The invention of talk

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Somebody has just invented talk. We humans have so far communicated entirely through the written word, signs, smell, and touch.This new medium seems to have devastating power. It is probablya "transformational" technology. Everything will change. Individualscan exchange large amounts of information rapidly, far more rapidlythan with the written word. People can ask questions to checkthat they are understanding and are understood. Up to a dozenpeople can use talk to interact at once. Using amplification andbroadcasting, it may be possible for one person to talk to millions.People can whisper, shout, curse, brainwash, and cast spells.Derivatives of talkpoetry and songmay be even more powerfulthan talk itself: they are like crack to cocaine.

This new medium has powerful therapeutic potential. Some visionaries have even suggested that talk alone, unaided by drugsor surgery, may be able to heal. Unfortunately there is also hugepotential for harm. Terrorists have already begun to talk. Thereis growing evidence that most talk is not based on evidence. Inshort, most of it seems to be rubbish. Worse, there often seemsto be a gap between what people mean and what they say. The opportunitiesfor misunderstanding are immense. These anxieties have naturallyled to calls for regulation, and the World Health Organisation,the American Medical Association, and the European Union havealready produced quality scales which, it is hoped, will allowpotential listeners to identify high qualitytalk.

Nonsense, all nonsense. But is our reaction to the internet any different? Speak to any group of doctors about the internet,and the first question is usually: "But there's so much rubbish.What can be done to distinguish high from low quality material?"The answer from this theme issue seems to be: "A great deal, butnot much of it works or is used." Quality scores are proliferatinganddyingat a tremendous rate (p 569), and authorities in Geneva(p 566), Brussels (p 567), Britain (p 566), Spain (p 567), theNetherlands (p 567), and no doubt many other countries are busytrying to regulate health information on the internet. Many individual organisations in the United States have also joined the quest(p 602), but the usual American view of "let the market and the customer decide" seems to beprevailing.

New evidence presented in this issue shows that few of the quality scores have been validated (p 569) and that sites thatmight be thought credible do not anyway contain more accurateinformation (p 581). But these failures may not matter becausethose using the internet are not paying attention anyway to thesescores (p 573), and sites are popular for reasons other than quality(p 577).

If I was in the business of trying to regulate the web I would after reading this issue give up. It is truly like trying toregulate the West Wind or talk. Instead, we should concentrateon doing great things on the internet to transform health care(p 555).

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