Cyber medicine--panacea or cure?

Medical websites, offering instant diagnosis and cure for your ailments--real or imagined--are proliferating with such speed that health regulatory authorities worldwide are hard pressed to deal with the flood. The storm has now reached Africa and medical opinion is sharply divided on the merits or otherwise of cyber medicine. Tom Nevin reports.

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Dwindling resources, burgeoning populations and a chronic shortage of doctors and nurses are throwing healthcare in Africa into crisis. It is time African doctors took a closer look at medical websites and worked out how to use the internet to its best advantage--and also how to avoid abuse of the system.

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Some healthcare providers say the internet can't be ignored and, if used correctly could widen the healthcare net and could save practices' and governments' time and money. Others are not so sure, and temperatures on both sides of the debate are rising.

Virtual medical advice can be obtained either by looking up the information or by subscribing to a virtual clinic with 24-hour online access to trained nurses and doctors and, of course, quacks and medical charlatans.

Worldwide there are a staggering 17,000 medical websites, of which only 200 can be considered legitimate, according to Claudine Singer, a senior analyst with the internet research firm, Jupiter Communications.

Like almost everything else on the internet, it is the quality and thoroughness of the product or service that most concerns doctors and regulators. Unlike buying a lemon on an e-auction for used cars, going wrong with medical treatment can have serious, even fatal, consequences.

The big danger in medicine on the internet is that there's nothing to prevent an unqualified entrepreneur from putting up a virtual brass nameplate as a medical expert.

"The epidemic of so-called doctors to be found on the web these days, particularly sourced from the US, is internet medicine gone mad," says a Namibia specialist. "If you have a mind to, you can diagnose and find treatment for any ailment under the sun, simply by visiting any of thousands of online health sites.

DODGY AND DOWNRIGHT DANGEROUS

"As things stand today," she says, "dodgy and downright dangerous sites like these are impossible to regulate. As soon as one site is shut down, five more take its place under other names and addresses. I guess that's what spooks our regulatory authorities. But I am of the opinion that the internet could be used in a professional and sensible manner to help overworked doctors manage their practices."

Dr Francis Khama, a GP and researcher in Ndola, Zambia, agrees, but cautiously so. He likes the idea of the internet's potential healthcare outreach to distant rural areas, but worries about unsupervised diagnosis. "It's a serious concern that patients can visit virtual surgeries around the world at the touch of a button, type in their symptoms and then be instantly diagnosed," he says.

He concedes that modern healthcare must make a space for cyber medical outreach, "but there must be properly considered guidelines". As a first step Khama would like to see computer linkages to remote clinics that are staffed only by nursing sisters and who could affect more accurate diagnoses by accessing reliable medical sites, or by "chatting" to better qualified medical personnel.

A Sandton, Johannesburg, GP sees the issue in an urban context. "I have to be a doctor and a businessman," he says. "I'm trying to run a medical practice company that is viable and makes a profit. I'm limited by my time. I'm like a worker who works with his hands. Whether you're a carpenter or a doctor, you can only do so much work in a day.

"A lot of my time is taken up with nonproductive tasks. If I could get rid of those in some way, that would free my time for me to generate income in a productive way. I would like to build a medical website that would be used as an advisory service."

As an example, he cites patients needing medical examinations for insurance and other reasons. They could consult the practice's web-site, find out what they needed to know and supply information interactively from their homes before they visited the rooms.

"That would save a huge amount of time for both doctor and patient," he maintains. "We could e-mail the results of the examination back to the patient through confidential means so they could actually generate their own report at home if they wanted to. I'm not sure if that confidentiality is available at the moment, but that would be helpful and informative to the patient."

The internet is certain to become a prime medium in dispensing healthcare into distant, rural communities with immense cost-saving, and life-saving, benefits.

"If that happens," observes Khama, "it would be confined to the country in which the healthcare provider operates. Doctors have to be registered in the countries they work in."

ONE OF WORLD'S MOST REGULATED

The South African healthcare industry is amongst the world's most regulated, and this is generally welcomed by its medical practitioners. There is, however, a rising tide of opinion that seeks greater flexibility in the way internet medicine can be included in the range of services on offer by medical professionals. Officially, South African medical practice web-sites are largely taboo. Healthcare watchdogs in other African countries take a more generous view.

"I have my own website that I've set up for the practice," says a Johannesburg north GP. "I've looked at using that as a tool to communicate with our specific patients, but I could be treading on thin ice. Medico-legally it's not allowed, according to a ruling I've had from the SA Medical Association (SAMA), and I think that's rubbish."

Right now all SAMA will allow on medical practitioners' websites is a resume of their practices and the services offered. What most doctors would really like is a website that includes information on medical issues their patients most frequently phone and inquire about.

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"That would save time giving repetitive information," says the GP. "We could simply refer our patients to our home page where they would be given answers to frequently--asked questions--a good example would be information on malaria prophylaxis. This could further be linked to pharmaceutical companies' sites or travel clinics' sites. That way patients planning travel to malaria-risk destinations could assemble a pretty comprehensive information package."

The GP sees it as a much-needed service for his patients. But he, and many doctors in South Africa, are still feeling their way and must be careful not to cross SAMA's ruling.

RELATED ARTICLE: The web as a medical school

An innovation in medical school outreach by South Africa's Stellenbosch University is enabling doctors to further their studies in family medicine in their own time.

The study course, unique in Africa, is so successful that the university's medical faculty was forced to turn applicants away for 2003. Students have enrolled from South Africa, Botswana, DRC, Namibia and Tanzania. The most distant student lives in China near the border with Tibet.

The web-site was designed and set up by university programme manager Professor Brian Mash. It offers general practitioners two options: a two-year diploma in family health, or a four-year Masters. "The most fantastic thing about this web-based programme is that it has the potential to train people throughout Africa, in countries where there is no family medicine programme of any kind," says Mash.

The course attracts GPs in state and private healthcare sectors, employed in both rural and urban environments. Participating doctors must work in a setting acceptable to the university and must find a senior colleague to act as their mentor. The fastest growing sector of users of medical advice on the internet are the elderly who have discovered the vast range of healthcare counselling to be accessed on the internet.

One Cape Town doctor who practices in a region that attracts retirees and pensioners says the internet has boosted his turnover in repeat visits from his patients, and brought in quite a few new ones.

"Visiting online diagnostic sites has become pretty trendy in the area," he says. "Quite a few elderly internet surfers visit diagnostic sites and then come and see me claiming to have exotic diseases because they apparently recognised symptoms they saw on their PC. Some are quite disappointed when I tell them they don't have Congo Fever or Alaskan Whale Sickness, or some such."