Wikipedia–bad medicine
The internet has become a great tool for researching information from new gadgets to statistical analysis of politics. One of the most popular websites for research is Wikipedia, an online, democratic encyclopedia. As I have discussed previously, I link to it frequently, to give an overview about a particular topic. I admit I go to the website many times a day to get more information on a topic of interest to me, sometimes just for entertainment, and occasionally to laugh at the quality of articles. Wikipedia functions as a democracy, meaning anyone can edit it. Sometimes it appears that the project is more of an anarchy, but there are “police”, called administrators or admins, and several levels of bureaucracy above the police, to control the situation. The admins are elected by the community of editors. They can block editors (kind of a punishment), and as best as I can tell, every single action by anyone is subject to a lot of yelling, screaming, whining, and complaining. Actually, a social scientist might find the whole system quite fascinating, as I do.
A Wikipedia article is almost always the #1 hit when a google search is done on a subject. This might be useful if you are interested in episodes of 24 or need to know all about the Boston Red Sox. In most cases, the quality of the articles are not a life and death issue. If a Yankees fan chooses to vandalize (yes, that’s the term used by Wikipedia cognoscenti to describe actions that aren’t approved by the general Wikipedia community) the article, I am relatively certain that the world will not collapse into barbarism and a new Dark Age.
Now, if Wikipedia just focused on useful, but not critical to human life articles, I would not be writing a about it. The issue, at least for me, is that Wikipedia is almost always the number one hit for just about any medical issue that I can imagine. The quality of these medical articles range from immorally dangerous to marginally acceptable. Many of the articles are filled with pseudoscience and quackery in describing treatments. Will there come a time that Wikipedia is sued for providing “medical advice” that causes a death? Will an administrator be sued for allowing a quack cure into an article? I’m not a lawyer, but are those admins shielded from litigation?
The legal issues are outside of my base of knowledge. However, analyzing articles for their level of quality is well within my background and skills, and I have examined more than a few of these articles. I group them into three broad categories, ranging from acceptable to poor quality to outright dangerous. Below are some examples:
So, how useful is Wikipedia to patient education? I consider it to be a tool, but not a very good one. I take the time to read the citations, and I determine the quality of those citations based on reading them, and based on the quality of the publication. How many people take the time to do the same? It appears that there are devoted medical and science editors, who do everything they can to make the articles better. But many of them appear to burn out, and leave, which means their pet articles begin to whither, then decompose.
Even though Wikipedia is the usually the first source most people will search for medical information, it is mediocre at best. The quality varies so much that it makes it impossible to know whether an article is useful or not, unless one spends a lot of time reviewing citations. At that point, you almost want to delve into editing it (which I have tried in a limited way). Personally, I recommend UpToDate to anyone who is seeking current, evidence–based medical information.
Just to make sure you aren’t confused by the Wikipedia article, acupuncture has no efficacy not because science is against it. It doesn’t work because there is no science to it.
By Michael W Simpson
A Wikipedia article is almost always the #1 hit when a google search is done on a subject. This might be useful if you are interested in episodes of 24 or need to know all about the Boston Red Sox. In most cases, the quality of the articles are not a life and death issue. If a Yankees fan chooses to vandalize (yes, that’s the term used by Wikipedia cognoscenti to describe actions that aren’t approved by the general Wikipedia community) the article, I am relatively certain that the world will not collapse into barbarism and a new Dark Age.
Now, if Wikipedia just focused on useful, but not critical to human life articles, I would not be writing a about it. The issue, at least for me, is that Wikipedia is almost always the number one hit for just about any medical issue that I can imagine. The quality of these medical articles range from immorally dangerous to marginally acceptable. Many of the articles are filled with pseudoscience and quackery in describing treatments. Will there come a time that Wikipedia is sued for providing “medical advice” that causes a death? Will an administrator be sued for allowing a quack cure into an article? I’m not a lawyer, but are those admins shielded from litigation?
The legal issues are outside of my base of knowledge. However, analyzing articles for their level of quality is well within my background and skills, and I have examined more than a few of these articles. I group them into three broad categories, ranging from acceptable to poor quality to outright dangerous. Below are some examples:
- Acceptable. The best medical article that I have read on Wikipedia is Alzheimer’s disease. It is the second ranked google site for the disease (behind the Alzheimer’s Association website. The article appears to be well written, but it suffers from a jarring style resulting from too many editors participating in the writing. It is extremely well sourced, with over 220 citations (many of them current and from respectable peer-reviewed journals). Wikipedia has tried to create a manual of style for medical articles called MEDMOS, which appears to be an admirable strategy for keeping these articles focused, and it works well with the Alzheimer’s article. Some of the verbiage is very technical and somewhat difficult to follow, almost written for a physician or researcher rather than the average reader. I prefer the technical, but I am not sure most readers would agree with me. The best parts of the article are the diagnosis and management sections. The prevention section gives preference to some ideas that are probably not really useful. The worst part to me is the research directions section which gives a lot of information about clinical trials that may or may not be successful. The article wanders too much from overly simplistic to overly technical, so I wonder about its usefulness to a general population. UpToDate’s patient article about the disease is more readable and less technical. And if you are a physician interested in the evidence-based information about the disease, you can access the more technical information (for a fee, of course). In other words, I’m not appalled by the Wikipedia article, but I doubt that its very useful to the typical reader.
- Poor quality. I admit to not reading every medical article on Wikipedia, but I have read many of them doing research. But my qualitative analysis is that probably 40-50% of the medical articles fit in this area. The articles are mediocre for broad information about a disease or medical procedure, and often times contain information that just isn’t appropriate. As an example, the hypertension article is the number one google search hit, but is poorly written and confusing. For example, the causes section is written like a list, and really doesn’t help the common reader. It also has around 50 sources, some of them of poor quality. The treatment section, probably the reason why anyone goes to these articles, is of such poor quality that I consider it somewhat useless. The graph that describes thresholds of drug therapy is outstanding, and can be followed up with a brief description of medications for each underlying pathology. Other articles similar to hypertension in quality are coronary angioplasty, Rett syndrome, and chickenpox.
- Dangerous. There are so many bad medical articles on Wikipedia, I’m not sure where to start. Acupuncture is a typical article which reads very balanced and neutral, yet makes a nonsense statement like, “there is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is appropriate.” Well, there is no scientific evidence whatsoever for the efficacy of acupuncture in every medical condition studied and published in peer-reviewed journals. Part of the problem is that it’s almost impossible to double blind the trial, since both the patient and the practitioner can’t be fooled. In the best controlled studies, patients actually believed they got better, with or without actual acupuncture–typical placebo effect. Without taking up a lot of bandwidth, Harriet Hall has done a fairly balanced critique of acupuncture. There are worse articles. Urine therapy makes the implication that drinking one’s urine is curative, based on the long history of doing so. Or even the Alzheimer’s disease article in its form over a year ago, where it states that ginkgo biloba as a promising treatment for the disease, when most studies say quite the opposite. Of course, the ginkgo article itself, which is probably under the radar of most of Wikipedia’s medical article is extremely dangerous since it does not clearly state the scientific position, that it does not work for dementia, instead allowing, through the Wikipedia anarchy, to allow contrary opinions. So reading these articles, you would believe that there is a controversy. There isn’t one.
So, how useful is Wikipedia to patient education? I consider it to be a tool, but not a very good one. I take the time to read the citations, and I determine the quality of those citations based on reading them, and based on the quality of the publication. How many people take the time to do the same? It appears that there are devoted medical and science editors, who do everything they can to make the articles better. But many of them appear to burn out, and leave, which means their pet articles begin to whither, then decompose.
Even though Wikipedia is the usually the first source most people will search for medical information, it is mediocre at best. The quality varies so much that it makes it impossible to know whether an article is useful or not, unless one spends a lot of time reviewing citations. At that point, you almost want to delve into editing it (which I have tried in a limited way). Personally, I recommend UpToDate to anyone who is seeking current, evidence–based medical information.
Just to make sure you aren’t confused by the Wikipedia article, acupuncture has no efficacy not because science is against it. It doesn’t work because there is no science to it.
By Michael W Simpson