Why Medscape Worked: A Look Back


November 05, 2020

Medscape and JAMA both launched websites in 1995. It was soon obvious that most American physicians knew next to nothing about the internet and were not even knowledgeable about computers. Many feared them. Fewer than 20% used computers for any purpose.

The American Medical Association (AMA) recognized that computers were of increasing importance. While physicians generally preferred to keep computers out of their offices except for scheduling and billing purposes, the intelligent use of computers, including accessing the internet, would become critical to successful medical practices.

To further education and use of computers, the AMA began the Physicians Accessing the Internet (PAI) Project in 1996.

When I first joined Medscape in February 1999, one thing I commonly heard was: "I don't trust anything I read on the internet; there is so much junk there." And there was.

My mantra in response was: "I don't trust anything I read on paper; there is so much junk there." And there was.

Building trust in internet-based information required that those of us who believed in this new technology "sell" our colleagues on the point that the internet was "only" a new medium. But there was massive fear and bias to overcome.

The genius behind the founding of Medscape in 1995 was Peter Frishauf's recognition that an open internet democratized medical information. By creating access, it empowered users to make their own decisions about what to read. Previously, physicians had generally tailored their medical publications for other physicians. While not prohibiting non-physicians from reading it, the general public was not welcome.

The internet changed all of that.

Physicians Online (POL) was an early competing organization. POL allowed only physicians to access the site, believing that "the brotherhood" of physicians desired that exclusivity. Medscape founder Frishauf disagreed. Medscape has always been open-access and free of charge to all (no paywalls), though we did require registration.

By February 1999, an ever increasing segment (though still minority) of American physicians accessed the internet. Concurrent with my appointment as editor, Medscape announced its 1 millionth registrant in more than 200 countries. I recognized that our highest priority must be to convince American physicians that they could trust and use Medscape, even though most still did not use computers in medicine or trust the internet.

Physicians follow leaders. We term these experts key opinion leaders (KOLs).

I proposed to Medscape's CEO, Paul Sheils, the creation of an editorial board of KOLs. He agreed and that is what we did.

During my long career in pathology and my 17 years as editor-in-chief of JAMA, including responsibility for all of the Archives journals, I had worked successfully with many KOLs. Identifying and appointing an international editorial board who were held in high esteem by their peers and were diverse in age, gender, race, field of expertise, and geography was actually a fairly easy exercise: The first 16 experts I invited all agreed to serve with no financial compensation.

That First Editorial Board

So who were these folks and why did I invite them? You can read the brief bios of all of the board members but let me quickly summarize the unique skillset that they brought to Medscape:

  1. Magne Nylenna of Oslo, Norway, and editor-in-chief of the Norwegian Medical Journal, sat on the International Committee of Medical Journal Editors and was a founding editor of the World Association of Medical Editors (WAME). WAME was begun in large part to further ethical, free, open-access medical publishing.

  2. Cardiologist Saveli Bashinski of Moscow, Russia, was also a member of WAME.

  3. Daniel Ncayiyana of Cape Town, South Africa, was an obstetrician/gynecologist and editor of the South African Medical Journal (as a Zulu during Apartheid) and a member of WAME.

  4. Canadian Murray Kopelow of Chicago directed the Accreditation Council for Continuing Medical Education. Since I anticipated online continuing education to become a dominant endeavor, led by Medscape, Dr Kopelow's involvement was essential.

  5. Alternative medicine was all the rage, so I invited Steven Barrett of Allentown, Pennsylvania, a leader in the movement to demand scientific scrutiny of alternative medicine and founder of Quackwatch.

  6. Harvard's Karen Donelan was a bright, young, upcoming survey researcher with a particular interest in nursing, a field of great importance to a young Medscape.

  7. An internist and a Spanish-language television medical educator, Mexican American Aliza Lifshitz of Los Angeles, was the next pick.

  8. Thomas Starzl of Pittsburgh, the world's leading organ transplant expert, became our surgeon.

  9. Leading medical educator and long-time medical journal editor Vincent Fulginiti of Tucson was our pediatrician.

  10. The best general internist I knew was Thomas Delbanco of Boston, a proponent of patient control of medical records.

  11. Barbara Bolsen was a street minister for the homeless in Chicago and a long-time editor of American Medical News.

  12. American David Sackett, then teaching at McMaster University in Canada, was the world's recognized top expert on evidence-based medicine.

  13. We needed a lawyer, so we invited Peter Budetti of Chicago, also a physician and super expert in health policy.

  14. Women's health was represented by Humana's Mitzi Krockover of Louisville, Kentucky, who had been a TV medical reporter while at University of California, Los Angeles.

  15. SUNY Upstate President John Bernard Henry, also author of the world's leading textbook of laboratory medicine, became our pathologist.

  16. Keeping the ethics clean was a prime concern so we invited the best US medical ethicist, Arthur Caplan of the University of Pennsylvania.

  17. Craig Frances of University of California, San Francisco, an expert in pharmacy and consumer education, became our resident physician member.

We soon added James Curran, a renowned HIV/AIDS expert from CDC and then the dean of public health at Emory, and Donald A. B. Lindberg, director of the National Library of Medicine. Both appear in the photo above.

All had written job descriptions.

It was a stellar and diverse assemblage of recognized leaders, each with a large constituency of peers who recognized and respected their expertise, vital to Medscape's future success.

They would, individually and in aggregate, provide needed advice and service. By their presence, they endorsed both the legitimacy of the concept of internet medical publishing and Medscape. This recognition was absolutely crucial in making the leap to credible and exclusively online medical information.

With the burgeoning world-class Medscape editorial staff, headed up by Bill Silberg, and the CME enterprise, led by Judy Ribble, the success of Medscape's content and public positioning were thus virtually assured, as long as we did not make major financial, ethical, or scientific blunders.

When Medscape was acquired by WebMD in 2001, we redefined the scope of responsibilities of the Medscape Editorial Board and limited them to the new journal, Medscape General Medicine.

And that becomes a segue into another column...

George Lundberg is a contributing editor at Medscape, contributing editor at Cancer Commons, president and chair of the board of directors of The Lundberg Institute, and a clinical professor of pathology at Northwestern University. Dr Lundberg has more than 30 years' combined experience in medical publishing, having previously served as editor-in-chief of JAMA (Journal of the American Medical Association) and the 10 AMA specialty journals. Follow him on Twitter.

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