Osteopathy 2.0: Osteopathy and the new web

Article Outline

• Web 2.0
  • Medicine 2.0
• Osteopathy 2.0|osteopathic medicine 2.0
• Summary
• References
• Copyright

Using numerals with decimal points to identify a ‘version’ of software is a standard practice we're all familiar with. So, what does it mean if we apply a similar system of labelling to Osteopathy? What does the phrase ‘Osteopathy 2.0’ imply? Osteopathy 2.0 doesn't mean that osteopaths use different techniques or think differently about the body; it doesn't mean that patients will receive a different type of osteopathic health care. Instead, it refers to the way in which our profession has been, and continues to be, affected by Web 2.0, the ‘new’ version of the internet that is characterised by user interactivity, information sharing and collaboration, rather than simply the passive viewing of information online. In order to understand Osteopathy 2.0, it is therefore necessary to understand more about Web 2.0.

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Web 2.0 

Web 2.0 can be understood by asking the question, “what was Web 1.0”? Web 1.0 was the first ‘version’ of the internet. Companies and businesses created websites that were essentially online ‘brochures’; static pages of text and pictures that rarely changed and did not allow any form of interactivity or two-way communication between the site owner and the site visitor. For example, an osteopath may have created a website that had a home page with information about their practice, another page with information about the practitioner, and another page about typical treatment and what to expect, and perhaps a final page about consultation times and contact details.

Web 1.0 was similar to television in terms of the direction of information flow, from ‘authority’ to ‘end-user’. The website owners determined the content and served it to the search hungry public. Just like a TV show, a news report or a magazine advertisement, Web 1.0 sites worked with a ‘top-down’ information dissemination approach with the information only flowing in one direction. This, however, was bound to change as the internet matured and provided increasing opportunities for networking and information sharing between the ‘end-users’.

Information has never been more available than it is today and has become abundant. This abundance of information combined with constantly increasing communication opportunities provided by the internet have given individual users far more influence and has reduced the control of information flow by traditional authorities such as corporations, associations and media outlets. The organizations that used to control information have largely lost this privilege and Web 2.0 has given it to ‘the people’.

As technology and software developed over the last decade in conjunction with an exponential rise in the number of Internet users, Web 2.0 became the dominant movement online. Examples of these types of activities can be found on familiar sites such as Facebook, Twitter, YouTube and Amazon – to mention a few.

Facebook is highly representative of Web 2.0 as it is not a website full of static information provided to web surfers. Instead, Facebook provides a platform on which users can provide their own content. In addition, the site allows other users to comment upon and also share this information with their ‘friends’, or other people with whom they are networked with online. In addition, the software language used to create Facebook is available to users and software developers so that they can create ‘plugins’, additional pieces of software that increases the functionality of Facebook. The key point here is that Facebook provided the platform, but the users made it what it is today. The users add the content. The users use the content and share the content with their networks. The users create additional software that is active within Facebook, and which also increases the functionality of the site. All of this creates a social network of people that is not constrained by geographic location, and information can spread throughout this network very quickly.

Other examples of Web 2.0 include the hundreds of thousands of blogs, forums and discussion boards, wikis, RSS and other social networking technologies. In addition to these, however, Web 2.0 also refers to the delivery of the internet to different hardware devices such as smart phones, gaming systems, cars and even your refrigerator! The Web has ceased to be restricted to an information source on a computer and has instead become a communication system for users that is delivered wirelessly to a variety of internet enabled devices.

Medicine 2.0 

With the introduction of the term Web 2.0 as a general descriptor, individual variations related to specific industries, disciplines or concepts have been adopted, such as Science 2.0, Education 2.0, Library 2.0, Health 2.0 and Medicine 2.0. In September this year, I attended the 2nd World Congress on Medicine 2.0 in Toronto, Canada and saw first hand the rapid development of medicine in this area. Eyesenbach describes Medicine 2.0 as being “web-based services that provide social networking, participation, collaboration, and openness within and between health care consumers, caregivers, patients, health professionals, and biomedical researchers”.¹

Medicine 2.0 represents an increase in the focus on the patient in health care, and incorporates the idea of ‘participatory medicine’. Just as there are differences between Web 1.0 and Web 2.0, there are differences in the practice of medicine before Web 2.0 and after Web 2.0. These differences are summarised in Table 1.

Table 1. Comparison of Medicine 1.0 and Medicine 2.0 (adapted from Eysenbach¹)

How do these Medicine 2.0 attributes affect an everyday consultation with a health professional? First, it is becoming more common for patients to be informed about their condition, and they may have information that the practitioner is not aware of or familiar with. Not only do patients have access to powerful search engines, but they also have access to authoritative websites that provide verified or authenticated health care information. They also have access to online communities, discussion forums and the blogs of other ‘patients’, all of which can provide detailed and up-to-date knowledge. Patients increasingly want to be active participants in their care, and rather than relying solely on the advice of their practitioner, they will draw on other sources of information. These changes are consistent with the basic structure of evidence based medicine that has always included ‘consultation with the patient’ as part of it's three basic tenets (the others being practitioner experience and the best available external evidence).²

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Osteopathy 2.0|osteopathic medicine 2.0 

So, what does all this mean for osteopathy? In order to understand this question I started by asking questions such as, what is the profile of osteopathy and osteopathic medicine on Google? What about Wikipedia? Both Google and Wikipedia are among the most highly trafficked sites on the internet and Wikipedia often ranks number one in Google for search terms like Osteopathy. It is interesting to consider who controls what is written about osteopathy on Wikipedia. It is not the traditional authoritative organizations that govern osteopathy, but the people who contribute to Wikipedia (‘Wikipedians’) – and, most importantly, contribution is open to anyone who has an internet connection.

The definition of osteopathy on sites such as Wikipedia is therefore determined by the ‘crowd’ and not by an individual or organization. The definition is dynamic as it can be updated second by second. It is interesting to know how the ‘crowd’ defines our profession on Wikipedia because when people search for information about osteopathy and find a Wikipedia definition, they are likely to read it, especially if it appears at the top of the search engine results.

At the time of writing, there are just over 1.5 million pages indexed in Google for the exact search term ‘osteopathy’. For the search term ‘osteopathy blogs’ there are about 83,000 pages indexed. What is on all these pages? Who has written them? Is the information high quality, accurate and positive or is it poor quality, inaccurate or negative? It is important to ask who is finding these pages and reading them?

The total number of monthly searches performed in Google for the term ‘osteopathy’ is approximately135,000, with 90,500 for the term “Osteopathic Medicine”. How does this data compare to other professional groups who utilise manual therapy? By comparison there are 1.8 million monthly searches for the term ‘chiropractic’ and 673,000 monthly searches for the term ‘physical therapist’, with 165,000 for the term ‘physiotherapist’.

It's clear from these data that people are searching online for information about osteopathy, chiropractic and physiotherapy. Who these searchers are and exactly what they are searching for is part of the broader Osteopathy 2.0 question. There is a conversation happening on the web about osteopathy, the question is whether we as a profession are participants in that conversation?

Osteopathy 2.0 is more than just getting the internet installed at the office and using smart phones to remotely manage your appointment book. The technology and infrastructure are available to affect osteopathic education, professional interaction, patient-to-practitioner interaction and patient-to-patient interaction.

The question to ask is “How are Web 2.0 technologies being used to increase the participation and openness within and between osteopaths, patients, educators, researchers, regulators, and those in other health care disciplines? As the internet grows, Osteopathy has to ‘be there’ and our presence online has to increase – not by simply putting up more online brochures but by engaging in the conversations that are relevant to our profession. Osteopathy 2.0 is therefore about developing and maintaining relationships between people with an interest in osteopathy. The technology simply enables the conversation. By doing this, I predict that our relevance will increase. What do you think will happen if we don't?

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Summary 

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References 

1. Eysenbach G. Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. J Med Internet Res. 2008;10:e22
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2. Straus SE, Richardson WS, Paul Glasziou, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. 3rd Edition. Edinburgh: Churchill Livingstone; 2005;
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