CardioExchange Archive

CardioExchange’s John Ryan interviews Harvard Medical School professor C. Michael Gibson, founder and editor-in-chief of WikiDoc.org, a “living textbook of medicine” online.

Ryan: Why did you create WikiDoc?

Gibson: Innovation increases as free and open access to information grows. Our mission statement is that “Healthcare is enriched when medical information flows freely.” Traditional textbooks, typically in paper format, are often outdated before they are printed. At best they permit one-way flow of information, with no opportunity for bidirectional exchanges, comments, or reader participation.

Access to traditional print educational content is limited to those who can afford to buy it. The copyrighted material is owned by the publisher and cannot be broadly disseminated or repurposed. Many people now view access to medical information as a right. Although free online content is available, nearly all accessible sites (including society websites) are supported by pharmaceutical and device companies (an exception is the National Library of Medicine).

In late 2005, I created WikiDoc as a free, open-access website that allows an international community of healthcare professionals to “co-create” webpages without requiring that they be familiar with HTML or computer programming. Rather than top-down creation and one-way delivery of content, it is a bottom-up, grassroots, participatory community with bidirectional flow of information. Instead of a vertical organizational structure at a single academic institution, our horizontal structure of co-creation (which we also call “collective genius,” “peering,” or “online collectivism”) has engaged 7082 authors worldwide who have contributed to 200,458 chapters (with 26,625 freely downloadable images) that have been edited 768,180 times.

Our reader-supported site has no funding from pharmaceutical or device companies — and no advertisements. Instead of being copyrighted, the content is legally protected as “copyleft,” which safeguards against control by any individual and ensures free access forever. Visitors can copy, modify, and redistribute the information for their own purposes, as long as the new version grants the same freedoms to others and acknowledges the source or authors of the original content (e.g., parts of this sentence came from WikiDoc).

Our content is increasingly multilingual and organized into “microchapters” that display well on mobile devices, which many healthcare providers in the developing world can access despite being unable to afford print textbooks. The physician and patient content for a given topic are linked together. An overview page is written at the level of a medical student, and the microchapters are written at the level of a subspecialist. There is bidirectional flow of content with Wikipedia, although WikiDoc is targeted at physicians, whereas Wikipedia aims to reach a general readership. Several years ago we launched a sister site, WikiPatient, whose 1200 chapters of content are written at a fifth- to eighth-grade reading level.

About 20 full-time volunteer physicians in Boston curate the content. We meet every morning at 8:30 to set our goals, and again at 4:30 that afternoon to review our progress and address questions. These amazingly dedicated volunteers (our deputy editors-in-chief) labor along with me at night and on weekends. The content is served on Amazon Right Scale, which can recruit an expandable number of servers to scale up as traffic increases. Last month, in 46 hours, the site was visited 4.7 million times (about 2.5 million times daily or 896 million times a year).

Ryan: How do you ensure accuracy on WikiDoc?

Gibson: Traditional textbooks represent the views of highly selected authors. Content on a collaboratively authored site tends to be less biased, as it is based on consensus rather than any individual’s point of view. A discussion page allows a community of writers to openly vet WikiDoc content so that a consensus can be reached. Consensus does have its limitations, lest we forget that the “wisdom of the crowd” once perpetuated the view that the earth was flat and the sun revolved around it. Indeed, it was not until “content experts” like Copernicus, Galileo, and their predecessors were given a voice that the scientific paradigm shifted. Thus, experts have a critical role in moderating the wisdom of the crowd, and our goal is to crowdsource experts. Collaborative authoring on Wikipedia has been shown to be as accurate as Encyclopedia Britannica content or information in a Nature article.

Authors must register via a system that requires a “captcha” to verify they are human, and a team member also reviews their credentials. Prior versions of webpages are stored, and a page can be instantly reverted to any of its previous states if vandalism occurs. WikiDoc authors can choose to be alerted by email when changes are made to a topic that interests them. Only approved users who request permission are allowed to edit drug pages.

Ryan: How have patients responded to the site?

Gibson: Some 57% of patents use the internet to obtain medical information. In the past, doctors were trusted providers who delivered paternalistic, proscriptive information to largely uninformed patients. Guidelines and checklists have represented a great advance, but they tend to deliver one-size-fits-all healthcare. Doctors must now earn the trust of increasingly knowledgeable patients through open dialogue and conversation. Patients now want more-personalized medicine, tailored to both their genome and their envirome (their environmental risk factors). WikiDoc content allows patients to become better-educated consumers of healthcare. For many years, I posted my phone number online, and calls from patients who desired education were some of the highlights of my career.

Ryan: What is the future of WikiDoc?

Gibson: My son is spearheading the creation of board review questions at Harvard Medical School. We are working toward a process of “micro-CME” or “CME on the fly” as physicians access or create content. We hope to provide free content for integration into electronic medical records as part of the health information technology revolution. We have a variety of artificial intelligence initiatives underway and welcome all who would like to get involved. Just email me at charlesmichaelgibson@gmail.com.

Have you used WikiDoc? What are your thoughts about this online venture?