Is a medical Wikipedia a good idea?

I had wanted to proceed to part 5 of my Medicine and Evolution series, but, frankly, I wasn’t much in the mood for anything serious over the weekend, and, let’s face it, that case of the blog blahs continued even into yesterday. Otherwise I would have done my blog buds Abel Pharmboy and Bora more of a solid and tackled this a bit earlier, rather than posting about Jack Chick parodies and fluff about a possible new Star Trek movie.

Spurred on by Bora over at Science and Politics, Abel Pharmboy at Terra Sigillata has been discussing scienceblogging, whether it would be a good idea for science bloggers to publish hypotheses and data on their blogs. More relevant to me, he’s also brought up the question of whether starting up a medical Wikipedia would be a good idea, while linking to this article about the first five years of Medscape and this editorial by Peter Frischauf, who strongly argues for a medical Wikipedia (free registration required).

I’m not going to comment extensively about whether publishing data and hypotheses on a blog is a good thing, whether it can be a new way to disseminated scientific information, but I will comment briefly. For science, certainly getting ideas out there is a good thing, but from a career standpoint, I have very grave doubts over whether publishing such information is advisable, particularly for young scientists who could easily be scooped by larger, more established labs. I would never recommend that any young scientist publish a hypothesis that way, unless it is a hypothesis that he doesn’t intend to test (whether because of lack of resources or whatever) but is hoping to get another group interested in.

While I also agree with Bill Hooker that blatant scooping is despicable and that scientists who practice it as blatantly as the example he cites should be shunned, I’m not as sanguine as him about actually making such a culture change come about any time soon. Besides, most cases of scooping aren’t nearly as blatant as the one he describes. Most are a lot more subtle, and the vast majority don’t involve any chicanery at all. Indeed, in my experience, most cases involve multiple labs working on the same question. In such cases, one of these groups will inevitably succeed at publishing their results first, and the rest will be “scooped,” no dishonesty or using ideas or experimental protocols without appropriate attribution necessary. Important questions in science often attract multiple labs to solve them. If the principle investigator of a lab in a hot area of research publishes ideas and data that give his competitors, who were already working on the same question, a leg up, either by informing them of a blind alley that they shouldn’t waste time pursuing or of a promising experiment to try that is highly related to what the other lab was doing anyway, then the PI prematurely revealing his ideas has no one to blame but himself for getting “scooped.” (In fact, I wouldn’t even call it getting “scooped.”) Besides, in the case of a junior scientist accusing a big name in his field of scooping him, who’s most likely to be believed? True, it’s not fair, but that’s the way the world works, and not just in science. In an ideal world, Bill Hooker’s concept would be the way things should work and any hint that labs might be scooping each other would result in offers of collaboration, but that isn’t always how things actually work. Besides, competition is not always a bad thing in science; it spurs investigators on in a way that even a scientists’ love of discovering something new can’t always do.

Maybe I’m just turning into a cynic in my middle age.

As for a medical wikipedia, although the idea sounds superficially tempting, I reluctantly remain skeptical of the idea. The whole concept behind a Wikipedia is that anybody can contribute articles or edit currently existing articles. Indeed, Wikipedia’s slogan is “the free encyclopedia that anyone can edit” regardless of qualifications. However, I have grave doubts about whether this could work so well in medicine. For one thing, allowing anybody to contribute would open the door to any number of quacks, alties, and activists to alter articles to push their favorite forms of pseudoscience and quackery. Even though there are safeguards in place at Wikipedia to try to prevent this sort of chicanery, it doesn’t take much imagination to predict that Generation Rescue or SafeMinds would hijack any articles on autism, vaccines, or mercury to fit their agenda that claims that mercury from vaccines is the primary cause of autism in children, despite all the evidence to the contrary, or that organizations made up of HIV/AIDS “skeptics” would try to alter articles on AIDS, HIV, antiretroviral drugs, and related topics to enshrine their bad science in what would certainly become a major resource for medical information targeted at the lay public. Similarly, it’s not hard to imagine individual dubious practitioners like Dr. Rashid Buttar trying to edit articles on chelation therapy or various alternative medicine practitioners trying articles on homeopathy to make these treatments sound effective. Indeed, having been involved with the refutation of Holocaust denial, I know that some of my fellows in the fight against Holocaust denial have become active in Wikipedia because Holocaust deniers frequently try to alter articles on the Holocaust and various death camps to minimize or deny the magnitude of the atrocity. Any dedicated medical wikipedia would require a large number of expert volunteers to do the same. Where will these experts come from?

The very concept behind Wikipedia is that “exposing an article to many users will result in accuracy,” and that is presumably what would keep the dire predictions I made above from happening. Maybe so. However, here’s the problem with that concept in medicine. Activists and alties tend to have lots more time and, more importantly, lots more motivation than scientists and physicians who are experts in the field, and they would use them to distort the information on such a medical wikipedia. It would be a constant battle. Volunteers with real credentials would be hard pressed to keep up with all the attempts at editing controversial articles, unless there were some sort of mechanism in place to limit who could edit articles. Indeed, nearly everyone discussing a medical wikipedia seems to recognize implicitly that a true open wikipedia would probably not work in medicine, because nearly everyone I’ve seen who brings up the topic seems to qualify it by saying that contributors would have to register and have their qualifications checked. But who would determine what qualifications for which topic are sufficient or appropriate? (Remember, a fair number of purveyors of dubious treatments are doctors.) How many people would it take to evaluate potential new contributors? And, if there is an “entrance” test for contributors, then would this medical wiki really be a wikipedia at all? Would it not be, instead, simply a more rapidly updated real time version of medical sites like WebMD or Medscape rather than a true wiki? (Not that such a rapidly updated resource wouldn’t have the potential to be a very good thing indeed for patients. It would.)

Finally, I also have to disagree with Peter Frischauf’s questioning of whether the traditional model of peer-reviewed articles is obsolete. His complaints, that publishing is too slow and sometimes results are out of date by the time they are published, are valid. However, the solution is not to abandon the model that has served us so well for so long, but rather to develop ways of more rapidly publishing results and widely disseminating them. For example, many medical journals it can take a year or more from the date of first submission before an article sees print (it’s usually half that in basic science journals), even though the time for peer review for the two types of journals does not differ all that much. There is no reason that couldn’t be sped up considerably if we are wiling to invest the resources. Also, distributing the results widely and for free, as the NIH is now doing by requiring that all accepted manuscripts be registered and submitted to a database.

Finally, he states:

For readers, Wikipedia is a win. In traditional publishing, readers must wade through many articles on a subject, each written by a few experts, published at 1 moment in time. In Wikipedia you read 1 living article written by many, continually updated by many. Who needs 50 articles on avian flu when 1 will do? And Wikipedia content is often the best on the Web, which means the best anywhere.

This is so overly optimistic that I have to wonder if Frischauf has actually evaluated a large number of Wikipedia articles. In my experience, at least, Wikipedia content can be maddenly uneven in its quality and completeness. Some of it is excellent; most of it is merely adequate; some of it is useless. It’s way too hit-or-miss to be used as a primary resource for information, particularly specialized information, without evaluation of additional sources.There is no reason to think that a medical wikipedia would be any different. Wikipedia is a useful tool as a first pass at obtaining information on a variety of topics and getting ideas about where to look for more information, but for the vast majority of topics it doesn’t usually provide much in-depth analysis. (It is, however, very useful to bloggers as a source to link to when they don’t want to explain a term that they are using.) Frischauf vastly overrates the probable utility of a medical wikipedia when he uses an example of one article on avian flu being likely to replace 50 articles, and, by extension, implying that most of the articles on a medical Wikipedia would ever allow one article to replace many. Wikipedias, by their very nature, tend to be far too generalist for that.

Now that I’ve played the role of a the curmudgeon and given all sorts of reasons why I think a medical wikipedia is a problematic idea, let me just say that I’m quite aware that a lot of the same criticisms were leveled at the original Wikipedia, and it seems to be doing pretty well. Indeed, there are studies that show it having a similar error rate to more established sources, like encyclopedias. Although I remain skeptical that the wikipedia concept can be so easily translated to the medical realm in a manner that is accurate and useful for patients, physicians, and medical scientists, I for one would certainly be willing to give it a shot, if only because it’s an idea whose implementation is probably inevitable now that the concept has started to be discussed in the medical blogosphere. Someone is going to set one up, regardless of what one slightly popular medical/scientific blogger says.

Of course, if I ever signed on to be a medical Wikipedian, I’d probably have to give up blogging to do it, and I certainly don’t want to do that any time in the foreseeable future.