For hundreds of years, the doctor/patient relationship has been asymmetric, with the physician traditionally seen as holding the balance of power and the patient being dependent on the physician. While there are many reasons for this, one of the most important is the asymmetry of knowledge: The physician controlled almost all information and often parsed it out sparingly. Over the past 30 years, beginning with the first direct-to-consumer advertising in 1981, we have witnessed a dramatic shift in the information available to patients. And this shift has contributed to a noticeable increase in patient autonomy and choice in medical care. However, the revolution has just begun, brought to you by the Internet and Health 2.0.

Health 2.0 is an outgrowth of the Web 2.0 era. Using modern, flexible Web site design methods, Web 2.0 Web sites typically leverage social networking and the collective knowledge of the masses to create value and quality for users of the Web site. Two good examples of Web 2.0 are Facebook and Wikipedia. Health 2.0 Web sites apply these same principles and designs to health care.

Paul Bleicher

The most common use of the Internet for health purposes is the search for health information. Since the Internet first became publicly available, patients have been using the Web to gather information about their health. But the content was often uneven and easily dismissed when brought to physicians and sometimes simply dangerous. Although Google Health and its cousin Microsoft Health Vault offer an improved search of high-quality health Web sites, independent Health 2.0 Web sites such as OrganizedWisdom have begun to deliver high-quality information about patient illnesses and treatments.

OrganizedWisdom uses physician "guides" to vet search information as high quality and organize it in an easily digestible form for individuals seeking answers to health care questions. Armed with data from these sources, patients sometimes know more about therapies and clinical trials than their physicians, and are now taking on new roles in driving the doctor/patient dialogue.

Beyond information, some of the latest Health 2.0 Web sites actually allow patients to disintermediate the physician in many cases, much as Amazon eliminates the bookstore middle man and Dell the computer store. Through online Web sites, patients are now able to comparison shop for medical care in some markets (Carol) and buy care packages in the same way they might buy a book from Amazon. Additionally, dozens of Web sites allow consumers to rate their physicians, such as Vitals and rateMDs, and many have links to make appointments (ZocDoc) or search for disciplinary actions and malpractice claims against a physician. These sites allow patients to make more informed choices about their care and share with others their experiences.

Communities of patients

Social networks and communities are the bedrock of Health 2.0 and continue on the theme of shared information empowering personal health decisions. The most ambitious of these is Revolution Health, which provides health information, physician searches, health blogs and information, and many different health communities. Other similar communities such as iMedix follow the same concept of a general community for all health and wellness issues.

Many Health 2.0 communities specialize in a particular disease or small group of diseases, creating a Facebook-like user experience. Targeted communities have sprung up on Web pages devoted to diseases such as diabetes, mood disorders, and alcohol abuse and to wellness topics like exercise. Through these sites, patients are sharing their experiences, motivating commitment to treatment, and providing a support community for each other.