The Blogosphere and You: A Primer

MDNG PsychiatryJune 2008
Volume 9
Issue 3

Do you have blog envy? Are you getting jealous of your tech-savvy colleagues who end conversations with "I posted something about it on my blog"?

Do you have blog envy? Are you getting jealous of your tech-savvy colleagues who end conversations with “I posted something about it on my blog”? Then here’s my advice: Navigate yourself over to, and start your own blog. It will take you five minutes, and it is completely free. There’s only one catch—you have to have something to say.

About one year ago, I took my own blind leap into the “blogosphere,” and I lived to tell the tale. There are some struggles involved. It does constitute extra work, and a fair amount of it. But if you do it for the right reasons, and if you are of a certain grandiose, narcissistic temperament, blogging can be fulfilling.

When you start a blog, whether via a free site like or any number of paid sites, you need, at a minimum, to come up with a name and a purpose. Why blog? Some enjoy sharing medical knowledge with colleagues and the general public. Some blog for social or political change within the medical community. Some use blogs as extensions of their psychiatric practices, using it to periodically communicate information to their patients ( makes this easy). Still, others use their blogs specifi cally as money makers or to generate business for a separate website. In reality, blogs often combine different purposes, my own blog serving as a typical example. In 2002, I started a website to complement the monthly CME newsletter The Carlat Psychiatry Report, which I edit and publish. This was not a blog, although the distinction between the two entities is not always clear. Generally, websites are defined as more-or-less static repositories of information, whereas blogs are constantly changing via the addition of entries, or postings.

Getting started

Starting a companion blog for my newsletter had been on my “to do” list for a long time, because I had read that, from a business perspective, a blog is a good way to attract readers to a paid website. Since blogs are free and updated constantly, they tend to show up frequently on search engines, from where potential customers might be directed to my site. But because of inertia and lack of tech savviness, I kept putting it off.

Why did I fi nally take the plunge? Because I found a reason for truly wanting to blog, aside from the possible fi nancial benefi ts. Like many other bloggers, I blog about something I really care about, and the issue that gets me exercised is the extent of pharmaceutical company involvement in medical education.

On June 15, I started The Carlat Psychiatry Blog, subtitling it “In support of the search for honesty in medical education.” As many bloggers have done, I titled my fi rst entry: “Welcome to [my blog].” Since then, I have noted that many blogs beginning with such postings have gone on to die a gradual death, as the writer began losing interest in keeping up with work. And work it is. You have to keep adding fresh material to blogs, and this is difficult to fit into a heavy schedule, particularly when there are no immediate financial benefits. It has often been said of print media that “the beast must be fed,” meaning that it constantly requires newness to stay alive and relevant. The same can be said of blogs. I carefully composed my first entry, clicked on “publish,” and was thrilled to see that my blog was published. After the fi rst couple of days, my posting had received nine comments, which reassured me that at least somebody out there was paying attention. Over the fi rst month, I received a quick education on the nature of the blogosphere. As it turned out, there were several other blogs already out there covering much of the same idiosyncratic territory as mine, and these bloggers reached out to me with congratulatory e-mails. Even more generously, several of them announced my new blog in their daily entries, and they added my blog to their blog rolls, which are lists of blogs that they recommend. I would eventually learn that these “inbound links” are crucial for enhancing a blog’s visibility, not to mention that ultimate measure of a blog’s prestige—the Technorati authority number.


Just as Google ranks various websites according to how may “hits” they receive, Technorati is a dedicated blog search engine. The authority number is defined as the number of other blogs that have linked to yours over the past six months. To peruse the top-ranked health blogs, visit’s “healthcare 100.” These blogs are ranked using a combination of measures (including the Technorati authority number). Another way to check the popularity of your blog is to track the number of daily visitors. The easiest way to do this is to use Google’s free Analytics tool, which will provide dozens of graphs and pie charts to slice and dice your blog’s visitor data in various ways. Aside from narcissistic gratification, one of the reasons to check your ranking and your traffic is if you decide to allow advertising on your site. Google, as always, makes this an easy process, automatically matching advertisers with your blog on the basis of obvious confluence of interests.


Over time, I have developed something of a schedule for blogging. I set a goal of writing two entries per week—typically on Mondays and Thursdays. I amass material from several sources, both “primary” and “secondary.” Conventional sources of up-to-the-minute medical information include the major medical journals; the health sections of newspapers such as the New York Times, the Wall Street Journal, and USA Today; and a variety of medical websites. In addition, I bookmark my favorite blogs and make sure to scan them regularly, in order to “borrow” material and ideas from my colleagues. Finally, I take advantage of RSS feeds, which send me the latest news from a pre-specifi ed list of favorite publications. I recommend setting up a feed via Google Reader and Feed Burner both free.

Another useful feature of blogs is that they help you meet people who share your interests, including other bloggers and people who leave comments about your entries. In this way, I have received numerous requests for media interviews, as well as invitations to give grand rounds.


Of course, the interactive nature of blogs can become a detriment, when someone decides they dislike you and everything you stand for and decides to repeat said sentiment over and over again in the comments section. If such critical spam becomes too much of a problem, there are several possible solutions. You can simply delete comments; you can turn on comment “moderation,” meaning that you have to review and approve any comment before it’s posted; or you can turn off the comments function completely. Perhaps the strangest blog experience I’ve had thus far actually occurred before I started my blog. I had published an op-ed about the practice of pharmaceutical companies paying key opinion leaders to say bad things about generic competition. Soon after it was published, I received an e-mail from someone who identifi ed himself as Carl Weisman and said he had read my article and had visited my website. He was considering subscribing, he said, but fi rst wanted to know if I had any “formal” training in ethics.

I read the e-mail on my cell phone as I was driving up for a weekend of skiing, and planned to respond on Monday. But Carl was not in the mood for waiting; Saturday morning, he wrote me again: “Dear Dr. Carlat, I was disappointed to see that you haven’t responded to my inquiries. Since you haven’t responded, it seems likely to me that in fact you are gaining fi nancially from the newsletter, which raises questions in my mind about whether your writings are objective and fair…. I shall note your lack of response to my queries in my blog.”

Blog?! I Googled “Carl Weisman” but could neither locate a blog nor any information about a psychiatrist with that name. A week later, he e-mailed me again—“I thought you might be interested in seeing the following blog:” I clicked on the link, and indeed, there it was. The inaugural entry gave me a rapid case of heartburn: “Welcome to my blog on the topic of the Carlat Psychiatry Report and other Web misadventures.” He introduced himself as a psychiatrist, and “currently a student of medical ethics.” However, he did not disclose an affi liation, an office address, or a phone number. There was only a name, an untraceable Yahoo e-mail account, and a blog. From February 28 through March 18, I was treated to eight anti-Carlat blog entries, each one attacking my credibility in a variety of spurious ways. Finally, on March 18, as quickly as it began, it ended. There were no more entries to the blog and no more e-mails. Evidently, “Carl” got tired of his attacks. I half-heartedly talked to an attorney, both because I felt I was being slandered and because his blog included my name in its title without my permission. But my attorney felt there was little I could do, given the anonymity of Yahoo e-mail accounts. Furthermore, he pointed out to me that likely nobody had read any of his entries other than the writer and myself.

While the moral of this anecdote is that bloggers can behave badly under shield of anonymity, the converse is also true at times. Anonymity allows ethical bloggers to share frank and valuable observations that might otherwise jeopardize their careers. One of my favorite blogs in psychiatry, Clinical Psychology and Psychiatry: A Closer Look, is written by an academic psychiatrist with respectable credentials who tears apart poorly conceived studies with a penetrating intelligence that is remarkable. Without his cover of anonymity, his postings would have to be toned down and the blogosphere would be the poorer.

Parting advice

Blogging presents a steep learning curve, and there are many opportunities for mistakes along the way. I’ve made several, particularly in the realm of being overly biting in my comments. By their nature, blogs are more informal than print publications, and the ability to publish one’s thoughts immediately after conceiving them tempts one to bypass the standard vetting and editing process of print media. When I’ve allowed my entries to be driven by emotion, I have needlessly insulted people, and have had to devote later postings to apologizing for my excesses. For example, I referred once to Charles Nemeroff , a prominent psychiatrist who has many fi nancial interactions with the pharmaceutical industry, as Charles “Bling Bling” Nemeroff and later apologized for the insult. Interestingly, my posting elicited a fl ood of comments about whether I should have apologized at all, with some commenters castigating me for having done so. File that one under “no good deed goes unpunished.” Th e most important advice is to have fun with blogging. Make it an extension of your personality. If it becomes just another hassle that you don’t need, give it up quickly. But if you enjoy it, and if your blog becomes popular, relish the fact that you are contributing to a conversation accessible by everybody on the planet, all 6 billion of them.

Dr. Carlat is an assistant clinical professor of psychiatry at Tufts University School of Medicine, with a private practice in Newburyport, MA. He has written Th e Psychiatric Interview, and Drug Metabolism in Psychiatry, and is founding editor of The Practical Guide Series in Psychiatry, published by Lippincott Williams & Wilkins.

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