Richard Smith: Get with Web 2.0 or become yesterday’s person

Richard Smith Web 2.0—the social web—has the potential to improve global health greatly and to solve complex problems in health science—as it has already done in particle physics. I heard this message at a conference on global health in Geneva last week, but I also heard that the barriers to these potential achievements are social and cultural, not technological. The machines we can fix. It’s the people—particularly old timers (that’s anybody over 40, I’m 56)—that are the problem.

I suspect that most readers of the BMJ couldn’t tell you much about Web 2.0—despite the journal having had several editorials on the subject. The essence of Web 2.0 is that it’s bottom up and participative: it’s created by the many not the few.

Most websites are firmly Web 1.0—a few wise guys attempting to inform the many. has its Web 2.0 components (blogs and rapid responses), but mostly it’s potentates pushing stuff that they try and pass off as wisdom.

Web 2.0 can also be understood by listing its components—RSS feeds, blogs, wikis, podcasts, social networking sites, mash up technology, etc—but the only way to really understand Web 2.0, as to understand anything, is to jump in and start using it.

As an evangelist for Web 2.0 attracted to it by its anarchic, democratising, iconoclastic potential, I urge friends to start using Facebook. Most are reluctant. “My identity will be stolen.” “I don’t want to waste time.” “My children will be horrified.” “I don’t want my life to be exposed: it’ll be like being on Big Brother.”

My friends can chose to stay living in the old world, but I think that they are making a big mistake—because the appearance of Web 2.0 seems to me a crucial step in entering the information age, more crucial even than the invention of the world wide web.

The invention of the web was an essential technical development, but it’s the social and cultural change that will have far more impact.

Ten years ago we used to compare the early days of the web with the early days of film—when directors used one camera fixed on actors on a stage: it was theatre filmed.

Later came outside locations, cutaways, rapid scene switches, stuntmen, car chases, animation, and all the techniques we take for granted.

We couldn’t see ten years ago how the web would move by analogy from filmed theatre to films, but now we are beginning to see. We also begin to see how Web 2.0 can help solve the really big problems—like the gross inequalities in the world between rich and poor.

At the conference in Geneva we heard about the Peoples’ Uni , which aims to provide free education for health workers in the poor world.

Many cannot afford the fees of the distance learning courses of Northern universities, and so a group from Edinburgh has started free learning based on using open access material.

The amount of such material is increasing rapidly, but its educational value is increased by adding teaching and assessment based on the material.

That’s what the People’s University is doing. The university is still a bit Web 1.0, confessed Richard Heller, co-ordinator of Peoples’ Uni. It’ll be more Web 2.0 when the students set the curriculum and do the assessment. That will come.

Particle physicists have been among the first to grasp the potential of Web 2.0 to solve previously insoluble scientific problems by linking computers around the world in the Atlas project. E-science is not about technology but about global interaction: it’s a social not a technological development. Biologists are using Web 2.0 capabilities to unravel the human genome, but we’ve been slower in health to exploit the possibilities.

And our tardiness is social. The Global Fund for responding to AIDS, TB, and malaria has tried to use Web 2.0 through My global fund at work, but the response has been slow.

The reasons, said the manager of the project, are generational, educational, cultural, linguistic, and psychological.

Many health workers come from very respectful cultures where the young do not criticize the old. For many people it’s a huge and terrifying step to press a button and potentially allow the whole world to read your words.

Doctors, I fear, are too fond of a top down world—because they are usually at the top. But that top down world is crumbling. Think of Nicolae Ceauşescu’s statue being hauled down and smashed. That’s the old world of Web 1.0. Get with Web 2.0 in a serious way or become a yesterday’s person.

Richard Smith is director of the Ovations Chronic Disease Initiative, editor of Cases Journal, and a member of the board of the Public Library of Science. In the past he’s been the editor of the BMJ, chief executive of the BMJ Publishing Group and UnitedHealth Europe, a doctor of sorts, and a television doctor. He loves making soup, trouble, and marmalade.

Competing interest: Richard Smith is the editor of Cases Journal, which has claims to be a Web 2.0 journal. He’s also a Facebook fanatic.