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The purpose of this paper is to criticise the paper by Jennie A. Abrahamson and Victoria L. Rubin (2012) “Discourse structure differences in lay and professional health communication”, Journal of Documentation, Vol. 68 No. 6, pp. 826-851.

The author reviewed the antecedents of Rhetorical Structure Theory (RST) in discourse analysis, and paid close attention to the differences between the original formulation of RST, later formulations of the RST model and the application of RST in this paper. The author also reviewed the literature on physician-patient communication, and patient-patient support to contextualise the findings of Abrahamson and Rubin.

The paper shows evidence of over-simplification of RST since its initial formulation. Next, the Motivation relationship in the original Mann/Thompson formulation of RST appears problematic. This makes the authors’ RST findings that patient-patient (or consumer-consumer) information sharing appear to be more effective than physician-consumer information sharing rather tenuous. An important additional flaw is that there was only one physician participant in this study. A practical limitation to the study is that physicians mostly interact face-to-face with patients and use of consumer advice web sites may not fit well with the current practice of medicine.

The author had limited examples in the paper to examine how the authors had categorised the binary unit relationships.

RST is promising for discourse analysis of information advice web sites but simplifications in its application can lead to unwarranted claims.

The purpose of this paper is to respond to Urquhart and Urquhart’s critique of the previous work entitled “Discourse structure differences in lay and professional health communication”, published in this journal in 2012 (Vol. 68 No. 6, pp. 826-851, doi: 10.1108/00220411211277064).

The authors examine Urquhart and Urquhart’s critique and provide responses to their concerns and cautionary remarks against cross-disciplinary contributions. The authors reiterate the central claim.

The authors argue that Mann and Thompson’s (1987, 1988) Rhetorical Structure Theory (RST) offers valuable insights into computer-mediated health communication and deserves further discussion of its methodological strength and weaknesses for application in library and information science.

While the authors agree that some methodological limitations pointed out by Urquhart and Urquhart are valid, the authors take this opportunity to correct certain misunderstandings and misstatements.

The authors argue for continued use of innovative techniques borrowed from neighbouring disciplines, in spite of objections from the researchers accustomed to a familiar strand of literature. The authors encourage researchers to consider RST and other computational linguistics-based discourse analysis annotation frameworks that could provide the basis for integrated research, and eventual applications in information behaviour and information retrieval.

In this paper the authors seek to compare lay (consumer) and professional (physician) discourse structures in answers to diabetes‐related questions in a public consumer health information website.

Ten consumer and ten physician question threads were aligned. They generated 26 consumer and ten physician answers, constituting a total dataset of 717 discourse units (in sentences or sentence fragments). The authors depart from previous LIS health information behaviour research by utilizing a computational linguistics‐based theoretical framework of rhetorical structure theory, which enables research at the pragmatics level of linguistics in terms of the goals and effects of human communication.

The authors reveal differences in discourse organization by identifying prevalent rhetorical relations in each type of discourse. Consumer answers included predominately (66 per cent) presentational rhetorical structure relations, those intended to motivate or otherwise help a user do something (e.g. motivation, concession, and enablement). Physician answers included mainly subject matter relations (64 per cent), intended to inform, or simply transfer information to a user (e.g. elaboration, condition, and interpretation).

The findings suggest different communicative goals expressed in lay and professional health information sharing. Consumers appear to be more motivating, or activating, and more polite (linguistically) than physicians in how they share information with consumers online in similar topics in diabetes management. The authors consider whether one source of information encourages adherence to healthy behaviour more effectively than another.

Analysing discourse structure – using rhetorical structure theory – is a novel and promising approach in information behaviour research, and one that traverses the lexico‐semantic level of linguistic analysis towards pragmatics of language use.

Public health policy often excludes access to essential medicines. Drawing on an in-depth case study examining access to essential medicines in the context of the HIV/AIDS pandemic in South Africa, and more briefly, making reference to the U.S. diabetes epidemic, we highlight the relationship between the need for essential medicines in world populations, and the role of groups external to government in promoting access to essential medicines in public health policy. We consider how, in the context of health stratification, the activities of patient advocacy groups, and “third way” social policies of the pharmaceutical industry generate “social capital,” creating enhanced access to essential medicines for a few, and promoting the ideal of the right to access for all. The implications for the development of public health policy inclusive of essential medicines are discussed.