EDITOR‘S CHOICE
The Internet :
Its Role in Medicine and Healthcare
Suman Kapur*
The information technology revolution is being
described as the most important development in
the history of humankind since the industrial
revolution. Characterised as ‘The Third Wave’ by
Alvin Toffler, in his book of the same title, it has
the potential to change the ways of man and
society beyond the wildest of imaginations.
The computer, invented initially to process
information, slowly grew into a storehouse of
information. It then became sophisticated and
ever more powerful and got hooked to others
of its kind to form a formidable network. This
network further acquired the capability of
distributing electronically processed information
to all and sundry, overcoming every conceivable
form of barriers, including geographical and
political. Today, it is a global collaborative
medium and a rich resource of information of
all kinds – science, technology, research,
education, and commerce. Through a host of
emerging tools and protocols, it enables person-
to-person, computer-to-computer, or person-to-
computer communication.
Welcome to the fast growing and exciting electronic
world of wonders, that is the INTERNET!
With continuing advances in information and
communication technology, the applications of
computers in medicine have increased rapidly,
and have the potential to revolutionise
healthcare. And, the Internet, with its powerful
penetration and scalability, has become an
increasingly popular medical information
resource. By re-architecturing the workplace
around computer-based technology, doctors,
researchers, and other healthcare providers are
creating a new vision of work and organisation
* Head, Department of Neurochemistry,
Institute of Human Behaviour
and Allied Sciences, New Delhi.
in such areas as patient care, medical and
health education, and research. This evolving
technology includes the electronic medical
record, the Internet with its e-mail, WWW (world
wide web), and file transfer capabilities. There
is an urgent need to integrate this technology
into a total information system for the clinician
in the new century and the new millennium.
Electronic mail has the potential to enhance the
professional relationship both between
physician and patient, and among physicians
of the same and different specialities. There are
distinct advantages of communicating via E-
mail: It is faster than all other forms of mail
services. It can be exchanged across time zones.
It is not dependent on the presence or absence
of both the sender and the receiver at the two
ends at the same time. It is less expensive than
all other means of communication like sending
a fax or making a phone call. E-mail is the most
useful resource extending the avenues of
learning to an international audience through
news or list-server groups. Associations,
departments, educational sites, organisations,
peer-review scientific journals, and Medline
database web pages of prime interest to
healthcare providers have been developing at
an amazing pace. The WWW provides an all-
in-one medium for image, sound, and video.
WWW is the best method of electronic
publishing and many magazines and
newspapers are available on the Internet.
Further developments of technological advance
nurturing our interests will consist of on-line
journals, telemedicine as well as advances in
health screening and assessment, international
chatting, computer-based training and
education in different fields of medicine, and
centralisation of cyberspace information into
database search sites.
Internet, which allows instant transmission of text
and graphics and permits talking via computers,
is the ideal medium for sharing medical expertise.
It can serve to save precious human life; help
treatment in difficult and complicated cases by
seeking expert opinion on the Net and overall,
facilitates an exchange of ideas. This could well
lead to valuable innovations and discoveries.
Interactions in the cyberspace will also help the
doctors in India, especially those practising in
smaller cities, towns, and rural areas and who
therefore, often feel isolated, to keep in touch with
new developments. They can become members
of information groups and search through free
information databases on the Internet. Most of
the journals published in other countries take a
long time to reach remote places in India and are
also very expensive. These can be now accessed
for a nominal fee on the Internet without any
unnecessary loss of time.
A survey by the Royal College of Surgeons of
Edinburgh has shown that health surfers, including
doctors, are the biggest measurable group of net
users. “A quarter of the material on the Internet is
now health-related, and about a third of web
surfers are searching for health information,” says
Dr. Harry Brown, author of “Netlines” in the British
Medical Journal1. Healthcare professionals can
retrieve plenty of information on such subjects as
AIDS, emergency medicine, geriatrics,
orthopaedics, rehabilitation, preventive medicine,
public health, rural medicine, transplant medicine,
and travel medicine – all available on the many
web sites. Healthcare professionals can also
become a part of the various discussion forums
of their interest and can exchange their experience.
Information on higher education in medical
sciences and job opportunities in different hospitals
and research institutes can also be found on the
Internet.
Healthcare is an area that generates a wealth of
information in the form of journals, reports,
conference proceedings, etc. It is difficult for a
healthcare professional to keep himself abreast
134 Journal, Indian Academy of Clinical Medicine
of all the developments taking place in his field of
interest despite the phenomenal growth of medical
journals. In 1997, the number of entries in Index
Medicus exceeded seven million. With the advent
of the Internet, information resources (on-line
databases, CD-ROM producers, full text
documents of various societies and the commercial
agencies, news groups, directories, individual
home pages and corporate resources) are now
open to one’s finger touch. Literature search can
be done on databases such as MEDLINE, EMBASE
and BIOSIS as well as on other Web sites in no
time. Healthcare professionals can also get
information on health workers, societies and
hospitals, healthcare companies, and on
healthcare management and policy. On an
exploratory browsing of the Net, they can query a
database for known references or retrieve an
exhaustive list of relevant material to review the
available literature or pull up a list of first quality
recent references to answer a particular question2.
A large amount of information on patient care,
education, and support is available. Most health
sites have traditionally been information-based
and the Net (Internet) is, for example, the best
way to find a self-help group for any disease. It’s
also a huge source of details on individual
diseases, no matter how obscure, and is
increasingly being used by patients as a way of
locating the best hospitals and doctors. Names of
some of the medicine-related Indian and
important international websites are given in
Tables I, II, and III.
Changes in healthcare delivery and the explosion
of health information available on the Internet are
already affecting primary healthcare practice in
America. Briggs and Early3 have reviewed how
recent developments in the technology of the
Internet affect the way healthcare is provided. They
refer to the growth rate in Internet access and all
the improvements in performance resulting from
new technologies, in particular in the areas of
telemedicine and in communication between
patient and healthcare professionals. Modern
information technology not only affects the delivery

Vol. 2, No. 3
July-September 2001
of healthcare, but also can significantly influence
the doctor-patient relationship.
Increasingly, the Internet will be used to convey
more ‘real-time’ information. A physician
practicing in a remote village can now consult a
specialist sitting at any distance by providing him
all images and data on-line, thus eliminating the
risk involved in and save the time and money spent
on travel.
Table I : Names of some of the major medicine-related Indian web sites.
Topic
Indian Medlars centre
Indegene, India’s Premier Health Portal
JAPI : Journal of Association of Physicians of India
Association of Physicians of India
Journal of Indian Medical Association Online
T B India
All India Institute of Medical Sciences
BITE-IN
DISHA
Institute of Speech and Hearing
National AIDS Control Organization
Public Health India
Leprosy Projects
Schizophrenia Research Foundation
Journal, Indian Academy of Clinical Medicine
Useful site for practising physicians
Health sites are also becoming interactive. There
is the new virtual checkup for women at http://
www.allhealth.com/virtualcheckup where one has
to just key in a few personal factors such as blood
pressure, cholesterol level, lifestyle details, and
family profile. Virtual Check Up also has sites that
will assess individual risks for osteoporosis and
heart disease. Other health sites are already
offering heart monitoring and cancer risk
assessments, opinions on best prescriptions to
Journal, Indian Academy of Clinical Medicine
Vol. 2, No. 3
seek, and virtual health shops offering a multitude
of health supplements.
While Internet technology has dramatically
improved the access to health material, the biggest
shake-up is taking place in the General Physician’s
clinic. Doctors can key their patients’ symptoms
into a computer and receive an instant diagnosis.
In several rural areas of the UK, doctors are using
ISSN-based technology to enable a medical
Name of the website
http://indmed.delhi.nic.in
http://www.indegene.com
http://www.japi.org
http://www.japi.org/API.
http://www.jimaonline.org
http://tbindia.info.nih.gov/project1.html
http://www.aiims.edu
http://www.pugmarks.com/aiims
http://www.bitin.com
http://www.netfx.net/disha
http://www.speechfoundation.com
http://www.nic.in.naco
http://education.vsnl.com/publichealthtoday
http://www.foundation.novartis.com/
leprosy_india_gra
http://www.xmission.com
http://www.indegene.com/jiacm
http://www.md.consult.com
consultant to examine patients 120 miles away.
Such technology will mean that, in 20 years’ time,
many patients will no longer need to travel to see
a specialist. Diagnosis will be made in their family
doctor’s clinic, by a consultant examining them
with the help of video images and remote sensors
that can relay data on blood pressure, heart rate,
and other vital signs. The Net is also set to allow
doctors to change the way they treat patients. It is
anticipated that doctors will be able to use a DNA

July-September 2001 135
database of patients to tailor drugs for their specific
conditions and eliminate possible side effects.
The Internet has become a new platform for
telemedicine. Cyber Medical Center (CMC), a
project that integrates the technologies of
multimedia, database management, a multiple-
site video-conferencing system and the WWW, is
aiming to create a multimedia network system for
the electronic management of patients’ records,
teleconsultation, on-line prescription, on-line
continuing medical education and information
services on the web4. British doctors are already
using the Internet to make diagnoses, carry out
remote examinations, and give consultations. Soon
they will operate remotely on patients thousands
of miles away and use virtual reality to allow
leading surgeons without leaving their offices to
consult around the bed of a patient.
Table II : Some of the useful websites for physicians (International).
Topic
National Library of Medicine: Internet Grateful Med Search
Electronic BMJ (British Medical Journal)
New England Journal of Medicine On-line
The Journal : Current Issue (Lancet)
Annals of Internal Medicine
Postgraduate Medicine
American Family Physician
Postgraduate Medical Journal
Hospital Practice
Pro COR (Conference on Cardiovascular) Health
Medscape
It is possible to speak (transmit voice) in real time
on the Internet. Audio-conferencing programmes
work by digitalising speech and then sending the
digital data over the Internet. Internet can thus
help in arranging teleconferences at an affordable
cost.
Net is also impacting the way surgery is carried
out. Cybersurgery is the latest health craze on the
Net. VRML enables doctors to actually view
136 Journal, Indian Academy of Clinical Medicine
complicated surgeries underway in real time
environment. The singer Carnie Wilson was not
alone during her gastrointestinal bypass operation.
Along with half a dozen doctors and nurses, there
were 52,000 people watching the two-hour
procedure live on the Net. Apart from improving
the rating (due to celebrity patients), watching
operations could help potential patients to make
up their minds, and younger surgeons to learn
from the vast experience of their senior colleagues
and peers. There is no more a need to visit a doctor
for estimates on the expenses for a given treatment
or corrective surgery. For plastic surgery, just scan
in your picture and e-mail it along with a credit-
card consultation fee of $ 250 to HYPERLINK at
http://www.celebrity or www.doctor.com/
personal.html which is run by a team of doctors,
and back comes the advice on what work is
Name of the website
http://igm.nlm.nih.gov
http://www.bmj.com
http://www.nejm.org
http://www.thelancet.com/journal
http://www.annals.org
http://www.postgradmed.com
http://www.aafp.org/afp
http://www.postgradmedj.com
http://www.hosppract.com
http://www.procor.org
www.medscape.com
needed, and how much is it likely to cost.
One of the biggest challenges, particularly in
emergency medicine, has always been to bring
together the patient and the right doctors as quickly
as possible. The Net has started coming to our
rescue in such instances. In North Carolina,
researchers were able to treat an airline patient
during journey 30,000 ft above the ground, using
data transmitted live on the Internet.

Vol. 2, No. 3
July-September 2001
Remote sensor technology is already changing
the way we care for the elderly. In Germany,
doctors and social workers have set up a
telemonitoring system where elderly people and
the chronically ill and housebound are
monitored, using a camera and a high speed
telephone line.
Table III : Other health information sites.
Name of the site
http://www.ayurvedic.org
http://www.ayurvedwebline.com
http://www.ayurvarta.com/eng
http://www.ayurveda.com
http://www.baidyanath.com
http://www.badlani.com/Goodhealth
http://www.chennaionline.com/medizine
http://www.classicalhomeopathy.com
http://www.doctornet.com
http://www.doctorsaab.com
http://education.vsnl.com/reikinetindia
http://www.emedilife.com
http://www.goodhealthnyou.com
http://www.growingwell.com
http://www.healthcarehouse.com
http://www.healthlibrary.com
http://www.internetindia.com/health
http://www.indiadiets.com
http://health.indiamart.com/kidshealth
Many developments in science have their origins
in science fiction, and telepathology is no
exception. The concept was first illustrated in 1924
in the magazine ‘Radio News’. It was not until
1980, however, that the first working telepathology
system was demonstrated. Telepathology can now
be used for remote primary diagnosis, remote
referral to a specialist in pathology, remote
teaching, remote presentation of post-mortem or
microscopic findings, quality assurance image
Journal, Indian Academy of Clinical Medicine
Vol. 2, No. 3
circulation and feedback, and consensus diagnosis
for pathological review in clinical trials5. In the
next 5 to 10 years it will be possible to build sensors
that are almost as powerful as the entire pathology
lab. The doctor can then search a database on
the Net and look up data on other people who
suffered from similar symptoms and immediately
Name of the site
http://health.indiamart.com/alternativemedicine
http://www.indiandoctors.com
http://www.indianhealthzone.com
http://www.indiaspace.com/homeopathy
http://www.indiayogi.com
http://www.jabalpurdoctors.com
http://www.lovelight.com
http://www.mdspeak.com
http://www.meditimes.com
http://www.po.com
http://www.saffronsoul.com
http://www.sreekrishnapharmacy.com
http://www.thriveonline.oxygen.com
http://www.webhealthcenter.com
http://www.wholehealthnow.com
http://www.yoga.indiainfo.com
http://www.yogacare.com
http://www.yogasite.com
http://www.youngmaster.com
conclude and say you have – XYZ.
The resources available on the WWW can be
deployed as a very useful “Information for Health”
tool bridging the information gap and reducing
the number of accidents and risks due to misuse
or improper use of drugs6. Misuse of prescription
medications is a serious problem largely due to
lack of information. WWW can well be deployed
to fill in this gap in appropriate and safe use of
prescription drugs7. Within the past 10 years, a

July-September 2001 137
wealth of data has shown that diet and exercise
play an enormous role in fighting disease. Today,
it is well recognised that life style patterns increase
an individual’s risk for particular disease. Physical
inactivity is recognised as an independent risk
factor for cardiovascular diseases. A large
proportion of the US population does not
participate in regular physical activity and research
has shown that, without intervention, most people
remain sedentary. American Cancer Society
attributes one-third of all cancer deaths to poor
diet. To be disseminable, physical-activity, and
dietary habit interventions must move beyond
reliance on strictly face-to-face modes and begin
to fully use newer technologies such as the
Internet8.
A panel of experts from the fields of
neuropsychology, neurology, psychiatry,
behavioral medicine, family medicine, paediatrics,
physical medicine and rehabilitation, occupational
therapy, nursing, speech and hearing,
epidemiology, and biostatistics met with the public
some time ago to discuss effective rehabilitation
measures for persons who have experienced a
Traumatic Brain Injury (TBI). And biomedical
researchers and clinicians were made available
the draft statement on the Internet immediately
following its release at the conference and were
later updated with the panel’s final revision of
recommendations9.
The digital divide in information between the
developed and the developing nations requires
new approaches within the field of scientific
publishing for all concerned parties to work in
concert and solutions that neither the public nor
the private sector will be able to achieve on its
own. The World Health Organization (WHO) and
the Open Society Institute (OSI), a part of the Soros
Foundation network, have teamed up with leading
information providers, ISI and Silver Platter, and
other public and private partners to provide access
to high quality scientific information via the
Internet, for research centers in the countries of
Africa, Central Asia, and Eastern Europe. The pilot
project is a part of a wider United Nations
138 Journal, Indian Academy of Clinical Medicine
programme called Health-Inter-Network which
aims to improve global public health by facilitating
the flow of health information worldwide, using
Internet technologies. Research, and sharing the
knowledge gained through its efforts, is
fundamental to improving public health. “Valuable
research is carried out in the developing countries
and emerging economies, but researchers are
hampered by not being able to share essential
scientific information and communication,” says
WHO Director-General Dr. Brundtland, “If
researchers and scientists can read the same
journals, search the same databases, join in the
discussion groups, compete for the same grants
as their colleagues from wealthier countries, it will
strengthen their own research, bring them into the
international community of researchers, and
eventually improve dissemination of their results.
Internet – as a global cooperative network of
university, corporate, government and private
computers, all communicating with each other –
can go a long way in meeting the WHO goal of
“Health for All”. As we move into the next century,
and a new millennium, the Internet, as we know it
today, should help us to define the world of
tomorrow. It is however worth remembering that
many health- and medicine-oriented sites have
serious shortcomings with regard to quality and
reliability of content. Some guidelines could prove
more useful in getting valuable feedback from
information providers and users alike, in
improving the quality of information at its point of
production7. Till that happens and till a computer
terminal is at place on every healthcare provider
and medical practitioner, print journals like the
one you are reading now will remain indispensable
although JIACM has also gone on-line.
Also, remember you need to be computer savvy
and to a large extent you need to know exactly
what you want! Queries have to be focussed to
retrieve meaningful information. For a lot of
information lies dumped on the Internet, and
as such may not be very reliable because there
are no guidelines on what is to be on the
Internet.

Vol. 2, No. 3
July-September 2001
References 6. Benger J. A review of telemedicine in accident and
emergency: the story so far. J Accid Emerg Med 2000;
1. Internet Access Essentials, Ed Tittel E, Robbins M, AP 17 (3): 157-64.
Professional, MA. 7. Doupi P, van der Lei J. Rx medication information for the
2. Beginner’s guide to the Internet, Ed Aggarwal, MD, TFY public and the WWW: quality issues. Med Inform Internet
Technical publications, New Delhi. Med 1999; 24 (3):171-9.
3. Briggs JS, Early GH. Internet Developments and their 8. Marcus BH, Nigg CR, Riebe D, Forsyth LH. Interactive
significance for healthcare. Med Inform Internet Med communication strategies: implications for population-
1999; 24 (3): 149-64. based physical promotion. Am J Rev Med 2000; 19 (2):
4. Chen HS, Guo FR, Lee RG et al. Recent advances in 121-6.
telemedicine. J Formos Med Assoc 1999; 98 (11): 767- 9. Consensus conference, rehabilitation of persons with
72. traumatic brain injury, NIH consensus development panel
5. Wells CA, Sowter C. Telepathology: a diagnostic tool for on rehabilitation of persons with traumatic brain injury.
the millennium?, J Pathol 2000; 191 (1): 1-7. JAMA 1999; 282 (10): 974-83.

Journal, Indian Academy of Clinical Medicine
Vol. 2, No. 3
July-September 2001 139