Physicians

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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zenslykeyword advertisinggoogle plus 1CharlesMike Recent comment authors
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zensly
Guest

I’m late to this conversation, but I’m very surprised to read that Up To Date is considered a good source by this audience in this advanced digital age. Even today, their own site says that their information is at least 4 months old. For broad searches that return many sources

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Guest

I’m now not positive where you are getting your info, however good topic. I needs to spend a while finding out much more or understanding more. Thanks for wonderful info I used to be searching for this information for my mission.

google plus 1
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I must say you made some good details there. I did research online about the issue plus located a number of people that definitely agree with your current Article

Charles
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Charles

I’m late to this conversation, but I’m very surprised to read that Up To Date is considered a good source by this audience in this advanced digital age. Even today, their own site says that their information is at least 4 months old. For broad searches that return many sources, try http://www.hakia.com. To search for the most recent information about specific diseases, symptoms, treatments, etc. published through PubMed, use MedInfoNow.com. Furthermore, MedInfoNow.com will send to you each week via email the latest abstracts and citations from PubMed in your chosen field.

Mike
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Mike

e-patient Dave has a valid criticism of the author’s exaggeration of the study results.
What was written in this blog does not accurately represent the findings of the original source. Second line of the article: “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”
This implies that these doctors used wikipedia as the sole source of of medical information. It is not “their source”, it is “a site that they visit”. The author exaggerated the original study.

Ann
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Ann

I think the discussion has become heated here because the first line of the first comment was, indeed, condescending. People respond negatively to condescension. It tends to shut them down and cause them to disregard anything that comes after it.

Dan
Guest
Dan

Many are aware of the embellishments/alterations that may occur with Wikipedia. However, there are references at the end of each subject or topic searched and located. The references are valid, which is why doctors go to wikipedia for information.
Doctors in general are not naive. They look at the references more than they look at the body of the wikipedia entry.

WikiDoc
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WikiDoc

Please see http://www.wikidoc.org which does move beyond wikipedia. There are more images, expanded differential diagnoses. Over 1,200 contributors have edited the site over 400,000 times. Many pages have editors assigned who can be contacted.

Physchim62
Guest

I really can’t see what the fuss is about. So physicians read Wikipedia and edit Wikipedia. Wow! I know several full professors who read (and edit) Wikipedia articles in their respective fields. Wikipedia provides a reasonably easy overview of a subject, and its articles can usually be improved by someone knowledgeable. The idea that professionals shouldn’t use Wikipedia simply because there’s “better” stuff out there is frankly ridiculous. There just aren’t enough hours in the day to read all the original research being published, especially not if you have to do something useful with your day as well. And lets… Read more »

Margalit Gur-Arie
Guest

OK Dave, so this is what you said: “MedPedia reliability was pretty well assassinated in February over on the e-patients.net blog” “‘approved by a MedPedia editor’ is crap as a guarantee” On the enclosed link to your blog, I saw that e-patients want EQUAL (original caps) access to MedPedia as MDs. I assume that means editing and adding articles. Wouldn’t that turn it into a Wikipedia, which as you say “any fool knows can be edited by any fool”? I am NOT implying here that e-patients are fools. I have no idea really what e-patients are. We are all patients… Read more »

e-Patient Dave
Guest

Maggie, if your suggestion that “a different name” is a covert way of suggesting I’m sexist, you have no freaking idea what you’re talking about. (And why not come out and say so?) Your assessment that I think the drug I got is The Drug has nothing to do with this conversation (plus I know it’s not). I pointed to Dr. John Grohol’s dissection of the Medpedia depression entry, not my own. Re Naomi’s credentials: did I impugn her credentials? No, I explicitly cited how she reported something that’s not in the piece she cited. Now, if you’re asserting that… Read more »

Margalit Gur-Arie
Guest

Bravo Maggie!! I am all for patient involvement in treatment decisions and I believe most physicians appreciate the patient that can actively contribute to his/her own care. Just like rbar wrote, if one is dealing with a particular disease either for a long time, or if one is highly motivated and capable of research, that particular patient may very well be ahead of the physician on rare occasions and that is a good thing. However, to suggest that the clinical body of knowledge should be vetted by patients is a bit extreme. One thing that distinguishes the most motivated and… Read more »

rbar
Guest
rbar

JD wrote: “But what the internet has done (not just Wikipedia) is to make it clear that much of the time when it comes to the basics of a disease–causes, symptoms, treatments–there is nothing mysterious or even very difficult about what doctors know, and it is not outside of the grasp of reasonably intelligent people with a decent education. In retrospect, of course, that is obvious, but there has been a cult of the physician that has done much damage in our society and I do look forward to its unwinding.” I among the first to admit that at least… Read more »

maggiemahar
Guest

e-patient Dave– Your comment is a tad . . . condescending. I wonder, if the post had been written by someone with a different name, would you have written “Good heavens, Henry, be careful!” Somehow I think not. Before accusing Naomi of getting the facts wrong, you might want to check out her credentials at the end of hte post. She’s a seasoned jouralist and the post is accurate. But accuracy doesn’t seem to be your main concern. Your comment has very little to do with the post itself, which you seem to be using simply as a jumping off… Read more »

Tim
Guest

I firmly believe that medical professionals and medical doctors are very necessary to a cohesive, comprehensive wellness medical model. Doctors provide necessary evaluations, screenings, tests, diagnoses, prescriptions etc. However, when it comes to getting adequate, timely, comprehensive and prescriptive nutritional advice many doctors fall short. Our medical system is devised to create a force of medical professionals adept at identifying conditions and treating these conditions with drugs. Most are not taught to teach patients how to remedy the condition, prevent the condition or follow a protocol of comprehensive (including natural mechanisms) prevention and management. It is a widely accepted fact… Read more »