When Doctors Talk …

But there are other questions as yet unanswered: is Sermo obligated to notify regulators if a doctor says she's using yak's milk to treat cancer or nine times the approved dose of a drug? What if comments are pertinent to a malpractice case? Both Sermo and WebMD say they zealously protect physician anonymity from all third parties. Ultimately Caplan withheld his endorsement. "It's a new arena of ethics for sure. It made me nervous enough that we backed away," he says. "I'm not going to yell about you," Caplan diplomatically assured the company. Meanwhile, Palestrant acknowledges that after the initial overture, Sermo never did call on Caplan's services: "After a year or two we've mostly allowed that relationship to lapse ... so I wouldn't call it an active relationship at this point."

These networks may be funded by today's industry players, but they don't necessarily support the status quo. Last January a Brooklyn, N.Y., internist named Sean Khozin began a post declaring, "It's now clear to most people that the current healthcare system is unsustainable." His message spawned a work group of over 1,000 physicians who collectively wrote a letter to the American people, which they later posted publicly, explaining how the insurance industry and defensive medicine assaults their autonomy, endangering patient health and crippling the country with unnecessary expenses. Khozin says we can simply follow the money to find health-care waste, citing Princeton economist Uwe Reinhardt's calculation that physicians take home less than 10 percent of health-care dollars. Two months ago that initial online work group became a registered nonprofit called Doctors Unite.

According to Khozin, the online grass-roots collaboration that spawned Doctors Unite is the first example of "a new channel of communication that represents the collective voice of physicians." Khozin believes the American Medical Association has become too entangled with tangential interests. (The AMA doesn't have its own social network, but it does work with Sermo.) "The focus has to be on the patient and their engagement with their health-care provider because that's where it all happens really. The focus has been totally diluted."

As president of Doctors Unite, Khozin now has the ear of White House health-policy advisers, having initiated talks with both sides during the campaign. No word on whether he'll loan them his Sermo account. Otherwise, they'd be well advised to inquire about a government discount. There may be no better way to understand health care today than listening to the frank online exchanges already happening between thousands of men and women on the front lines.

Ford Vox is a resident physician at Washington University in St. Louis. He signed Sermo's "Open Letter from America's Physicians" last year.

© 2009