Medical blog analysis fuels call for standards

A new study of medical weblogs says anonymity, negative comments about patients and product promotions often prevail.

The July 23 Journal of General Internal Medicine study of 271 blogs authored by physicians and nurses found that more than 40% of such blogs are published anonymously and describe individual patients.

About one-third contain negative comments about the medical profession, and 18% comment negatively about patients.

The study also found that 17% of the blogs include enough information for patients to identify themselves or their physicians.

While violations of patient privacy were rare, three blogs showed recognizable photos of patients, and eight displayed patient radiographs.

The study's lead author, Tara Lagu, MD, MPH, said blogs are a welcome development because they allow doctors to communicate freely, but they present a challenge to medical professionalism.

"Some of these bloggers are talking about patients in a way that physicians usually only talk behind closed doors," Dr. Lagu said. "The Internet is a public space, even though when a person is in their little room writing a blog it may not feel that way."

Another concern is the lack of disclosures about financial conflicts. One in 10 medical bloggers promoted health care products, the study showed. A 2006 health care marketing survey found that nearly one-third of bloggers were asked by public relations companies to write about or endorse products.

These concerns are not new. A Healthcare Blogger Code of Ethics, created by an informal coalition of medical bloggers, addresses issues of confidentiality, conflict disclosure and professional courtesy. Bloggers who abide by the code may post the group's seal of approval on their site, and blogs are reviewed for adherence to standards.

Dr. Lagu said the code is welcome but argued that professional groups should adopt policies explicitly addressing blogging ethics. The American Medical Association has no policy, and none is under development.

Some physicians disagreed with the notion of formal medical blogging standards.

"That's a horrible idea," said Robert M. Centor, MD, a blogger and member of the American College of Physicians' Board of Regents. "The beauty of the Internet and blogging and personal Web sites is that you can do with them what you want to do."