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Medical blogs are sometimes seen as just rants about the state of health care, but they have also been credited with spreading public understanding of science and rooting out modern day quacks. Rebecca Coombes checks out the medical blogosphere
In “internet time” blogging has been around for almost an eternity. Now, with the possible exception of the odd intransigent high court judge, blogging has achieved household name status since catching the public's imagination nearly a decade ago.
The medical “blogosphere” is an especially crowded firmament. The opportunity to access raw, unfiltered material, to post instant comments, and to share information with a (often niche) community has become an addictive pastime for many doctors. The field has developed to the extent that devotees rely on their favourite blogs as their first port of call for topical opinion and debate. Taken as a group, the medical bloggers—the popular ones, at least—are overwhelmingly younger men, and many have a typically masculine geeky humour.
But the field is far from just a playground for the young. For example, David Colquhoun, professor of pharmacology at University College London, is 71 and now a celebrated blogger in his field. Professor Colquhoun thinks that a blog's power lies in its independence. Unlike newspapers, blogs don't feel bound to present a balanced picture, he says, “which, only too often, means giving equal space to people who believe the earth is flat and those that don't.
“On a blog I can just give my view. It's obviously that—and people can take it or leave it. Also, bloggers often seem to be better at investigative journalism than journalists are. All sorts of facts about dodgy practices appear on blogs long before they reach the regular magazines or papers; that is both fun and useful, I think.”
Today annual awards are given for the best medical blogs—including a prize for the best literary medical blog—and competing websites offer rankings of the best blogs. The site www.edrugsearch.com ranks more than 400 of the most popular blogs on health and medicine. It's hard to gauge just how popular some of these sites are, as top rated bloggers—such as BMJ columnist Ben Goldacre, who writes www.badscience.net—keep this a closely guarded secret. Many of the most quoted and linked-to blogs are by anonymous doctors, who shelter under fake names to vent opinions on anything from political interference in the NHS to how science is misrepresented in the media.
NHS Blog Doctor (http://nhsblogdoc.blogspot.com), by a general practitioner writing under the pseudonym of Dr John Crippen, is described as an “extremely depressing” look at the NHS. Dr Rant (www.drrant.net) does what it says on the tin: rant about medicine related topical issues, laced with lots of strong language. These sites examine political interference, root out modern day quacks, correct ignorant journalism, digest interesting stories, or comment on big official reports, for example. Many also use details that would not meet the BMJ's policy on patients' confidentiality. Dr Crippen, for example, keeps a work diary that details consultations with noteworthy patients.
Ben Goldacre says that blogs are popular because they are more honest than other media: “It is hard to get away with misrepresenting stuff when the original source is but a click away.
“I see it as a way of making conversation public—what is good about it is you get unmediated expertise. In the old days, you had to rely on a journalist to tell you what, for example, Iain Chalmers, told them. I think journalists were often really bad at this. On a blog, there he is. In the press it's hard to know what is true. But with blogs people can link directly to the original source—this never happens in a newspaper.” He complains that newspapers will also plagiarise blogs without giving credit, whereas blogs will refer and link to a person's site. And on an online blog people can make instant comments, verifying a story or adding more information, whereas “in newspapers the comment is published a few days after the original article, when everyone else has moved on,” says Dr Goldacre.
Professor Colquhoun was switched on to the power of blogs after fighting a successful campaign to halt the proposed merger of Imperial College and University College London. “Everyone was unhappy about it but said it was a ‘done deal' and could not be stopped. As soon as I started a blog support came flooding in, and it was possible to publish raw, unfiltered information instantly. It took only five weeks after starting the blog to defeat the whole daft idea, and that made me realise the amazing power of the web.”
After peace descended on UCL Professor Colquhoun found he was addicted, and he started to publish opinions on quackery and also on politics, religion, and education.
“It slowly dawned on me that all these pages were closely related, [were] just different aspects of ‘endarkenment' thinking, and the pages got too big to load quickly, so they are now all supplanted by two proper blogs” (including DC's Improbable Science at http://dcscience.net/).
Professor Colquhoun says he still gets an “enormous” amount of enjoyment from blogs. “I think they have really had some success in spreading public understanding of science and even in influencing public affairs (firstly with the merger and more recently with withdrawal of NHS funding for homoeopathy). My own research is on the stochastic properties of single ion channels. I love it, but it is specialist and of zero interest to the public. So it's fun to talk about things that do interest the public. It's also fun to be able to influence politicians and vice chancellors, though that is rather harder.”
He says that before blogs the ordinary academic had no chance to influence anything much, other than by voting every five years. Now—with a little technical expertise—“they can post stuff for the world to see while sitting in front of the TV or even on a hilltop.” Blogs are also easy and cheap to produce—many blog hosts are free.
What turns off many would be users is the feeling that the blogosphere is a wild west of crackpot opinion-mongers. How do you determine the relative “value” of a medical blog? Ben Goldacre says that it is easy to sift through the huge choice of medical blogs, building up a bank of trusted sites and following trails to new ones.
He says, “I'm a 33 year old doctor, and I most enjoy reading narrow interest magazines. A BMJ editorial is always going to be more interesting to me than a Times editorial, a Nature article more than a New Scientist feature. The http://science.reddit.com site [a ranking of science writing that is posted and voted on by users] is consistently brilliant, much better than anything in the newspapers.” Blogs also offer users “grand rounds”: informal syndication of the best from other blogs. For example, a group of blogs will take it in turns to host a paediatric grand round, rounding up the best of that week's blog entries related to paediatrics.
Ranking by www.edrugsearch.com
1. Random Acts of Reality (Trying to Kill as Few People as Possible . . .) (http://randomreality.blogware.com/)
2. Bad Science (www.badscience.net/)
3. MedGadget.com (http://medgadget.com/)
4. Kevin MD, Medical Weblog (www.kevinmd.com/blog/)
5. NHS Blog Doctor (http://nhsblogdoc.blogspot.com/)
Professor Colquhoun adds: “Blogs are an enormous step towards real democracy, though the price for that is that every madman and quack can do the same. Indeed, that is what makes it so important for people with knowledge, expertise, and honesty to fight back and draw a line in the sand at the tide of nonsense that engulfs us. The papers don't fulfil that role at all well—and in fact often exacerbate it.”
(See also Medicine and the Media doi: 10.1136/bmj.39343.478403.68.)