The true price of FOAMED

Free Online Access Medical Education is a great concept... but it comes with a price.

Franz Wiesbauer, MD MPH
Franz Wiesbauer, MD MPH
29th Jun 2018 • 6m read

As the founder and CEO of a medical education platform, I get the pleasure of working with some of the world’s best medical educators. I spend many hours a month searching far and wide for high-caliber teachers to head up our courses. So, when I tell you that exceptional teachers are really hard to find (and building equally exceptional courses are just as difficult), you can trust that I’ve been around long enough to know what I’m talking about.

I recently received an email from a potential Medmastery teacher who was interested in doing a course with us, but who ultimately declined. In the email he explained, I love what you guys are doing but I don't want a course of mine to be locked behind a paywall. I'm all about FOAMED now.

Ahhh... FOAMED. Free Online Access Medical Education.

FOAMED is an amazing concept. I deeply respect the community behind it and know that it comes from a good place of wanting to share one’s knowledge with as many people as possible. I completely understand that FOAMED was borne out of a deep frustration with the ultra-bloated student debt that burdens graduates from Western medical school systems. So a massive thank you! is owed to the whole FOAMED community for dedicating their knowledge and time to sharing medical knowledge with the world.

But (as with all good things) there are a few caveats and, unfortunately, FOAMED has a couple of serious ones.

The first and easiest to explain is that, by definition, an open-access learning environments lacks the checks and balances system that is a requisite for medical education. If someone does a free online course in coding and they happen to learn something completely wrong, the worst they might do is wreck a piece of software. If a doctor gets it wrong, someone could get killed!

It may be argued that the system is naturally self-correcting—that fellow doctors immediately point out errors to ensure the accuracy of FOAMED resources. Though this may be true for the most part, the point is that there are no guarantees.

When you access a medical course online, you have absolutely no way of knowing whether or not that information has been vetted by other experts or peer-reviewed in any way. It also doesn’t take into account that early-career doctors may lack the experience to discern fact from error. There’s no doubt that most of the information they learn will be incredibly valuable, but there will always be that small margin of error that could mean the difference between good patient care and a mistake that could cost somebody's life.

But let’s assume for a moment that all FOAMED resources are 100% accurate. The reality is, these courses do not create themselves. There are compassionate physicians behind them pouring their blood, sweat, and tears into keeping the profession moving forward. And thanks to their sacrifices, we can all access some medical education online for free. But as we go about consuming courses that our well-meaning colleagues have spent so much of their free time building—expecting zero or very little in return—there’s a third party lurking in the background, rubbing their hands with glee as they profit from the both of us...


By using these free courses to collect data about you and sell that information to advertisers, Google is essentially "selling" you to the highest bidder.

The internet appears to be free. But it's not. How could it be? The internet consists of millions of servers that need to be maintained, that consume energy, and that need to be fed with content and code. Someone has to pay for that! And these folks need their money back... with profit! So every single day you are being sold to someone. If you are using the internet like most people—a little bit of googling, killing time on social media, reading articles on blogs, and watching videos on YouTube—then you are being sold to someone every single day. So, here's a heuristic that you can jot down in your book of wisdom: If you are not paying for a product, then you're the product being sold. Think Facebook ads, Google ads, YouTube ads, and the list goes on and on.

So how much is Google costing the FOAMED community?

Without having done a proper analysis, I'm convinced that the FOAMED community has helped Google and Facebook make millions (if not billions) of dollars. Here's a quick example. YouTube (owned by Google) has been reported to make between $0.1 and $0.3 per ad view. A view occurs when a user either watches 30 seconds or more of the ad, or clicks on it. On average, 30–40% of YouTube ads get viewed in that way.

Let's do a little thinking experiment. Let's assume that every day about one million FOAMED videos get watched on YouTube (I believe this number is by no means exaggerated, and my feeling is that the true number is probably even higher). Let's assume that 500,000 of these YouTube videos carry an ad. Let's also assume that 35% or 175,000 of these ads are being viewed. If YouTube receives an average of $0.2 from the advertisers per view, that amounts to $35,000 per day, every day. So, throughout the year, YouTube alone can easily make $12,775,000 from the FOAMED community and again, it’s likely to be much, much more.

So it looks free, but really it's not. And that's just YouTube!

The FOAMED community also feeds other platforms like Google AdSense (the ads you see when you’re reading blogs), Facebook, Instagram, and (probably to a lesser degree) Twitter. I think it's safe to say that the FOAMED community has created a multi-million dollar business for these internet giants—that's money not being reinvested back into medical education—money that could be used to feed teachers, instructional designers, and their families.

So, if you’re a teacher who’s providing FOAMED content to contribute to a truly noble cause, it's important to be aware that, in the process, you’re helping these internet giants make tons of money with absolutely zero return to the medical community (the advertising money that most FOAMED contributors get back from these tech giants is negligible). And if you’re a consumer of FOAMED content, you’re paying them with your attention, your personal data, and your browsing habits.

But at least it’s free! Isn’t it?

I'm wondering why free has become the new gold standard against which online education platforms are currently being measured. We don’t expect food, shelter, clothing, and entertainment for free, so why do we expect high-quality education at no cost? Though the FOAMED community is packed full of incredible content, it has just as much content that is bad-quality (at best) and dangerously wrong (at worst). And with no set of checks and balances to maintain the caliber of that education, we risk undermining the overall quality of online medical education as we move forward.

Michael Grippi MD shooting a course for Medmastery.

Building exceptional educational programs requires financial backing to pay for the teachers, designers, accreditors, developers, and IT infrastructure that all comes with it. At Medmastery, our mission is to improve the health of millions by empowering clinicians through affordable, world-class education. It's not just a paywall. It's a team of super-talented designers and content experts that help clinical teachers to produce high-quality, professionally outstanding, beautiful, and affordable online courses. The money that's spent on a Medmastery subscription is used entirely to support our team, our teachers, and their families.

Mak Moyaedi MD checking out the clips for his new Medmastery course.

And I don’t know about you, but I’d rather support medical educators that give me the knowledge I need, than the tech giants that give me the ads I don’t want.