Clinical Trials versus Online Health Information - A Case In Cosmos Versus Taxis

In the Economist's recent article entitled, "Health 2.0", it explores the merits and risks of online health information. Dr. Daniel Hoch, quoted in this article states, "[Many doctors] don't get the wisdom of the crowds". Hayek writes in Individualism, “[Reason] is a product of an acute consciousness of the limitations of the individual mind which induces an attitude of humility toward the impersonal and anonymous social processes by which individuals help to create things greater than they know, while the latter is the product of an exaggerated belief in the powers of individual reason and of a consequent contempt for anything which has not been consciously designed by it or is not fully intelligible to it.”
According to Hayek, the aggregate or the whole has greater knowledge than any individual, including an expert. Critics argue the potential inaccuracy of online health information. Health 2.0 cites a 2004 study in the British Medical Journal that showed 6% of online information posted by an epilepsy support group was inaccurate.
As clinicians, we make clinical decisions based on clinical trials. However we all know the limitations of these trials, particularly in safety information. The challenge of every clinician is the answer to what degree our particular patient in question is represented in a given clinical trial population. This is key particularly in assessing the risk of adverse events.
Online health information is a form Hayek would describe as cosmos. It captures the local knowledge, disbursed in the aggregate, embodying the complex wisdom of the aggregate. Clinical trials represent Taxis, whereby a limited number of experts dictate the relevance of central knowledge not necessarily applicable to the whole.

Collaborative Patient Care

Surowiecki writes in The Difference Difference Makes, "expertise beyond a minimal level is of little value in forecasting change."

In the developed world of Japan, Europe, and North America, there is a rise of health care professionalism across many fields beyond a simple college degree. Physical therapy comes in the flavor of a PhD. Nursing is rising in its clinical specialties and its own Doctor of Nursing Practice. Pharmacy has transition from the B.S. in Pharmacy to the Doctor of Pharmacy programs. What value is there in this sum of rising specialized expertise?

McMaster writes in Design for Emergence, "Distributed knowledge emerges from interaction, rather than from any single point of storage". What I take this to mean is that the totality of collaborative knowledge and understanding is greater than the sum of the individual contributions or any one individual. I see this emerging in health care.

The rising sum of specialized expertise in health care is only valuable when these specialties care for patients collaboratively. In fact studies confirm this. Many randomized clinical trials show that these collaborative health care teams raise patient outcomes and reduce costs of care.
Take for example, the nurse, doctor, and pharmacist relationship. The key word for each profession is prognosis, diagnosis, and pharmacotherapy, for nurses, doctors, and pharmacists respectively. Each profession specializes in one of these three categories, and know just enough to understand the other two. Yet working together a patient gets the best judgment on their prognosis or future outcomes, the diagnosis of their problem, and the optimal drug regimen at the lowest cost.