Harvard warming up to the Web. Long pursued by dot-coms, medical school responding
BY LIZ KOWALCZYK
Boston Globe
If there was ever a sign that the Internet has gone establishment, this may be it.
After keeping a cautious distance from Web-based ventures for years, Harvard Medical School is negotiating with an undisclosed company to offer its 180 continuing education courses for doctors online within a year.
While Harvard's continuing medical education program is the largest in the world -- 40,000 doctors and other health care professionals travel to the classes each year -- the university is starting to acknowledge the potential threat from online competitors. And with the number of physicians at Harvard teaching hospitals moonlighting for health-care dot-coms, Harvard's legendary medical complex is warming up to the Web in other ways too.
Just two recent examples: Harvard-affiliate Beth Israel Deaconess Medical Center -- where last year doctors began writing for the consumer site, CBS HealthWatch -- will start recruiting residents for the after-hours job in July. The medical school is also finalizing an agreement to run Aetna US Healthcare's consumer site, InteliHealth.
Even though health-care sites have struggled to make money and even survive, companies are pursuing Harvard because they believe the name will bring credibility and eventually dollars. And Harvard is responding.
Changing mindset
``People have come 180 degrees on this subject,'' said Dr. David McDermott, a Beth Israel physician who helped launch one of the first Internet consulting programs at the hospital a year ago. ``The same people who were putting up roadblocks are now saying `Why didn't we do this sooner?' ''
Some medical schools like Johns Hopkins University in Baltimore -- which ran InteliHealth for five years -- and research hospitals like the Mayo Clinic in Minnesota have become household names through their Web sites and contracts with online companies. However, Harvard, ever the skeptical traditionalist, has kept its distance from the wired world.
Dr. Stephen Goldfinger, medical school dean for continuing education, said that the Harvard name alone has been so successful at attracting doctors and patients that there's been an unwillingness to risk the university's reputation by linking with dot-coms, many of which are laden with advertising.
But there's also a realization, especially as teaching hospitals struggle with record operating losses, that successful marketing increasingly requires an Internet presence. At Harvard, influential faculty like Dr. Anthony Komaroff, editor in chief of Harvard Health Publications, also have pushed to loosen attitudes -- and with the change has come new questions about the proper role for Harvard's esteemed doctors.
How much time should they devote to Internet ventures? Should the Harvard name appear alongside drug ads? Are they helping consumers hungry for medical information -- or just adding to the confusion?
Dr. Leon Eisenberg, 77, the Maude and Lillian Presley professor emeritus of social medicine, and an Internet skeptic answers: Very little; no; and adding to the confusion.
``We love to believe that the driving force is to educate the public or physicians,'' he said. ``But the driving force is to collect income as fast as possible. And the lure of the Internet is almost irresistible.''
But a growing number of Harvard doctors argue that such ventures help consumers and patients -- as long as they're structured carefully and physicians stick to providing general educational information and not personal advice.
The 5,500 medical school faculty members cannot spend more than 20 percent of their time working as outside consultants and a new policy under consideration would prevent all Harvard faculty from teaching for competing educational institutions -- actual or virtual -- without permission.
So far, the medical school is not aware of any doctors who've run afoul of the 20 percent rule, said spokesman Don Gibbons.
Harvard University associate provost Dennis Thompson said that the new policy means doctors will need permission before they can teach online.
But Thompson said it's unclear whether physicians will be allowed free rein to consult for online second opinion and consumer education sites. And as Harvard takes over the Aetna site, competing with physicians' other consumer-directed ventures, that could become a thorny issue.
Komaroff, one of the faculty members who is overseeing the Aetna project, would not discuss the details.
Watching their language
Dr. Thomas Delbanco, chief of the division of general medicine and primary care at Beth Israel Deaconess in Boston, said that 15 to 20 doctors who moonlight for CBS HealthWatch try to answer more than 5,000 questions from consumers annually and review more than 3,000 educational pieces.
``We've been churning out more and more work,'' he said. ``But there's a difference between practicing medicine over the Internet and providing education. So we're very careful and we use very carefully crafted language. And we clearly say that we don't endorse any drugs or products that Medscape (the CBS HealthWatch sponsor) is trying to sell.''
Medscape is not allowed to say it is working with Harvard Medical School. But Delbanco can -- and does -- list his title on the site: professor of medicine, Harvard Medical School.
Delbanco said he has no equity in the company, but he would not say how much doctors are paid for their consulting time -- although if other online health sites are an indication, doctors should not quit their day jobs.
Onhealth.com pays Beth Israel Deaconess $100,000 a year for the content that the hospital's doctors provide, but the physicians receive just 10 percent of that -- which works out to about $100 per 500- to 1,000-word article.
``Many answers are reassurances or just advice to go see your doctor,'' McDermott said.
Partners HealthCare Telemedicine, which uses Harvard doctors to provide second opinions to doctors around the world, pays doctors $200 to $250 for an opinion, which the program director said is significantly better than most Web sites. Four-hundred doctors provide 600 second opinions a year.
``Income is a small factor but for most people it's not going to amount to a major amount of money,'' said Dr. Lowell Schnipper at Beth Israel, who recently turned down a consulting offer from Oncology.com because he works for a competing CD-ROM venture, Oncologyuptodate. ``The biggest reason is visibility. Harvard sometimes can be very conservative and maybe we're a little late on the draw. But there is now a desire to raise the flag if it's done in a responsible way.'' |
