"It is easier to do a job right than to explain why you didn't"
- Martin Van Buren (1782-1862), 8th US President

The "10 Questions" is a good start for building credibility and trust in medical blogs, but are they enough? Rita Schwab could tell us a lot about ethics and certification. These subjects tend to be quite complex and subtle. Credentialing is there for a reason.

Does health and medical blogging pose unique challenges that have not been faced before in other settings?

Dr.O suggests to look into HONcode. John Mack notes eHealth Code of Ethics. Ves Dimov specifically emphasizes HIPAA. These are good standards. But do they really cover every potential pitfall unique to blogging and online communities with broad user participation?

I really doubt it. Older standards have been designed to deal with static websites, run by editorial staffs of large organizations. Now any individual can become an instant publisher with global reach. The tools we take for granted today did not exist a few years ago.

Now technology is ahead of policy. Consider Wikipedia:

An anonymous entry created by a prankster, who in the end was forced out of his job, linked John Seigenthaler Sr., the former publisher of the Tennessean newspaper and founding editorial director of USA Today to Kennedy assassinations. To quote CNN:

"The entry motivated Seigenthaler to write an op-ed piece for USA Today blasting Wikipedia's credibility. He described himself as a close friend of Robert Kennedy and said he had worked with President Kennedy. He said "the most painful thing was to have them suggest that I was suspected of their assassination [ ... ] Wikipedia is inviting it by its allowing irresponsible vandals to write anything they want about anybody."

Do we want to risk our collective credibility by waiting for a scandal to erupt out of a medical blog? Or do we want to act now and stake out the higher ground?

Of particular concern is translating general priniciples of existing standards into the specific terminology and realities of blogosphere. In some cases, the older guidelines should be updated to account for greater openness of the media. Consider these questions / examples:

• Anonymity: Is it always "bad" or under certain circumstances could be justified? Consider the value of whistleblowers.
• Opinion vs. fact: Blogs are prized for passion and "unvarnished" view. Where to draw the line against bias and malicious intent?
• Etiquette: When is our use of links, pings, trackbacks, blogrolls is appropriate and when is it spammy and promotional?
• Openness: Can we trust a blog that censors comments or restricts honest debate to push an agenda? When are restrictions OK?
• Disclosure level: Should we answer the "10 Questions" once or put disclaimers in every blog? Per post? Per author?
• Organizations: What if an individual blogs as employee? Contractor? What about multi-contributor blogs?
• ETC, ETC, ETC...

Perhaps we should define a list of blog categories, ratings or types and the criteria for "qualitying and certifying" a blog to a niche? This does not have to be onerous, but be a set of guidelines to describe our blogs, declare where we fit in and help readers make their trust decisions on a detailed level. Compare to board certifications. MPAA ratings. Hotel stars.

Let's get creative. Credibility of what we do is at stake!

Maybe we should even set up an informal workgroup to develop, review and maintain our professional health blogger standards? Or do we think the general public trusts us already so we can rest on our laurels?

Please comment and forward this post. We will compile our collective wisdom into a clear action plan.