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Examining Anonymity In The Healthcare Blogosphere & A Conversation With “Gadfly”
Earlier this week, I had the pleasure of speaking at the first Healthcare Blogging Summit, which was held on December 11 in Washington, DC.  During the conference, I presented some of the key results of a global online survey of healthcare bloggers.  After reading some commentary about the poll on various blogs and speaking with people at the conference, I learned that many were surprised that so many of the  respondents (about 40%) hide their identity.  For example, Paul Walker, who writes The Zone Read, had this to say:

“One challenge with influencing healthcare bloggers in particular is this: Almost 40 percent blog anonymously. . . Directly correlated, in my personal opinion, is another  . . . finding: The majority of bloggers have a low to medium level of trust in their peer healthcare bloggers. They do seem to trust that their peer bloggers will encourage active and unbiased conversations on their blogs (begs the question: if you don’t know who they are how do you know they are unbiased?).”

Clearly, Walker thinks there is a correlation between blogging anonymously and readers’ ability to gauge the reliability of a blogger’s statements.  Clearly, it’s a lot harder when the person is hiding behind a pseudonym.  However, anonymity is highly valued by a number of healthcare bloggers, as it provides them with a way to freely comment on issues that are controversial.

Blogger Relations & Anonymous Bloggers

Anonymity does not only affect bloggers, it has a tremendous impact on established interests who are seeking to enter the blogosphere or work with bloggers to communicate their messages.  Take Kaiser Permanente as an example.  In recent months, it has been rocked by one scandal after another.  The most recent controversy surrounds Kaiser’s implementation of HealthConnect, an electronic health records management system.  A Kaiser employee, Justen Deal, had serious concerns about HealthConnect project and expressed them in an e-mail that was sent to thousands of Kaiser employees.

Kaiser’s many opponents in the blogosphere, quickly latched onto the story and used it to support their assertions that Kaiser is mismanaged and places profits over patients.  One of these bloggers is someone who goes under the pseudonym, “Gadfly.”  She has been battling Kaiser for the past few years and has advised lawyers, journalists and others examining the company.  

Some of my contacts have informed me that Kaiser is very interested in working with bloggers and may even deploy its own public facing blog in the future.  As a result, they are very interested in working with bloggers to communicate their position on the Deal e-mail and other issues.  One of the bloggers  Kaiser has a relationship with is Matthew Holt, who writes the well-regarded Weblog, The Health Care Blog.  Holt regularly writes about Kaiser and in some cases, his comments have been has been less than complimentary.

Earlier this month, the Healthcare Information and Management Systems Society (HIMSS) announced that it was holding an educational session to discuss issues relating to the deployment of “patient-facing information over the Internet.”  Gadfly belittled the event as a “PR-blaster” for Kaiser (a representative of the company attended the event) and called Holt a “tame blogger.”  Others commenting on her blog piled on, accusing Holt of “pandering” for Kaiser and calling him a “pimp and a hooker.” 

Therein lies the rub of “blogger relations.”  Organized interests are interested in engaging bloggers, but are more likely to contact those they feel are approachable.  Holt clearly fits into this category.  However, Kaiser is less willing to work with anonymous bloggers and frankly would like some of them to just go away.

The hostility toward anonymous bloggers apparently extends into the blogosphere.  Some have complained that “established” healthcare bloggers ignore or discredit those who criticize established interests anoynmously. In addition, others have suggested that organizers of events like the Healthcare Blogging Summit are less than willing to involve anonymous bloggers or have critics attend. 

For example, Gadfly left several comments on this blog and Envisioning 2.0 saying that “the speakers at the conference are mainly people trying to cash in on the [healthcare] industry.”  She also said that “it seems like you favor PR people, doctors and lawyers, and people high profile enough to run their own conferences.  I'm willing to bet your Summit was white as snow as well: not because [you’re] racists, but because you are promoting the people who look ‘successful’ to you.”

After reading her comments, I contacted Gadfly offline and let her know that panel members and attendees were very racially and ethnically diverse and that the blogger survey was open to all – whether they were foes or friends of established interests. 

Should Anonymous Bloggers Be Shunned Or Accepted? 

Clearly, many questions have to be answered about how organizations wishing to engage bloggers should work with those who choose to remain anonymous.  In addition, bloggers seem to be very skeptical of those who hide their identity because they feel they lack credibility.  However, because anonymity is prized in the blogosphere, we will have to come to terms with it.  One way forward might be to speak with anonymous bloggers, especially those who are foes of established interests, to find out their take on the pros and cons of anonymity.  To help with this process, I decided to speak with one of my critics Gadfly about this issue.  Her commentary (which has been edited for space and style) appears below.

A Conversation With Gadfly About Anonymity & The Evolution Of The Healthcare Blogosphere

Q1: The healthcare blogosphere is populated by people who are blogging for many different reasons.  Some are doing it to promote themselves, while others are advocating for a cause.  Do you feel that these two different types of bloggers can co-exist?

A1: I think advocacy bloggers will eventually [be] squeezed out because blogs with business sponsorship/approval will be able to manipulate social media to get the lion's share of visibility, and these visible blogs will have a vested interest in not linking to or otherwise recognizing blogs that their sponsors or potential clients don't approve of. The blogs that have this visibility also seem to have very little compunction about taking over a story from smaller blogs without acknowledging, much less supporting, the source.

Q2: What are the pros and cons of blogging anonymously?  Does an anonymous blogger have a higher or lower "credibility" hurdle to  overcome?  What are your suggestions for how they can this? Should they even try?

A2: Anonymous bloggers do have a problem with credibility, and this is particularly unfair for whistleblowers given the widespread appreciation of the difficulties they face. When a credible blogger insists that a whistleblower break their anonymity as the price for credibility instead of supporting the principle of anonymity (perhaps being satisfied with documented proof), what they do is set up another human being for vicious retaliation and public savaging. Believe me, the self-righteous blogger wouldn't want to have to go through the same thing if the situation was reversed.

The desire to protect anonymity is in itself a means for corporate retaliation. My own case shows that all a corporation has to do is gain your name from the government agency where you filed a whistleblower complaint and file a legal action against you for whatever spurious cause. Your name will then become part of the public record, reporters may swarm if the legal action draws on a public scare tactic, and your name will be all over Google forever.  Oh, and consultants will try to cash in by inserting your name into their presentations on blogging, security, etc. Which can then be posted on university Web sites. There's no end to it.

I think the principle of anonymity needs to be aggressively defended. In this age of scare-mongering, it's easy to make little exceptions in the name of public safety. But, those exceptions become precedents, and eventually anyone advocating for a cause against the establishment will be at risk.

Q3: As other areas of the blogosphere have expanded, people have complained that certain bloggers are being acknowledged while others have been left to toil in obscurity.  What can healthcare bloggers do to mitigate this or do you feel this trend is inevitable?

A3: I've just started to complain about toiling in obscurity. For the last three years I've just tried to be friendly, I've offered tips, and I've "understood" when bloggers seeking to establish a professional reputation gave me short shrift. At this point, though, I think I've put in my time. I blog regularly, I have absolutely no financial sponsorship or career interest (in fact my blog more or less makes me unemployable), and I've helped a lot of people behind the scenes. Also, if people read my blog instead of applying stereotypes, they will discover most of the implicit rules of professionalism - good spelling and grammar, reference to sources, and readable style. I don't cuss people out - after three years I'm just getting to the point where I can call something "stupid" without cringing at the audacity of the judgment.

At this time many bloggers are struggling to support themselves and gain the respect of others. It's sad that this seems to be a competition (re: limited blogroll space and attention-share), and it's sadder that some of the higher profile bloggers have started to assert that [anonymous bloggeers’] links are really not that important and/or quality will somehow rise to the top. The rise of social media as part of the PR profession means that the blogosphere is headed toward pay to play. The only way to offset this is for established bloggers to go the extra mile to support those who are outside the business-interest circle. The future shape of the blogosphere will depend on their decision and ethical backbone in this regard.

Editor’s Note: Your comments on this topic are, as always, welcome. 

10 Comments/Trackbacks

Thank you for taking the time to think about the whistleblowers perspective, and congratulations for managing to winnow all my issues down to a single blog post. :-)

Well, it's a free country, and people are certainly entitled to blog anonymously.

I'm also free NOT to read anonymous blogs.

I looked at my list of RSS feeds and there's not a single anonymous blog. Frankly I had never given the issue any thought.

Now that I've thought about it, though, I can easily rationalize my choices. I'm not against anonymous blogging in principle, but my time is scarce and I need to know how to digest and weigh information -- anonymity doesn't help me do this.

A person's identity doesn't influence the quality of argument or evidence provided. Anyone who needs to know *who* is behind the opinion is stating their propensity for prejudice and cronyism.

China is now forcing bloggers to identify themselves because they know that people are less likely to post unapproved statements if they have all the guns of the state aimed at their head. Think this isn't a problem because we live in the U.S. in the land of the free? Try getting a job after you're ID as a troublemaker is PERMANENTLY branded on Google.

Most faux-objective rhetoric that attempts to put people in the crosshairs as the "price" for credibility comes from people with a vested interest in punishing critics - corporate minions, hired PR guns, parasitical consultants, etc. I hope most people who read the comment above realize that.

By attempting to preserve her anonymity, the blogger behind CorpHQ is taking one of the few steps she can take to promote a discussion of the issues, rather than promote herself or open herself up to personal attacks from those who would rather see her and her blog silenced. You can obviously find the same attempt to protect anonymity elsewhere in the blogosphere.

While I have a great amount of respect for bloggers, including Matthew Holt, who somewhat bravely open themselves up to personal criticism when they discuss serious concerns regarding large organizations and corporations, anonymity does not diminish my respect or appreciation for bloggers, like Gadfly, who attempt to protect their own identities.

justen deal

For some of us, blogging at the very least semi-anonymously isn't so much of a choice as it is a necessity. I want my readers to have as much information about my biases and baggage as I can, but I also don't want to invite former clients/patients to my front door. It's a fine line and I struggle with where exactly I should end up.

I no longer see clients regularly and eventually, it won't be as big an issue for me. But having just come out of forensic work in a state hospital, partial anonymity truly is a requirement for me to be able to blog at all.

For me, I provide my name and degree, but choose to not display my location or exact employer. I do describe my working environment in my profile and my background. This allows me to continue blogging while providing at least a veil of protection.

If a former client wants to find me, they will. I can't stop them. But I don't have to make it quite as easy.

Well, this makes the comment that Gladfly left on my blog slightly more clear...but only slightly. Why the attack...and specifically what and whom is being attacked?

"I have to say I'm rather disappointed that BlogHer is supporting PR/branding blogs, while doing very little to support the unpaid and unsung little-engine-that-could blogs like mine. Well, I guess that's the sort of thing that gets you invited to Blogger Wonks."

Fard, As your willingness to interview Gladfly demonstrates, perhaps a little "seek first to understand and then be understood" might serve her cause better than accuse first, ask later.

Of course the Blogger Wonk was open to anyone and I am glad I got a chance to meet you in person.



Great seeing you at the blogger wonk as well. I always feel that listen first, speak second is always the best policy.

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Marianne - my blog has been around for years. There has been plenty of time for people, as well as institutions such as BlogHer, to listen and help anonymous bloggers with the credibility problem. Sometimes a person has to start speaking a bit louder to be heard.

It seems a few people have heard me now, which sadly confirms that the blogosphere can be like the workplace: those who don't make waves are just ignored, and those who do make waves are slapped around for making waves. :-/

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