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The Internet and World Wide Web have been truly revolutionary in bringing democracy to communications and eroding political and cultural barriers to freedom of expression. The freedom of expression and communication that is inherent to the Internet and Web is stimulating for users and anathema to would-be censors who have something to fear from freedom of communication. The prospect of censorship by legislation or government regulation is anathema to all those who prize the freedom of the Internet and Web.

Freedom of Internet expression and communication raises a question that always arises from freedom of speech: What is one free to say?

If Internet speech is not subject to legislated or regulated censorship, then it is constrained only by (1) the possibility of legal action under laws covering libel, slander and defamation, (2) threat of criminal prosecution for fraud or incitement of overthrow of the government, or (3) voluntary observation of codes of conduct-as, for example, voluntarily accepted codes of professional conduct among physicians.

In the United States, the First Amendment is very permissive regarding freedom of expression. The right to even hateful and malicious speech has been upheld in Supreme Court interpretations of the First Amendment-for example, see Minnesota Rag by Fred Friendly, a book that tells the story of such a Supreme Court case, and the April 2003 Supreme Court decision that allows the burning of a cross as freedom of expression so long as the purpose is not to intimidate.

While wide latitude of free speech is allowed, speech that crosses the boundaries of generally accepted good taste is generally held to be not in the public interest-although there may be no law to restrain it. Editors of print and electronic publications usually observe publically accepted standards of good taste and do not publish remarks that cross the boundaries of good taste.

One of the features of the Internet and Web is the absence of editorial control on self-created sites. The content of speech on self-created sites is subject only to personal and collegial codes of conduct and the possibility of civil or criminal legal action against the site's creator. A "Wild West" environment of unrestrained truth-stretching and mutual vilification has developed among many sites-an environment not unlike that among pistol-toting editors of weekly newspapers in Western gold-mining camps described by Mark Train in his Roughing It.

The Internet, the Web and Professional Responsibility

Medicine as a profession and physicians as professionals have long accepted responsibility for protecting the interests of patients and the public. This responsibility has been formalized in codes of professional conduct, and carried out by individual physicians who abide by the tenets of the codes. While these codes of professional conduct do not carry the force of law, they are generally accepted by professional public as carrying substantial moral force. Discipline of physicians for serious breaches of medical conduct or ethics is the responsibility of state medical boards on behalf of the public.

The physician first learns codes of professional conduct in medical school. At the end of medical training the physician swears to uphold the tenets of the Oath of Hippocrates, the most venerable code of medical conduct for the individual physician. The physician abides by the Hippocratic Oath for his or her entire professional life.

Scientific and clinical research is carried out within codes of conduct that protect the welfare of human research subjects. The scientific quality of medical research is subjected to rigorous peer review to determine its fitness for publication. Clinical or scientific research presented before colleagues at medical meetings is subjected to rigorous critique by professional colleagues. In that the public accepts the proposition that these activities carried out under professional codes of conduct are in the best interest of patients and the public, the medical professional maintains the public's trust. The public accepts the proposition that laymen are not qualified by education or experience to participate in these activities.

The Internet, the Web and Public Trust

Education of patients and the public is accepted by physicians and their professional organizations as one of their professional responsibilities. The Internet and World Wide Web quickly became a major means for reaching patients and the public with relevant information. Patients and the public also quickly learned that the Web gave them access to important sources of reliable information such as the National Library of Medicine. A diligent layman can learn about evidence-based medicine and become proficient in separating dross from gold in the medical literature.

Reliable, accurate, science-based patient and public information is professionally responsible and in the public interest. It builds and maintains public trust in the medical profession. Conversely, untruthful information and inflammatory statements do not build public trust and may be in breach of the Hippocratic Oath injunction to "do no harm".

Physicians and their organizations are not professionally responsible, nor do they enhance public trust in the profession, when they use Internet and Web sites to present personal views and clinical claims that have not been subjected to peer-review. Professional peers, not patients and the public, should be arbiters of scientific and clinical accuracy and validity.

It is not professionally responsible to denigrate the work or publications of other physicians in a forum directed to laymen. The layman may not be fully informed of medical and technical knowledge. Professional disagreements should be aired in a forum of peers. Denigration that aims to destroy another physician's practice is morally reprehensible. A publically-aired "cat fight" is recognized as such by the public, and public trust is thereby lost.

Physicians who market their services have a responsibility for "truth in advertising". Use of trademarks or service marks as commercial names for a hair restoration procedure, without disclosing the scientific basis for the procedure, its complications and side effects is not in the public interest. Nor is it in the public interest to use a commercial name to market a procedure that is described under a commonly accepted name in the medical literature, without revealing the name used in the medical literature.

The ISHRS believes that the Internet and World Wide Web are exceptional communication tools to inform and educate the public, patients and potential patients. Since 1999, the ISHRS has had a constantly updated Website devoted to patient and public education (www.ISHRS.org). Information on the ISHRS Website is drawn from peer-reviewed literature.

The ISHRS deplores the use of the Internet and Web to confuse the public about hair restoration by opinion disguised as fact, advertising claims that can verge on the outrageous, and personal attacks by physicians upon the expertise of other physicians. This use of the Internet and Web adversely affects the efforts of hair restoration physicians and surgeons to clearly differentiate themselves from individuals and companies with questionable advertising practices.

The Medical Foundations of Hair Restoration Surgery

Surgical hair restoration has its origins in medicine and its further development has continued to be in the hands of surgeons and physicians, beginning with Norman Orentreich, MD, who introduced modern concepts of hair restoration to the United States in 1959. The practice of hair restoration surgery has always been guided by the principles of medical ethics and the Oath of Hippocrates.

The ISHRS was formed in 1993 by hair restoration surgeons who recognized the value inherent in an international forum for sharing scientific and clinical knowledge. The organization's Mission Statement, Bylaws and Code of Ethics reflect these values. Professional excellence should include professionally responsible use of the Internet and World Wide Web to inform and educate patients, potential patients and the public.

The ISHRS is dedicated to assure the enrichment of professional excellence of its members through education and by fostering creativity, science and originality in the advancement of hair restoration surgery (HRS). Membership is available to physicians and surgeons who are fully licensed to practice medicine and have an interest in hair restoration and surgery. Membership in a surgical assistants auxiliary is available to surgical assistants employed by physician members of the ISHRS.

ISHRS Mission

The ISHRS has as its purpose:

  • To advance the art and science of hair restoration surgery
  • To encourage the free interchange of ideas, knowledge and experience among members in order to maintain the skills and artistry of members at the highest level
  • To encourage professional excellence
  • To encourage continuing medical education (CME) in hair restoration surgery

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