As stated earlier, I recently attended a health blogger summit in New York that was put on by Consumer Reports.  It certainly says something about the rising influence of medical bloggers that we would be invited - along with some in traditional media that have crossed over into the world of blogging - to discuss issues related to healthcare online.  Good or bad, we have become a voice that is being heard increasingly in the discussion about medical care and medical policies.

As we discussed the role of medical blogging, one attendee used the phrase "the wisdom of the crowd."  Others immediately jumped on this phrase, debating if there is, in fact, wisdom in the crowd.  Many examples were given (and are still being given) of ways in which the crowd is wrong - my last post about false beliefs in the dangers of immunizations speaks to a dangerous concept that is drawing a crowd.  The fact that many people agree to the truth of an idea does not make that idea right.

I think this whole debate, however, misses what the term "the wisdom of the crowd" actually means.  The crowd has wisdom because of its diverse voices.  A single blogger is not as trustworthy as the aggregate of medical bloggers.  Falsehood on one blog should be corrected by another blog or by its readers.  Multiple differing ideas and debate lead to more reliable conclusions.  Unquestioned individuals - even reliable ones - are more likely to err.

This is not a "majority rules" phenomenon.  The majority of the crowd may be wrong, with individuals standing against the tide.  The truth The nature blogging that makes it so powerful is its interactivity.  I write something and that expresses my opinion and others are free to criticize and correct.  I would certainly hope that misstatements or blatant errors in my posts would be challenged by readers and other bloggers.

Traditional media, on the other hand, does not lend itself to such debate.  Reporters do research (some more, some less) and then "do a story" on what they find.  They may be held to task in editorials or in other ways, but there is little interaction with readers.  There are those who challenge the claims of reporters or "experts" in the traditional media, but as a whole, something said on TV or written in a newspaper is assumed true by most of the viewers or readers.

Crowds, however, can turn into mobs.  Mobs are groups of people that are unified by beliefs that push those beliefs on others.  You cannot join a mob unless you subscribe to what they are mobbing about.  There are certainly mobs on the Internet - groups of people that put down anyone who questions their dogma.  These groups don't just to defend their beliefs, they attack others who do not hold them.  Mobs are about conflict, not about solutions.

simpsons-mob-torches

Not all mobs are disorderly or uneducated.  There are many stories of scientists who hold to unpopular theories that are shunned by the scientific community.  This is termed "snobbery," but it is nothing more than a passive-aggressive mob mentality.

Our discussion in NY led me to mention the Healthcare Blogger Code of Ethics, to which my blog (along with many others) subscribes.  Discussion in blogs needs to be as open and honest as possible, with allowances for contrary opinions.  Blogs (and traditional media, for that matter) should not be believed without question.  The writer always has a perspective being pushed, and is prone to make mistakes.  The idea of the code is to give readers a clear idea of where the blogger is coming from.

Here is the Healthcare Blogger Code:

  1. Clear representation of perspective - readers must understand the training and overall perspective of the author of a blog. Certainly bloggers can have opinions on subjects outside of their training, and these opinions may be true, but readers must have a place to look on a blog to get an idea of where this author is coming from. This also encompasses the idea of the distinction between advertisement and content. This does not preclude anonymous blogging, but it asks that even anonymous bloggers share the professional perspective from which they are blogging.
  2. Confidentiality - Bloggers must respect the nature of the relationship between patient and medical professionals and the clear need for confidentiality. All discussions of patients must be done in a way in which patients’ identity cannot be inferred.  A patient’s name can only be revealed in a way that is in keeping with the laws that govern that practice (HIPPA, Informed Consent).
  3. Commercial Disclosure - the presence or absence of commercial ties of the author must be made clear for the readers. If the author is using their blog to pitch a product, it must be clear that they are doing that. Any ties to device manufacturer and/or pharmaceutical company ties must be clearly stated.
  4. Reliability of Information - citing sources when appropriate and changing inaccuracies when they are pointed out
  5. Courtesy - Bloggers should not engage in personal attacks, nor should they allow their commenters to do so. Debate and discussion of ideas is one of the major purposes of blogging. While the ideas people hold should be criticized and even confronted, the overall purpose is a discussion of ideas, not those who hold ideas.

I hope we medical bloggers remain a crowd - with our crowdly wisdom - and never becomes a mob.  When you read things on a blog (or anywhere else), always read carefully.  Weigh what you read against what you get from other sources.  Pay attention to the crowd.  Don't listen to the mob.

And if you ever think I am joining of a mob, please set me right.  I promise to put down my torch.

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