It started with an e-mail to thousands of health bloggers from Dr. Geoff Rutledge, Chief Medical Information Officer at the health website 

: “I was on a search for the best medical blogs, when I found you… I think your blog is great. I’d like to invite you to participate in the network of medical expert bloggers at Wellsphere… I offer you the opportunity to be a featured medical expert blogger for a new Wellsphere community. Members and visitors will see your postings highlighted, featured, and clearly marked as authored by a true medical expert.” 

A large number of health bloggers—at least 1,500, according to Wellsphere&mdash;accepted Rutledge’s invitation. Most linked up with Wellsphere because they hoped the company would help them reach new readers. 

, who writes at the blog “Every Patient’s Advocate” wrote “[W]hen Wellsphere came along, I saw it as an opportunity to maximize exposure… In fact, my blog numbers (about 4,000 people per month), doubled when my blog began to appear on Wellsphere.”

For many months, Wellsphere recruited bloggers with little controversy. However, on January 28, 2009, Wellsphere announced that the HealthCentral Network had purchased the company for an undisclosed sum. Soon after the press release hit the Web, health bloggers were up in arms. Many felt that Wellsphere took advantage of them by aggregating their content and selling it to HealthCentral Network. Others objected to Wellsphere’s terms of service agreement, which gave the company permission to redistribute and monetize bloggers’ content.

Although many health bloggers were angry at Wellsphere for selling their content to the HealthCentral Network, others were more accepting. In addition, some had little sympathy for those who had not taken time to read Wellsphere’s terms of service agreement before consenting to let the company repost blog content on its site.

Wellsphere is not the only social media company that has run into controversy regarding content ownership. The popular social network Facebook recently changed its terms of service agreement to note that after a user leaves the site, Facebook will retain some rights over content and information that the user uploaded. After much outcry, Facebook deleted the new language from its agreement and engaged its users in a discussion about the issue.

The Wellsphere and Facebook controversies illustrate how difficult it is to reconcile two opposing needs:

	• The public’s growing need to quickly and easily find and share information online using social media technologies

	• Technology providers’ need to run profitable businesses while protecting themselves from potential user lawsuits

	• Site developers should recognize and clearly acknowledge that users of social media services retain rights and ownership over their content.

	• Social media companies should understand that most people are not lawyers. Developing “plain English” terms of service agreements for the masses is critical.

	Users of social media should recognize that, in order to continue providing valuable services, many sites need to focus on becoming (and remaining) profitable; this means that they may repurpose or redistribute site content to attract sponsorship dollars. However, these activities should be clearly spelled out to users.

	There are no easy answers to the content ownership and distribution question. Despite this, it is important to foster and participate in robust debate about this issue. Only then will people come to a broad understanding and agreement about how to foster collaboration and conversation while ensuring that sites that provide useful information and technologies continue to function.

The path toward resolving the thorny issue of content ownership may lie in both sides understanding and accommodating the needs of the other. Specifically:

Do you read the terms of service agreement for blogs and other social media sites before posting content? As the user-generated content business model gains popularity, will members demand to be compensated in some way when sites capitalize on the traffic generated by members of the community?

Fard Johnmar is the founder of Envision Solutions, LLC, a full-service healthcare marketing communications consulting firm. Visit 

 to learn more about the company and the services it offers. 

Articles

It started with an e-mail to thousands of health bloggers from Dr. Geoff Rutledge,
Chief Medical Information Officer at the health website Wellsphere.

Wellsphere Blogger Flap Raises Questions about Content Ownership

I’m writing this on November 5, 2008, a day after a historic election that propelled a once little-known Chicago politician to the summit of US political power. President-elect Barack Obama’s ascension to the White House was fueled in part by an Internet-driven grassroots campaign that brought together Americans of all backgrounds. The campaign deftly utilized social networks, blogs, mobile phone messaging, and other technologies to energize and motivate millions of citizens. 

Obama’s election should silence the skeptics who still believe the social media revolution is a fad. If political operatives can leverage social technologies to elect a president, smart people can use them to improve healthcare in the United States and around the world. 

This is not a new idea. In October, more than 1,000 people involved in developing technologies designed to harness the energy and wisdom of the crowds to solve vexing health-related problems descended on San Francisco to attend the 2008 Health 2.0 conference. A major focus of the conference was on helping health consumers fi nd accurate medical information and navigate the complex health fi nance system. 

Although Health 2.0 has moved from the fringe to the mainstream, some observers are skeptical about its relevance and impact. Dmitriy Kruglyak, founder of the online community Trusted.MD, is one of them. In a 

, he suggested that “Health 2.0 represents irrational exuberance around unproven healthcare ideas that do not have a sustainable business model.” Health 2.0 conference co-founder Matthew Holt quickly shot back, calling Kruglyak’s analysis “weak” and suggesting that Health 2.0 is about how “consumers/patients/ citizens relate to each other” not “

hyping the creation of a standalone industry

I think Health 2.0 boosters tend to overestimate the impact consumers and social technologies will have on health. Simply put, consumers are not all-powerful. They do not have the ability to equally infl uence medical technology development, healthcare budgets, and other major drivers of the complex health system. 

Consumers’ influence over the development of medical technology is limited; although their input can have some effect on relatively unimportant factors like medical device features, much of the critical activity is driven by drug manufacturers and other health industry players. Consumers also exert only indirect influence on health financing and the allocation of healthcare dollars. Although they can help reduce administrative expenses and demand for health services, they do not have much control over how large sums of money are spent by hospitals, state and federal government agencies, and managed care companies. 

However, consumers can play a central role in medical decision making (eg, drug prescribing, end-of-life care management, and diagnostic testing) and information sharing. We have recently seen many instances in which consumers using the Internet have influenced decisions about which medicines and therapies should be provided to patients. For example, the FDA recently announced that it would fund a 

 to determine if generic Wellbutrin is truly safe and effective. The FDA decided to conduct this study after reviewing hundreds of postings on an online forum hosted by the producers of 

 indicating that generic and branded Wellbutrin are not equivalent. A great deal of research, including 

 published by Manhattan Research, indicates that millions of Internet users are regularly seeking and using health information produced on blogs, online forums and other social networks, and other social technologies. 

Health 2.0 advocates who wish to ensure the success of the movement will have to be realistic about the true impact Internet-empowered consumers have on the health system. As we have just seen in the US presidential election, people using social technologies helped to accelerate information exchange and shape perceptions of policies proposed by the candidates. However, they had little infl uence on overall campaign strategy or on how campaign donations were spent. Obama and his advisors successfully leveraged these tools because they recognized how and when they would be most eff ective. Health 2.0 boosters would do well to follow their example. 

 to learn more about the company and the services it offers.

President-elect Barack Obama’s ascension to the White House was fueled in part by an Internet-driven grassroots campaign that brought together Americans of all backgrounds. 

The Dirty Secret about Health 2.0: Consumers Are Not All-powerful

In recent years, several studies have indicated that physicians are very dissatisfied with the medical profession. According to an article published in the June 17, 2008 edition of the 

, declining reimbursements, managed care, physician shortages (especially in primary care), and concerns about malpractice are contributing to doctors’ discontent. Another frustration is the steady erosion of the doctor—patient relationship. Once the primary source of medical information, physicians are routinely challenged by a raft of medical “Googlers.”

Dr. Scott Haig highlighted physicians’ growing frustration with Internet-empowered patients in a famous 

. He suggested that patients have a wealth of information but lack the expertise to interpret and apply it correctly. Many people reacted negatively to Haig’s essay. For example, an article discussing it posted November 10, 2007, on Tara Parker-Pope’s 

” received hundreds of negative comments.

Unfortunately for Internet-leery physicians, the Web’s influence is steadily growing. In August, the 

 released research indicating that “56% of American adults sought information about a personal health concern from a source other than their doctor.” It is clear that online health content is affecting patients’ habits. A study published in July 2008 by my firm, 

, revealed that nearly 38% of US adults say they have doubted a medical professional’s opinion or diagnosis because it conflicted with information they found online.

Despite these compelling statistics, it would be a mistake to conclude that Dr. Web has become Americans’ most trusted source of health information. In fact, people still take physicians’ advice seriously—online and off. For example, Envision Solutions found that 13% of Americans would consult physician-developed blogs and other online content first if they believed they had a medical problem or disease.

Many physicians want to repair the patient—doctor relationship. However, a few view the Internet with great skepticism and resent that relatively untrained people are regularly questioning their medical decisions and demanding unnecessary treatment. What’s a beleaguered physician to do? Unfortunately for overtaxed physicians, some are prescribing more active engagement with Internet-empowered patients. In a January 2008 

“Today, there are many accurate, high-quality health sites, and doctors should make it a standard practice to recommend them to each and every patient. Besides reducing the randomness of a Web search, this can reinforce a physician’s advice during a visit, which is especially helpful, as studies show that patients typically remember no more than half of what their doctor tells them.”

Parikh suggests that physicians who fail to heed this advice will ultimately face a larger problem: Internetpowered conspiracy theories that have very real public health consequences. Recently, the CDC released 

 indicating that measles cases sharply increased during the first seven months of 2008. The culprit: a growing movement, partly fueled by the Internet, of parents who refuse to vaccinate their children because of fears about a link between the measles vaccine and autism. Commenting on this unfortunate trend, Parikh said:

“The theory that vaccines cause autism first came onto the scene in the late ‘90s, just as people were going online en masse. We weren’t paying much attention until parents started to refuse vaccines. When we looked, we realized that many parents were exposed to story after story on autism Web sites and in chat rooms about the dangers of vaccines. That echo chamber of opinion became a reality despite our best efforts to prove otherwise. Now we’re left with a lingering conspiracy theory that vaccines cause autism, even though the best, unbiased evidence says otherwise.”

Although the Internet train has left the station, it’s not too late for more doctors to get on board. While many physicians fear the Web and blame it for eroding their quality of life and relationships with their patients, it cannot and should not be ignored. Doctors of all ages will either learn how to harness the Internet or be overwhelmed by it.

Fard Johnmar is the founder of Envision Solutions, LLC, a fullservice healthcare marketing communications consulting firm. Visit 

According to an article published in the June 17, 2008 edition of the New York Times, declining reimbursements, managed care, physician shortages (especially in primary care), and concerns about malpractice are contributing to doctors' discontent. 

Fard Johnmar

Articles

Wellsphere Blogger Flap Raises Questions about Content Ownership

The Dirty Secret about Health 2.0: Consumers Are Not All-powerful

Social Media Notebook: Get on Board the Health Internet Train