Book Review

The Medicalization of Cyberspace

N Engl J Med 2008; 359:2074November 6, 2008

Article

The Medicalization of Cyberspace
By Andy Miah and Emma Rich. 160 pp. New York, Routledge, 2008. $140 (cloth); $43.95 (paper). ISBN: 978-0-415-37622-8 (cloth); 978-0-415-39364-5 (paper).

In the developed world, the Internet has become a given, and it is changing how people communicate, think, and understand the world. It is certainly changing medical practice. Patients consult Web sites before seeing physicians, and subsequent visits to the latter are often framed by printouts from the former. At least 80% of adults who use the Internet have searched for health information. Even physicians will now go to Google before opening a medical textbook. From PubMed to Wikipedia, to a huge array of health-oriented Web sites, there is quick access to sophisticated, free medical information on any disease, drug, or symptom. There is also, of course, plenty of health faddism, hype, and hucksterism.

Most people want to know where health information is coming from, and most seem to be able to tell the difference between the mainstream, reliable sources and the purveyors along the fringe. For better and for worse, Internet access has changed both the doctor–patient relationship and the experience of illness. Cyberspace is loaded with health information because that is one of main things that Web users want. We're both tied to the Web and obsessed with medical worries and medical questions. The authors of this book examine how the digital culture, which is so rich in medical content, reflects the identity of the humans who create it and consume it.

Physicians by nature are practical, and they will find it a challenge to comprehend even a short book written by intense medical sociologists, who by nature are ontologically and linguistically obverse, even obtuse. But stay the course. Don't get depressed by jargonology such as “prostheticization of the body” and pseudo-insights such as “the body is neither obsolete . . . nor does it `no longer exist'” (which is, nonetheless, good to hear). Despite the lingo, authors Andy Miah and Emma Rich have extracted from cyberspace fascinating narratives about topics such as the persistent sexual arousal syndrome, the Visible Human Project, the controversy about an online auction for a human kidney (which never actually happened), suicide chat rooms, and the pro–anorexia nervosa (Pro-Ana) movement. The authors wisely avoid making ethical judgments or entering into heavy ethical analysis. Instead, they seek to listen to what is going on in cyberspace and to understand how it affects the way that people see health and disease. Online conversations, Web sites, chat rooms, blogs, and YouTube videos are more important to patients and to health than the medical world realizes. Action in cyberspace can promote (or demote) a disease, a therapy, a medical center, or a physician. Talk online can create consensus about what is ethical and what is damnable and can produce political pressure to fund certain research. Public understanding and public support for health-related issues are increasingly shaped by what happens in cyberspace. We had better listen, too.

At the end of this dry, intellectual analysis, Rich adds an afterword about her father's death from mesothelioma. This short, touching narrative bears witness to the new role that cyberspace can play as people cope with health crises. In the year before the diagnosis, as Rich's father was deteriorating, she and her family turned again and again to online information sources, even though they could be overwhelming. And when the diagnosis was finally made, nearly all of their understanding of the disease came from Web sites — not from physicians. In online networks Rich found practical advice, solace, and support, even as her father lay dying. Yes, there are souls behind some of these new machines.

Edward W. Campion, M.D.

Citing Articles (1)

Citing Articles

1. 1

   Claire F. Snyder, Albert W. Wu, Robert S. Miller, Roxanne E. Jensen, Elissa T. Bantug, Antonio C. Wolff. (2011) The Role of Informatics in Promoting Patient-Centered Care. The Cancer Journal 17:4, 211-218
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