I spent last night eating and drinking with two old friends who happen to be web programmers. It is fair to say that we have a lot to learn from the way they share knowledge, and our evening’s conversation made me feel very uncomfortable about the whole medical research machine.

The origins of the internet lie in sharing of information among like-minded individuals, initially scientists. Much of the protocols, programming, infrastructure and software of the internet rely heavily on web programmers not to patent their ideas and to make them available to the broader public. Ideas and innovations are often introduced for free and programmers and experts evaluate, give feedback and improve ideas. Although Bill Gates and many others have hugely profited from various aspects of mushrooming of IT in the past few decades, imagine a world where we had to pay per e-mail, or pay for the right to write this very blog which you are currently reading! Open knowledge and an ethos “for the greater good” ensure this culture.

In medicine, the two major types of knowledge we share are innovations (most commonly of drugs or devices) or research studies (from basic science to epidemiology, from animal studies to patient studies). The way in which these new types of ideas are shared or disseminated is generally through publication in peer-reviewed journals, which are either subscription only, or open-access. Subscription-only journals involve a cost to readers and open-access publication involves a cost to the author or their institution. Subscription-only journals have started releasing certain articles as open-access. The cost is justified by the cost of peer review and the cost of publication.

The balance of medical research is very much tipped in favour of intellectual property rights rather than open information. Sharing of data is relatively uncommon, either because of fears of “data theft” or due to conflicts of interest, particularly in industry-funded studies. The conclusions of the research are heavily influenced by the way in which the research is funded and there is good evidence that researchers and clinicians can be influenced. Open-access datasets are a relatively new and evolving concept.

Research careers and progression are still very much judged by the publication model: “publish or perish” and often only indirectly by ability of knowledge to change practice and change norms. Although clinicians and researcher are driven by the Hippocratic oath and wanting to do good for patients, the current research model is often too investigator-driven or funding body-driven and only relatively recently have the end users (the patients) been involved in designing and prioritising research. The current global interest in the Polypill is an example of how different research institutions around the world are competing to gain the accolade of being the first to conduct the first trial of the Polypill. All the Polypills being suggested use generic drugs, but they will all be patented and promoted as new entities. Imagine if the different research groups worked together with “open Polypill” technology and the Polypills remained generic.

I was asked for examples of medical research where researchers put open access to knowledge before their own interests. Three examples came to my mind. Firstly, defibrillation as a process has never been patented. Secondly, oral rehydration therapy was originally trialled to treat cholera in Bangladesh and has been used to treat hundreds of millions of people with diarrhoea and dehydration worldwide without patent of process or the product. Thirdly, the results of the Human Genome Project are being made gradually openly available. Let me know of the other examples that must exist so that I can defend medical researchers better next time....

The questions of how best to train and educate doctors during medical school and throughout their careers have been difficult to answer for hundreds of years. I was reflecting on this over the last couple of weeks as I attended two overseas conferences. Like most conferences, these meetings aim to bring doctors and scientists up-to-date with the latest research developments in their fields of interest within medicine and the health sciences. They both had top-level speakers and excellent programmes, and both had substantial e-learning and other online resources. Lectures and conferences are the mainstay of teaching and continuing medical education in medicine and many other disciplines, but are they good at what they set out to do? This is a question particularly pertinent to evidence-based medicine, because what it ultimately aims to do is disseminate the best evidence and enable its uptake in clinical practice.

We know that people can learn over the internet using e-modules, video-conferencing and other modalities equally well, but I think there are two reasons why conferences persist. First and foremost, in a world of compulsory continuing medical education, they offer convenience. They are the easiest (and most passive way) to disseminate evidence from research. Secondly, they offer the chance to network (and relax) with peers and opinion leaders which even market leaders like TED.com will find it difficult to emulate.

As educational budgets are cut throughout the NHS and doctors increasingly fund their own continuing medical education, the reality is that pharmaceutical or other industry-sponsored educational events are likely to grow and not decrease, and more safeguards will be needed to avoid a reduction in educational content and an increase in drug company promotional material. As postgraduate deaneries are threatened, there are fears for the standards of training of doctors, but we should be equally worried about who is going to pay for the teaching in the new NHS. The Medical Students International Network (MedSIN) is remarkably forward-thinking about trying to avoid private industry sponsorship of education in medical schools. However, in a difficult economic climate, even with increasing tuition fees, industry-sponsored undergraduate education may rear its head.

There is a role for conferences in the dissemination of research and in promoting evidence-based practice and knowledge translation, but they should not be the only way we keep up-to-date. What is the best way to learn? As some UK public health trainees, say in a recent article: “In order to retain its position as a leader in the field of public health, the UK needs to adapt its training programme to better reflect today's challenges.”

The great swapthon

The BBC 'Great Swapathon' voucher bid to boost healthy living
A child eating a healthy lunch Families are being urged to swap the sugary snacks for strawberries or other healthy options

Families in England are to be offered £250m in vouchers in a bid to encourage them to eat healthily and exercise.

Apparently 4 million £50 voucher books will be on offer through the News of the World and Asda stores.

Health Secretary Andrew Lansley said: "It's a great example of how government, the media, industry and retailers can work together to help families to be healthy.

Is there any evidence-base for this?

Basically the money could go to 5 million familes if you give them £50. Therefore of the 16.5 million families in the UK about one in every three could get the money. see familes in Britain publication.

I filled in the questionnaire for me and my two kids, and this is the sort of advice I got

'Swap Fizzy drinks (and drinks with added sugars) for water, unsweetened juicds or milk',

'Swap fry up for grill-ups',

Swap creamy indian dishes for tomat-based sauces or grilled dishes

They then ask you to:

Tell us how it went?

Once you’ve tried your swap for a week, it’s time to share how it went. Your experiences and ideas are a valuable part of the Swapathon. Your shared tips help support everyone taking part, and encourage others on to make their own changes. See what our Swapathon community are saying.

The website annoying, it is slow, and its pretty one dimensional and repetitive. If I tried this for a week I'd be swapping my computer. In fact save your breath and swap this site for some exercise instead.

Are we surprized or do they think the public is stupid. Food policy experts have previously questioned the wisdom of allowing big brands to become involved in telling the public how to eat more healthily.

I say give the money to schools, they could do something useful with £250 million. I'll let you know when the adverts start to my email address