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.
Maggie
That template for that kind of site exists:
http://www.guideline.gov/
brad
Although I have used Wikipedia, I agree that it is not the best source of medical information, for the reasons discussed. For many of my patients I find that recently published articles contain valuable information that helps me provide “state-of-the-art” care. Many of these articles appear in various medical journals to which I don’t subscribe, and require payment to view. However, the cost of these articles can discourage physicians from accessing them. (I have found articles costing as much as $39 to view) I believe that there should be a mechanism whereby a physician can gain free or minimal cost access to medical articles that may assist them in caring for patients.
As a former academic physician I conducted medical research and wrote many articles(for free) that were then published and now others have to pay to read them. Major university hospitals provide free access to articles for their practicing physicians but many physicians in non-university based practice settings are not so lucky. I imagine most physicians are reluctant to pay $20-$40 to read a medical article, particularly when they are uncertain whether the article will contain highly relevant information to their case. Perhaps the federal government could find a way to help physicians gain free or low cost access to articles. This might be done by:
1) mandating that all publications that resulted from federally funded research be accessible “online” for free.
2) creating a low cost annual subscription for online access to most medical journals
Having unlimited access to these articles will ultimately allow physicians to provide better up-to-date care for their patients, and in my mind this is what all physicians should be aiming for.
These days Wikipedia is becoming de-facto standard for any information whether it is related to health care or automobile or research or IT. It is an excellent source of information for any subject matter of interest.
Hi Naomi Freundlich,
These days Wikipedia is becoming de-facto standard for any information whether it is related to health care or automobile or research or IT. It is an excellent source of information for any subject matter of interest.
seems to me you’ve begun to answer your own question by showing how difficult this would be. the piece you refer to says,”nearly 50% of US physicians going online for professional purposes…” while you say “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.” They seem to say different things. And saying they use it for “their” source rather than “a” source prejudices things further yet.
The fact is that people, including docs will, as the song says, go where they want to go and do what they want to do irrespective of the resources available. Spending millions on yet another bureaucracy diverts dollars needed for care while not assuring any improvement in that care.
I think this highlights the problems that doctors face in evaluating the torrent of information that comes at them every day, and the need for a good system to deal with that information. In the end, the only hope for that is government help, a solution that already applies in most of the developed world.
Professional refereed journals, “throwaway” journals sponsored by suppliers, mailings and personal contacts by suppliers, professional scientific meetings, “courses” run by universities and by suppliers, stories in popular media, “curbside” information from colleagues, etc. etc. all deluge the physician. Some of the information from these sources is good, some is biased by commercial factors, some is the result of poorly constructed studies and careerism by researchers, and some is just plain wrong.
What this means is that we need to create ways to filter this information accurately. Many large health care systems have those types of systems in house. There are a few independent sources that are worthwhile — The Medical Letter comes to mind. But by and large most doctors are on their own.
Dan’s suggestions are good. However, the most obvious way to deal with this is the creation of a national clearinghouse for medical information, run by the government and administered by medical scientists. These types of agencies already exist in many other countries. They have been proposed here by the Obama administration and others. Making that information available to both doctors and the public, including on the internet, will be an important part of this. One potential feature of a good national electronic medical record system would be to incorporate references to this information for each case, triggered by providers’ entries of information about patients.
Meanwhile, players like the pharmaceutical industry are already working to undermine this solution, trying to impose rules that would prevent release of accurate information that would harm their commercial interests. The NY Times had an article this week about the drug industry seeking to do just that.
Fifty years ago conscientious doctors could hope to keep current on most of what was happening, at least in their own specialties. Now that is impossible. Good practice standards require good information, and filtering of information is going to be necessary to get good information to doctors. The important thing is going to be to create good ways to do that other than Wikipedia type solutions, and to protect those ways from the influence of forces trying to manipulate the truth for their own financial benefit.
Brad–
Thanks for the link–
Is this something new?
How complete is it (I ask because you refer to it as a template. It certainly looks like a good start.)
Dan-
You write: “we should mandate that all publications that resulted from federally funded research be accessible ‘online” for free.
I agree.
I also agree that physicians, at least, should have access to online subscriptions to medical journals at a reasonable cost. (While printing and mailing hard copies of jouranls is very expensive, it doesn’t cost hte journal very much to put the material online.
Of course, medical journals have to make enough money to pay their staff, printing and mailing costs, etc. It is very hard for some small journals to stay afloat– though they do make money from advertisements.
But a few journals are very profitable –so profitable that one wonders why they can’t make their content available –at least to physicians–at a very low price.
Back in 1999, Dr. Jerome Kassirer resigned as editor of the New England Journal of Medicine, which is owned by the Massachusetts Medical Society, because he felt the Society was turning the Journal into a “business” and making NEJM into a “brand” to help promote the Society’s spinoff journals.
From the Boston Globe: “Although the Massachusetts Medical Society once published figures on the journal’s finances, it has refused to do so in recent years as its profits have soared to estimates of more than $20 million from $386,540 in 1979.
The Society had just built what the Globe described as “plush” headquarters in Waltham Mass and moved teh journal out of the Harvard Medical School and to the new Society headquarters. Kassirer feared this would interfere with the Journal’s editoriall independence.
Subsequently, Marcia Angell became editor–and she was very good. When she came on board, the Society agreed to stop using NEJM as a brand.
I did a quick search, but haven’t been able to find out how profitable NEJM is today. Does anyone know?
Jim==
Two points.
First, other countires have govt’ sponsored registries or “clearing-houses” for information on products and procedures that doctors use all of the time and report are extremely useful.
In the U.S., the VA, Kaiser and Mayo all maintain their own clearinghouses of info drawn from their data base of clinical experience. This is one reason why outcomes are better at the VA, Kaiser and Mayo.
Secondly, it would make sense to ask Google (and other search engines) to consider listing the most reliable sources of medical info first (the new sites Naomi mentions, the site that Brad refers to) rather than listing the most popular sites first.
I would guess that Google and others would be willing to make an exception for medical information. And this would be a huge help not only to doctors, but to patients searching for info online.
Some of Wikipedia’s info is very good. Some isn’t. The fact that Pharm companies (or anyone) can change it is very disturbing.
As a jouranlist, I’ll often look at a Wikipedia report when I’m searching for something, but I would never quote Wikipedia without finding another more secure source to back it up. I don’t know any reputable jouranlist that would use Wikipedia alone or as a “red check” (a confirming source.)
Hey Maggie
Actually, Clearinghouse has been around for a long time. A nice repository of every guideline and consensus statement published. Perhaps template not the right word, but it is the right venue from which to base the model you have in mind (CER, etc., although they have that already as well–past analyses and the like). AHRQ also has the same kind of site for health innovations–things along the QI line. Carolyn Clancy runs a great shop. NOt an accident she still is firmly in place with change in administrations.
Brad
Pat S. and Everyone–
Everyone– I’ve been commetning on this thread
becuase Naomi doesn’t work on Fridays and given the long-week-end probably won’t have a chance to reply until Tuesday.
But I’m sure she’ll have comments too.
Pat S.–
Everything you say makes sense.
We do need one clearing house.
What about the site that Brad cites? http://www.guideline.gov/
Does it give comparative effectiveness info?
I looked at the Up to Date site–looks interesting but the subscription cost is prohibitive for non-physicians. Quite frankly, I think 500 bucks/year for docs is too pricey.
But Medpedia has potential.
I can understand charging a fee, but it ought to be reasonable.
Maggie – interesting post, thanks. Can’t help but think this is indeed becoming a larger trend among the “e” movements where patients and providers are simply becoming extreme consumers of health information rather than co-producers of knowledge or information that can be used to help others. I was recently observing a hospital where they were using google to look up medical questions. What about asking someone they are working with? Or calling a colleague in oncology or pediatrics for example? Embedded in these “e” movements is the term participation. Are we really participating? How could collaboration and participation look different when seeking and producing knowledge?
Thank-you Maggie for filling in!
Brad,
Thanks for the link to the AHRQ’s guideline site; this is the agency that Obama wants to put at the helm of developing a comparative-effectiveness database.
Dan,
I also agree that a reduced rate per article would help docs not affiliated with a major university center access new journal articles.
Pat,
You are right about the unfiltered torrent of information professionals have to sort through. And when someone (like Cochrane, for example) finally does a literature review, they find a wide range of quality and findings in the studies they look at. Having a national clearinghouse will only be truly useful if a larger, unbiased organization is making evidence-based decisions on data and offering guidance on treatment.
Panacea, Carey,
Up-to-Date is often purchased by large medical centers that can easily absorb the cost. The initial price is steep but renewal rates do drop substantially. Plus, the site does not accept advertising or industry access to subscribers.
As for Medpedia (accessible at http://www.medpedia.com), there is real promise with this site. One feature that might help address Carey’s concerns about physician’s not being “co-producers of knowledge;” the site plans to let groups of interest create free communications hubs for themselves and their members.
Another new method for increasing exchanges between physicians–including treatment findings and research–are the social networking sites aimed at doctors. These sites, including Sermo (which claims to have signed up 15% of all practicing physicians)and Medscape Physician Connect (part of WebMD)allow physicians to “talk” amongst themselves about their clinical work. The downside; these sites allow drugs companies and other marketers to “listen in” for a price–obtaining demographic, prescribing and other trend data.
Naomi