Beyond Wikipedia

No surprise, these days more and more doctors are searching online for medical information. What is surprising, however, is that in a recent study, nearly 50% of physicians indicated that they use Wikipedia—the open-access encyclopedia that allows anyone to edit articles—as their source for medical information.

The study, conducted by Manhattan Research, and reported on here found that although physicians were visiting Wikipedia for medical conditions and other health information, only about 10% of the 1,900 physicians surveyed created new posts or edited existing posts on the encyclopedia.

“The number of physicians turning to Wikipedia for medical information has doubled in the past year alone,’ said Meredith Abreu Ressi, vice president of research at Manhattan Research. ‘Physicians, just like consumers, are heavily search engine reliant, and often Wikipedia results are what come up in the top of the organic results.’

Abreu Ressi noted the concern about accuracy regarding Wikipedia, which allows its users to create content for the site essentially without restriction. Articles are subject to perpetual editing by Wikipedia’s readers. Inevitably, false information sometimes slips through the cracks.”

Wikipedia is not a reliable source of medical information for doctors.

The fact that anyone can anonymously edit the content is the most obvious problem with the concept. For example, this article by Peter Rost, MD in BrandweekNRX provides details of how representatives from the pharmaceutical companies  Abbott and AstraZeneca removed negative information about the side effects of  their drugs from the site:

“The first drug company caught messing with the Wikipedia was AstraZeneca. References to claims that Seroquel allegedly made teenagers ‘more likely to think about harming or killing themselves’ were deleted by a user of a computer registered to the drug company.”

“[I]n July of 2007, a computer at Abbott Laboratories’ Chicago office was used to delete a reference to a Mayo Clinic study that revealed that patients taking the arthritis drug Humira faced triple the risk of developing certain kinds of cancers and twice the risk of developing serious infections. The study was published in the Journal of the American Medical Association in 2006.”

The irony of this situation is that doctors don’t have to resort to Wikipedia. There is a surfeit of more authoritative medical information that can be accessed electronically. Indeed there are scads of peer-reviewed  medical journals available online, as well as searchable treatment guidelines from the U.S. Preventive Services Task Force, the Agency for Health Care Research and Quality, and professional societies like the American College of Physicians, among other organizations. Private insurers publish their own treatment guidelines that they encourage network providers to use, and in the case of organizations like Kaiser Permanente and the Mayo Clinic, outside providers can gain access as well. But sifting through this overload takes time– something most doctors don’t have a lot of.

Thus, the appeal of Wikipedia: Aside from the sponsored sites that are bankrolled by drug companies, Wikipedia is often the first reference that comes up when doctors search the Web for information about a particular disease or condition. (Most search engines list the  most popular website first, and Wikipedia draws millions of eyeballs.) But doctors should be concerned about accuracy. And keep in mind that Wikipedia, like many of the medical sites out there, ultimately offers no guidance on which treatments are best for patients. It’s a barely-comprehensive overview.

I believe we would all be safer if a government agency consolidated all of the really good, independent research into one giant, searchable database that doctors could access easily. For this database to be truly valuable, it must be continually updated to include comparative-effectiveness studies that can guide practitioners in making informed decisions about care. Obama’s economic stimulus plan includes $1.1 billion for comparative effectiveness research—and a 15-member panel of government health experts was created to decide who will conduct these studies and how the new research will be applied.

For those quick to shout “rationing!,” the House conferees specifically stated that they did not intend for the comparative effectiveness research funding to be used to create mandates for coverage, reimbursement, or other policies for any public or private payer. It’s meant to be a resource for practitioners, offering “guidelines,” not “rules.”

Better Websites

When we will actually see such a database is hard to predict. There is still internal wrangling among Democrats about who should oversee comparative-effectiveness studies—and downright opposition to the idea from some conservatives. This week members of the New Democrat Coalition proposed legislation that would establish an “independent,” non-governmental office to oversee comparative effectiveness studies instead of the government panel.

Partially financed with economic stimulus money, this office would be overseen by a 21-member board that would include HHS officials, patients, physicians and private insurers, among others. So far, the industry-heavy group, Partnership to Improve Patient Care and drug-maker Merck have indicated that they support this legislation.

In the meantime, there are Web-based resources already out there that are far superior to Wikipedia for practitioners—and even motivated patients—to access. Kevin Pho of KevinMD says that doctors already have a good source of comparative effectiveness research in UptoDate:

“Over 360,000 clinicians, thousands of patients and the majority of academic medical centers in the U.S. consult UpToDate for answers to their clinical questions. For those who don’t know, UptoDate is a peer-reviewed, evidence-based, medical encyclopedia available via DVD or online that’s revised every 3 months. It does not carry advertisements, and is funded entirely via paid subscriptions. I am a big proponent, and like many other doctors, could not practice medicine effectively without it by my side.”

Medpedia, a free, health and medicine site that is modeled on Wikipedia—with the important difference that it  limits who can write and edit site information—came on line earlier this year. The goal of the site is to create and interlink content on about 13,000 drugs and 30,000 medical conditions. Medpedia’s editors must be invited to participate and have to be physicians or PhD’s. They are also required to disclose any conflicts of interest they have; i.e. whether they accept money from a drug company to conduct studies. One aim of Medpedia is to link practitioners and patients into “Communities of Interest,” to keep current on developments in particular disease areas. Whether it will be successful really depends on how much interest the site garners from doctors—and if they have enough time to edit and continually add to the knowledge base.

The fact that so many providers and consumers are going online to get medical information represents a real sea change in how knowledge is accumulated. As is the case with all web content, from parenting advice to politics to pornography; the range of medical information available online varies widely in quality and origin. It takes time to sift through the onslaught and pick out the really useful stuff. It’s encouraging that there are efforts, both public and private, to create up-to-date, meaningful content that can help drive better medical practice and maybe, just maybe, provide an impetus to improve patient care and cut down on unnecessary and costly treatments. Now the challenge is to get doctors to scroll past Wikipedia to find it.

Naomi Freundlich writes for the Century Foundation, where she works with THCB author Maggie Mahar on the HealthBeat project. Prior to joining the Century Foundation, she served as Science and Medicine Editor at Business Week from 1989 – 1997. Her work has appeared in numerous publications, including the New York Times,  Business Week, Real Simple and Parents magazine.

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