http://www.ganfyd.org/deeds/commons.html

Do you have a link where I can see this license?

Best,

-David

EBM Librarian
http://ebmlibrarian.wetpaint.com/

UBC HealthLib Wiki
http://hlwiki.slais.ubc.ca/index.php?title=Main_Page

(Probably not a coincidence that these Wikis are run by librarians and also have review/editorial processes.)

Neither Graham nor I have criticized the technology of Wikis. Anyone who reads this blog knows I’m a big fan of Wikis. I’m pretty solidly on record as a fan of PubDrug and a cautious admirer of Ganfyd.

What I’m opposed to is a medical Wiki intended for clinical reference (informing patient care) that has no quality control. I’m opposed to it because it is dangerous.

Brian, I’m outside the hallowed halls of academia, too. I work in a small, purely clinical hospital library with limited resources. Trust me when I tell you that whatever pains you have felt as a result of these expenses are felt quite keenly in my library.

Like Ken, you’ve incorrectly described my criticism as highlighting vandalism as a cause for concern. Again, malicious vandalism isn’t the problem. The problem is that contributors to AskDrWiki aren’t vetted, and the information added to AskDrWiki isn’t vetted.

Sure, peer-reviewed, edited resources sometimes contain bad information, but at least this is minimized by the existence of an editorial or review process.

I’m glad you agree that “some restriction of contributors is necessary,” and absolutely agree that the question of how to define and manage restrictions is a large and important one. Contrary to what you have implied, I have consistently advocated for contributors to be restricted to qualified medical professionals- I have never suggested limiting participation only to MDs.

Graham and I have both expressed a concern that there is too little review and editorial oversight in AskDrWiki. In response, you have asserted that even WITH peer review and editorial oversight, bad information gets published. So if bad information gets published even WITH quality control measures in place, how much WORSE would the published information be without them?

My worry is that we’ll find out if a medical Wiki is run on Wikipedia-type model rather than on a Citizendium-type model.

Again, thanks so much for sharing your thoughts. I’m really delighted to be participating in a conversation with such engaged, articulate participants.

Best,

-David

A few thoughts. Forgive the length, but just as you are worried about the potential for a medical wiki, I am just as excited!

I think it’s easy to criticize the technology when you may not see the bigger picture. Any time new technology is developed, there are always critics. Whether you choose to contribute, advance the technology or never use it is your decision.

Graham, once you graduate from medical school and venture out into the real world, you will see that many of the ‘abundant’ medical resources we take for granted are no longer there. David, as a librarian, I’m sure that it seems that these resources are all around you. However, as a practitioner outside of the hallowed academic halls, I can safely tell you – they are not. For example, with the financial constraints affecting one of the hospitals I practice in I’ve seen the subscription for Up to Date and several online resources eliminated.

The idea of a medical wiki is not designed to supplant 13 years of my medical education. Instead I hope it to be a resource to improve upon it. Hopefully it can grow into a community of like minded individuals creating a basic resource in medical education available to all levels of people in the medical field. As its contributors multiply, it will develop in scope gaining an ability to self police and misinformation or net vandalism is dealt with even faster than in David’s instance this morning. In fact, in direct response to Graham’s previous malicious posting, several safeguards were instituted in an effort to further prevent future instances.

I also personally believe that some restriction of contributors is necessary, but where do you draw the line? As I hope you both realize by now, in the medical field there are many non-physicians who make significant contribution to expanding medical information and improving patient care. Whether it’s the nurse with observations on the bedside care of the patient, the pharmacist that can offer tips on compounding, or the medical student with enough time on their hands to research a topic in depth or offer tips to improve online medical technology. Should these people be restricted from contributing? What about the PhD in genetics or physiology? Their contributions I know could be more comprehensive than mine in some fields – so why restrict them from the onset? It’s easy to tighten the ropes once something is seen as a significant problem. It’s much harder to loosen them if potential important contributors are scared off by too strict a policy or intimidation by the technology.

As someone who has published and written many medical chapters, reviews and articles I can safely tell you that there is just as much misinformation out there in ‘peer reviewed’ medical journals and text books. I would refer you to the case of “Dr. Jon Sudbo” and his articles published in The Lancet and New England Journal of Medicine. Luckily no one wrote a blog topic entitled “I will never trust The Lancet” In fact, our hope is that a constant review in real time by a medical community with vested interest in the website will allow for a whole new level of peer review. As pointed out in an separate Nature editorial, as the wiki grows – so does the accuracy (see http://www.nature.com/news/2007/070226/full/070226-6.html)

I hope this fuels the discussion. I hope that you give second thought to the use of technology and embrace it in your education and in the care of your patients. It isn’t going away and will only improve in availability and scope by the time you are practicing.

Best Wishes,

Brian Jefferson

What if, on the anaphylaxis page, someone changes the dosage of epinephrine from micrograms to miligrams? Or just changes the decimal point?

If/when the site gets popular, will editors have the time/resources/attention span to catch small but deadly details like that?

I’m all for a consumer site that explains medical information in better detail–most patients are woefully ignorant about medicine–but presenting information as accurate, when it could have been changed, is scary. I agree with David–there need to be better controls, and information should really be reviewed before it’s presented publicly.