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ANOTHER hotel, another hangover. Another breakfast trying to decipher the
notes scrawled on a beer mat during my creative small hours.

This one looks like the seismograph trace of the great Kanto earthquake, so
it’s probably the business plan for an offshore republic I’m planning to
establish on one of those icebergs the size of a county that keep breaking away
from the Ross Ice Shelf. Citizens of the Republic of Icedom will enjoy low
taxes, firm government and year-round winter sports—at least until the
nuclear power plant (Soviet Navy surplus) melts clean through the bottom.

No, I remember. I was drinking last night with an Internet health-care guru,
and he’s come up with an even crazier idea. So mad, in fact, that it is likely
to find a place in Tony Blair’s master plan for modernising Britain’s National
Health Service, which he is due to announce this summer. The idea is to reinvent
the NHS as an “e-health” service. Goodbye boring old doctors and hospitals,
hello e-nhs.com.

Some background. Health-care organisations around the world have been leaping
into e-health with all the rationality of a teenager dressing for a first date.
Commercial websites supplying medical advice and dispensing drugs by mail order
have been around for a while. The latest venture is two-way telemedicine, in
which patients deliver blood-pressure readings and symptoms to their doctors
down the line.

Meanwhile, researchers at IBM are looking seriously at the possibility of
synthesising drugs on the doctor’s desk to suit each patient’s personal
biochemistry. And why stop there? Any device that would work in a doctor’s
surgery could be miniaturised for use at home. A desktop molecule synthesiser
would be a pricey household gadget, but cost has never stopped serious drug
consumers before.

How might all this be relevant to shabbily genteel public health services
like the NHS? The message from my barroom friend and the rest of the e-health
brigade is that the public will soon demand online services, and that they will
save us all a fortune.

Believe the first, but not the second. If we have learned one lesson from the
history of medicine, it is that demand for medical care is unlimited and that
new technologies simply add to it. The NHS is already learning this lesson in a
small way with its telephone helpline, NHS Direct, through which callers receive
free medical advice from nurses. It’s a popular idea—four out of five
callers say they are “very satisfied”—but it has yet to cut demand for
other types of treatment.

Undeterred, Blair’s modernisers are pushing ahead with plans for offering
further medical services through the Internet. Their mistake, of course, is to
assume that medicine is just about exchanging information. It’s a common fallacy
in our info-centric world, hilariously exposed in a new book called The
Social Life of Information* by John Seely Brown and Paul Duguid. They
conclude that, despite the hopes and propaganda of the IT industry, few human
interactions can really be reduced to bits and bytes.

I predict that health care, with its inconvenient demand for bodily
specimens, not to mention healing hands, will be one of the last to be
digitised. It’s a shame, really. Right now, I wish I could download some aspirin
via my laptop.