Int. J. Environ. Res. Public Health 2009, 6 500 PatientsLikeMe and Inspire are at least two health social networks offering access to clinical trials at present, selling anonymized data to pharmaceutical companies, universities and research labs. For example, in May 2008, Novartis recruited clinical trial participants from PatientsLikeMe estimating that they were able to speed up their 1,200-patient study of a new medicine for multiple sclerosis by a few months [9]. In another instance, PatientsLikeMe contacted 1,500 ALS patients for another research project and received 50 DNA samples (3.3%) [10]. The yield might not seem high but the time and cost savings in identifying, screening, contacting and obtaining responses from relevant patients is significant. In addition to lower-cost patient recruitment, there are three other ways that health social networks are improving the quality of clinical trials. First, the depth of information generated through large online patient communities creatively interacting and monitoring their conditions with quantitative tracking tools can lead to new findings that give a better understanding of the underlying conditions. PatientsLikeMe in-house research staff is publishing some of these findings, such as the identification of non-motor symptoms of Parkinson’s disease in younger sufferers [11]. Second, health social networks provide a feedback loop to the clinical trials process. For example, PatientsLikeMe patients noticed and suggested corrections and improvements to the graphical display of data in ALS clinical trials [12]. Third, online health tracking in conjunction with clinical trials means that patients can make their experience feedback, including response to drugs, available as a public resource. The obvious next phase of active patient participation in health social networks is patient-inspired research and patient-run research. This concept is also called open source health research and crowd- sourced health research. Self-run clinical trials and structured self-experimentation is emerging as patients may no longer have the inclination to wait for formal research findings and pharmaceutical company-sponsored clinical trials, and can possibly fill the medicine gap for orphan diseases and other conditions that do not make good business cases in the existing pharmaceutical model. Patients can review research literature and other remedy suggestions on their own and try them, tracking the results in a rigorous manner, sharing the information and running non-traditional clinical trials themselves. In one example, a PatientsLikeMe patient, newly diagnosed with rapidly progressive and young-onset ALS gathered 250 patients to self-experiment with lithium [13] per a research paper he had found [14]. The self-run patient study results were preliminary and found that the use of lithium did not slow disease progression. The example highlights many elements of the new power and role of patients, their ownership of the health care process and the attendant contentious legal, ethical, methodological and other issues. Inevitably, fraud is likely to arise or may already exist in health social networks as there are significant economic incentives for drugs and other treatments to have high patient usage statistics and favorable reputations. The bona fide peer community may be one of the most helpful resources in detecting and policing fraud due to the deep knowledge of patients regarding their conditions and remedies, and their time spent on the websites.