We are the first to admit that openness has a dark side. The barriers come in many forms: institutional, financial, educational, ethical and even technological. Resistance to change could be "affirmative" ranging from plain old intertia to false rationalization that it is in consumers best interest to put up or shut up. Sometimes it is simply a matter of not knowing where to start. Past transformations of the medicine, such as introduction of managed care and public health programs, happened with a lot of pain and over much opposition. But they did prevail because the public pressure has reached a breaking point. The public and the employers voted both with their wallets and through the political process. This had time and again put the providers between the choice:

• Fight and you shall die
• Accept and you shall survive
• Embrace and you shall prosper

Today the Internet empowers the public to express themselves with greater efficiency than ever, as recent political campaigns have shown. The change is here to stay. Embracing the Open Medicine and prospering will be the course the forward-thinking providers will choose. HealthVoices is all about giving the healthcare consumers and providers their voice, moving us all a step closer to Open Medicine.