HEALTH2.0: Knowledge Prostitution

The powerhouse that is Scott Shreeve, not content with jetting around the US, looking after his newest (and 4th) kid and filling my inbox with amazing stuff, is having a go at prostitutes by comparing them to doctors! Personally I’ve never logically understood the stigma about prostitution, and I like the Heinlein novel where one of the lead characters is a prostitute who charges her son by the hour to see her after he’s 21. After all, they’re providing our society’s most cherished function, and when you pay a high price for great service for anything else in this world it is regarded as a good thing. (And yes I do understand the stigma in this version of the alternate universe).

But I digress….

What Scott’s piece, Knowledge Prostitution, suggests is that for social networking sites to pay members for opinions is not healthy. He particularly looks at Sermo, and he also suggests that the information gained from his inquiry about a rare form of wrist pain is not too helpful.

FD about me and Sermo here. CEO Dan Palestrant bought me dinner to pick my brain (I think I won!), Sermo has paid for advertising for the THCB jobs board, and Sermo is a sponsor of the forthcoming Health2.0 conference—for which Scott is on the advisory board. I like both Daniel and Scott a lot, so it’s good to see a little healthy dispute between MD computer geeks!

My take is twofold. First, I think Sermo believes that paying
doctors is a minuscule part of the motivation for them to answer
questions.  Daniel told me that they’ve only paid a tiny fraction of
the doctors using the service, and paid them relatively little. They’re
on Sermo because they like it and find it useful. Of course when Sermo
was starting, the concept of offering money for selected opinions was a
small part of their attempt to get going—after all they are in a way
selling those opinions on to their end clients. But it’s probably not
much of a driver and I’m sure no one got paid to give Scott an opinion.
(Perhaps a Sermo-ite can explain how it works in the comments?)

Meanwhile, let’s not forget that lots of doctors take money for all
kinds of opinion-delivering to non-patients—from appearing as expert
witnesses, to being paid to take part in surveys and focus groups. And
let’s not even discuss what certain doctors do for money from medical device companies, which goes back to my remarks about the relative ethics of MDs and hookers.

My suspicion is that Sermo will probably be cutting off the pay for
opinion concept now that they’re at critical mass, as it would stop
Scott and others being suspicious. We’ll see, but I suspect that money
as a motivation for MDs answering questions ranks below, say, showing
off! (This is the same principle as why consultants blog for no pay!)

The second part of Scott’s complaint is rather more valid. Although
he got lots of answers to his clinical question, the vast majority
weren’t very helpful. Fully half were “don’t knows”. Now given the rare
condition he had that’s what he probably would have got if he’d asked
the same thing in the doctors’ lounge, but it may not be too helpful to
hear it online. It’s possible that the way Sermo is set up makes it too
easier to offer “no opinion”. But obviously what Sermo and everyone
else in the wider social networking space is driving at is getting to
more useful answers. If they don’t eventually get whatever’s needed in
terms of critical mass of knowledge to answer these questions then
either they have the wrong people signed up, or those questions are not
answerable.  In either case that’s not a great answer, and I’m damn
sure that the Sermo folks are very keen to do better.  But for me, how
they tackle that is the critical issue.

Otherwise people like Scott will go get other opinions, which—as he
notes—he’ll have to pay for. And of course they might not be correct,

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