By Franz Wiesbauer, MD, MPH - 29th Jun 2018 - The Medmastery show

The true price of FOAMED.

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 calibre 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 ultimately declined. In the email, he explained that "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 debts that Western medical school systems burden their graduates with. 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 environment lacks the checks and balances 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 can do is wreck a piece of software. If a doctor gets it wrong, it could get someone 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 is likely true for the most part, the point is that there is no guarantee.

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 costs someone their life.

But let’s assume for a moment that all FOAMED resources were 100% accurate. The reality is, those 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 the courses that our well-meaning colleagues have spent so much of their free time building–expecting zero or very little return–there’s a third party lurking in the background, rubbing their hands with glee as they profit off the both of us.


By using those free courses to collect data about you and sell the 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 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 other 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 wisdoms: 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 of the ad or clicks on it. On average, 30-40% of Youtube ads get viewed in that way.

So let's do a little thought experiment. Let's assume that every day around 1 million FOAMED videos get watched on Youtube. I think this is by no means exaggerated. 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 assume that 35% or 175,000 of these 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 on the FOAMED community and again, it’s likely to be much, much more.

So, it's free but really, it's not. And that's just Youtube.

The FOAMED community also feeds other parties 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. Money that’s 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, you need to be aware that though you are contributing to a truly noble cause, 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). 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 is 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 is also filled with just as much content that is bad-quality at best, dangerously wrong at worst. And with no set checks and balances to maintain the quality of that education, we risk undermining the overall quality of online medical education as we move forward.

true price of foamed

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 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 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.

true price of foamed

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.