Web Watch: Living in the brave new world of medical wikis

By Jessica Berthold
Welcome to Web Watch, a new ACP Internist column about interesting and informative medical Web sites.
To those who know their way around a keyboard, the buzz these days is all about “wikis”—communal Web sites that anyone can help create or edit.
Medical and health wikis are springing up fast, with subjects ranging from medical billing to flu preparedness. Some are geared toward consumers; others are clearly for health professionals and scientists (Neurodegeneration Research Wiki, anyone?)
One of the most popular is AskDrWiki, started a year ago by four cardiology fellows at the Cleveland Clinic. A general medical wiki that skews toward cardiology, the site comprises review articles, clinical notes, pearls and medical images from doctors around the world.
Web sites such as AskDrWiki provide speed and ease when accessing clinical information.
When the site started, anyone could add or edit content. Over time, and after receiving feedback from users, however, the founders decided AskDrWiki needed to operate differently from other wikis, due to the potential for harm to patients if inaccurate information were posted.
Now, contributors to AskDrWiki must be licensed clinical professionals who have proven their credentials to the site administrators, Ken Civello, MD and Brian Jefferson, MD. The two doctors are alerted when new material is posted, and they review it promptly. Contributors’ names are clearly listed on the site and in some cases, their curriculums vitae are posted as well. Studies are referenced.
Most importantly, said Dr. Civello, only two people are allowed to edit medication dosage information.
“The way you are going to hurt people is with medication, so anything that has a medication dosage, or any page in the pharmacology section, is edited only by me or the pharmacist on our team,” he said.
So why would anyone use a restricted wiki, instead of a well-established textbook, for medical information?
Speed and ease, said Dr. Civello.
“The problem with textbooks is that by the time the chapter is published, it’s been a year since it’s been written, so it’s out of date,” Dr. Civello said.
At the moment, AskDrWiki is used mostly by medical students and residents, and in an ancillary way, Dr. Civello said.
“I think the majority of the people who use the site are looking for a differential diagnosis, or to jar their memories,” Dr. Civello said. “It’s sort of a reference to supplement what they already know.”
David Rothman, a medical librarian and creator of a popular blog about his discipline, thinks medical wikis can be a useful starting point for doctors to do research—much as a high school student might use Encyclopaedia Brittanica or Wikipedia. “An inadvisable use would be to stop one’s research there,” he said.
The traits to look for in a reliable medical wiki include a detailed editorial policy; a review process for submitted information; verification of contributors’ credentials; a clear listing of the names of editors and administrators; and frequent revisions of content, Mr. Rothman said.
“It is as ridiculous to say ‘wikis are good’ or ‘wikis are bad’ as it would be to say that ‘books are good’ or ‘books are bad.’”—David Rothman
Aside from AskDrWiki, two other high-quality, general interest medical wikis are PubDrug, a drug information database; and ganfyd, a general medical wiki, said Mr. Rothman, who has a comprehensive list of medical wikis on his site. He also noted that medical publisher Elsevier recently launched WiserWiki, which includes content from its “Textbook of Primary Care Medicine” by John Noble.
“Each wiki must be evaluated on its own merits in the same sense that any book must be examined on its own merits,” Mr. Rothman said. “It is as ridiculous to say ‘wikis are good’ or ‘wikis are bad’ as it would be to say that ‘books are good’ or ‘books are bad.’”