INFORMATION TECHNOLOGY

Using the Web, Epidemiologist Aims to Improve Public Health in Developing Nations

By VINCENT KIERNAN

Dr. LaPorte, a professor of epidemiology at the University of Pittsburgh, is striving to use the Internet to bring information about disease and public health to people in developing nations.

On a shoestring, he has forged the Global Health Network, a collaboration among public-health specialists around the world. The group recently launched an Internet-based course in epidemiology aimed at bolstering public health in poorer nations.

But he has irked the editors of conventional medical journals by repeatedly asserting that printed journals will be the dinosaurs of 21st-century science.

The on-line "Supercourse," titled "Epidemiology, the Internet, and Global Health," comprises 16 World-Wide Web-"lectures" on topics including nutrition, Hodgkin's disease, and health economics. Ten more lectures are being prepared for posting on the site (http://www.pitt.edu/~super1/).

Each one consists of 20 to 30 Web pages tied together by hyperlinks. Many of the pages also include links to information provided by other organizations. The lecture on multiple sclerosis, for example, includes links to the Web site operated by the National Multiple Sclerosis Society.

Rather than mimic what he calls the "talking-head model" of instruction, Dr. LaPorte says the Supercourse was designed to take advantage of the Web's ability to provide links among pages of text.

That arrangement allows users to follow any number of links, learning about the subject in as much detail as desired, he says. "You can bounce around, go shallow, go deep."

The first lecture is available in English, French, German, Chinese, Japanese, Russian, and Spanish. Other lectures will be translated from English into the other languages as volunteer translators have the time, Dr. LaPorte says. The Supercourse offers no academic credit, but he hopes to arrange for a university in a developing nation to provide credit for it.

The course materials are to be supplemented by on-line versions of textbooks in epidemiology and public health that the British medical journal BMJ has agreed to place on the Internet, says Dr. LaPorte.

The on-line lectures and textbooks are likely to prove invaluable in developing nations, where current books and scientific information are scarce and expensive, says Eugene R. Boostrom, a senior public-health specialist at the World Bank and a collaborator in the Global Health Network. "People will be able to keep current. It's very difficult to do that in developing countries," he says.

Many developing countries have little access to the Internet. But Dr. LaPorte says the availability of the Supercourse and similar scientific materials would prod international agencies and the governments of developing nations to find the funds to bolster connections to the global computer network. Moreover, he adds, parts of the Supercourse also could be installed locally on computers in developing nations, reducing the need for connections to the Internet.

People born today in developed nations live about 25 years longer, on average, than people born in those nations in 1900, Dr. LaPorte says. About 24 of those added years are the fruits of public-health measures, and the Global Health Network seeks to extend those benefits to developing nations. "It has to have a positive effect on improving health," he says. "It has to."

Public-health experts have used the Web to subject each of the course's lectures to peer review, but in a fashion very different from that used by most journals and scientific societies. In conventional peer review, a document is circulated to a few experts for their comments. By contrast, the Supercourse posts a draft of each lecture on its Web site and allows any users to peruse it and submit comments, along with an indication of their own background. The author then has the chance to revise the lecture.

As a result, Dr. LaPorte says, reviews come from a broader spectrum of specialists. The introductory lecture, for example, was reviewed by people from 20 countries, including professors, pharmacists, health professionals from international agencies, and a journal editor. Altogether, he says, development of the course has involved 500 academics from 50 countries.

The authors are not paid for their work, but Dr. LaPorte says he has no shortage of volunteers: "Sixty people want to write lectures for me."

Unlike printed textbooks, the on-line lectures also can be updated quickly, he says, noting that "a new research finding can be immediately pushed into the course." For that reason, the Supercourse could also be a valuable supplement for students in medical schools, he argues.

He would like to extend the collaborative nature of the Supercourse even further, by taking a page from the Internet-based games that allow participants at various locations to play against one another simultaneously. A multisite game could be developed to test the disease-prevention strategies that are taught in the Supercourse, he suggests. "What an incredible learning tool it would be to have 15,000 people playing disease prevention at the same time!"

Dr. LaPorte earned a bachelor's degree in psychology from the State University of New York at Buffalo in 1971, and a master's and doctorate in psychology from the University of Pittsburgh in 1974 and 1976.

But his real interest lay in epidemiology, so he earned an additional master's degree in that field from Pittsburgh in 1980. When he joined in an international study of diabetes, he recalls, "I was trying to collaborate with people in Japan, and it would cost $2 a minute to talk to them" by telephone.

Eventually, though, he heard about the Bitnet computer network, one of the precursors of today's Internet. It would allow him to send text messages to overseas colleagues. What's more, he learned, sending messages through the Bitnet system was free, and the messages were delivered almost instantly. "This was the best thing that I had ever seen," he says.

Dr. LaPorte, by then an associate professor of epidemiology at Pittsburgh, and eight colleagues issued a call to arms: In a 1988 article in the American Journal of Epidemiology, he urged epidemiologists to use Bitnet to disseminate epidemiological information. "It is time for medical scientists to come into the age of electronic communication," argued the paper's authors.

The paper got no reaction. "No one paid any attention to it for five or six years," Dr. LaPorte recalls.

Then Vice-President Gore began to talk about the information superhighway. That inspired Dr. LaPorte to inquire at several federal agencies about using computer networks to disseminate information about public health. He received the warmest reception from an agency not known for working in public health: the National Aeronautics and Space Administration. There Dr. LaPorte ran across Anthony Villasenor, who was in charge of scientific uses for the agency's computer network. "He knew exactly what I was talking about," the epidemiologist says. Since then, the space agency has paid for much of Dr. LaPorte's work in the field, as part of a larger program to foster scientific use of computer-network technology.

Dr. LaPorte says the Supercourse's collaborative strategy for peer review could be adapted for other uses, such as reviewing drafts of scientific articles. Indeed, he is far from reticent in criticizing scientific and medical journals. In 1995, he and another eight colleagues, from the Global Health Network, published an essay in BMJ titled "The Death of Biomedical Journals." It called on scientists to "take control of their research communication" by disseminating it via the Internet. The authors said printed journals would soon be "obsolete."

That attitude has not endeared Dr. LaPorte to journal editors. "He tells people, 'You're going to be toast in a few years,'" says Frank F. Davidoff, editor of Annals of Internal Medicine. "There's some value to being provocative, but some people think he's serious."

Others worry that relying on cyberspace for communicating medical research could jeopardize patients. "We like speed, but we revere quality. We will not compromise quality just to make things faster," says George D. Lundberg, editor of the Journal of the American Medical Association.

He thinks that Dr. LaPorte has "little understanding of medical practice or medical information." As an example, Dr. Lundberg cites a talk given by Dr. LaPorte in September, at the International Congress on Biomedical Peer Review and Global Communications, in Prague. Dr. LaPorte suggested that medical journals could finance Web-based journals by publishing pharmaceutical advertising that is keyed to the content of individual Web pages.

Such a practice would be a major breach of ethics, says Dr. Lundberg -- advertising and editorial matters should be completely separate. The A.M.A. journal keeps its advertising-sales staff in the dark about the contents of upcoming issues, he points out, so that there is no chance of a sales representative's trying to couple advertisements to journal articles.

In retrospect, Dr. LaPorte acknowledges that his proposal was a bad idea. But he thinks that electronic journals could still attract ads for Web pages, just as printed journals themselves attract ads.

Despite his scrapes with the journal editors, he has won their support for another scheme, one in which they would provide researchers in developing countries with free access to on-line versions of the journals. The Global Health Network would serve as the intermediary, providing a server that would grant access to the journals only to researchers from certain countries.

The project has stalled lately, as Dr. LaPorte and his colleagues have searched for a benefactor to pay for the estimated $100,000 annual operating cost.

Citing such delays, Dr. Davidoff suggests that Dr. LaPorte may be more a visionary than a detail man. "He's quite successful at catching people's interest, but what you really need is some solid, workhorse staff," says Dr. Davidoff.

But John R. Patrick, vice-president for Internet technology at International Business Machines Corporation, says the Supercourse shows that Dr. LaPorte can bring a vision to fruition.

"What he's doing here represents the future," Mr. Patrick says. "It's how the world is going to be."