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Scott Shreeve, MD

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I'm the CEO of a new type of patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health.
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Health 2.0: The Cathedral and The Bazaar

Bazaar (bə-zär’) n.
  1. A market consisting of a street lined with shops and stalls, especially one in the Middle East
  2. A shop or a part of a store in which miscellaneous articles are sold.

One of my all time favorite reads is the seminal work by the accidental revolutionary and open source legend Eric Raymond entitled “The Cathedral and the Bazaar“. In the paper Eric makes that case for how software can and should be most effectively developed. He uses the emotive analogy of a Cathedral and its symbolic imagery of authoritarianism, dictation from on high, and a cloistered society of elites dictating to the commoners what is and should be. This is put in stark relief to the Bazaar where an anything goes style of the free market, the hustle and bustle of transaction, the ability to find almost anything you want if you are willing to look, and the bewildering fact that actual economic activity can occur from the chaos. The traditional, proprietary software model is of course the cathedral, and the free(dom)wheeling and chaotic bazaar is the open source model.

I introduced this concept in a couple of presentations I gave this week at Consumer Health World in Chicago. The first presentation was part of an all-day breakout session for Health Care Bloggers. I was on a panel with Enoch Choi and Ashe Damle discussing The Helping Hand: Social Media and eApplications. My point in this presentation was to highlight that the entire point of Social Media is to change the nature of relationships. To make time, geography, cultural, communication, interpersonal, and many other former barriers dissolve – often times overnight. This can clearly be seen in the medical content field. Traditional, the medical sciences and the resultant fruits of reseach were available to only the few who could (as demonstrated by their education) “understand” and worthy (as demonstrated by two initials) to “interpret”. Social media doesn’t necessarily tear down the ivory tower (because it remains very useful), but certainly opens it up brick by click (the bazaar now happens within the sanctuary of its own walls):

After this introduction (more overview of changing roles, Health 2.0 definition, and trends), I showed 10 clear examples of how this is having an impact on real people, with real companies, who really are adding value to the system by leveraging these technologies. A sarcastic perspective of the impact of the Health 2.0 style companies and the awkward nature of the new relationships can be seen below:

This cartoon was provided to me by Indu Subaiya. Sorry, the unknown artist remains uncredited.

I concluded my presentation by once again summarizing how the Bazaar style of innovation, implicit in the Health 2.0 model, fundamentally changes healthcare relationships:


The Bazaar as the archetypal image of Health 2.0 should get some airtime. It captures the essence of the hunt for value amidst the uproar, directional progress amidst the chaotic motion, and best outcomes when given choice. Given all the possibilities in the cool of the morning before the Bazaar is fully underway, it might be more than we all bargained for.


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