Two pieces in the health blogosphere caught my attention as being connected even though they were ostensibly about different topics. The first, by Tom Lee (the California Dr. Tom Lee, not the Boston one), appeared yesterday on the California Healthcare Foundation’s iHealthBeat site (actually not officially in the “blogosphere” because it’s a “Perspectives” piece rather than a blog post): “Is It a Matter of Time Before Physicians Are Replaced by Expert Online Medical Content?” The other is a collection of insightful thoughts on the definition of “participatory medicine” triggered by Gilles Frydman on the e-patient.net blog.

Lee makes several interesting points, emphasizing the corollaries in content commodification between the newspaper and health care industries. Not only do I see corollaries myself, but I described these in considerable detail in opening the 2008 Information Therapy (Ix) Conference at the Newseum — a building with a 74-foot engraving of the First Amendment on its facade facing Pennsylvania Avenue between the Capitol and the White House. We held that conference there quite deliberately, in order to explore how Ix and free access to information will play a role in shaping a truly American redesigned health care delivery system.

In framing last year’s conference (slides here), I explored the history of the uniquely American approach to information democratization. Not only was the idea of a free and critical press revolutionary when the founders wrote the Constitution, the US also was the first country to mandate the use of statistics (via the census) and use those data in the organization of democratic government. In other words, information democratization and data science were paired together from this country’s birth.

The proliferation of the mass media was just one of many manifestations of the US’s historical preoccupation with information democratization. Other US innovations relative to the other fledgling democracies include public legislative sessions, concisely written & widely published federal & state constitutions, and comprehensive postal network & assured postal privacy. Just think of the “2.0″ role of 18th-century colonial newspapers that went beyond just publishing then-radical documents like the Declaration of Independence. Those newspapers not only played a critical role in reporting protests and championing the cause but providing a forum for discussion. As Paul Starr (also author of the the Pulitzer Prize-winning Social Transformation of American Medicine) pointed out in The Creation of the Media, the public input turned disorder into a more coherent opposition movement.

What I went on to say, though, was that information democratization was not only a great American opportunity but Starr also described its perils and potential dangers. The key is harnessing that power, and the key for health care is to marry it with the best that science has to offer. By layering evidence-based medicine, behavior change science, decision sciences, predictive modeling, comparative effectiveness research and other technologies onto information democratization, we can fully tap its potential in a productive way.

This is where the connection between Lee and Frydman comes in. Lee describes “at least three brakes or limitations to the forces of commodification.”

1. Not all content is created equal
2. Some content is best experienced in conjunction with a physical experience
3. Content commodification ultimately will be driven by the economics of the content business.

I think that there is much more to it than that, most critically that the value that the clinician can provide often is much less about content than about context and communication. Participatory medicine transpires where good content gets contextualized for the specific needs of a particular patient/consumer and effective communication helps to facilitate an interactive dialog. That interaction should support one or more of the following: informed/shared decision making; effective behavior change or support; and/or coping or practical support.

This entry was posted on Tuesday, May 19th, 2009 at 11:40 am and is filed under Consumer empowerment, Ix Definitions, Participatory Medicine, Patient-Clinician Relationship. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.