Medical site attracts porn fans


The round table in Dr. Christoph Lehmann's office is piled high with papers. In the back, another physician taps at a keyboard, crunching numbers for a scholarly article on their most recent study in informatics -- the application of computer science to medicine.

With his short sleeves, rimless glasses and restlessly observant eyes, Lehmann is at home in this cramped academic setting -- fitting for a man who has spent his career working in disciplines as diverse as skin disease, neonatal medicine and computer programming.

The German-born physician combined those skills six years ago at Johns Hopkins Hospital when he developed DermAtlas -- an online dermatology database that generates 30,000 hits a day, helps caregivers around the world, and enhances Hopkins' reputation as a premier steward of information on the specialty.

But even a Renaissance man must face the limits of his knowledge.

Two years after creating the online medical resource, Lehmann found to his horror that some people -- lots of people, actually -- were browsing his digital images of diseased body parts, not for educational purposes, but to satisfy a craving for a bizarre vision of online porn.

"I'm still surprised," Lehmann says, "at how many people have ... uh, interests ... that I would never have anticipated."

The discovery led Lehmann, 41, and two other Hopkins physicians, Bernard "Buddy" Cohen and George Kim, on an unexpected journey that stretched their knowledge of medical science, photography, computers and education -- and leaves them exploring an uncertain boundary between a teacher's compulsion to share and the censor's need to withhold.

Their recent paper in the Journal of the American Academy of Dermatology is titled "Detection and Management of Pornography-seeking in an Online Clinical Dermatology Atlas." In plain language, "skin" can mean different things to those inside and outside the world of medicine. Those inside it had to adjust.


Lehmann's medical studies led him to a pediatrics residency in West Virginia, and then to a Hopkins neonatology fellowship. Meanwhile, personal curiosity was drawing him into medical informatics, the study of how information technology can improve medical education and practice.

At one point, he worked up a model for storing and sharing thousands of online images when he met Cohen, a dermatologist down the hall who had amassed a sizable collection of digital photos.

"Dermatology is a visual field," says Lehmann, who doesn't practice the specialty. "You'll never be able to identify genital warts in a 3-year-old if you haven't seen it. You see it -- you know it."

DermAtlas -- accessible free by typing a World Wide Web address -- cross-references images by body part and diagnosis, along with age, race and gender.

So, for example, someone who wants to see an example of psoriasis on a boy's leg can type in search terms for the body site, gender and age. The system displays multiple close-ups, each with brief patient history -- and offers links from those images to all other skin diseases of the leg.

Because the same malady can look different in patients of different races, DermAtlas also sorts by pigmentation (light, dark, medium).

"It's a book online," Lehmann says. "It's open 24/7. And this technology opens the door for us to get contributors from all over the world." That includes items from patients, caregivers and other interested parties from as far away as Brazil, Egypt and Pakistan.

It's not the first such resource in the field, says Cohen, who serves as co-curator, but it's the largest, with nearly 9,000 images. It's the most widely consulted resource of its type and the second-most-visited dermatology site in the world, behind the American Academy of Dermatology.

Cohen calls Lehmann -- who is director of clinical information technology at Hopkins' children's hospital -- a multidisciplinary genius. With a worldwide reputation of his own, Cohen is no slouch either. Both see the DermAtlas as a global community service.

But neither foresaw the more sinister implications of posting photos of unclad body parts online, many of them children's.

Unwelcome visitors

In 2002, Lehmann, who monitors the site closely, noticed a 40 percent jump in users -- from 3,000 to 5,000 daily visits -- in one 24-hour span. Investigating the spike, he checked out the Web sites from which these new visitors were linking to DermAtlas.

Many were from a site titled -- and here Lehmann raises his eyebrows --

"It was clearly a fetish site," he says -- one offering "gore, necrophilia, stuff like that."

Lehmann is not in the business of passing judgment; what people want to do in private is their business, he says. Even so, this finding was disturbing.

"We lost our naivete," he says. "A resource we had designed for good purposes, a few people had decided to use for things not intended. It was very disappointing."

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