Gwendoline Margaret Spurll

Title: Writing Post-Internet

The internet has profoundly affected medical writing.

Medical writing has four stages; data gathering, data synthesis, conclusions from the data, and dissemination of the conclusions.

I started writing on medical topics in the 1970's.  At that time, to review a subject you had first to go to the medical library. There you found the wall of books called Index Medicus.  There were about 20 heavy volumes for each year.  Let's say your topic was the effectiveness of influenza vaccine. You got out the volume containing “I” for 1974.  You found “influenza.” You looked under the subheading “vaccine.”  You found the papers that mentioned effectiveness, and wrote down their references.  You put back 1974, and got 1975. Repeat. In this example the current year was 1978, so the 1977 and 1978 Index Medicus was still in monthly form, so for those years, you had to get down one volume for each month.  Then you took your list of references, went to the stacks, and found the appropriate journal.  Sorry, that year was out for binding.  You looked for the next referenced journal.  This one was available.  You pulled the five pound book from the shelf,  carried it to the photocopier, copied the article, and returned the book.  

And in 2013? You turn on your laptop, open the browser, and go to the Medline website.  You  type in “influenza vaccine” as search one, randomized control trials as search two, then link the two searches by “and” and you have a list of the 14 randomized controlled trials on influenza vaccines in the last 15 years.  Press another button and you can see the abstracts.  You read the abstracts. Does this article  answer the question?  If does you can press PDF and you have the whole article to read or save. You can do the whole search without getting out of your bed.  

You can judge the reliability of the publication by the “impact factor” of the journal and whether it is peer reviewed.   

Our trainees now take an additional shortcut.   They do not bother with Medline.  They go straight to Uptodate, a continuously updated website edited by experts in various fields of medicine.  It is a more or less well digested, more or less unbiased summary of current knowledge.  It costs $500 a year by subscription, but McGill provides it free to staff and students. But if you don't go beyond Uptodate you don't get the nuts and bolts of the data, and critical analysis of  data is still important in determining how reliable the conclusion is.   

For another example, I might want to know how to cure Parkinson's Disease.  I do my Medline search, looking for “Parkinson's disease” and “cure.”  I find 141 articles, but none offers a cure, only speculation on future possibilities. Next I go to Google.  Aha!  Ayurvedic medicine can cure Parkinson's disease.  There are testimonials on the website.  I just have to buy their medicine. But I know that buying this medicine will make me poorer, but not healthier.  It is buyer beware in the non-peer reviewed world of the internet.  Every month or so one of my Parkinson's friends brings in a new “cure,” and I just feel sad, for them at being fooled and for me at having so strongly ingrained a critical sense.    

The wikipedia is an inconsistently reliable resource.  A wiki is a text editable by anyone who  accesses it.  Some parts of the wikipedia are exceptionally good.  When I was evaluating new laboratory equipment for cell typing recently, I found that the scientists in the area had done a phenomenal job of compiling information on each of the antibodies used by the machines to differentiate types of cells.  Even a prolonged sojourn on Medline could not have found as much detailed information.  But other topics in  the wikipedia are less well done.

Once you have collected your data you have to synthesize it.  This is no easier post-internet, and perhaps harder, because of the potentially daunting amount of information you can collect.  It still requires putting together vast amounts of complex and perhaps contradictory information into  one consistent whole.  

The actual writing part is much easier than it used to be.  In the “bad old days” you would write your text, then decide the paragraphs needed to go in a different order, cut out part of the page and reorder the parts, and tape them together in the new order.  Then you would retype them.  Now, using word processing software, once the text is on the page you can lift it and put it anywhere you want, and end edit to your heart's content.  

The biggest change brought by the internet is ease of publication.  One can write anything  and publish it as a book, and sell it, without anyone reviewing it or credentialing the author.  Scientists are being approached to “edit” or “peer review” for new online startup journals, which are cheap to publish since there is no actual physical printing required, but these journals may lack credibility. 

I find the new world of internet knowledge exciting, invigorating, but in the end disappointing, because even with all of this data, we don't have all of the answers.   I always want to know the end of the story, but in medicine as in life there is always more to know.