TECHNOLOGYControlling content: Physicians launch health Web sitesThere are thousands of health sites, but some physicians believe there's still not the right information available to patients. So even as other sites suffer financial trouble, they're spending time and money to build their own.By Tyler Chin, amednews staff. May 28, 2001. Joel Rutstein, MD, a San Antonio rheumatologist, has cut his practice by a third and invested $200,000 to launch a consumer site offering information about arthritis. What's more, he plans to spend double that amount over the next two years to give the site a chance to succeed, even though a massive amount of health information -- and thousands of arthritis sites -- are available on the Internet and well-capitalized health sites are struggling to survive. By producing and posting their own content online, Dr. Rutstein and other physicians are putting their credibility on the line against well-regarded sites, such as those offered by the Mayo Clinic, the National Institutes of Health and the Centers for Disease Control and Prevention, which can draw on far greater resources than individual physicians. Even access to capital is no guarantee of success. Well-capitalized sites such as those owned by WebMD Corp. and Medscape Inc. are struggling despite spending millions of dollars to establish brand recognition and credibility. Drkoop.com, which was supposed to ride the credibility of former U.S. Surgeon General C. Everett Koop, MD, is barely hanging on. Education key objectiveBut physicians who have developed information-based sites say their main motivation is to educate patients, not make money. Patient education is a mission for Marisa Weiss, MD, a breast cancer oncologist in Wynnewood, Pa. "Many of my patients and women around the world seem to be overwhelmed by the vastness and complexity of the medical information they have to sort through in order to make decisions," said Dr. Weiss, who created a site to keep women up to date with the latest breast cancer research and treatment. "I'm a doctor first. If you see women suffer with breast cancer day in and day out and you care as much as I do, you have to find a creative and effective way to help reduce the devastation that this disease causes." Wellington S. Tichenor, MD, an allergist in New York, started his site because he wanted to educate patients about sinusitis. The condition is more commonly treated by otolaryngologists, who are surgeons, and he wanted to tell patients that allergists can help them, too. "Although both otolaryngologists and some allergists treat sinusitis, allergists will treat more of the medical aspects of sinusitis and surgeons will treat more of the surgical aspects," Dr. Tichenor said. "It is important, however, for most patients to have treatment by both types of physicians." On the right trackTo minimize potential liability, site operators stress that they provide general information, post disclaimers that the information is not a substitute for medical visits, and make it clear that they neither treat nor diagnose patients online. "As many doctors as there are, each has our own perspective," said Alan Greene, MD, a pediatrician in Danville, Calif., and one of the pioneers in the online content field. He started a pediatric site in 1995, sold it to adam.com in August 1999 when dot-coms were riding high and reacquired it in February 2001 after the dot-com bubble collapsed last year. "There is room for a lot of physicians to do this," Dr. Greene said. "People want to hear what their doctors think. The demand for megasites is not unlimited, but I think the demand for people wanting to hear from individual doctors is unlimited." George Lundberg, MD, editor in chief of Medscape.com and its consumer site, CBSHealthWatch.com, agreed that patients want to use the Internet to communicate and obtain health information from their physicians. But doctors would be better off taking advantage of offers from medical societies and other entities giving them free or low-cost basic sites that they can use to direct patients to sites they consider reliable, he said. If a physician wants to go beyond a basic site's offerings, then he or she "had better arm himself or herself with a knowledge base to [develop] competence as author, editor and publisher or the physician may end up looking silly and actually harming the patient and the patient-physician relationship by acting in an amateurish way," Dr. Lundberg said. "They probably are not qualified to do all those three things, so they better learn how or get help." Any physician thinking of offering his or her own content to patients should expect the effort to be time-consuming and costly, say doctors who have rolled out content sites. The bigger the scope of the site, the more time and money it will cost. For example, Dr. Rutstein's arthritis site provides comprehensive up-to-date information about developments in the rheumatology field as well as Internet-based video programs. He spends 25 to 60 hours a week on the site and expects to shell out $200,000 a year to operate it. Some of the content is free, but books, videos and premium content cost $19.95 a year, recently increased from $11.95. Dr. Rutstein would not say how many paying subscribers his site has, but "obviously I [have] lost a great deal of money at this point." He will keep the site going for a couple of years, then evaluate whether to continue it. Labor of loveDr. Rutstein hopes to break even and then build on top of that milestone. He would attain that goal if only 10,000 people pay the fee, which he purposely priced low to make the site a "no-brainer" option for the audience he's targeting. Dr. Rutstein is confident that goal is doable because tens of millions of people worldwide have arthritis and osteoporosis, he said. "Right now, it's a labor of love," he said. "You may look from the outside and say, 'This is crazy. Why take the risk?' But any project like this that is creative and unique, you don't know the answers until you do it and see how people respond." What makes his site different from other arthritis sites, Dr. Rutstein said, is that he takes scientific studies published in peer-reviewed journals or presented before the American College of Rheumatology and recouches them in lay terms, putting the information in context for patients. "I'm not saying that there aren't articles [on other sites] that are of benefit, but they are more for physicians' benefit. I can critically review them, but most patients don't have the scientific background to do that. But just because an author is a physician doesn't automatically mean the content is credible," Dr. Rutstein acknowledges. To ensure that the information he provides is objective and accurate, he spends a lot of time researching and writing. He also would correct posted material if a physician or someone else pointed out legitimate errors, though that hasn't happened yet, he said. "When I write a piece, I try to present the pros and cons so patients are aware of them," Dr. Rutstein said. "It's up to me to have personal integrity. Anyone who is writing and generating information that will be read by physicians and patients has an obligation to hold themselves to the highest standards possible. Anyone who doesn't do that in time will be discovered." Like Dr. Rutstein, Dr. Weiss spends an enormous amount of time overseeing, writing and editing articles for her breast cancer site. She launched the site in 1999 after concluding that she could offer patients something other sites could not. "We could not find another site that had the voice, the tone and the feeling we wanted to create," Dr. Weiss said. "Many sites in the public domain are dry and written for every audience from reporter to medical professional to consumer. We strongly believe that women have a strong resource to go to." Good intentions aside, the site, initially launched as a for-profit entity funded by unrestricted educational grants, has struggled financially. So far, it has cost about $1 million, some of which came out of her own pocket, said Dr. Weiss, who hasn't paid herself a cent for her work. She is now converting the site to a nonprofit entity to reflect how it really operates and to gain access to funding from foundations and individuals. But physician content sites don't have to be costly, time-consuming multimedia productions. They can be simple yet sophisticated efforts offering a wealth of useful information at a cost of a few hundred to a few thousand dollars. For example, Dr. Tichenor, the allergist, kept his costs low because he did the work, including coding the Web pages, himself. Minimum startup costs for a do-it-yourself site are about $500, including registering the site's name, using a service to register it with search engines and purchasing an HTML program. "If someone else does it for you, it is feasible to do it for $1,000 or so but to have a decent site probably means up to $5,000," Dr. Tichenor estimates. When he launched his site in 1996, he spent about five hours a week on it, he said. Now that there is a lot of health information online, he spends less than two hours on it, he said. ADDITIONAL INFORMATION:Master of your own contentSome tips for creating an informational site:
Sources: Alan Greene, MD; George D. Lundberg, MD; Joel Rutstein, MD; Patrick F. Sheehy, MD; Wellington S. Tichenor, MD; Marisa Weiss, MD Homegrown health siteshttp://www.breastcancer.org/Creator: Marisa Weiss, MD, 1999
http://www.arthritiscentral.com/Creator: Joel Rutstein, MD, 2000
http://www.sinuses.com/Creator: Wellington S. Tichenor, MD, 1996
Copyright 2001 American Medical Association. All rights reserved.
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