The Japanese Journal of American Studies, No. 13 (2002)

Is the “Cyberspace Revolution”
Really a Revolution?1
A Case Study: Healthcare
and Modern Scientiﬁc Thought
Yoneyuki SUGITAINTRODUCTION
Frederick Jackson Turner found great signiﬁcance in the frontier forthe development of American society, believing that the open spaces ofthe West nurtured American democracy.2 Space, in the form of foreign
markets in the early twentieth century and outer space in the 1960s, hasbeen important to American society in many eras and in many ways.
Now, many believe cyberspace is transforming industrial society into an
information-oriented society in the United States.
This paper ﬁrst demonstrates that a large number of previous studies
exist on the information-oriented society, but that these studies differ intheir interpretations of information technology (IT) and in whether IT
has precipitated a revolution. As a concrete way of examining this controversy, this paper focuses on healthcare as a case study, deﬁning modern scientiﬁc thought and then using it as a criterion to judge whether IT
has brought about a revolution in this ﬁeld. Third, it presents a brief history of medicine in the United States, especially the great developments
in medical science after World War II. Fourth, it demonstrates how thecurrent healthcare system adopts IT in the United States, and its significance. This paper concludes that because IT does not transcend modern
Copyright © 2002 Yoneyuki Sugita. All rights reserved. This work may be used,with this notice included, for noncommercial purposes. No copies of this work
may be distributed, electronically or otherwise, in whole or in part, without permission from the author.
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scientiﬁc thought, it cannot be considered a revolutionary force in healthcare.
I“CYBERSPACE REVOLUTION” REVISITED

IT has affected society greatly, but there is disagreement as to what
extent IT has changed society. Many observers believe that IT has, atleast to some extent, revolutionized society. Russell Ackoff and Sumio
Koike expect that technological developments will change society infundamental ways, including value systems and the philosophy of life.3
Alvin Tofﬂer regards the present era as the third wave in which the information revolution affects not only technology and the economy, but also
other aspects of society such as ethics, culture, philosophy, institutions,and political structure.4 Douglas Robertson argues that the computer may
be a fourth innovation, after language, writing, and printing that would
create a new civilization.5 Robert Posch, Jr. claims that IT alters every
phase of society including law, commerce, culture and citizenship.6
William Martin believes that the impact of IT on society will be as signiﬁcant as that of Industrial Revolution.7 Yoneji Masuda claims that IT
transforms existing society into a fundamentally different informationsociety.8 Toshihiko Hayashi and Eisho Ohmura insist that IT should betransforming the principle of human relations from a tree-structure intoa network structure, which is revolutionary progress in the history of
mankind.9 Tetsuo Kogawa suggests that electronic individualism maytranscend modern European individualism.10 Tadao Umesao optimistically contends that human beings may lead more humane lives with thecoming of an information industrial age.11 Kazufumi Orisaka indicatesthat today is a transitional period from an industrial society into an information society where people will lead spiritually rich and satisfactory
lives.12 Frances Cairncross, another optimist, writes that the rapid development of communication technologies will increase human contact,
leading the world to a better place.13 Many other observers, such as
Daniel Bell,14 Peter Drucker,15 and John Naisbitt,16 draw bright pictures
for the future with the development of IT.
In contrast to these opinions, some people feel pessimistic about the
future of an IT-oriented society because of the increasing gap between
rich and poor or they still question whether IT has fundamentallychanged the existing industrial society. Tom Forester warns that too
much reliance on computers may undermine the process of discussion

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and persuasion among people that underlies democratic society.17
Langdon Winner poses a serious question about the optimistic view thatwidespread access to the Internet will automatically create a better world.
He regards this kind of dogmatic view as religious conviction.18 Accepting the importance of information, Katsuhiko Matsuishi criticizes
the optimistic argument that an IT-oriented society is a post-industrial
or post-capitalist society. Instead, he concludes that it is still a high information-oriented industrial society.19 Nobuyuki Takenaga claims that
because an information society is still within the capitalist economic system, it is not a post-industrial society but a high-intensive (ultra) industrial society. Consequently, the so-called “information revolution” will
not bring about utopia, and severe competition will continue among
highly developed industrial nations.20 Clifford Stoll points out the emptiness of virtual reality on the Internet.21 A collection of essays in Cutting
Edge critically insist that as long as the existing power structure continues, technological developments will be more likely to worsen the problems of poverty and misery.22 Shunpei Kumon believes that the current
age is the beginning of the information phase of industrialization in modern civilization. In short, his viewpoint holds that IT has not yet changed
society fundamentally.23 According to Tadamasa Kimura, informationand knowledge are closely related to industrial society; he calls society
after the 1970s “the high consumption society.”24
Since IT’s impacts on society are multi-dimensional, it is difﬁcult tobridge the gap between these differences in opinion through a generalized consideration of this issue. Moreover, it is necessary to apply clear
criteria to judge if IT truly has revolutionized society. Thus, this paper
adopts a case study, focusing on the meanings and signiﬁcance of IT in
healthcare, and uses modern scientiﬁc thought as the criterion to evaluate IT’s effects on society.
II BIOMEDICINE AND MODERN SCIENTIFIC THOUGHT
This section deﬁnes modern scientiﬁc thought and examines theprocess by which it was applied to healthcare. This will help us examine whether IT has precipitated qualitative differences in healthcare in alater section. From ancient times through the Middle Ages, people did
not consider pathological cause-and-effect relationships within individual bodies. Instead, they believed in the existence of supernatural powers beyond human control. Suffering from illness was an indication of

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punishment for misconduct such as defying divine will or other inappropriate behaviors. People accepted illness as human fate. In order todeal with this fate, they prayed for cures and conducted exorcisms.25
Since the concept of healthcare originated from religion, it developed
historically as a part of religious activities.26 Because people did not recognize the causal relationship between etiology and illness, they regarded illness as an imbalance of the four bodily humors, based on the ancient
Greek understanding. Doctors emphasized the importance of environment to restore and maintain a natural balance.27 In short, disorder of thehumors was the only illness, and physicians concentrated their attention
on each individual patient, not on disease per se, to restore health.28
The mode of social life and structure that emerged gradually inWestern Europe in the seventeenth century rapidly spread worldwide.
This was the beginning of modernity. In the modern era, the speed ofchange is quite rapid, and is most prominent in science and technology.29
Modern medical science began with anatomy, physiology, and classiﬁcation of symptoms into disease categories established by Andreas
Vesalius, William Harvey, and Thomas Sydenham, respectively, in thesixteenth and seventeenth centuries. These disciplines were the origins
of biomedicine, which regarded human beings merely as living organisms.30 From the end of the eighteenth to the beginning of the nineteenth
centuries, modern science gradually organized illness as scientiﬁcally
explicable physical conditions. The rise of clinical medicine eliminatedreligious perspectives of illness and systematized various symptoms
based on a rational, scientiﬁc way of thinking.31 The introduction of thestethoscope and ophthalmoscope into medical diagnosis in the nineteenth century made it possible for physicians to listen to and observeillness. Development of these medical technologies precipitated the riseof an anatomical view of illness in place of the humoral theory.32 Basedon bacteriology advanced by Louis Pasteur, Joseph Lister, and RobertKoch, the theory that germs precipitated most infectious diseases began
to prevail in the mid and late nineteenth century. In the late nineteenth
century, the development of laboratory, graphic, and x-ray diagnosis
technologies further facilitated objective clinical analysis.
Biomedicine, the main paradigm of modern Western medical science,
has four major characteristics. First, human beings have both physicaland mental dimensions. These two dimensions are inseparable. Manycases demonstrate that mental health treatment can contribute to progresson the physical level. Especially during the growing stage of childhood,

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kindness and tenderness are reported to have a more effective inﬂuenceon the increase of IQ advancement than nutritious food.33 Modern
Western European medicine, however, artiﬁcially separated these twodimensions and paid attention only to the physical aspect of healthcare.
Modern medical science clearly separates “mental health” and “physical health.”34 Just as Descartes’ doctrine of the duality between physicaland mental worlds furnished the basis for the development of natural science, medical science deals solely with human bodies, especially after
the late nineteenth century.35 In other words, modern biomedicine wasestablished by separating humanity from illness.36
Second, the basic assumption of modern biomedicine is that the humanbody is a machine that medical science can manage and ﬁx.37 Physicians
seek causes of diseases in biological changes, neglecting environmental, social, psychological, and emotional factors. They use all the technologies available to ﬁnd causes in the “machine,” and once they ﬁnd
the cause, they use all the means available to “repair” the problem. Consequently, physicians naturally believe that using more advanced technology and increasing interventions are good by nature and are necessary
for the successful management of diseases. Science and technology
make forward progress as time goes by, which makes it possible to ﬁnd
the cause and the cure of diseases faster, more easily, and with less pain.
Physicians believe in the linear progress of modern science and technology, a belief that scientiﬁc progress continues in a linear way, andthat more is better in the medical ﬁeld. The more physicians use technologies for diagnoses, the more they see their patients through the lenses of indirect data and objective experts’ opinions.38
The third characteristic of modern biomedicine is that it has been
extremely specialized and segmented since the late nineteenth century.39
The anatomical view of illness where a speciﬁc part of the body rather
than the entire person, suffers, became popular. Physicians are categorized by their specialties, such as internal medicine or surgery. Internal
medicine is further subdivided into cardiovascular, respiratory, and digestive tract internal medicines. Currently, there are more medical specialists than general practitioners in the United States. Physicians deal
only with speciﬁc internal organs according to their specialties, losing
sight of the totality of human beings and their non-physical demands.
Finally, modern scientiﬁc thought brought about by the Renaissanceexcludes concepts of ambiguity, probability, or subjectivity, explaining
phenomena in the world by objective principles.40 In medicine, these112

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changes took place slowly. In the seventeenth and eighteenth centuries,
physicians still relied on patients’ own explanations and discourse about
their illnesses. This situation changed with the emergence of physicaldiagnosis technology such as pathologic autopsy and stethoscopy. Physicians no longer relied on patients’ ambiguous, subjective explanations,but on elaborate and objective analyses of physical symptoms acquiredby direct examination of patients. In other words, physicians gradually
moved away from subjective to objective evidence, which was produced
by advanced technology.41
III BRIEF HISTORY OF MEDICINE IN AMERICA
In order to understand the impact of IT on current healthcare, it is helpful to look at a brief overview of the history of medicine in the UnitedStates. In the antebellum era, Americans demonstrated a strong tendency toward self-reliance and turned to their personal religious faiths todeal with illness because they believed that individual moral failure
brought about illnesses. Physical and mental dimensions were not clearly
separated. Consequently, Americans then believed that strong emotions
such as anger, fear, grief, and envy would lead to ill health.42 Clergymen
primarily took care of the sick. Not only relatives but also ministers andfamily church members visited the sick to mitigate their painful experiences.43
In 1847, the American Medical Association was founded in order to
set standards for medical practice and raise the status of American physicians. Most American physicians were general practitioners, but becauseof the development of the anatomical way of thinking, professionalization of clinical medicine began in the late nineteenth century.44 At theend of the nineteenth century, Americans began to rely on professional
physicians outside their family and close friends’ circles for medical
treatment. Healthcare had been a private matter for most Americans, but
the market mechanism gradually prevailed in this ﬁeld, which resulted
in increasing the emotional distance between patients and physicians.45
This is characteristic of modern scientiﬁc thought: researchers (physicians) must take a neutral, independent, and objective stance toward thesubject of research (patients). Physicians seek the speciﬁc cause of illness in the speciﬁc organs, which leads to fragmentation of the body.46
Professionalization means that physicians rely on objective results ofmedical laboratory tests for their diagnoses and ways of treatment, andIS THE “CYBERSPACE REVOLUTION” REALLY A REVOLUTION?

113

deal with the speciﬁc organ as if it were a part of a machine to be ﬁxed.
Patients became dissatisﬁed with this kind of impersonal healthcaredelivery.47
Before World War II, the U.S. government adopted ambivalent andinconsistent attitudes toward supporting science and technology.
Vannevar Bush, director of the wartime Ofﬁce of Scientiﬁc Researchand Development (OSRD), argued in his report to President Harry
Truman in July 1945 that the United States had “no national policy for
science. . . . There is no body within the Government charged with formulating or executing a national science policy. There are no standing
committees of the Congress devoted to this important subject.”48 The
war, however, drastically changed this attitude. The government cameto support science and technology actively in the postwar era.49
World War II was a watershed in medicine. During World War II,
many medical innovations came into existence. In June 1941, the Committee on Medical Research (CMR) was established under the OSRD.
CMR concluded 600 contracts with universities, research institutes, andother organizations, and employed about 5,500 scientists and technicians. This Committee successfully developed penicillin, DDT, serum
albumin as a blood substitute, immune globulin against infections and,with the help of the Army and the Allied Powers, improved malaria therapy through new drugs.50 Anesthesiology and surgery made great strides,
and the U.S. government helped the expansion of medical education.
During the war 15 million Americans in uniform and their dependents
tasted advanced healthcare. Their expectations for healthcare wereraised, and they demanded more and better healthcare in the postwar
era.51 Americans believed in continuous progress in medical science, its
application to treatment, and increasingly demanded more effective
medical care. This way of thinking is based on the concept of linear
progress.52
Taking advantage of these innovations, especially sulfonamides andantibiotics in the 1940s, physicians regularly cured diseases. Sulfa drugs
had been used to treat infectious disease since 1936. The military began
to use penicillin, which was more effective than sulfa drugs, in 1942, andmass production for the general public became successful in 1945. A
wave of optimism and expectations about the future of medical treatment
prevailed in American society.53 After World War II, the American government spent an enormous amount of money on biomedical research,second only to the military budget.54 Biomedical research took the

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overwhelming share of the basic research fund provided by the Federal
government in the postwar era.55 The government poured funding primarily into developing insecticides, chemotherapeutics, and vaccines.
Spending for biomedical research amounted to 87 million dollars in
1947, which rose to 161 million dollars in 1950, 2 billion dollars in 1966,
and jumped to 14 billion dollars in 1986. The Federal government accounted for over half of these funds. In particular, the government gavepriority to assisting acute care hospitals, training medical specialists, andproviding subsidies for biomedical research.56 Congress took the initiative to assist small towns and rural communities by implementing the
major construction of hospitals through the Hill-Burton Act of 1946.57
In May 1950, Congress established the National Science Foundation, an
independent U.S. government agency, for promoting science and engineering and the organized development of a national science policy.
Congress also demonstrated its renewed interest in medical research byproviding assistance for the National Institute of Health (NIH), which isa major governmental medical research center, and was a source of
research funding in the postwar era.58
Americans believed that mass production and cutting-edge weapons
based on science and technology were primarily responsible for their victory in World War II. After the war, they were convinced that continuous success would be dependent on their scientiﬁc progress.59 According
to Vannevar Bush, “without scientiﬁc progress no amount of achievement in other directions can insure our health, prosperity, and security
as a nation in the modern world.”60 In order to maintain its hegemonic
power in the postwar world, the United States kept its leading positionin science and technology. The concept of linear progress and its status
as the hegemonic power in the postwar era drove the United States topromote science and technology. The emergence of IT is the result of
this progress-oriented society. In the 1960s, the Department of Defense
realized the idea of a computer network, which was designed at RAND
Corporation as a project of its Advanced Research Projects Agency(ARPA). This was the origin of the Internet, which was ﬁrst devised asa tool to secure a military communication network in case of nuclear
attack.61 The current advanced stage of the Internet comes from the postwar drive for scientiﬁc progress.

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IV IT AND CURRENT HEALTHCARE IN THE UNITED STATESAmericans are increasingly turning to web pages for healthcare information for several reasons. Internet connectivity has been increasing dramatically in the United States. As of January 2000, the United States
possessed more than 53 million Internet host computers, about 73 percent of the host computers in the world. In 2000, over 104 million people
used the Internet in the United States. Rapid and widespread development of IT also popularized the Internet among Americans as a meansof obtaining health-related information. It is estimated that more than
100,000 web pages provide health care information.62 A recent survey
indicates that more than 60 million U.S. residents searched the web forhealth-related information, 70 percent of these searchers report that
information acquired by their research inﬂuences their healthcare decisions.63 Americans access these health-related web pages for more information about their illnesses and symptoms, and for second opinions fromother physicians about the diagnoses, treatments, and medications theyreceive.
Secondly, those who are dissatisﬁed with managed care utilize theInternet to fulﬁll their healthcare needs. Managed care is a method ofcontrolling healthcare decision-making to contain medical expenditures.
According to the American Medical Association, managed care companies cover more than 90 percent of U.S. medical practices, and 85 percent of employees covered by job-based insurance are enrolled in somekind of managed care program.64 Managed care companies normally do
not permit their members (patients) to seek specialists’ care directly iftheir cases may be treated for less expensive fees by primary careproviders. A survey conducted by the Kaiser Family Foundation and theHarvard School of Public Health indicates that 87 percent of doctors
believed that managed care companies restricted the services needed bytheir patients.65 The Independent Doctors of California representing
about 300 physicians and the Association of Independent Physicians,
which mobilized approximately 80 physicians in New York, encouraged
their patients through the Internet to abandon managed care and returnto the traditional system, where only doctors and patients can makehealthcare decisions.66 According to a Harris Interactive poll, favorable
assessments of managed care companies dropped drastically from 51
percent in 1997 down to 29 percent in 2001.67 As these ﬁgures show,

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many Americans have complaints about the managed care system.68 In
response, Americans have increasingly assumed responsibility for theirown and their family’s health by turning to the Internet.69
Patients in the United States complain about the lack of close communication with their physicians. Physicians are quite busy consultingwith as many patients as possible. Managed care companies encourage
physicians to shorten the consultation time with patients so that they canschedule more patients each day. Consequently, patients and their family members do not have enough time to discuss thoroughly their symptoms, diagnoses, and treatment. Moreover, most patients simply do nothave the appropriate medical knowledge or information to communicate
effectively with their physicians. In addition, physicians focus on biological changes and explain the analyses of medical tests to their patients,
leaving little time to discuss non-biological, social, emotional, or personal matters that may be indirectly associated with patients’ illnesses.
Patients may also have many questions about medical jargon, alternative treatments, effectiveness, and side effects of medication theyreceive. When patients consult with their family doctors, it is quite difﬁcult to ask detailed questions without becoming a nuisance. Thesepatients have become increasingly frustrated with the current lack ofcommunication with their physicians and have turned to the Internet for
supplemental information. The Internet provides them with MEDLINE
plus, a popular version of MEDLINE which is one of the best databases of medical and healthcare information derived from thousands ofbiomedical journals, and a catalog of information concerning speciﬁc
diseases and symptoms with a search function prepared free of charge
by the National Library of Medicine (NLM). The NLM is the largest
medical library in the world and is located on the campus of NIH.
Cyberspace also offers newsgroups in which those who suffer the same
illness can share useful information, chat rooms and bulletin boards to
network with other people and exchange health-related information, andother convenient features. In addition, healthcare providers sometimes
voluntarily provide health information and answer questions on the web.
In short, the lack of communication between physicians and patients andpatients’ quests for more information drive patients to rely on theInternet.
In the medical ﬁeld, because of the profound information gap between
suppliers (physicians) and consumers (patients), the suppliers have normally decided the type and amount of service consumers should have.

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Consequently, a paternalistic relationship between physicians and patients came into existence. This relationship is now changing into a partnership because of patients’ easy access to recent medical ﬁndings andto information about various kinds of treatments.70 Making use of thewide variety of information about their particular diseases available on
the web, patients can now contribute to clinical decisions affecting theirown health.71 According to a Harris Interactive poll, these people aremost interested in getting information about speciﬁc diseases such as
depression, allergies, cancer, and high blood pressure.72 When patients
suffer incurable diseases or medication is not available in the market,
they may use the Internet to look for clinical trials conducted all over theworld.73 Obtaining medical information on the web privately and at any
time may empower people to make better-informed decisions and toenjoy greater participation in the healthcare process.
The increasing costs of healthcare also encourage Americans to takeadvantage of the power of the Internet. In 1997, the annual healthcare
expenditure per capita accounted for approximately 14 percent of theGross Domestic Product, the highest ratio in the world. Patients look for
information on economical health insurance, preventive care, improvement of health, and more cost-effective treatments and medicine.74 In
addition, approximately 43 million Americans, about 16 percent of the
population, had no health insurance in 1997.75 One of the ways these people get medical information is through the Internet.76 Access to IT is inexpensive, and there are many free terminals available in public facilities
such as public schools and libraries. Accessing most of the information
on web pages is free of charge. The Internet provides the uninsured witha way to obtain free medical information.
Containing medical expenditures is also one of the most important
themes in healthcare. Databases and computer networks are used for thispurpose. In 1983, the U.S. Federal government introduced the Diagnosis-Related-Group-based Prospective Payment System (DRG/PPS) to
Medicare to control rising healthcare expenditures.77 DRGs are “small
integers ranging from 0 to about 500. These integers represent inpatientclassiﬁcations on the basis of diagnosis, procedure, age, gender and discharge disposition. These groups were constructed to control Length-ofStay, which in turn correlates to resource consumption and severity ofillness.”78 DRGs are categorized into nine tiers based on required resources. This classiﬁcation system reﬂects actual cost more accurately.79
In addition, former Vice President Albert Gore proclaimed that the118

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National Information Infrastructure (NII) would save between 36 to 100
billion dollars a year in healthcare expenditures. Gore believed that the
NII would enable Americans to obtain necessary healthcare services
anywhere, anytime, in more efﬁcient ways. The NII was also expected
to be beneﬁcial for preventive care, which would help to contain medical expenditures.80
Because of the size of the United States, people in rural areas live faraway from major medical centers. For example, the area of Arizona is
more than 113,000 square miles, but only Tucson and Phoenix provide
cutting-edge medical services. Approximately 300,000 people living in
the rural areas spend hours driving to come and consult specialists whennecessary. Arizona introduced telemedicine to help address this issue.
According to the American Telemedicine Association, telemedicine isdeﬁned as “the exchange of medical information on the health and education of patients and/or health care providers via electronic means forthe purpose of improving patient care.” Although telemedicine was technically available even in the 1960s, rapid development of IT in the 1990s
put telemedicine into practical use.81 In 1993, only about 1750 telemedicine consultation cases were reported in the United States; however, thisﬁgure jumped to approximately 58,000 cases in 1998.82 In Arizona, thestate legislature established the Arizona Telemedicine Program as a partof the Arizona Rural Telecommunications Network in 1996. This program has been saving the patients’ time and money by providing themwith the opportunity to gain specialized medical treatment without traveling hundreds of miles.83 Telemedicine technologies also provide
healthcare providers in rural areas with training programs and continuing medical education credits.84
Recently, acute care has been giving way to chronic disease management. According to the Centers for Disease Control and Prevention, anagency of the Department of Health and Human Services for protecting
the health and safety of people, chronic disease is deﬁned as “illnesses
that are prolonged, do not resolve spontaneously, and are rarely cured
completely.”85 Chronic diseases include high blood pressure, diabetes,
arthritis, cardiovascular disease, and others. More than 90 million
Americans suffer from chronic diseases, and their medical care expenditure amounts to approximately 400 billion dollars, accounting for morethan 60 percent of overall healthcare costs.86 Telemedicine proves to be
proﬁtable for healthcare providers to manage home healthcare patientswith chronic diseases. Installing a small device using phone lines at home

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establishes a daily line of communication between healthcare providers
and home healthcare patients. Utilizing IT, healthcare providers may
send daily reminders to their patients with chronic diseases, including
information such as reminders about taking their medications or listingsof foods they should avoid. Home healthcare patients, in turn, can measure their blood pressure, body temperature, pulse, and other indicators,
and send this information to the hospitals that will accumulate the data
in an orderly fashion. Telemedicine helps the patients control eating
habits, medications, and other facets of their lifestyles, all of which are
indispensable elements of effective treatments for chronic diseases. A
report by Cyber Dialogue, a private company, reveals that one-third ofchronic disease patients conﬁrm that the Internet helps them to comply
with prescribed medications.87 Another source indicates that 79 percent
of chronic disease patients carry out online searches for useful information.88 Telemedicine and other IT-related measures will be useful formonitoring home healthcare patients with chronic diseases.89
Computer-based patient records (CBPR) are one of the most important factors in providing effective and efﬁcient medical services and incontrolling medical expenses.90 CBPR promote the comprehensive
compilation and storage of patient records, including clinical data, administrative information, and medical history. CBPR allow healthcare
providers to include many important elements that paper medical records
cannot include, such as medical resources, graphic ﬁles, and links to
medical references like MEDLINE.91 The advantages of digitalizing
diagnostic information include building a database to search and display
the information swiftly, to make it easier to implement statistical work,and to transfer the information rapidly via computer networks. As aresult, whenever and wherever people suffer from illnesses, physicians
can access patients’ medical histories, which can help prevent redundant
medical tests, inappropriate prescriptions, and dangerous combinationsof medication.92 CBPR improve the efﬁciency of healthcare, because thisinnovation can shorten the time needed to ﬁnd and distribute the patients’records, and multiple healthcare providers, including administrative
clerks, can work on the same patient records simultaneously in different
places.93
CBPR may also reduce the amount of medical malpractice. According
to the National Academy of Science, a private and non-proﬁt organization of scientists engaged in the research and promotion of science andtechnology, medical malpractice kills between 44,000 and 98,000

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Americans each year. In order to minimize human errors, Massachusetts
General Hospital in Boston adopted web-based electronic medical
records and clinical transaction monitoring systems. These systems
effectively maintain and disseminate patient information, send alerts
when medication needs to be changed, and collect and distribute up-todate medical ﬁndings and promising treatments.94 CBPR can also belinked to a useful decision-making support tool like Arden Syntax
Medical Logic Modules (ASMLM). ASMLM are decision-making support tools that provide physicians with warnings according to the medical logic input in the system. For example, if a physician orders a CT
scan for a patient with a record of kidney failure, ASMLM warn thephysician of possible complications that might arise.95
Different physicians may use various diagnoses and treatments to deal
with the same symptom and disease. Consequently, Evidence-Based
Medicine (EBM) has become popular to help convince patients that they
are receiving proper, well-accepted treatment. EBM is deﬁned as “theconscientious, explicit, and judicious use of current best evidence inmaking decisions about the care of individual patients.”96 The most common use of EBM is the combination of the individual physician’s professional judgment with objective evidence from available literature
concerning speciﬁc symptoms. EBM tries to demonstrate objective evidence for the best course of treatment by referring to the compilationsof scientiﬁc data concerning the results of speciﬁc treatments and medications.97
Even with the multi-faceted promise of technology in the medical
industry, the adoption of IT in the medical ﬁeld faces many serious obstacles. As for introducing telemedicine, high-resolution video-imaging
transmission technology and fast broadband Internet connections areindispensable to the effective implementation. The initial cost of installing the necessary IT equipment, approximately 100,000 to 120,000 dollars, as well as the running costs for implementing telemedicine, can be
overwhelming.98 To complicate matters, few health insurance companies cover telemedicine.99 In addition, because IT develops rapidly, theconstant upgrading of equipment and software is also necessary.
Obtaining, managing, and utilizing various kinds of information isquite complicated and requires systematic operation. In order to organize operational CBPR and DRG/PPS, the compatibility of different
machines and equipment must be ensured.100 Moreover, medicine codes,

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disease identiﬁcation codes, and medical practice codes must be uniformly deﬁned and applied. Standardization is yet to be introduced at theIT application level.101 Computerization in healthcare requires rigid
quantiﬁcation and standardization.102 Both of these issues complicate theimplementation of IT in the medical ﬁeld on a larger scale.
It is difﬁcult to assess the accuracy and effectiveness of the medical
information found on the Internet. For example, a group of physiciansat the University of Michigan examined web pages concerning Ewing’s
sarcoma. Approximately 6 percent of those web pages examined gaveincorrect information, and almost half provided questionable treatment.103 Moreover, the sheer volume of information available on the web
may overwhelm online users. For example, MEDLINE indexed approximately 920,000 entries in 1998, and is continuing to increase at a rateof 31,000 entries a month.104
Healthcare providers using the Internet are most concerned about
assuring security and privacy. For example, in the summer of 1999, a
hacker illegally accessed the internal network of the medical center ofUniversity of Washington and succeeded in downloading several thousand patient records, including personal information such as names,
addresses, and clinical data. In addition, while many healthcare providers
post privacy policies on their sites, according to a survey conducted in
January 2000, the companies’ willingness to enforce these policies isquestionable. Privacy policies include restrictions on who collects
personal information, what kind of personal information is collected,
who has access to the information, and the rules around sharing the collected personal information with a third party. In 1996, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA),
which provided basic legal safeguards for the security and privacy ofAmericans’ personal health information.105
No matter how complicated and difﬁcult these obstacles may seem,
most of these issues could be solved by ﬁnancial investment, technicaladvancement, managerial reorganization, and legal protections. Theseobstacles may not hinder a revolution if IT truly has the potential to bringabout a revolution in society. The fundamental nature of IT must be
reviewed to evaluate the truth of the concept of the “cyberspace revolution.”

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VIT AND MODERN SCIENTIFIC THOUGHT IN HEALTHCARE

Modern scientiﬁc thought consists of four primary factors. Thismethodology is based on the doctrine of duality of human beings withboth physical and mental dimensions. Modern scientiﬁc thought focuses only on the physical dimension of the human condition, and believes
in linear progress. Consequently, the modern viewpoint holds that thedevelopment of science and technology is inherently good, and it welcomes more intervention of science and technology into human life. Thisway of thinking makes much of objective evidence and devalues ambiguous subjective judgment. Finally, it requires quantiﬁcation and standardization.
Because of the doctrine of duality between the physical and mental
worlds, modern biomedicine concentrates its attention on the physicalnature of human beings, regarding only biological changes as causes of
illness. The anatomical view that regards a certain biological change asa symptom of a speciﬁc disease prevails in modern biomedicine. IT iscompatible with the anatomical view because they share a one-to-one
speciﬁc cause-and-effect mechanism; a speciﬁc input automaticallyleads to a speciﬁc output in the IT realm. As long as medical science
focuses its attention on humankind’s physical dimension, IT works wellwith it. However, neither IT nor the anatomical view can successfully
deal with the mental or the emotional dimensions of human beings,
because this subjective realm is more complex, and shifts intricately andunexpectedly rather than linearly. IT has been developing quite rapidly,
but its basic principles remain the same, and it remains less suited to thenon-physical aspects of healthcare.
Telemedicine and CBPR sound quite revolutionary, but they are justthe latest stages of technological development; the essence of modern
scientiﬁc thought about healthcare remains the same. Telemedicine and
CBPR utilize IT extensively to collect, analyze, organize, and disseminate scientiﬁc data to provide efﬁcient healthcare services. They, however, handle objective biomedical data such as changes over time ofblood pressure, blood sugar levels, electrical brain waves, the results ofother medical tests, prescribed medications, and other data. The very
information IT deals with falls in the realm of the physical dimension.
Telemedicine and CBPR have increased the speed and efﬁciency of thecurrently-used process enormously, but they have not, and will not,change the fundamental content of the information. IT dramaticallyIS THE “CYBERSPACE REVOLUTION” REALLY A REVOLUTION?

123

changes the methodology, but not the substance of medicine. Consequently, the more physicians use IT, the further their modern scientific thought based on the doctrine of duality may be accelerated. With thedevelopment of IT, physicians may come to rely even further on objective, scientiﬁc data that deals only with the physical dimension of humanbeings. As a result, physicians will become increasingly isolated fromhumanity’s emotional and spiritual health issues. A true medical revolution would expand medical science to incorporate the mental dimension of human beings, and this sort of revolution is simply impossible
through the development of IT.106
Americans continuously seek more powerful medicine and believe in
medical progress, while at the same time fearing that too much professionalization and segmentation in the medical ﬁeld and the knowledge
gap between physicians and patients threaten their autonomy in dealing
with illness. In addition to this paradox, the growing number of uninsured people, the rise of medical costs, and the increase in malpracticecases in the United States in the 1980s precipitated a healthcare consumer movement that demands some control over the healthcare decision-making process. This movement is rooted in the general consumer
movement in the 1960s started by Ralph Nader, which promoted consumer rights and individual autonomy.107 In other words, the movement
emerged as a way to control the linear progress of modern scientiﬁcthought.
Adoption of IT in the healthcare ﬁeld is an extension of this consumer
health movement.108 IT is a tool for health service consumers to recapture their autonomy, but since IT is an inﬁnite frontier, people continuously demand more, faster, and better technological development,
assuming that technological intervention in healthcare is inherently
good. This is the same kind of linear progress mindset found in modern
scientiﬁc thought. Health service consumers seek simple text information at ﬁrst. Then, they request multimedia information, more elaborate
information, online direct communication with healthcare providers, andthen continue to demand more and more information. Setting aside any
value judgments of the concept of linear progress, the underlying concept of the current healthcare consumer movement based on IT remains
the same as that of modern scientiﬁc thinking. Even though the healthcare consumer movement emerged as a countermeasure to the development of modern scientiﬁc thought, these two phenomena ironically sharethe same concept of linear progress. Hence, there is no fundamentally

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qualitative difference between modern scientiﬁc thought and the healthcare consumer movement based on IT.
One of the characteristics of modern scientiﬁc thought in thehealthcare ﬁeld was the movement away from relying on subjective information and toward a reliance on objective evidence. Because of technological developments, physicians now obtain objective ﬁgures by
medical tests, set the healthy standard levels for particular tests, andjudge patients’ conditions according to these established levels. In orderto make objective decisions, quantiﬁcation and standardization of theresults of medical tests are indispensable. The introduction of IT into
healthcare also promoted a wave of quantiﬁcation, standardization, andregimentation, all elements of modern scientiﬁc thought.109 Research on
medical outcomes requires high-quality, coherent documents about
diagnoses, treatments, and their outcomes. High-performance computers swiftly accumulate, quantify, and standardize these documents tobuild a database. This database enables effective research on medical
outcomes, which provides information on the most cost-effective treatment. Without this development, neither DRG/PPS nor EBM would bepossible. Objective quantiﬁcation, standardization, and regimentation,some of the essential elements in modern scientiﬁc thought, are also prerequisites for the emergence of DRG/PPS and EBM.
No matter how rapidly and extensively IT develops in the healthcare
ﬁeld, its basic concept mirrors modern scientiﬁc thought. The development of IT is compatible with this way of thinking. Therefore, the application of IT in the healthcare industry will not bring about revolutionarytransformations in this ﬁeld.
CONCLUDING OBSERVATIONSIn these times, people take the “cyberspace revolution” or “information revolution” for granted without serious examination of the fundamental nature of IT. This case study has demonstrated that IT is simply
an extension of modern scientiﬁc technology and that there is no qualitative difference between the concept of IT in the healthcare ﬁeld andthat of modern scientiﬁc method. IT in healthcare shares the doctrine ofduality with modern scientiﬁc thought. Both IT and modern scientiﬁcthought are predicated on the concept of linear progress. IT drives physicians to rely further on objective, scientiﬁc data and to isolate themselvesfrom patients. IT further promotes quantiﬁcation, standardization, andIS THE “CYBERSPACE REVOLUTION” REALLY A REVOLUTION?

125

regimentation of health-related data. IT has not brought about any fundamental changes in healthcare. It is not from the substance but by themethod that IT has dramatically altered the healthcare ﬁeld.
NOTES
1
The Cyberspace Revolution would be responsible for both quantitative changes—
the unprecedented rate at which information enters the public domain, and qualitativechanges—behavior, values and world view in people’s lives.
2
Frederick Jackson Turner, The Frontier in American History (New York: Henry
Holt, 1920).
3
Russell Ackoff, Redesigning the Future (New York: Wiley, 1974); Sumio Koike,
Shin Joho Shakairon [New Theory of Information Society] (Tokyo: Gakubunsha, 1998).
4
Alvin Tofﬂer, The Third Wave (London: Collins, 1980).
5
Douglas Robertson, “The Information Revolution,” Communication Research 17,
no. 2 (April 1990).
6
Robert Posch, Jr., “The Fourth Wave,” Direct Marketing 60, no. 10 (February 1998).
7
William Martin, The Information Society (London: Aslib, 1988).
8
Yoneji Masuda, Managing in the Information Society (Oxford: Basil Blackwell,1990).
9Toshihiko Hayashi and Eisho Ohmura, Bunmei to Shiteno Nettowaku [Network as
Civilization] (Tokyo: NTT Shuppan, 1994).
10
Tetsuo Kogawa, Moshi Intanetto ga Sekai wo Kaeru to Shitara [If the Internet May
Change the World ] (Tokyo: Shobunsha, 1996).
11
Tadao Umesao, Joho no Bunmeigaku [Study on Civilization of Information] (Tokyo:
Chuo Koron, 1988).
12
Kazufumi Orisaka, Kodo Johoka Shakai no Shoso [Various Aspects of Intensive
Information Society] (Tokyo: Dobunkan Shuppan, 1996).
13
Frances Cairncross, The Death of Distance (Boston: Harvard Business School Press,
2001).
14
Daniel Bell, The Coming of Post-industrial Society (New York: Basic Books, 1973).
15
Peter Drucker, The Age of Discontinuity (New York: Harper & Row, 1969).
16
John Naisbitt, Megatrends (New York: Warner Books, 1982).
17
Tom Forester, Oﬁsu Robotto ga Yattekita [The Microelectronics Revolution](Tokyo: Diamondsha, 1981).
18
Langdon Winner, The Whale and the Reactor (Chicago: University of Chicago
Press, 1986).
19
Katsuhiko Matsuishi, ed., Joho Nettowaku Shakairon [Theory of Information
Network Society] (Tokyo: Aoki Shoten, 1994).
20
Nobuyuki Takenaga et al., Maltimedia to Joho Nettowaku Shakai [Multimedia andInformation Network Society] (Tokyo: Bunka Shobo Hakubunsha, 1996).
21
Clifford Stoll, Intanetto wa Karappo no Dokutsu [Silicon Snake Oil] (Tokyo:
Soshisha, 1997).
22
Jim Davis, Thomas A. Hirschl, and Michael Stack, eds., Cutting Edge (London:
Verso, 1997).
23
Shumpei Kumon, Joho Bunmeiron [Theory of Information Civilization] (Tokyo:
NTT Shuppan, 1994).
24
Tadamasa Kimura, Dejitaru Debaido towa Nanika [What Is Digital Divide?](Tokyo: Iwanami Shoten, 2001), 91.

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25
Shizu Sakai, Igakushi heno Sasoi [An Invitation to Medical History] (Osaka: Shinryo
Shinsha, 2000), 3; Heinrich Schipperges, Chusei no Igaku [Medicine in the Middle Ages](Kyoto: Jinbun Shoin, 1988), 98.
26
Shigeto Tsuru, “Wakai Hitotachi he,” [“Message for Young People,”] Sekai(January 1987), 196.
27
Nancy S. Jecker, “Knowing When to Stop,” The Hastings Center Report 21, no. 3(May-June 1991), 5.
28
Stanley Reiser, “The Era of the Patient,” The Journal of the American Medical
Association 269, no.8 (24 February 1993), 1012–13.
29
Anthony Giddens, Kindai towa Ikanaru Jidaika [The Consequences of Modernity](Tokyo: Jiritsu Shobo, 1993), 13, 18–19.
30
Noboru Kobayashi et al., eds., Iryo ni totte Igaku towa Nanika [What Is Medical
Science for Healthcare?] (Tokyo: Kodansha, 1977), 128.
31
Claudine Herzlich and Janine Pierret, “Byonin” no Tanjo [Illness Yesterday, Illness
Today] (Tokyo: Fujiwara Shoten, 1992, original text: Malades d’hier, malades d’aujourd’hui Paris: Payot, 1991), 57.
32
Stanley Riser, “Valuing the Patient’s Views,” in Annals of the New York Academyof Sciences 368, ed., Bianca L. Rosenberg (New York: New York Academy of Sciences,
1981), 18.
33
Michitaka Hirose, Bacharu Riariti tte Nandaro [What is Virtual Reality?] (Tokyo:
Diamondsha, 1997), 202.
34
Koichi Kawabuchi, Sei to Shi no Sentaku [Choice between Life and Death] (Tokyo:
Keiei Shoin, 1997), 21.
35
Hiroshi Hasegawa and Tsunetsugu Munakata, eds., Kodo Kagaku to Iryo [Behavior
Science and Medicine] (Tokyo: Kobundo, 1991), 3; Yoshio Kawakita, Kindai Igaku no
Shiteki Kiban [Historical Basis for Modern Medicine] (Tokyo: Iwanami Shoten, 1980),
925.
36Tsuru, “Wakai Hitotachi he,” 198.
37
Herzlich and Pierret, “Byonin,” 114, 124.
38
Stanley Reiser, Shindan Jutsu no Rekishi [Medicine and the Reign of Technology](Tokyo: Heibonsha, 1995), 278.
39
Ibid., 177.
40
Kenichi Imai, Joho Nettowaku Shakai [Information Network Society] (Tokyo:
Iwanami Shoten, 1984), 41.
41
Reiser, Shindanjutsu, 239, 278–79.
42
Mary Ann Jimenez, “Concepts of Health and National Health Care Policy,” Social
Service Review 71, no. 1 (March 1997), 35.
43James H. Cassedy, Medicine in America (Baltimore: Johns Hopkins University
Press, 1991), 10, 45; Paul Starr, The Social Transformation of American Medicine (NewYork: Basic Books, 1982), 18.
44
Reiser, Shindanjutsu, 177.
45
Starr, The Social Transformation, 18, 22.
46
Akio Nishimura, Iryo Kagaku [Healthcare Science] (Tokyo: Iryo Bunkasha, 1999),
27.
47
Sharon R. Kaufman, The Healer’s Tale (Madison: University of Wisconsin Press,
1993), 301–02.
48
Vannevar Bush, Science, the Endless Frontier (Washington, D.C.: National Science
Foundation, Reprinted 1960), 12.
49
J. Stefan Dupre and Sanford Lakoff, Kagaku to Kokka [Science and the Nation](Tokyo: Tokai Daigaku Shuppankai, 1965), 25–30.

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50
Bush, Science, the Endless Frontier, 13; Starr, The Social Transformation, 340;
Mary Ellen Condon-Rall, “The Army’s War Against Malaria,” Armed Forces & Society
21, no. 1 (Fall 1994), 140.
51
Eli Ginzberg, The Medical Triangle (Cambridge: Harvard University Press, 1990),
23, 175.
52
Daniel M. Fox, Health Policies, Health Politics (Princeton: Princeton University
Press, 1986), 116, 149, 207.
53
Kaufman, The Healer’s Tale, 150; John Duffy, The Healers (Urbana: University of
Illinois Press, 1979), 238–39.
54
Yoshinori Hiroi, Iryo no Keizaigaku [Economics of Healthcare] (Tokyo: Nihon
Keizai Shinbunsha, 1994), 176.
55
Yoichiro Murakami and NTT Data System Kagaku Kenkyujo, eds., 21seiki no “I”
wa Dokoni Mukauka [Where Is the 21st-century Healthcare Heading?] (Tokyo: NTT
Shuppan, 2000), 74.
56
Patricia Day et al., eds., The State, Politics, and Health (Cambridge: Blackwell
Publishers, 1996), 99.
57
Duffy, The Healers, 239, 268; Ginzberg, Medical Triangle, 35.
58
Cassedy, Medicine in America, 143–44.
59
David Shenk, The End of Patience (Bloomington: Indiana University Press, 1999),
67.
60
Bush, Science, The Endless Frontier, 11.
61Motohiro Tsuchiya, Joho to Gurobaru Gabanance [Information and Global Governance] (Tokyo: Keio Gijuku Daigaku Shuppankai, 2001), 61.
62
Maureen Donohue, “Physicians Must Prepare for Move Toward Internet-based
Health Care,” Family Practice News 31, no. 2 (15 January 2001), 42.
63
Gretchen K. Berland et al., “Health Information on the Internet,” The Journal of theAmerican Medical Association 285, no. 20 (23 May 2001), 2612.
64
Milan Korcok, “Managed Care Under Attack from US Physicians,” Canadian
Medical Association Journal 159, no. 6 (22 September 1998), 644.
65
Marissa J. Ventura, “Survey Highlights Rift Between Providers and Health Plans,”
RN 63, no. 1 (January 2000), 14.
66
Korcok, “Managed Care Under Attack,” 644.
67
“Dim View of Managed Care,” Health Management Technology 22, no. 8 (August2001), 9.
68
Another report says that over 80 percent of Americans are satisﬁed with the quality of their own managed care; however, they are convinced that managed care in general decreased the healthcare quality by restricting patients’ freedom to choose
physicians. Michael W. Lynch, “Does America Hate Its HMOs?” Reason 30, no. 5(October 1998), 21.
69Martha Earl, “Caring for Consumers,” American Librarians 29, no. 10 (November
1998), 44–45.
70
Ronald E. Keener, “ ‘Patient-Doctor Digital Divide’—Online But Uncommunicative?” Health Management Technology 21, no. 1 (January 2000), 37.
71
Warner V. Slack, Cybermedicine (San Francisco: Jossey-Bass Publishers, 1997),
xiv.
72
Robert Davis and Leslie Miller, “Millions Scour the Web to Find Medical Information,” USA Today 13 July 1999.
73
Hiroaki Mitani, e-Herusu Kakumei [e-Health Revolution] (Tokyo: Nihon Iryo
Kikaku, 2001), 3.
74
Ibid., 53–55.

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75
Gregg Easterbrook, “How to Love Your HMO: Managing Fine,” New Republic 222,
no. 12 (20 March 2000), 21.
76
Lisa Ramirez, “ ‘Cyberdocs’ Popular, but Potentially Dangerous Some Say,”
Knight-Ridder/Tribune News Service, 26 July 1999.
77
Teruo Hirose, “Iryo Seido Kaikaku no Shuho wa Machigatte Inaika,” [“Is There
Anything Wrong with the Healthcare System Reform?”] Iryo 13, no. 7 (July 1997),
57–58.
78“What is a DRG?” http://www.mhconsulting.com/drgs.htm (M+H Consulting
home page).
79
Tyler J. Brannen, “DRG-Based Per Diem Payment System Matches Costs More
Accurately,” Healthcare Financial Management 53, no. 4 (April 1999), 42.
80
Albert Gore, Joho Supa Haiwei [Information Super Highway] (Tokyo: Dentsu
1994), 267.
81
Mark J. Syms and Charles A. Syms III, “The Regular Practice of Telemedicine,”
Archives of Otolaryngology 127, no. 3 (March 2001), 333–34.
82
Timothy F. Kirn, “Telemedicine Finally Making Inroads,” Family Practice News30, no. 14 (15 July 2000), 32.
83
Ronald S. Weinstein, “Powering the Arizona Telemedicine Program,” HealthManagement Technology 22, no. 6 (June 2001), 46.
84
Katherine Watt, “Telemedicine Extending Services Statewide,” Inside Tucson
Business 10, no. 44 (22 January 2001), 15B.
85
Centers for Disease Control and Prevention, http://www.cdc.gov/nccdphp/about.htm.
86
Roy L. Simpson, “The Role of IT in Caring for the Chronically Ill,” Nursing Administration Quarterly 24, no. 3 (Spring 2000), 82; Jeremy J. Nobel and Julie C. Cherry,“IT Helps Manage Patients with Chronic Illness,” Health Management Technology 20,
no. 11 (December 1999), 38.
87
AIDS Weekly, 10 January 2000.
88
Mitani, e-Herusu, 123.
89
Roger Fillion, “Sharing the Health Technology Expands Long-Distance Care,” The
Denver Post, 5 April 1999.
90
Marshall Rufﬁn, “The Future Is Here,” Physician Executive 22, no. 11 (November
1996), 22–29; Roy Schoenberg and Charles Safran, “Internet Based Repository ofMedical Records That Retains Patient Conﬁdentiality,” British Medical Journal 321,
no. 7270 (11 November 2000), 1199–1203.
91
Gekkan Shin Iryo, ed., Denshi Karute [Electronic Medical Record ] (Tokyo: ME
Shinko Kyokai, 2001), 27–28.
92
Kazuhiko Ohe, “IT Kakumei to Korekarano Iryo,” [“IT Revolution and Future
Healthcare,”] Byoin 60, no. 1 (January 2001), 20.
93John Camoriano et al., “Zadankai: Kawariyuku 21seiki no Iryo,” [“A Round Table
Discussion: Changing Healthcare in the 21st Century,”] Eizo Joho Medical 33, no. 2(February 2001), 11.
94
Larry Stevens, “Health Care Turns to the Web,” Internetweek (May 1, 2000), 33.
95
Gekkan Shin Iryo, Denshi Karute, 51.
96
David Sackett and William Rosenberg, “Evidence Based Medicine,” British
Medical Journal 312, no. 7023 (13 January 1996), 71.
97
Mitani, e-Herusu, 108.
98
Watt, “Telemedicine Extending,” 15B.
99
Masatsugu Tsuji, Toru Mori, and Masaaki Teshima, “Beikoku ni okeru Joho Haiwei
to Enkaku Kyoiku/Iryo,” [“The Information Super Highway and Its Application in the
Fields of Education and Medicine in the United States,”] Joho Tsushin Gakkai Nenpo 9(March 1998), 139–40.

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100
Masaru Yamamoto et al., “Senryakuteki Iryo Joho Sisutem no Kochiku,” [“Structureof Strategic Medical Information Systems,”] Nagoya Kogyo Daigaku Gakuho 42 (1990),
162–63.
101
Kazuhiko Ohe, “Iryo no Johoka no Doko,” [“Trends of Medical Information,”]Denki Tsushin (September 1998), 6.
102
Shigekoto Kaihara, “21seiki he Muketeno Iryo Joho Shisutemu no Kadai,” [“Health
Information System Toward 21st Century,”] FUJITSU 46–2 (March 1995), 142.
103
Michael O’Reilly, “Developing a Code of Conduct for the Web,” Canadian Medical
Association Journal 161, no. 10 (16 November 1999), 1301.
104
Jeff Goldsmith, “How Will the Internet Change Our Health System?” Health Affairs
19, no. 1 (January/February 2000), 152.
105
Mitani, e-Herusu, 58–59, 255–58.
106
Michitaka Hirose, Bacharu Riariti, 202–04.
107
Kaufman, The Healer’s Tale, 311; Charles B. Inlander, “Consumer Health,” Social
Policy 28, no. 3 (Spring 1998), 40.
108
Narumi Eguchi, “ ‘e-Health’ to Byoin Keiei,” [“ ‘e-Health’ and Hospital Management,”] Byoin 60, no. 1 (January 2001), 27.
109
Murakami and NTT, 21 seiki, 68.