Perspective
Down the Rabbit Hole
A venture into the wonderland of medical blogs.
By Charles R. Meyer, M.D.
One warm day in June 2002, my spikey-haired classmate at Bennington College turned on his laptop to start a presentation that would complete his M.F.A. in creative writing. Those of us in the audience shifted on the hard, wooden benches, trying to settle in for another informative-but-slow talk about Emily Dickinson or Kathryn Mansfield. Instead, he launched a sparkling tour of what he claimed was a new form of creative expression, Web logs. To some of us graying skeptics, they seemed like online diaries, an Internet outlet for adolescent self-indulgence. What we never imagined was that blogs would one day become a major political and cultural force, launching one presidential campaign and perhaps dooming another, fueling political scandals and challenging the power of traditional media. Today, millions of blogs cover virtually every topic in our society, and even medicine has found a place in the blogosphere.
How it All Began
In 1997 as the Internet was evolving from seed to weed, Jorn Barger, a technically savvy Chicagoan with a penchant for James Joyce, launched the Web site robotwisdom.com and started commenting on everything from Finnegans Wake to Britney Spears. Deciding that his site and others like it needed a new moniker, he coined the term “Web log,” since much of what he and others included on their Web pages were virtual logs of their daily thoughts and activities. Catchy as the term was, its eventual nickname, “blog,” was snappier, and it became the most looked-up word on Merriam Webster’s online dictionary in the years following.
In 1999, Blogger, the first software to automate the creation of blogs, was released and anybody with an Internet connection and a drive for self-expression could readily launch their own blog. Since then, blogs have become yet another geometric growth statistic in the torrid history of the Internet. In the years following Barger’s 1997 scribblings on Ulysses, the number of blogs exploded to an estimated 4.12 million in 2003. Today, a blog survey site, Technorati (technorati.com), claims it tracks 35.4 million sites that contain 2.3 billion links. My own Google search for “medical blogs” returned 82,700,000 hits. Clearly, the need for self-expression is a not-so-silent epidemic that has spread through cyberspace.
And self-expression is what blogs are all about. At the most basic level, a blog is one individual placing his or her opinions, thoughts, or feelings out on the Internet for all to read and react to. Those opinions stretch from the banal to the baffling; thoughts can sound like Goofy or Goethe; and feelings range from the superficial to the super-prurient. As Biz Stone, one of the creators of Xanga blogging software, described it in his book, Who Let the Blogs Out: A Hyperconnected Peek at the World of Weblogs, “Is blogging self-expression, personal publishing, a diary, amateur journalism, the biggest disruptive technology since e-mail, an online community, alternative media, curriculum for students, a customer-relations strategy, knowledge management, navel gazing, a solution to boredom, a dream job, a style of writing, e-mail to everyone, a fad, the answer to illiteracy, an online persona, social networking, resume fodder, phonecam pictures, or something to hide from your mother? It’s all of these and more.”
Stone’s remarks smack of heady hype, as does much of the writing about the potential for blogs, yet bloggers have had a few notable success stories that have made them feel headier. Discovering and then publicizing sloppy journalism, bloggers ignited and stoked the popular firestorms that led to the resignations of New York Times editor Howell Raines and CBS anchor Dan Rather. Instead of consigning the racially tinged remarks of Sen. Trent Lott at Strom Thurmond’s birthday party to the editorial scrap heap as the mainstream media intended, bloggers broadcast the details over the Net until the media couldn’t ignore them and Lott stepped down as Senate majority leader. And Gov. Howard Dean jump-started his improbable presidential bid by raising $15 million through Blog for America.
Some blogs carry more weight than others. One of the most frequently visited blogs is Instapundit.com, the brain-board of conservative law professor Glenn Reynolds, which tallies 120,000 hits each day. Instapundit’s liberal counterpart is perhaps Dailykos.com, created by former GI Markos (“Kos”) Moulitsa Zuniga in 2002 to vent his frustration with the Afghanistan war. Dailykos.com’s volumes skyrocketed with the onset of the Iraq war, as Kos penned articulate criticism from the viewpoint of a veteran.
The explosion of political blogs is fueled by dissatisfaction with conventional media and with politics as usual. David Kline and Dan Burstein in their book Blog! How the Newest Media Revolution is Changing Politics, Business, and Culture quote a Pew Research Center poll taken during the 2004 elections that found that 45 percent of Americans believed little or nothing of what they read in their daily newspapers. A blogger is biased but overtly biased, which many people prefer to professed-but-feigned objectivity from the newspapers and television stations.
However, as evidenced by blogs prominently displayed on most newspaper Web sites, the mainstream media are joining rather than fighting the blog revolution, though hard-core bloggers dismiss journalists “hired” to blog as mere pawns of the journalism establishment constrained by the same old rules. Blogs have also invaded academia. Appellate court judge, author, and University of Chicago law professor Richard Posner writes a scholarly blog, Becker-posner-blog.com, with University of Chicago economics professor Gary Becker. And a neuroscience course at Princeton University offers credit for active participation in its blog.
Alice in Medical Blogland
I decided to take my own tour of some of the blogs written by and for doctors. Although none of the ones I visited carry the political clout of an Instapundit.com or the gravitas of a Becker-posner-blog.com, they do show docs around the country experimenting with this 21st century communication medium. And I found that exploration of any corner of the Internet quickly opens into a dazzling, sometimes baffling, and seemingly endless world of options as confounding as Alice’s rabbit hole. What follows is a taste of what I found during my trek through the wonderland of medical blogs guided by Forbes magazine’s “Best Medical Blogs,” by recommendations of MMA Web writer Sarah Branson, and by links on blogs I visited.
- Docnotes.net
Subtitled “Occasional Notes from a Family Physician,” www.docnotes.net is the creation of Jacob Reider, a 40-something assistant professor of family medicine and assistant dean of medical informatics at Albany Medical College in New York. Since 1999, he has been updating his site once every few days with tales about his own private primary care practice. “I’m trying to be more transparent about what physicians do for a living,” he writes of his blog. Among his current interests are a vaccine against certain bacteria, the effectiveness of pillow covers in preventing asthma, whether pharmaceutical firms are preventing generic drugs from reaching the market, and paternalism in medicine. He also gets introspective, as when he revealed, “The nurses think I’m too slow, but the patients disagree.” Like most blogs, Reider’s has links to sites that interest him, Society of Teachers of Family Medicine podcasts and an Osler blog. As a confirmed techie, he includes a review of a tablet PC he is testing, using the same informal style he uses in his blog posts. His readers can also search blogs, Google, or PubMed or link to his archived blogs by category (orthopedics, pediatrics, etc.) or topic.
- Over!My!Med!Body!
A bit edgier is Over!My!Med!Body! (OMMB) at www. grahamazon.com. Produced by a third-year medical student at a West Coast university, OMMB features anatomical art from the National Library of Medicine on every page and frequently has short, humorous video clips from Japanese television, including a recent instruction about keeping your Band-Aid on all day. The author writes short comments with links to something he has found interesting such as “The Wallaby Cure: A new antibiotic compound has been found in wallaby milk.” The write-up claims that compound AGG01 was found to be effective against a relative of the hospital superbug MRSA, or golden staph, as well as E. coli, Streptococci, Salmonella, Bacillus subtilus, Pseudomonas spp, Proteus vulgaris, and Staphylococcus aureus.“No word if it’s actually safe in humans yet.”
- Pushfluids.com/blog
Some medical blogs are outlets for those who want to complain or need to vent. One such blog is www.pushfluids.com/blog, written by three M.D.s-in-training in New York City and Chicago. The site “walks the line between self-pity and self-parody” and recently included a paragraph about one of the authors’ post-call “bitch personality.”
- Politedessent.com
For a view of medicine through the lens of popular culture, Politedissent.com, subtitled “Comics, Medicine, Politics, and Fun,” looks at the accuracy of medical content in and the entertainment value of comics and current TV shows such as House. Comic addicts can feast on the links to 40 comic blogs and a reference to drugs, real and invented, that appear in comic books.
- Hcrenewal.blogspot.com
Health care politics gets a more sober analysis on hcrenewal.blogspot.com, which is devoted to “addressing threats to health care’s core values, especially those stemming from concentration and abuse of power.” Recent posts quoted a Los Angeles Times op-ed piece about drug company influence on research and an article in the same paper about alleged financial improprieties of former secretary of Veterans Affairs, Anthony Principi.
- blog.bioethics.net
The national trend of mainstream journalism diving into blogging is seen on blog.bioethics.net by the editors of the American Journal of Bioethics. It has a pleasing layout, short, articulate comments about bioethics news from around the world, and a long list of links to quality online journals.
Worthwhile or Waste of Time?
Like Alice, I found my head spinning after my trip through the medical blogosphere. The variety and volume of information is overwhelming. I kept asking, Is this worthwhile? Do I need these people’s opinions cluttering my brain?
Blogging is supremely egocentric as evidenced by the tone of writers such as radio talk show host and blogger Hugh Hewitt, who in his book Blog: Understanding the Information Reformation that’s Changing Your World puts himself at the center of all the revolutionary events in blog history, and one of the authors of pushfluids.com, who presumes that the reader wants to know about her “bitch personality.” Yet almost all blogs draw many voices and reading them is an opportunity to hear like-interested folks opine on matters weighty and whimsical. Too often opinion in medical circles is restricted to the oracular word of the New England Journal of Medicine or the shoot-from-the-hip “authority” in the doctors’ lounge. Medical blogs have the potential to offer a national dialogue, widening a physician’s perspective beyond the front door of the clinic.
That blogs are a source for unvarnished opinion is indisputable; whether they are a source for reliable information is an unresolved debate. Anybody can say anything in a blog, although blog proponents contend that blog “truth” evolves as the mass of contributors self-correct any mistakes that get posted. As Biz Stone puts it, “Rumors and misinformation can also spread through the blogosphere, but there seems to be a code among bloggers as a whole to sniff out lies and self-correct when things get out of hand.”
Although a recent study of Wikipedia articles found an average of four mistakes per article, it also uncovered three mistakes per article in the “authoritative” and juried Encyclopedia Brittanica. For medicine, which relies on peer-refereed articles grounded in the scientific method, relying on the “authority of the crowd” seems almost sacrilegious and accepting factual mistakes dangerous. Yet medical truth, like “blog truth,” is evolutionary, with study after study wending their way toward “the answer.”
And the concept of having a medical marketplace of ideas accessible to millions in seconds is a truly untested proposition. Controlled, randomized medical studies are in no danger from blogs, but the discussion fostered by blogs could push medical knowledge forward.
Kline and Burstein contend that the blog phenomenon has historical roots: “Once you start to look for bloglike phenomena in the history of our civilization, you start to find them everywhere. The Talmudic tradition … is also a form of proto-blogging—scholars and thinkers debating the meaning of text passages from another era and creating commentaries, refinements, additions, and different shades of interpretation. ... da Vinci probably wrote the greatest unpublished blog of all time in his more than 30,000 pages of diary entries.” Through letters to the editor and studies that confirm or refute previous studies, medicine too holds its debates in a stylized, almost ritualized format. Perhaps medicine needs to tap more of the blog culture and escape from some of our previous formality. Regardless of historical precedent, however, I do worry that blogs are just one more example of the preference in our culture for opinion over reporting of fact. The Frankens, O’Reillys, and Limbaughs of the world have captured millions of ears while the New York Times and Chicago Tribune are scrambling to maintain circulation. Medicine’s Deepak Chopra and Andrew Weil sell millions of books that circulate opinions supported by sometimes unconventional science.
Whether medical blogs will fuel or dampen such ideas is unclear. And then there is the dog phenomenon. A September 12, 2005, New Yorker cartoon pictures two dogs talking, with one saying to the other, “I had my own blog for a while, but I decided to go back to just pointless, incessant barking.” What I found on my tour of the blogosphere wasn’t just the adolescent self-indulgence I saw in the examples of blogs that my Bennington classmate presented or pointless yapping. I did find opinions, entertainment, and information worth an occasional taste.
Really blogs, medical or otherwise, are like the rest of the Internet, too large to swallow whole, with morsels inedible as well as delectable. And any life is too short to spend too much time sampling. MM
Charles Meyer is editor in chief of Minnesota Medicine.