The dissemination of medical information through the Internet has probably enhanced in a large measure the education of the practitioners of the art. Time will tell how this expedited acquisition of "information" resulted in increased "knowledge" and how this knowledge was utilized in ways that benefited mankind.

Regardless of the future outcome of the information revolution, certain developments need to be carefully monitored to ensure that serious and undesirable problems do not reach a harmful level difficult to eradicate. One such problem seems to be emerging in a rather rapid manner: the pirating of data displayed in the Internet. To be more specific I will use the specific example that prompted me to think the issue needs attention.

While participating in a symposium dealing with fracture care, I heard the presentation made by a distinguished surgeon discussing the basic principles of fracture healing. His message was well articulated and illustrated. However, at least ten of the "images" that he flashed on the screen were pictures taken from a lecture I had delivered at a previous meeting of the same organization. I had given authorization to place my lecture in the Internet. The images the surgeon displayed from my previous talk dealt with histological changes we had documented during experimental studies conducted in our laboratories. No credit was given to us for the reproduced slides.

I did not feel at the time that the use of my images was inappropriate particularly because the surgeon who delivered the paper is an honorable physician. However, I pondered as to the possible harmful effects that this practice could have if it became widespread. Could an entire lecture dealing with a clinical subject or a detailed description of an experimental study be presented and/or published by an unscrupulous person implying that it represented his own work? Since opportunities to present material at medical meetings are many and the number of medical journals is over 30.000 worldwide, the chances of getting by with the infraction without being caught are also great ¹

I suspect that the practice of taking images from the Internet to use during publication and/or delivery of medical material will increase exponentially. How to prevent abuse and the serious effects from this trend, is the concern I think it needs prompt attention. Since the personal episode I have illustrated I found out that a number of physicians have refused to allow their lectures to be placed in the Internet for fear of having their images copied by someone else.

I would like to suggest that as starting point, presenters of scientific material identify every image with its source to lessen the likelihood of being utilized by others without appropriate acknowledgement. It is obvious, however, that unscrupulous people will go around this issue by "cropping" the slides and deleting the identifying marks or logos. .

I also suggest that medical organizations, such as the AAOS, AOA, Subspecialty Societies and others, should require from participating physicians to clearly acknowledge the use of other people’s images. Failure to do so would call for open condemnation of the culprits and barring them from further participation in the activities of the involved educational organization. These actions could have a positive impact.

This issue should be placed on the agenda of orthopaedic societies and associations currently using the Internet, or planing to record scientific presentations made during their sponsored educational endeavors. They, in turn, could develop a uniform practical strategy before the "trend" becomes a "problem."

Augusto Sarmiento, MD

1. Smith R. What clinical information do doctors need? British Journal of Medicine, 313 (7064):1062-8, 1996