THE RIGHTS OF MAN

AND THE WORLD WIDE WEB

D. Fredrickson

  La rholution du virtue1 ne fait que commencer. I1 s'agit d'un veritable
`cyber-bang' dont les cons6quences dconomiques, culturelles, sociales,
politiques sont incalculables. Je crois, en fait, que nous n'avons encore rien
vu...La rholution actuelle est comparable, dans son essence, ir la rholution
de la Renaissance et de la Rt;forme...(l)

  This unrestrained opinion of the Internet merits attention in the context
of the theme chosen by His Majesty for this meeting of the Academy. Several
questions are evoked. Does the sudden appearance of a new world-linking
highway of digital information mean the arrival of a new Enlightenment?
How are we to tell an actual from a virtual revolution? While far from being a
universal preoccupation, millions of persons are "browsing" daily on the
World Wide Webt2) . Yet it remains a great boutique of vendors hawking
goods, offering entertainment, with uncensored and unedited display. Will
this untamed and highly commercial venture magically change the
productivity, education and research of humankind?

The Negative.

  This "Web", which has come upon us so swiftly, is growing without
control, with its ethic undefined. Anyone may paste up a "home page";
anyone may copy anything there. Standards are loose; no copyright is
assured. Worse, global access to the Web is not equally shared. The basic
infrastructure is in place in most countries, but is not functional in some,
usually because of inadequate telephone and other equipment. The cost of
equipment and charges for entry into most Web programs also remain
prohibitively expensive to many. "Surfing on the Web," therefore, is low on
the priorities of developing countries.


The Rights of Man and the World...                              56

The Positive.

  Nevertheless, all over the world use of this global network is on the
rise--in governments, in research, educational, and commercial institutions.
Computer-literacy is now the entrance key to many kinds of employment.
The twenty-first century will find most professionals, researchers, and many
teachers bound to an umbilical computer-linkage, their productivity
determined by connection to external sources of advice and direction. Urban
and remote hospitals are becoming linked by the Web, and medical practice in
isolation is no longer wise or acceptable. Research is no longer governed by
the birth-rate of ideas but by the speed of flow of post-natal announcement.
The Web has come to determine how knowledge is refined from ever-rising
streams of information and how it is distributed to those whose productivity
depends upon it.

The Existential Nature of Discovery.

  Discovery in most field has an existential nature. No invention or
discovery exists before submission to peers by publication and after speedy
dissemination to the wider scrutiny and consensus required for an admission
to the realm of knowledge. The Net thus has become complementary to the
sciences and education, because it can hold treasure houses of data that are
collected, indexed and made universally available. For conveyance, the
World Wide Web is the messenger of a greater Enlightenment.

  Medline.The caches of data on Netline are many. The largest and
most used index of medicine and biological research is MEDLARS (Medical
Literature Analysis and Retrieval System run by the National Library of
Medicine in Bethesda, Maryland c3). Among the more than 30,000 periodicals
published each year, about 4,000 are biomedical journals--more than half
published outside the United States-- and which contain more than 400,000
citations (articles) per year. Within ten days of receipt each of these citations
is indexed, and with its abstract, entered into the computerized data base
MEDLINE, created in 1960. MEDLINE is the main root of some 40
separate computer data bases provided by the NLM in its MEDLARS. All
told, these indexes now contain over 20 million bibliographic citations and
abstracts.

  By 1970, tapes containing the full MEDLINE data began to be
distributed to International MEDLARS Centers, and thereafter up-da&
regularly. Operators at each Center are trained to assist users in searching the
data bases or carry out many searches themselves as a service. One month


57                                              D. Fredrickson

ago, the leaders of the twenty-one MEDLARS Centers gathered in
Washington for their biennial conferences. Hong Kong was the latest to sign
the agreement of cooperation. Features of the home pages of the present
Centers, along with their UNIVERSAL RESOURCE LOCATORS (URL's)
by which they can be brought up on the Net appear on page "A" of the
attached Appendix. Today Medline is available on-line at about half of U.S.
medical schools, and nearly every student has `a user codes permitting them
access at will. Now over 100 different locations around the world have tape
or on-line access to Medline, and many other sites use the indices on CD
ROM discs. Last week a new version of MEDLINE or GRATEFUL MED
for the Internet was released. This will permit users world wide to have
access to the index directly from the server at the NLM.

   SEARCH.  This version of MEDLINE will be the most efficient and
"user-friendly" yet among versions that have been made progressively more
powerful and efficient by the development of cognitive and lexical systems
based on construction of a Universal Medical Language (UML). The
center piece of this is a Metathesaurus, displaying the linguistic roots of
terms in different languages. So far including French, German, Spanish and
Portuguese, the Metathesaurus will continue to expand to cover other
languages, and continue to integrate the clinical and research terminologies.
The system of Medical subject headings (MESH) terms are constantly
expanded to used to construct linkage of headings in tree-like or hierarchical
fashion.

  Using a "browser such as Netscape--the currently most popular one
in use on the Web--searching the data in MEDLINE has become fast and
efficient. Effective use of the WEB is based much on the use of Hypertext
Markup Language (HTML) which is a feature of the Web, allowing
specific words on the page of the browser to be activated by the touch of the
computer's mouse.  This permits automatic switching to other MESH
headings or to different data bases as the object of the search is progressively
and quickly localized through the ramifications of the MESH headings.

  A simple example is shown on page "B" of the Appendix. Here
Grateful Med was asked to find the titles and locations of the articles on the
subject of leukemia written in French by our colleague Professor Jean
Bernard, during the narrow period in the late 1960s. The search, yielding the
titles of about tenarticles was completed in approximately 30 seconds.
Another click and the abstracts of selected articles were displayed.


$3~ Righb of Man and the World...                               58

  The Browser allows graphic illustrations to be activated and enlarged,
and the reviewer may to capture a copy from the screen for his own use. All
material on the page-or linked pages- may similarly be printed by the viewers
own `computer and stored in his files.

  USAGE. An annual total of over seven million searches of MEDLINE
are now done through the NLM's computer system alone. It is estimated that
about 40 million are done worldwide. The capacity of the system at NLM,
where 20,000 searches are made each day, illustrates the power of today's
retrieval engines, which in turn will be greater tomorrow. Half of the
searchers are health professionals. Presently 25 per cent of American
physicians take advantage of the ability to search MEDLINE from their
offices, homes, or patient bedside. Physicians have thus within their grasp
far more information than anyone can memorize or find in any other way--
knowledge assisting them to make the most correct diagnosis and treatment.
Many testimonials have been made how ability to"Search has been
life-saving.

TELEMEDICINE.

  The development of the use of the WEB for consultations, teaching
sessions, the distant reading of pathology sections, electrocardiograms,
radiograms, CAT-scans, MRI imaging and transfer of other data indicate that
this will soon be a large part of the medicine of the future. The reduction of
all data to digital form and its presentation on the Web places no limits on the
sending of material for consultation and teaching purposes. In fact, the
greatest limitation on the computerization and sharing of individual patient
records remains the assurance of the protection of the privacy of the data.
When this is problem is overcome, virtually all physician and hospital records
will be available on the Internet for be used for consultative and billing
purposes.

BIOMEDICAL RESEARCH

  GENBANK. Genbank is another NLM database. One of the largest
collaborative biomedical studies in progress in the world today is the mapping
of the human genome. More than 125,000 laboratories are participating and
providing data to three centers of collection. The primary centers are at the
National Center for Biological Information at the NLM; the
European Biological Institute at Cambridge University, and the CBI at the
National Institutes of Genetics in Tokyo. These three centers of data
collection are painstakingly cataloging and indexing DNA sequences,


59                                             D. Fredrickson

developing the full structure of each of the 100,000 human genes, and
annotating their positions on the human chromosomes. Any worker around
the world may push a button on the NETSCAPE home page of the National
Center for Biotechnology Information at NIH and enter a fragment of DNA
which will be rapidly compared with others in the index and classified.
Allied tasks are the recording the protein products of their expression when
they are learned, collection of mutations of single genes along with
descriptions and comparison of the phenotypes of associated disease. The
aim is assembly all these related pieces of information into the map of the
genome of man, one of the most rapidly expanding data bases in the world.
By agreement among all the participants, all of the data are freely accessible
and exchanged on an up-to-date basis. At least 90 percent of all such human
genetic data is estimated to be present. A small amount is kept from these
data bases by commercial operations which regard it as proprietary
information. Like the patenting of genes, the withholding of genetic
information in this way is regarded in parts of Europe as a violation of Les
Droits de 1'Hommes. It is a position toward which many Americans are
sympathetic.

   A few features of the GENBANK or ENTREZ programs are
illustrated in photographs from NETSCAPE displayed on page "C" in the
Appendix. They include the structure of genes that can be called up by the
viewer as data emerging from the DNA sequencer, the chromosomal location
of gene clusters identified, and a listing of the diseases now known to be
caused by abnormal genes including names of mutations. HTML is used to
link information about given genes to the MEDLINE system for analysis and
quick identification of articles in which the genes are featured. Soon, more
and more of the journals from which the indexed citations come will
themselves be published on disks or tapes. Thus with a few clicks of the
mouse, one can see the structure of a gene, view the structure of its protein
product, pursue the descriptions of chemical behavior and of phenotypic
variation in the bearers of the different mutations, in the full texts of the
authors who have made the original observations.

The Visible Human

  A striking example of the power of the new tobls available for storing
and manipulating data on the computer has recently been released by the
National Library of Medicine. A man, condemned to capital punishment,
dedicated his body to science. Radiograms, both standard and by
computerized axial tomography, and magnetic resonance imaging were made


The Rights of Man and the World...                               60

at intervals of one millimeter from head to toe. The imaging was repeated
before the cadaver was sectioned by microtome and the images captured at the
same intervals by digital photography. The data were then accessible to
"electronic dissection", by which one can make spatial images of an organ or
any parts of the body.  A dramatic virtual image of such a computer
dissection is presented in the photograph "D" in the Appendix, showing the
relationships of the optic nerve to other structures(4). One must keep in mind
that the picture is achieved by mathematical manipulation of the photographic
digital data base. Today, many schools have given up the teaching of
anatomy. Teaching tools such as these will permit the revival of this subject
in almost unlimited ways. One wonders what Albacusis or other great Arab
surgeons would have thought of such electronic assistance for their healing
art.

The Need for Infrastructure

  There are several troubling aspects of the unevenness with which
peoples of the world are linked in such technology. One concern, expressed
by many third world scientists, is the failure of the indices to admit their
citations to the base. This is a reflection of the level. of peer review
considered adequate for admission of the citations. Recently UNESCO has
been active in ways to explore this might be overcame.(5)

    Lack of infrastructure (Web servers, adequate telephone service,
and the computer equipment itself) is one of the most troubling aspect of this
new technology to users. It is estimated that of many million connections to
the Internet, only about 0.3 percent are in Latin America @I, a fault laid to the
fragile nature of the telephone system. It is hoped that more assistance for
improved infrastructure will be extended by world-wide financial institutions,
businesses and philanthropies. One recent example of such is the donation of
millions of dollars by the Soros Foundation to make the Net available to
research institutions in the Soviet Union.

   The final page of the Appendix shows the geographical distribution of
the 20 major centers to which the MEDLINE data base is distributed and
up-dated regularly. From the Centers, some regional users are enabled to
obtain the searches they need for their professional work, but access is
uneven and sometimes expensive when commercial carriers are needed. Note
that the Bireme\Paho center in Brazil acts as the axis for the continent of
South America. Egypt and South Africa are presently the two centers in
Africa. Now, of course, GRATEFUL MED is at last on the Web and its


61

D. Fredrickson

availability will continue to rise. Where the Web and the Medline data bases
are now accessible, health care is improving as a result. The capacity of a
country to participate in sophisticated research, enhance its education and
training to be more productive in modern industry is also related to its ability
to participate in this "virtual revolution."

  L'homme n'a di connaissance des chases naturelles que par les moyens
de la correspondance avec ce qui tombe sous les sensc7).

NOTES

(1) Philippe Q&u, in "Voyage dans la plankte Cyber." L'Express. No. 2327 February 14, 1996. '
(2) The Internet is a communications system designed for transmitting digital data at very high
speeds. Computers can access the Internet through telephone modern connections or directly
through communications devices caller "routers". Beginning in the 1960's the "net" was
developed as an easier, informal communication between physicists, engineers, academics
and other defense contractors. It offered electronic mail (email), access to other computers
(telnet), and real-time exchange of files (f.t.p). Long-distance discussion groups (usenet)
were added. Over the years the technology improved to permit faster transmission and receipt
of large amounts of digital data, including graphics. Soon "browsers" capable of finding and
displaying data at known locations on the network were devised. In the middle 1900s , a
network developed on the Internet that came to be called the World Wide Web.

(3) These include EMBASE, produced by Excerpta Medica, concentrating on European journals
and those containing pharmacological citations; PASCAL ( about 25% medical and 25%
biology, rest science and technical ) maintained by CNRS and  available from servers of
INSERM or DIMDI (Deutsche lnstitut fiir Medizinische Documentation);  LILACS, which
ccntains MEDLINE plus literature in Portuguese and Spanish, correlated by Bireme in Brazil;
.D,1-rA-STAR, (Knight Ridder), CURRENT CONTENTS (Title citations only); , ULRICH'S
IN'IERNATIONAL PERIODICALS DIRECTORY; and many more. speciality directories,
including the more than 40 maintained by NLM for cancer, AIDS, toxicology, bioethics, and
other topics. The Institute of Information of the Chinese Academy of Medical Sciences has a
date base of several hundred thousand citations in Chinese from the literature of both
traditional and Western Chinese medicine.

(4) This image has been derived in the Voxel project from Hamburg University, using the Visual

Human data base.

(5) Gibbs, Wayt.. Lost S,cience in the Third World. Scientific American, August, 1995, 92-99.
(6) Casari, Adolfo. Internet or Internot. The Internet May/June 1995, 29-31.
(7) RenC Descartes. Cogitationes privatae.