Bioethics Discussion Blog: Anonymity on the Blog: Bad, Good or of No Consequence?

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Monday, May 05, 2008

Anonymity on the Blog: Bad, Good or of No Consequence?

After over 500 threads and probably thousands of comments by visitors, it’s about time we discussed here the topic of writer anonymity and the ethics of anonymity of those who comment on this blog. I think that the significance of writing anonymously may be different between different websites. As an example, comparing a chat room with my blog. Should one consider the purpose of the website in this regard? Would the need for identity be more or less necessary while chatting in real time on various topics and attempting to develop some sort of friendship or relationship compared with discussing one established topic with a delayed response and no intent to personally relate? Should anonymity belong in either venue or in neither?

In a blog like mine, although most of the comments have been in one form or another from anonymous writers, do you think something important is missing in the discussion by the anonymity? What is the personal harm to the visitors to this blog by fully identifying themselves including their e-mail address? What is the benefit, if any, to this blog by such identification?

Somehow, I think that the fear of self-identification on a discussion blog such as mine is an unnecessary hindrance to full expression and that an unethical consequence of anonymity is that anonymity can lead in some visitors to the development of uncivil and ad hominem laden narrative or unsubstantiated or undocumented arguments. Though, as moderator, I have the power to prevent publishing such comments, nevertheless deleting a comment, though rare, is not a duty for which I look forward.

There has been discussion on the blogs in the past year and longer on this issue of anonymity and even about a formal blogger’s Code of Ethics.

What is your take on the issue of anonymity on the Internet in general but also on this Bioethics Discussion Blog. ..Maurice.

12 Comments:

At Monday, May 05, 2008 11:03:00 PM, Anonymous Anonymous said...

I think allowing anonymous comments means a blog gets more comments than it otherwise would, particularly in the case of a blog where healthcare is discussed--it allows people to speak up about things they might not want an employer to find with a simple internet search, for example.

Generally speaking people don't use anonymous remailers or servers when they are commenting on blog posts, e3ven if they choose to remain anonymous; this means that if the blog owner really wants to track them down, he or she could (as, potentially, could others). Whether most people know their comments are not totally anonymous or not (I do, and I am sticking with the veneer of anonymity) I don't know; however, I suspect that they don't, and that those who do generally don't care too much. The illusion of anonymity is enough for most people.

As to whether it is ethical to be online anonymously, I think that depends on intent; if you are anonymous to protect yourself or others, I don't see a problem with that. If you are anonymous so you can go and start a flame war somewhere, or (as in the case that spawned that code of ethics), however, then that is unethical.

--PG (which today, can stand for Pseudonymous Guest)

In the end I would be sad to see anonymous and pseudonymous bloggers and commenters shut down; we would lose many voices that are important and would otherwise remain unheard -- because they say critical things that are unpopular but need to be said, or because they tell personal stories that make a difference, or because they are marginalised and too scared to raise their own clear voice.

 
At Tuesday, May 06, 2008 3:33:00 AM, Anonymous Mike said...

I have had other blog owners discuss this very question with me on several occasions. I suspect there is a fear of personal recognition from some posters due to their employment position or perhaps because of their status in a specific industry.

Some may just want to stay anonymous so they don't have to worry about the content they post. As you mentioned sometimes this may lead to less than desirable content on the blog, but as a blog owner this is easily remedied.

At the end of the day I don't see how being anonymous or not plays a significant role in blogging, unless a blog is being attacked by malicious posters.

 
At Tuesday, May 06, 2008 4:24:00 AM, Blogger Christian Sinclair, MD said...

Great topic Maurice! I think there are really two issues here, anonymity on the part of the primary blogger versus anonymity of those who comment on the post.

The ethics of being a primary blogger and having anonymity seems like a thin protection, as many medical bloggers found out last year when a prominent 'anonymous' blogger was 'outed' during a trial. Being part of a non-anonymous team blog, we feel putting our names and our credentials allows for a immense amount of credibility for our thoughts and opinions. We can still bring up controversial areas (physician-assisted suicide, euthanasia, withholding artificial nutrition) without giving our own opinion the primary focus. I am finding myself less interested in reading anonymous medical blogs lately and I can't quite put my finger on why, but it just doesn't feel right. Although there are some very talented medical writers out there, I prefer the bloggers who are open.

As for commenters, their writing is important to a dynamic nature of a blog, but they usually have much less invested so I do not expect them to have the same standards or same risk/benefit to writing a comment, although I would hope they can maintain a civil tone, which is always hard when you are reading some one else's hastily written words.

 
At Tuesday, May 06, 2008 7:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Christian, I agree with you that the owner of a blog which intends to provide education, rational discussion and realistic direction to its visitors should not be anonymous since anonymity will, as you note do virtually nothing for protection and will only cloudy the appearance of the intent of the blog.

I would also agree with PG that denying anonymity would most likely result in less comment participation by visitors which could reduce the value of a blog whose goal is discussion.

And yet looking at the broader issue about anonymity is that it may truely represent a personal lack of responsibility. This lack of the responsibility of the individual is constantly being reflected today in politics, tort court cases, about the war in Iraq and the treatment of prisoners and in the "professions". Perhaps, despite any advantage to the benefit of a discussion blog, anonymity is simply further feeding a social ill as I have just described. ..Maurice.
(Maurice Bernstein, M.D.
Associate Clinical Professor of Medicine, Keck School of Medicine, University of Southern California. So now you know where to find me!)

 
At Tuesday, May 06, 2008 9:47:00 AM, Blogger Payne Hertz said...

Anonymity is critical to enabling people to discuss difficult, dangerous or controversial topics without fear of embarrassment or reprisal.While it has the drawbacks mentioned here of encouraging flames or poorly thought out or unsubstantiated arguments, to the extent it protects privacy it is a necessary evil. This is particularly true for medical blogs. Privacy has always been considered a critical component of the doctor patient relationship for fairly obvious reasons.If a doctor has an ethical duty to protect the privacy of his patients, then he should also be concerned about the privacy of patients who don't happen to be his direct responsibility, but need that protection every bit as much as his patients do.

I blog anonymously for a reason: fear of retaliation. I write about a very controversial subject: chronic pain patients and how they are treated by the medical profession, and often reveal a lot of my anger and outrage at what I consider to be criminal abuses of people with pain. One of these abuses is medical blacklisting, where a person's real name is spread among a group of doctors in an effort to punish that patient or sabotage his medical care, or simply to warn other doctors of a patient who may or may not pose some kind of perceived threat.

I recently had an incident with an ER medical blogger where I wrote a comment critical of his opinion on another blog, and he retaliated by revealing my real name on that blog as well as on his own blog which he was able to obtain from my phone number which I had listed as the contact person for a chronic pain support group. He also libeled me by claiming that I had "revenge fantasies" and was calling for violence against doctors. His revelation of my name was hardly an accident or even an impulse decision, but something he did consciously knowing what the impact would be if a doctor or employer ever did a Google search on my name. In a system where people can be labeled as drug-seekers simply for being too polite (I'm not making this up) and denied medical care on that basis, having my real name associated with an inflammatory chronic pain blog has a very real potential for negative repercussions.

So from my personal experience, if you are a patient or patient advocate you should avoid using your real name or any information that can be used to discover your identity as much as possible. My only problem with anonymous posts is that they are labeled just that:
"anonymous," and thus you lose a sense of who is saying what in long discussion threads. I don't think it would be too bad to require people use a pseudonym when commenting on blogs for the sake of continuity, but the only way to do that with Blogger is to limit comments to registered users.

 
At Tuesday, May 06, 2008 10:18:00 AM, Blogger Maurice Bernstein, M.D. said...

"Payne", thank you very much for providing us with your personal experience with regard to the identification and disclosure aspects of writing to blogs. It is a shame that blog owners can't be more "professional" in their own behavior with regard to the world-wide broadcasting of the contents of their blog.

What do you think about the attempted discussions of developing a Blogger's Code of Ethics, perhaps particularly for medically oriented blogs with the goal to attempt to make blogging more professional? ..Maurice.

 
At Tuesday, May 06, 2008 4:09:00 PM, Blogger MY OWN WOMAN... said...

I have to agree with Mr. Sinclair, this is a great topic. Let me try to put my own spin on things. I'm a "manager" of sorts in an ER. I respond to this blog as well as write my own. I do blog anonymously but I always use the same name and the same address. I do not change my name at will. I blog my opinions, right or wrong with the same name.

Now, why don't I just come out and say my name is so and so? Well for many reasons. I think when I am able to say things about my frustrations about my staff, or my aches about my patients, I can change the names, sexes, dates, times without changing the "intent" of the feeling. If I blogged under my "real" name, I'd have to keep all those things to myself. I'd be charged with a major HIPPA violations. I started my own blog as a cathartic way of releasing my emotions. It helps keep me sane in an otherwise unsane ER.

Now, if I was Dr. Joyce Brothers offering up medical advice, then I'd guess that I would have to put my name up for all to see so as to give my advice credence. But alas, my blog is my inside oozing to the outside. They are my opinions, my experiences, my joys and my sorrows.

Maybe I'm rambling, but I think that if you have an "anonymous" name that you blog under continuously, it's "almost" the same as blogging under your own name.

Sometimes when you walk on the tight rope on the high wire, a safety net beneath you is not a bad idea.

 
At Wednesday, May 07, 2008 3:18:00 PM, Blogger Payne Hertz said...

"What do you think about the attempted discussions of developing a Blogger's Code of Ethics, perhaps particularly for medically oriented blogs with the goal to attempt to make blogging more professional?"

I think it's a step in the right direction. The essential problem with blogging is that it is a new form of communication and while common sense and common courtesy go a long way in making it a safe and productive medium for people to use, most people just aren't aware of the kinds of ethical and legal problems that can arise with blogging without some kind of guidelines in place. The Terms of Service that Google and other blog hosts use are fairly vague and are geared more towards protecting them against liability than helping people create quality blogs. It would be nice if someone were to put together some solid legal and ethical guidelines for us all to follow.

With regards to medical blogs specifically, I think there is a greater duty on the part of doctors to ensure that the information they post is factually accurate, as doctors are considered authority figures and pretty much anything they say is taken as gospel by many people. There is a world of difference between a 15-year-old girl writing in her blog that "95 percent of the boys in my school are jerks," and a doctor writing in his blog that "95 percent of chronic pain patients I see in the ER are drug addicts." Most people reading these two different blogs will not likely conclude that 95 percent of boys are jerks, but will tend to believe that 95 percent of people with cp are addicts, simply due to the differential in authority of the two writers.

While this may seem like common sense, most medical blogs out there are very poor quality and some of them are little more than anti-patient hate sites where facts, fairness and professionalism be damned. There seems to be little concern about broad-brush denunciations of entire classes of patients, and even less desire to back arguments with factual data. Even where factual data is presented, it is sometimes twisted to mean something that it does not. As an example, consider the following example from an ER nurse: "I read an article in emergency medicine magazine that takes about a doctors role in treated chronic pain in the emergency setting. What's fascinating about it is that the author says that 50% of chronic pain sufferers have personality disorders or affective disorders. I can vouch for that. They wear you out, the people who come in for chronic pain because they are people who are neurotic and difficult to work with." I don't know if that information is factually accurate, but it could be that 2 percent of cp'ers may have personality disorders and 48 percent depression, you can't tell from that statement and of course, there is no cite for the article mentioned. But the way the information is presented it makes it sound like 50 percent of us have personality disorders or other severe psychiatric problems that render us difficult to work with.

So I would say that any code of ethics for med blogs would have to emphasize patient confidentiality, professionalism, and accuracy both in terms of factual data and the way that data is presented. Doctors should feel free to vent their frustrations with patients, but need to be careful about over-generalizing or crossing the line into bigotry or hate speech.

 
At Wednesday, May 07, 2008 6:07:00 PM, Blogger Marie said...

I believe that the option of remaining anonymous can provide a commenter a safe venue. While it does have obvious downsides, with postings being apocryphal, anonymity gives people an opportunity to express things that could be awkward and indiscreet if they disclosed their identities.

This is a wonderful Blog and I think the responses, for the most part, are insightful and thought provoking. Thank you so much Dr. Bernstein for creating such a great site.

Please feel free to view my blog at www.nourishourselves.blogspot.com. I initially developed it as a site to encourage each other in taking good care of ourselves, physically and emotionally. But since a devastating fall in March, I am currently focusing on the quality of medical care that I received. I welcome input and experience sharing.

 
At Wednesday, May 07, 2008 11:40:00 PM, Blogger IVF-MD said...

Great post. You have pointed out the pros and cons of anonymity. How about this angle?

I have a semi-anonymous blog in the sense that readers who first stumble on my blog can't necessarily find my real life identity (although some of the more skilled Google detectives have). I chose to do this because I wanted to write with authenticity, without it seeming that I blog in order to attract patients to my practice. My blog gets way more traffic than my private practice website. I have a friend in the PR/marketing field who says I'm crazy for not linking my blog to my main site, but she misses the point of why I blog.

 
At Thursday, May 08, 2008 5:41:00 AM, Blogger Christian Sinclair, MD said...

Funny you should mention that point IVF-MD, because I just stumbled across a blawg (Law blog) that points out the HUGE ROI (return on investment for all those doctors who received no business education in med school) for a blog by linking it to your main site.

Our team palliative medicine oriented blog has garnered us more attention as individuals but I doubt it has increased our medical referrals/business since it is not directly affiliated with any of our employers.

 
At Tuesday, May 13, 2008 1:29:00 PM, Blogger Joel Sherman said...

There's no perfect answer. I don't think the blogger should be anonymous if he/she wants the readers to be as responsible as possible. I know if I comment on a blog, I don't consider identifying myself if the blog owner doesn't.
But as others have noted there are some valid reasons for commenters to remain anonymous. But people are much more responsible if they publish their real identity. Ideally you should be able to make commenters use a unique pseudonym at least. Unfortunately this is not a supported option on blogspot. Hopefully everyone is aware that libelous comments are never truly anonymous and can be discovered through the legal process.

 

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