Under a general public licence, open-source code for computer programs is made available for users to analyse, redistribute and modify, as long as they operate under the same rules. The success of the GNU/Linux operating system demonstrates that programmers are willing to invest time and expertise in open-source projects; the resulting software is stable and also evolves quickly.
And user interest comes not only from medical students looking for programs for their hand-helds — cash-strapped practices and hospitals are also examining open-source software as an alternative to proprietary systems. As Douglas Carnall has argued in BMJ (www .bmj .com/cgi/content /full /321 /7267 /976), if the code is free greater resources are available for customization and customer support. Carnall's editorial provoked a lively online discussion (www.bmj.com/cgi/eletters/321/7267/976).
Granting agencies are also interested. The European Union will spend 3.6 billion Euros supporting research over the next 5 to 10 years, and has placed an emphasis on projects that will yield open-source software. In April 2001, the McMaster University Department of Family Medicine Primary Care Network received $1 million from the Ontario Ministry of Health Primary Care Reform Initiative to enhance and expand OSCAR, an open-source primary health care system (www.openhealth.com/en/press/20apr01.html).
SourceForge (www.sourceforge.net) hosts projects of all sizes, while the Spirit Project (www.euspirit.com) specializes in medical software. At LinuxMedNews (www.linuxmednews.com), Dr. Ignacio Valdes and fellow enthusiasts keep their fingers on the pulse with news, discussions and project lists. Vancouver-based Minoru Development Corporation maintains Openhealth (www.minoru-development.com/en/healthcare.html) . Most software intended for desktops or mainframes (as opposed to hand-held computers) is still at the pre-release stage. Exceptions are the beta versions of FreePM (www.freepm.org), open-source practice management software that was recently reviewed at LinuxMedNews. Tk_familypractice (www .psnw .com /~alcald#informatics) provides patient record and other software for physicians.

Figure.