Sure, you can tell the difference between Anonymous and Mark Glenn, but can you tell a fake name from a real one? Let’s say, you’re presented with two names:

Name 1: Judy Alfonso
Name 2: Connie Jackson

Can you tell the real from the fake?

In fact, both names are fake, generated randomly from So is “Mark Glenn” from above. It’s as easy as visiting a website and hitting F5 to get essentially unlimited fake names. So, then, these aren’t names at all – they’re pseudonyms.

So does it matter if reviews have a real name, a fake name, or no name?

In practice, it doesn’t. Simply stated, any trust put in a reviewer’s name is misplaced. Let me explain why.

There are generally a few forms of identification on the Internet: true name, pseudonymity, and anonymity. Most everyone is familiar with true names. What about pseudonymity and anonymity? The concept might be understood but the distinction between the two is subtly blurred.

Pseudonymity refers explicitly to the use of a pseudonym, which is essentially a fake name. This can be a username (sometimes called a “handle” or “nickname”), and may have the appearance of a true name. But of course, it’s not a true name since it’s fictitious.

Anonymity refers to having no name at all, fake or otherwise. No nicknames or fake names, just a homogenous lack of individual identity. All users are equal, all messages are judged purely on their content.

Review sites generally require a user-reported first and last name, username (made up by the user) and email address, which do absolutely nothing to prove either a user’s identity or their bona fide affiliation with the doctor. But review sites rarely, if ever, allow a user to remain completely anonymous.

Make no mistake, short of connecting review site accounts to a social security number or similar unique identifier (good luck with that), reviews on review sites are generally unverified and should be treated as such. Patients and websites alike cannot (and very likely would not) verify the identity and relationship with a particular doctor, so any reviewer’s name – real or otherwise – adds nothing to the trustworthiness of the review.

As an aside, eMerit is a bit different – members collect reviews at point-of-service, which helps ensure that reviews are from confirmed patients, backed by extensive linguistic analysis and human review processes, ensuring quality. But when the review hits the site, prospective patients do not know or see that an unknown intermediary vetted

[1] the reviews. All they see is a review that they then must decide to trust or not to trust.

Trust in reviews doesn’t come from what name a reviewer uses – it comes from content, specifically content in aggregate. A patient can smell marketing puffery (or sabotage) miles away based on the content of a set of a reviews. A single review carries little to no trust, but in aggregate, patterns emerge. Patients use these patterns to discern whether your reviews are trustworthy.

So if a reviewer’s name is completely useless, why use names on reviews at all? Why not make all reviews anonymous by default? After all, we know that anonymity and Internet speech go hand in hand. According to UN Human Rights Council Special Rapporteur, David Kaye:

“Encryption and anonymity enable individuals to exercise their rights to freedom of opinion and expression in the digital age and, as such, deserve strong protection” [2]

Two of the largest social networks, Facebook and Google Plus, missed the mark on anonymity/pseudonymity and privacy and both ended up reversing course to protect its users’ rights to unencumbered expression[3][4]. Review sites should offer similar protections for its users’ privacy, but without the window-dressing of forced pseudonymity.

Instead of perpetuating the burden of privacy “snake-oil” that contributes nothing to trust in reviews and imposes significant barriers to online speech, let’s enable free speech and let the content speak for itself. Not only would embracing anonymity for reviews increase the volume of reviews, but also the quality of content. Of course, some users will inevitably abuse anonymity, but those same bad actors would be capable of abusing a pseudonymous system, too. But, more importantly, anonymity provides a disinhibitory effect that allows for unobstructed free expression, shields patients against a myriad of potential public communication risks[5] (e.g. embarrassment, harassment, frivolous lawsuits to suppress speech) and facilitates a more open and honest discussion.

Despite efforts to eradicate Internet privacy, it’s here to stay. With advocacy groups like the EFF and privacy/anonymity software like Tor becoming more prevalent every day for fear of dragnet surveillance and over-collecting service providers, the Internet seems to be reclaiming its privacy. However, with the Department of Justice vying for backdoored encryption, there is certainly a tug-of-war afoot.

So, which side are you on? Let us know in the comments below.

[1] The use of “vetted” here refers only to our systems to prevent abuse of our system. We do not filter or otherwise censor patient reviews collected through our system in any way.[2] Report of the Special Rapporteur on the promotion and protection of the right to freedom of opinion and expression, David Kaye[3] Wikipedia – Nymwars: Expired Google Policy[4] Wikipedia – Facebook real-name policy controversy[5] The Online Disinhibition Effect