Warning!
Copyright by C. Michael Gibson, M.S., M.D.
•
•
You may not copy, display, reproduce, retransmit, store, distribute, disseminate,
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Gibson, M.S., M.D., except as otherwise expressly permitted under applicable
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You may print or download Content for your own personal use. You may not
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directly or indirectly, a collection, compilation, database or directory without the
express prior written permission of C. Michael Gibson, M.S., M.D. You may not
sell, write, modify, redistribute or otherwise use the Content for any commercial
purpose without my prior written permission.
The Future of Medical
Communications
Copyleft by C. Michael Gibson, M.S., M.D.
This material is free for anyone to copy, modify for their
own purposes, and redistribute or use as they see fit, as
long as the new version grants the same freedoms to
others and acknowledges my original work.
Copyleft by CM Gibson
1966 Stillwell Oklahoma
Copyleft by CM Gibson
The World is Flat: One of the Premises
• Innovation increases as open access to
information increases
Copyleft by CM Gibson
Old World vs New World: Organizations
Old World
New World
Symbol: The silo
Symbol: The Globe
Organization: Vertical
Organization: Horizontal
“Command and
Control”
“Cocreation” “Collective
genius” “Peering” “Online
collectivism”
The corner office
Cubicles at Google
Copyleft by CM Gibson
Old World vs New World: Information Flow
Old World
New World
Insular and Secretive
Open Source
Innovate from within
Innovate from without
Knowledge flowed only to
those at the top
Knowledge flows to and
from all
Medium: Paper
Medium: Internet
Copyright
Copyleft
Copyleft by CM Gibson
Old World vs New World: Competition
Old World
New World
Expensive Weapons of
Mass Destruction
Inexpensive Weapons
of Mass Collaboration
Copyleft by CM Gibson
Old World vs New World: Collaboration
Old World
New World
John is the brightest
child in kindergarten
John plays well with
others in kindergarten
Physician as a
“individual player”
Physician as a “team
player”
Promotion depends on
first/last author
publications
Promotion depends
upon more broadly
conceived contributions
and collaboration
Publish or perish
Collaborate or perish
Copyleft by CM Gibson
Old World vs New World: Internet
Old World
New World
Internet 1.0
Internet 2.0
Website with one
directional flow of
information
Participatory community
with bidirectional flow of
information
Think YouTube; MySpace
Copyleft by CM Gibson
Old World vs New World: Media
• The HIT
• The BIG Star
• The ROCK Star
Copyleft by CM Gibson
• The NICHE
• The MICRO Star
• The GARAGE Band
Old World vs New World: Media
• Record label
• One artist sells many
millions
Copyleft by CM Gibson
• iTunes
• Tens of thousands of
unknown artists sell
many millions
Old World vs New World: Media
• Professional
• Mainstream
Copyleft by CM Gibson
• Amateur
• Underground
Old World vs New World: Media
• The blockbuster
• Mass culture
• Access limited to 6 TV
networks, 4 local radio shows
• Network news
Copyleft by CM Gibson
•
•
•
•
The NICHE
The individual culture
Access to unlimited content
Online news
Old World vs New World: Media
• Broadcast one show to
millions
Copyleft by CM Gibson
• Broadcast millions of shows to
one
Old World vs New World: The Truth Standard
Old World
New World
The professor
Consensus & guidelines
Diagnosis: “In my
experience …”
Registry experience of
many physicians
Auscultates murmur
ECHO
Eminence based
therapy: “In my
experience …”
Evidence based therapy:
“In the GUSTO, TIMI
experience …”
Copyleft by CM Gibson
Old World vs New World: Medical Information
Old World
New World
Private
Good
Public
Good
Business Model:
No Business Model:
Author, publisher, journal
personally profit by selling
medical information to
those who can and will pay
for it via either purchase or
subscription
Medical information is now
ubiquitous
No entity should individually
profit by selling medical
information
Copyrighted protection of
journal or publisher
Copyleft distribution to
society
Copyleft by CM Gibson
Limitations to Current Methods of Disseminating
Medical Information
• Textbooks
• Journals
• Websites
• Shouldn’t all three be brought together?
Copyleft by CM Gibson
Current Model: Textbooks
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•
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Paper format
Outdated before it is printed
Represents views of selected authors
Broad community peer review lacking
Text based: No video, no audio, noninteractive, one way flow of information
Copyleft by CM Gibson
The Textbook Business Model
• Material is copyrighted: It is owned by
the publisher, it cannot be broadly
disseminated, it cannot be repurposed
• Access limited to those who can afford
textbook
Copyleft by CM Gibson
Retail Price of Cardiovascular Textbooks in US
Dollars
Braunwald's
Heart Disease
8th Edition
$157 - 190
Copyleft by CM Gibson
Hurst's
The Heart
12th Edition
$170 - 225
Textbook of Cardiovascular
Medicine, Topol
3rd Edition
$217 - 229
Countries with Per Capita Income < 900 US Dollars Per Year
Afghanistan
India
Rwanda
Bangladesh
Kenya
São Tomé and Principe
Benin
Korea, Dem Rep.
Senegal
Burkina Faso
Kyrgyz Republic
Sierra Leone
Burundi
Lao PDR
Solomon Islands
Cambodia
Liberia
Somalia
Central African Republic
Madagascar
Sudan
Chad
Malawi
Tajikistan
Comoros
Mali
Tanzania
Congo, Dem. Rep
Mauritania
Timor-Leste
Côte d'Ivoire
Mongolia
Togo
Eritrea
Mozambique
Uganda
Ethiopia
Myanmar
Uzbekistan
Gambia, The
Nepal
Vietnam
Ghana
Niger
Yemen, Rep.
Guinea
Nigeria
Zambia
Guinea-Bissau
Pakistan
Zimbabwe
Haiti
Papua New Guinea
Copyleft by CM Gibson
Based upon GNI ATLAS Method of the World Bank, www.worldbank.org
General Practitioner and Specialist’s Income
Country
Population
(million)
GP's
Monthly
Salary
(USD $)
Specialist's
Monthly
Salary
(USD $)
1300
7.1
35
50
3800
1128.2
637
1274
7500
8.5
130
155
7800
1323.6
133 - 160
170 - 230
12200
142.3
210
290 - 320
14400
38.2
580
750
43800
301.1
GDP
per capita
USD ($)
Tajikistan
India
Azerbaijan
China
Russia
Poland
United States
Copyleft by CM Gibson
Fact Book 2008
The Future of Medical Publishing
Copyleft by CM Gibson
http://www.mc.vanderbilt.edu/reporter/index.html?ID=5994
What is Copyleft?
• Copyleft is a legal principle which safeguards against
information being controlled by any one person, and
ensures that it remains freely accessible forever.
• All of the information in a copyleft document is free
for anyone to copy, modify for their own purposes,
and redistribute or use as they see fit, as long as the
new version grants the same freedoms to others and
acknowledges the authors of the original article (a
credit or backlink to the original article is sufficient for
this).
Copyleft by CM Gibson
What is a Wiki?
• A Wiki is an open source program that
allows multiple authors to co-create a
webpage.
• The authors do not need to know how to
program in HTML.
Copyleft by CM Gibson
Old World vs New World: Internet
Old World
New World
Internet 1.0
Internet 2.0
Wisdom of the man
Wisdom of the masses
Future World
Internet 3.0
Massive Wisdom
Copyleft by CM Gibson
MediaWiki: The Wiki Software
• What if someone makes a mistake or vandalizes the
site?
– A Wiki is a database, and any page can be
restored to an older version.
• Can there be a discussion about the content?
– Yes. Click on the Discussion tab and there is a
forum.
• How do you know when a change has been made to
a page?
– You can receive an email notifying you a change
was made.
Copyleft by CM Gibson
Wiki’s May Be Less Biased
• Because articles are written based upon
consensus, a Wiki is less susceptible to
retaining bias, a Wiki is very hard for
any group to censor, and a Wiki may be
more rapidly responsive to new
information.
Copyleft by CM Gibson
Internet encyclopaedias go head to head
• In order to test its reliability, Nature conducted a peer review of
scientific entries on Wikipedia and the well-established
Encyclopedia Britannica.
• Reviewers were blinded to the source of information and were
asked to check for errors in 50 articles matched for length.
• Reviewers were asked to look for three types of inaccuracy:
factual errors, critical omissions and misleading statements
• "Only eight serious errors, such as misinterpretations of
important concepts, were detected in the pairs of articles
reviewed, four from each encyclopedia," reported Nature.
Copyleft by CM Gibson
Nature 438, 900-901; 2005
Wikipedia vs Encyclopedia Britannica
http://en.wikipedia.org/wiki/Wikipedia:Errors_in_the_Encyclop%C3%A6dia_Britannica_that_have_been_corrected_in_Wikipedia
Copyleft by CM Gibson
You must pay nature to read the original article
Copyleft by CM Gibson
The World's First Medical Wiki: WikiDoc
Created by C. Michael Gibson, M.S., M.D. in 2005
WikiDoc is the world's first medical wiki which is a living
textbook of medicine that everyone can edit and contribute to.
Uses same software as Wikipedia, but is confined to medical
topics.
Over a thousand authors are contributing at present.
501C3 Foundation
Mission statement: “Healthcare is enriched when medical
knowledge flows freely.”
Copyleft by CM Gibson
WikiDoc: Overview
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Free, no required registration to view site
• No pharmaceutical or device company support
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World’s largest medical textbook
•
Video, audio can be inserted into medical textbook
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Daily news and polling results
• Living guidelines (polling and suggested edits to
guidelines)
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Social network
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Thousands of free downloadable “copyleft” images
•
Multilingual
Copyleft by CM Gibson
WikiPedia vs WikiDoc
• Complimentary
• Bidirectional information flow
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WikiDoc is oriented more to medical professionals
WikiDoc has medical news
WikiDoc has expanded images and videos
WikiDoc has expanded differential diagnoses
WikiDoc has toolbar to search internet
WikiDoc has toolbar on left to see what page most people
looked at next
• WikiDoc has a board review course
• WikiDoc has editors
Copyleft by CM Gibson
WikiDoc
Primary Data Published in
Literature or WikiDoc’s Open Source
Journal Of Medicine
WikiDoc News
(links to textbook
chapters)
WikiDoc Living
Guidelines Polling
related to published
guidelines
WikiDoc Textbook
Chapters Revised
Copyleft by CM Gibson
WikiDoc Polls
WikiDoc Discussion
WikiDoc Content
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•
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Over 75,000 chapters of content
425,000 edits to the pages
Over 1,275 registered authors
Over 19,000 copyleft images
About 25,000 to 75,000 pages viewed
daily
• Over 10 millions pageviews
Copyleft by CM Gibson
WikiDoc:
9th Largest English Language Wiki in the World
1. Wikipedia
2. Lyric Wiki
3. TV IV
4. BibleWiki
5. Archiplanet
6. Local.wikia
7. ArmchairGM
8. ValueWiki
9. WikiDoc
Copyleft by CM Gibson
(Encyclopedia Wiki)
(Music Wiki)
(TV Wiki)
(Bible Wiki)
(Architecture Wiki)
(Local news Wiki)
(Sports Wiki)
(Investing Wiki)
(Medical Wiki)
WikiDoc: Reach
Top 60 Countries That Use The Site
Copyleft by CM Gibson
WikiDoc: Medical Textbook
Sources of Information: Chief residency notes (BI and BWH), CMG board
review notes, National Library of Medicine for drugs, CDC for infectious
disease and public health, Wikipedia, Open Source Journal of Medicine,
Original Contributions
Copyleft by CM Gibson
WikiDoc: Example of a Page
Copyleft by CM Gibson
WikiDoc’s Search Toolbar
Copyleft by CM Gibson
WikiDoc: Social Network
Copyleft by CM Gibson
WikiDoc: News
Copyleft by CM Gibson
WikiDoc: Example of History Function
Copyleft by CM Gibson
WikiDoc: Comparing Versions of a Page
Copyleft by CM Gibson
WikiDoc: Expanded Differential Diagnosis
WikiDoc: Images
WikiDoc: Video
WikiDoc: Pathology
WikiDoc: Board Review
• There will be
the capacity to
add board review
questions on
each page
• Board review
software will
generate random
questions
WikiPatient
Copyleft by CM Gibson
WikiDoc: The Living Guidelines
Amazon Like Functionality
• Software that displays top pages viewed
by others before coming to the present
page
• Software that displays top pages viewed
by others after coming to the present
page
WikiDoc: Is it Achieving Consciousness?
• WikiDoc looks like a webpage, but it is not
• WikiDoc is really a SQL database, and the
content is being displayed from this SQL
database.
• This SQL database is updated by bots that
continually gather new information from
publically accessible databases on the
internet regarding proteins, genes etc.
Copyleft by CM Gibson
WikiDoc as a Research Tool:
• WikiDoc now searches itself to find
associations between symptoms,
physical exam findings and disease
states.
Example of WikiDoc Searching Itself to Create a Full Differential
Diagnosis of the Causes of Headache
WikiDoc searches 64,000 chapters to find all pages with the word
Headache in them
WikiDoc identifies >2,000 chapters associated with Headache
Physician reviews 2,000 chapters to ensure that only those Diseases truly
associated with Headache are included in database
(Excludes treatments of Headache, other symptoms associated with
Headache etc.)
Hundreds of diseases associated with Headache classified by organ
system, and published in a table in WikiDoc
WikiDoc continues to search for any new reference to Headache and adds
this to the database
Differential Diagnosis of Headache
Differential Diagnosis of Headache (cont.)
Differential Diagnosis of Headache (cont.)
Differential Diagnosis of Headache (cont.)
WikiDoc: Database of Differential Diagnoses Can
Be Used for Artificial Intelligence
Fever
Nuchal
Rigidity
Headache
Neutrophilia
…
Meningitis
…
…
…
…
…
…
Meningitis
…
…
…
…
…
Meningitis
…
…
…
…
Meningitis
People who look
up …
Click next on the
page …
Nuchal Rigidity
Meningitis
Headache
Meningitis
How Many Hyperlinks Connect Headache to
Other Diseases?
33
15
CV
Onc
Headache
5
23
ObGyne
Toxin
53
Drugs
27
53
12
12
ENT
Endo
3
5
GI
Heme
ID
Neuro
Can Artificial Intelligence Guess Meningitis?
www.20q.net
WikiDoc: Expert Algorithms
Copyleft by CM Gibson
WikiDoc: Open Source Journal of Medicine
The OSJM
“Front End” for submission of
materials to be placed on Wiki
Open source journal that can be cited
by ISBN number
Peer reviewed, reviews published for
complete transparency, slides and
video available, discussion of article
available
Similar to PLOS (Public library of
Science) effort at UCSF
No adds, no pharma or device
support
WikiDoc’s Business Model
• There is no business model
• WikiDoc accepts no financial support from
•
•
•
the pharmaceutical or device industry
There are no advertisements
A 501C3 non profit foundation has been
created
NPR model: Viewer supported,
philanthropy, volunteer efforts
Copyleft by CM Gibson
We Must Take Back Our Credibility
• Concerns regarding the relationship
between industry and doctors has eroded
the confidence of our patients
• There must be a mechanism(s) whereby
independent and unbiased education of
physicians and patients occurs that is
free of industry support
Copyleft by CM Gibson
Who Can Get Involved?
• Anybody! You do not need to be a doctor
– Students
– Nurses
– Research assistants
– Physician assistants
– Technicians
– Administrators
– Laypeople
Copyleft by CM Gibson
How Can A Student, Resident, or Fellow Get
Credit?
• If you click on the “Permanent Link” button,
this will provide you with a permanent
internet address for your contribution
• You are listed when the main contributors
button is clicked and the number of your
edits are tallied there
• Should you contribute sufficiently, you can
be designated an Assistant Editor- in-Chief
of a topic
Copyleft by CM Gibson
WikiDoc: Quantitating Main Contributors
To A Page
What Can You Do To Help?
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•
•
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•
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First, register, then you can:
Clean pages, add templates, fix links
Help with the differential diagnosis project
Help build the Clinical Trials Wiki
Write a news article
Become an editor of a textbook page: add to it,
watch over it
• Add a copyleft image
Copyleft by CM Gibson
WikiDoc Scholars Program
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Improving functionality (cleaning pages and fixing links)
Building the Clinical Trials Wiki
Building the differential diagnosis database
Teaching others how to edit pages
Creating content in other languages
Adding copyleft pictures and images
Adding questions to the board review course
Writing news stories and integrating news content into the
textbook
• Improving WikiPatient pages
Copyleft by CM Gibson