Exercising 'soft closure' on lay health knowledge? Harnessing the declining power of the medical profession to improve online health information

This study aims to address the increasingly complex medical predicament of low quality online health information contributing to lay health knowledge and consequently to clinical outcomes. We situate the predicament within a social change paradigm of individualism, choice, diminishing medical power, and emergence of the legitimacy of lay health knowledge. We contend that the prominence of lay health knowledge has been facilitated by the internet, and is due to a surge in broadcasting of experiential knowledge coupled with increased access to and enactment of medical and non-medically sanctioned online information on health and illness. We draw on and further test the application of social closure theory to help conceive a potential solution to this enduring problem. We conduct a quality assessment of an indicative case study, Apicectomies, and test the application of our notion of soft closure on its findings, resulting in targeted, feasible and potentially beneficial solutions to increasing the medical quality of online health information. We further present the extant application of soft closure by Healthtalkonline.org, which collates a medically reliable set of experiential knowledge on a range of health issues. As such, we propose a constructive re-enactment of the traditional closure of the medical profession on medical knowledge

The Medical Marketplace

In the mid-1980s, a number of Anglophone historians began to describe health care in early modern England as a ‘medical marketplace’ or ‘medical market’. These terms were foregrounded by several scholars more or less simultaneously. The opening chapter of Lucinda Beier’s 1984 Ph.D. thesis (published in 1987) was entitled ‘The Medical Marketplace’.1 In 1985, Roy Porter wrote of the premodern ‘medical market place’ ‘where physicians, surgeons, and apothecaries … melted into each other along a spectrum that included thousands who dispensed medicine full- or parttime’,2 and Irvine Loudon observed that one of the most important unresolved areas of eighteenth-century medicine was ‘the extent of the market for medical care and how that market was satisfied’.3 The following year Harold Cook’s Decline of the Old Medical Regime began with a chapter entitled ‘The Medical Marketplace’.4 This terminology was not confined to scholars working on the United Kingdom. Katherine Park’s Doctors and Medicine in Early Modern Florence (1985) contained an identically entitled chapter.5