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What If Healthcare Was Like Wikipedia?

By KIM BELLARD

Last week I wrote about, well, how awful social media has become, so this week it’s nice to write about pretty much the opposite: Wikipedia turned twenty last Friday (January 15). 

In person years that’s not even old enough to buy alcohol, but in Internet years that makes it one of the grand old masters, like Google or Amazon.  Wikipedia is one of the most visited Internet destinations, with its 55+ million articles, in 300+ languages, getting some 10b+ views per month. 

It is something that, by all rights, shouldn’t exist, much less be successful.  A non-profit, volunteer written/edited, online encyclopedia?  An online resource widely trusted for its objective, generally accurate articles in a world of fake news?  As the joke goes, it’s good that it works in practice because it does not work in theory.

That’s sort of the opposite of our healthcare system: it’s good that it works in theory, because it sure doesn’t work in practice.

Wikipedia works due to its army of editors (“Wikipedians”); some 127,000 have edited the English edition alone within the past 30 days.  They work in virtual real time; when someone wins an Oscar the update happens almost immediately.  When the U.S. Capitol was stormed two weeks ago, Wikipedia had a page up before the protesters were gone. 

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Wikipedia: Homeopathy and Evidence for Unpatentable Medications

flying cadeuciiRecently, I have had some interesting conversations with doctors and medical students of Naturopathic Medicine. I am slowly getting involved in editing Wikipedia medicine articles, and I was approached by several proponents of Naturopathic Medicine, who were upset about the following phrases from the Wikipedia article on Naturopathy:

Naturopathic philosophy is based on a belief in vitalism and self-healing, and practitioners often prefer methods of treatment that are not compatible with evidence-based medicine. Naturopathic medicine is replete with pseudoscientific, ineffective, unethical, and possibly dangerous practices.

Of course, they felt this was unfair. In their mind, the Wikipedia article was “wrong” and needed to be fixed and they were frustrated by the tendency for Wikipedia editors to thwart their efforts to “fix” the article.

This put me in an uncomfortable position. I had the option of remaining entirely silent, or informing these followers of Naturopathy of several issues:

  1. Wikipedia has become a “court for facts”. The Wikipedian community focuses on what has become verifiable scientific consensus.

  2. There is very little scientific consensus supporting Naturopathic methods while there is is a substantial amount of scientific consensus opposing some Naturopathic methods.

  3. Naturopathic methods tend to layer “placebo effects” (Ben Goldacre is the inevitable reference for how that works).

  4. These layered placebo effects tend to make the patients of naturopaths and the naturopaths themselves, believe that their methods are way more effective than they actually are.

  5. I have to admit that I fully expected to have a serving of Tim Minchin’s Storm. But what the hell. Why not?? So I jumped and put the basic issues forward.

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UCSF’s Wikipedia Experiment: Should Med Students Get Credit For Curating Medical Information Online?

You’re a loyal THCB reader. You have a symptom. You Google it. One of the first three hits will be an entry about the symptom or an associated condition on Wikipedia.

As an informed lay person, you wonder, “How accurate is Wikipedia for medical information?”

You’ve always been a little skeptical of Wikipedia, but over the years you’ve found it more and more reliable for celebrity tidbits (e.g. “How old is Jane Lynch?” or “What was the name of that guy in “Crash?”) and sports trivia (“How many Super Bowls have the Minnesota Vikings lost?”).

In fact, it’s become quite useful for understanding geopolitics, ancient and recent history, and helping explain science topics (Higgs Boson, anyone?).

So why not medicine?

We in academic medicine look down our noses at Wikipedia. “Show us original texts,” we harrumph. “Where does the original data come from?” we ask our residents and students.

Just like high schoolers and college kids are warned NOT to use Wikipedia as a research tool, medical professors hold the site lowly in regard to seriousness of purpose.

Well, it’s time to accept reality.

We all use it, whether we admit it or not. Some of us a lot. The good news is, Wikipedia’s going to get even better in the medical realm.

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