Have doctors, and particularly pathology testing, become outdated, replaced by modern whiz-technology, with data and diagnosis being transferred electronically and directly from laboratory to patient? In these days when information can be had with the speed of lightning at the touch of a keyboard button, it seems anachronistic that patients are still expected to wait in queues to fill forms to get medical attention, including sampling and testing of body fluids, for a variety of real or imagined disorders.

The list of diagnostic tests available from the website has become mind-boggling. These include tests for confirmation of pregnancy, blood sugar or cholesterol levels, evidence of infections like hepatitis or HIV and many many others. Tests kits can be bought over the counter in many countries or obtained though electronic order. In addition to these, of course, there is no end of advertising for and commerce in medicinals that promise to rejuvenate sex life or perform other minor miracles.

How is the average citizen to respond to this barrage of intrusive information? Some are attracted to the convenience or anonymity, or maybe they are just disillusioned with the type of medicine they had received. They can read printout information as well as anyone else, including their doctor whom they begin to see as an unnecessary intermediary between themselves and their disorder.

One cannot of course forbid access to these alternative methods of diagnosis and treatment. The average citizen has the right to make his or her decisions, even if in the process this entails making all the mistakes in the book, and spending inordinate amounts of money on ineffective medicine or quackery. It is, however, distressing to see the disastrous effects of misdiagnosis or misinterpretation of test results.

When ordering diagnostic tests the average health practitioners ensures that:

¤ The right tests are being requested and no more tests than necessary are performed;

¤ Where the result does not fit in with the overall clinical diagnosis, a repeat or follow-up test is requested;

¤ Interpreting a test is an integral part of a clinical examination and should not be done without reference to the clinical picture. Both positive and negative results may or may not be significant depending on the particular clinical situation, including reference to current lifestyle or medication;

¤ Testing is performed after sufficient information has been given to and consent obtained from the patient. This is particularly relevant in genetic testing or where it involves a third party, such as HLA or paternity testing.

These criteria are usually absent when health practitioners are short-circuited and tests performed through the anonymity of the internet. It is often the case that accuracy is sacrificed for speed. Moreover, what is portrayed as simple and reliable tests (often performed at home by the average inexperienced layman) often need to be confirmed by more sophisticated laboratory tests before they can be accepted as correct.

Another profitable line of trade is the advertising and supply of drugs or dietary supplements, including vitamins, minerals, herbs or amino acids. These can cause complications through cross-interactions, or where they replace a normal diet. They are particularly dangerous if taken in the absence of a proper diagnosis, because symptoms could be alleviated without curing the condition and this could lead to delay in diagnosis and curative treatment and could therefore allow the disease to advance further.

Advertisements promise to diagnose and even cure the most intransigent of diseases, and relieve pain in the privacy of your home, and all that is required is your credit card number. It is often difficult to distinguish between bona fide laboratory practice from fly-by-night quacks making the best out of this novel way of separating the gullible from their money.

In Malta, the advertising of medicinal products to the general public is covered under the Medicines Act. The Licensing Authority established under this law has the responsibility "to authorise the advertising and promotion of medicinal products" and "to establish standards to ensure the quality, safety and efficacy of medicinal products".

The Broadcasting Act also makes it clear that "Advertising for medicinal products and medical treatments available only on prescription shall be prohibited". Moreover, "Teleshopping for medicinal products and teleshopping for medical treatment, shall be prohibited" and "Advertising and teleshopping for all other medicines and medical treatment shall be clearly distinguishable as such, honest, truthful and subject to verification, and shall comply with the requirements of protection of the individual from harm". This is counsel of perfection and very difficult to enforce. In any case it has no relevance to products advertised by international bodies or individuals, as the vast majority of such advertisements usually are.

There is no doubt that the internet has become an indispensable source of information, a revolution in our way of interacting with the outside world. However, the old adage of "buyer beware" becomes more and more relevant the simpler the process of buying becomes. Those who decide to take responsibility for diagnosing and treating their health conditions should be aware of the great risk that they are taking.