent surveys indicate that between 60-90% of physicians are now using the Internet for something, up from single digits just five years ago.

Dr. Lundberg noted that it took radio 38 years to reach an audience of 50 million Americans, while the World Wide Web did it in four years. In 1995, Dr. Lundberg called the Internet "the future of the present" and "the most important advance in human communication since the printing press." "And I don't back down from that today," he stated.

Given this rapid pace, a key issue for the Medical Internet is self-governance. The Internet is "unregulatable," accordingly to Dr. Lundberg. "As we started creating the Medical Internet, one of our goals was to do it right, so that we would self-govern and not have to have laws affect how we behave. The precedent was medical journals and editors," he said.

Dr. Lundberg explained that medical journals had existed for about 300 years before rules were developed to guide the actions of authors and editors-the 1978 Vancouver guidelines. In contrast, he said, the Medical Internet has existed for about five years, and has spawned many rules of behavior and ethics. Dr. Lundberg called this the difference between "Gutenberg time" and "Internet time."

Dr. Lundberg commented on some of the other challenges created by the Medical Internet, including:

How to assure the quality of medical information. In 1997, Dr .Lundberg and colleagues published an editorial that described five questions consumers should ask of an health site: who wrote what you're reading, where do they work, where did the information come from, who owns the site, and when was the information posted. "If you can't answer these five questions, you shouldn't be there."

How to do electronic medicine right. One recent survey found that 34 million Americans wanted to contact their doctor by e-mail, although just 3 million actually did. "That's a huge opportunity gap," Dr. Lundberg. He said that conventional wisdom holds that e-mail might be appropriate for following established patients, but is verboten for new patients. "That's almost certainly wrong," he said. He pointed to a need to study effective practices in electronic medicine, and challenged his audience to figure out the right way to pay for e-mail medicine.

How to enforce state licenses to practice medicine. Dr. Lundberg predicted that the Internet would successfully challenge the existing practice of state medical licensure, because, "people will practice across state lines and no one will be able to stop them." One compromise might involve a model like driver's licenses, where a license in one state allows you to drive in all states. The state of origin keeps records and resolves disputes.

Dr. Lundberg's presentation was also the 2000 Robert Eilers Memorial Lecture. This lectureship honors the memory of LDI Founding Director Robert Eilers, professor of insurance at Wharton and community medicine at Penn's School of Medicine..

Dubbed by the Industry Standard in 2000 as the "Healthcare Internet's Medicine Man, George D. Lundberg, MD, is the Editor in Chief of MedicaLogic/Medscape, the world's leading site for health and medical information. Prior to joining Medscape in February 1999, Dr. Lundberg served as editor of The Journal of the American Medical Association for 17 years, and he was also editor in chief of the Scientific Information and Multimedia Group of the American Medical Association. Dr. Lundberg holds academic and honorary degrees from seven universities and is a board-certified pathologist. A member of the Institute of Medicine of the National Academy of Sciences, Dr. Lundberg is an adjunct professor of health policy at Harvard University.

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The Leonard Davis Institute of Health Economics.
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