Warning!Warning! You may not copy, display, reproduce, retransmit, store, distribute, disseminate, modify, publish, broadcast, circulate, create derivative

Warning!Warning!

• You may not copy, display, reproduce, retransmit, store, distribute, disseminate, You may not copy, display, reproduce, retransmit, store, distribute, disseminate, modify, publish, broadcast, circulate, create derivative works from, or sell or modify, publish, broadcast, circulate, create derivative works from, or sell or license any part of the Content, products or services obtained from this talk in license any part of the Content, products or services obtained from this talk in any medium to anyone, including but not limited to others in the same company any medium to anyone, including but not limited to others in the same company or organization, without the express prior written permission of C. Michael or organization, without the express prior written permission of C. Michael Gibson, M.S., M.D., except as otherwise expressly permitted under applicable Gibson, M.S., M.D., except as otherwise expressly permitted under applicable law or as described in these Terms and Conditions or relevant license or law or as described in these Terms and Conditions or relevant license or subscriber agreement.subscriber agreement.

• You may print or download Content for your own personal use. You may not You may print or download Content for your own personal use. You may not engage in systematic retrieval of Content from the slides to create or compile, engage in systematic retrieval of Content from the slides to create or compile, directly or indirectly, a collection, compilation, database or directory without the 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 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 sell, write, modify, redistribute or otherwise use the Content for any commercial purpose without my prior written permission. purpose without my prior written permission.

Copyright by C. Michael Gibson, M.S., M.D.

The Future of Medical The Future of Medical CommunicationsCommunications

Copyleft by C. Michael Gibson, M.S., M.D.Copyleft by C. Michael Gibson, M.S., M.D.

This material is free for anyone to copy, modify for their This material is free for anyone to copy, modify for their own purposes, and redistribute or use as they see fit, as own purposes, and redistribute or use as they see fit, as long as the new version grants the same freedoms to long as the new version grants the same freedoms to others and acknowledges my original work.others and acknowledges my original work.

Copyleft by CM Gibson

1966 Stillwell Oklahoma1966 Stillwell Oklahoma


http://www.amazon.com/exec/obidos/redirect?link_code=ur2&tag=conceptbakery-20&camp=1789&creative=9325&path=http://www.amazon.com/gp/product/0374292884?v=glance&n=283155

The World is Flat: One of the PremisesThe World is Flat: One of the Premises

• Innovation increases as open access to Innovation increases as open access to information increasesinformation increases


Symbol: The silo

Organization: Vertical

“Command and Control”

The corner office

Symbol: The silo

Organization: Vertical

“Command and Control”

The corner office

Symbol: The GlobeSymbol: The Globe

Organization: HorizontalOrganization: Horizontal

““Cocreation” “Collective Cocreation” “Collective genius” “Peering” “Online genius” “Peering” “Online collectivism”collectivism”

Cubicles at GoogleCubicles at Google

Old WorldOld WorldOld WorldOld World New WorldNew WorldNew WorldNew World

Old World vs New World: OrganizationsOld World vs New World: Organizations


Insular and SecretiveInsular and Secretive

Innovate from withinInnovate from within

Knowledge flowed only to Knowledge flowed only to those at the topthose at the top

Medium: PaperMedium: Paper

CopyrightCopyright

Open SourceOpen Source

Innovate from withoutInnovate from without

Knowledge flows to and Knowledge flows to and from allfrom all

Medium: InternetMedium: Internet

CopyleftCopyleft

Old WorldOld World New WorldNew World

Old World vs New World: Information FlowOld World vs New World: Information Flow


Expensive Weapons of Expensive Weapons of Mass DestructionMass Destruction

Inexpensive Weapons Inexpensive Weapons of Mass Collaborationof Mass Collaboration


Old World vs New World: CompetitionOld World vs New World: Competition


John is the brightest John is the brightest child in kindergartenchild in kindergarten

Physician as a Physician as a “individual player”“individual player”

Promotion depends on Promotion depends on first/last author first/last author publicationspublications

Publish or perishPublish or perish

John plays well with John plays well with others in kindergartenothers in kindergarten

Physician as a “team Physician as a “team player”player”

Promotion depends Promotion depends upon more broadly upon more broadly conceived contributions conceived contributions and collaborationand collaboration

Collaborate or perishCollaborate or perish


Old World vs New World: CollaborationOld World vs New World: Collaboration


Internet 1.0Internet 1.0

Website with Website with one one directional flowdirectional flow of of informationinformation


Participatory community Participatory community with bidirectional flow of with bidirectional flow of informationinformationThink YouTube; MySpaceThink YouTube; MySpace


Old World vs New World: InternetOld World vs New World: Internet


Old World vs New World: MediaOld World vs New World: Media

• The HITThe HIT• The BIG StarThe BIG Star• The ROCK StarThe ROCK Star

• The NICHEThe NICHE• The MICRO StarThe MICRO Star• The GARAGE BandThe GARAGE Band



• Record labelRecord label• One artist sells many One artist sells many

millionsmillions

• iTunesiTunes• Tens of thousands of Tens of thousands of

unknown artists sell unknown artists sell many millionsmany millions



• ProfessionalProfessional• MainstreamMainstream

• AmateurAmateur• UndergroundUnderground



• The blockbusterThe blockbuster• Mass culture Mass culture • Access limited to 6 TV Access limited to 6 TV

networks, 4 local radio showsnetworks, 4 local radio shows• Network newsNetwork news

• The NICHEThe NICHE• The individual cultureThe individual culture• Access to unlimited contentAccess to unlimited content• Online newsOnline news



• Broadcast one show to Broadcast one show to millionsmillions

• Broadcast millions of shows to Broadcast millions of shows to oneone


Old World vs New World: The Truth StandardOld World vs New World: The Truth Standard

The professorThe professor

Diagnosis: “In my Diagnosis: “In my experience …”experience …”

Auscultates murmurAuscultates murmur

Eminence based Eminence based therapy: “In my therapy: “In my experience …”experience …”

Consensus & guidelinesConsensus & guidelines

Registry experience of Registry experience of many physiciansmany physicians

ECHOECHO

Evidence based therapy: Evidence based therapy: “In the GUSTO, TIMI “In the GUSTO, TIMI experience …”experience …”



PublicGood

PrivateGood

Old World vs New World: Medical InformationOld World vs New World: Medical Information


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

Copyrighted protection of journal or publisher

No Business Model:

Medical information is now ubiquitousNo entity should individually profit by selling medical information

Copyleft distribution to society


Limitations to Current Methods of Disseminating Limitations to Current Methods of Disseminating Medical InformationMedical Information

• TextbooksTextbooks

• JournalsJournals

• WebsitesWebsites

• Shouldn’t all three be brought together?Shouldn’t all three be brought together?


Current Model: TextbooksCurrent Model: Textbooks

• Paper formatPaper format

• Outdated before it is printedOutdated before it is printed

• Represents views of selected authorsRepresents views of selected authors

• Broad community peer review lackingBroad community peer review lacking

• Text based: No video, no audio, non-Text based: No video, no audio, non-interactive, one way flow of informationinteractive, one way flow of information


The Textbook Business ModelThe Textbook Business Model

• Material is copyrighted: It is owned by Material is copyrighted: It is owned by the publisher, it cannot be broadly the publisher, it cannot be broadly disseminated, it cannot be repurposeddisseminated, it cannot be repurposed

• Access limited to those who can afford Access limited to those who can afford textbooktextbook


Retail Price of Cardiovascular Textbooks in US Retail Price of Cardiovascular Textbooks in US DollarsDollars

Braunwald'sHeart Disease

8th Edition

Hurst'sThe Heart

12th Edition

Textbook of Cardiovascular Medicine, Topol

3rd Edition$157 - 190 $170 - 225 $217 - 229


Countries with Per Capita Income < 900 US Dollars Per YearCountries 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

Based upon GNI ATLAS Method of the World Bank, www.worldbank.orgCopyleft by CM Gibson

General Practitioner and Specialist’s IncomeGeneral Practitioner and Specialist’s Income

Fact Book 2008 Copyleft by CM Gibson

The Future of Medical PublishingThe Future of Medical Publishing

http://www.mc.vanderbilt.edu/reporter/index.html?ID=5994http://www.mc.vanderbilt.edu/reporter/index.html?ID=5994Copyleft by CM Gibson

What is Copyleft?What is Copyleft?

• Copyleft is a legal principle which safeguards against Copyleft is a legal principle which safeguards against information being controlled by any one person, and information being controlled by any one person, and ensures that it remains freely accessible forever. ensures that it remains freely accessible forever.

• All of the information in a copyleft document is free All of the information in a copyleft document is free for anyone to copy, modify for their own purposes, for anyone to copy, modify for their own purposes, and redistribute or use as they see fit, as long as the and redistribute or use as they see fit, as long as the new version grants the same freedoms to others and new version grants the same freedoms to others and acknowledges the authors of the original article (a acknowledges the authors of the original article (a credit or backlink to the original article is sufficient for credit or backlink to the original article is sufficient for this).this).


What is a Wiki?What is a Wiki?

• A Wiki is an open source program that A Wiki is an open source program that allows multiple authors to co-create a allows multiple authors to co-create a webpage.webpage.

• The authors do not need to know how to The authors do not need to know how to program in HTML.program in HTML.



Wisdom of the manWisdom of the man


Wisdom of the massesWisdom of the masses


Old World vs New World: InternetOld World vs New World: Internet


Future WorldFuture World


Massive WisdomMassive Wisdom

MediaWiki: The Wiki SoftwareMediaWiki: The Wiki Software

• What if someone makes a mistake or vandalizes the What if someone makes a mistake or vandalizes the site?site?– A Wiki is a database, and any page can be A Wiki is a database, and any page can be

restored to an older version.restored to an older version.• Can there be a discussion about the content?Can there be a discussion about the content?

– Yes. Click on the Discussion tab and there is a Yes. Click on the Discussion tab and there is a forum.forum.

• How do you know when a change has been made to How do you know when a change has been made to a page?a page?– You can receive an email notifying you a change You can receive an email notifying you a change

was made.was made.


Wiki’s May Be Less BiasedWiki’s May Be Less Biased

• Because articles are written based upon Because articles are written based upon consensus, a Wiki is less susceptible to consensus, a Wiki is less susceptible to retaining bias, a Wiki is very hard for retaining bias, a Wiki is very hard for any group to censor, and a Wiki may be any group to censor, and a Wiki may be more rapidly responsive to new more rapidly responsive to new information.information.


Internet encyclopaedias go head to headInternet encyclopaedias go head to head

• In order to test its reliability, Nature conducted a peer review of In order to test its reliability, Nature conducted a peer review of scientific entries on Wikipedia and the well-established scientific entries on Wikipedia and the well-established Encyclopedia Britannica. Encyclopedia Britannica.

• Reviewers were blinded to the source of information and were Reviewers were blinded to the source of information and were asked to check for errors in 50 articles matched for length. asked to check for errors in 50 articles matched for length.

• RReviewers were asked to look for three types of inaccuracy: eviewers were asked to look for three types of inaccuracy: factual errors, critical omissions and misleading statementsfactual errors, critical omissions and misleading statements

• "Only eight serious errors, such as misinterpretations of "Only eight serious errors, such as misinterpretations of important concepts, were detected in the pairs of articles important concepts, were detected in the pairs of articles reviewed, four from each encyclopedia," reported Nature. reviewed, four from each encyclopedia," reported Nature.

Nature 438, 900-901; 2005Copyleft by CM Gibson

Wikipedia vs Encyclopedia BritannicaWikipedia vs Encyclopedia Britannica

http://en.wikipedia.org/wiki/Wikipedia:Errors_in_the_Encyclop%C3%A6dia_Britannica_that_have_been_corrected_in_Wikipedia


You must pay nature to read the original articleYou must pay nature to read the original article


The World's First Medical Wiki: WikiDocThe World's First Medical Wiki: WikiDoc

Created by C. Michael Gibson, M.S., M.D. in 2005Created by C. Michael Gibson, M.S., M.D. in 2005

WikiDoc is the world's first medical wiki which is a living WikiDoc is the world's first medical wiki which is a living textbook of medicine that everyone can edit and contribute to. textbook of medicine that everyone can edit and contribute to.

Uses same software as Wikipedia, but is confined to medical Uses same software as Wikipedia, but is confined to medical topics. topics.

Over a thousand authors are contributing at present.Over a thousand authors are contributing at present.

501C3 Foundation501C3 Foundation

Mission statement: “Healthcare is enriched when medical knowledge flows freely.”


WikiDoc: OverviewWikiDoc: Overview

• Free, no required registration to view siteFree, no required registration to view site

• No pharmaceutical or device company supportNo pharmaceutical or device company support

• World’s largest medical textbookWorld’s largest medical textbook

• Video, audio can be inserted into medical textbookVideo, audio can be inserted into medical textbook

• Daily news and polling resultsDaily news and polling results

• Living guidelines (polling and suggested edits to Living guidelines (polling and suggested edits to guidelines)guidelines)

• Social networkSocial network

• Thousands of free downloadable “copyleft” imagesThousands of free downloadable “copyleft” images

• MultilingualMultilingualCopyleft by CM Gibson

WikiPedia vs WikiDocWikiPedia vs WikiDoc

• ComplimentaryComplimentary• Bidirectional information flowBidirectional information flow

• WikiDoc is oriented more to medical professionalsWikiDoc is oriented more to medical professionals• WikiDoc has medical newsWikiDoc has medical news• WikiDoc has expanded images and videosWikiDoc has expanded images and videos• WikiDoc has expanded differential diagnosesWikiDoc has expanded differential diagnoses• WikiDoc has toolbar to search internetWikiDoc has toolbar to search internet• WikiDoc has toolbar on left to see what page most people WikiDoc has toolbar on left to see what page most people

looked at nextlooked at next• WikiDoc has a board review courseWikiDoc has a board review course• WikiDoc has editorsWikiDoc has editorsCopyleft by CM Gibson

WikiDocWikiDoc

Primary Data Published inLiterature or WikiDoc’s Open Source

Journal Of Medicine

WikiDoc News (links to textbook chapters)

WikiDoc Textbook Chapters Revised

WikiDoc PollsWikiDoc Discussion

WikiDoc Living Guidelines Polling related to published guidelines


WikiDoc ContentWikiDoc Content

• Over 75,000 chapters of contentOver 75,000 chapters of content

• 425,000 edits to the pages425,000 edits to the pages

• Over 1,275 registered authorsOver 1,275 registered authors

• Over 19,000 copyleft imagesOver 19,000 copyleft images

• About 25,000 to 75,000 pages viewed About 25,000 to 75,000 pages viewed dailydaily

• Over 10 millions pageviewsOver 10 millions pageviews


WikiDoc:WikiDoc:

1.1. WikipediaWikipedia (Encyclopedia Wiki)(Encyclopedia Wiki)

2.2. Lyric Wiki Lyric Wiki (Music Wiki)(Music Wiki)

3.3. TV IV TV IV (TV Wiki)(TV Wiki)

4.4. BibleWiki BibleWiki (Bible Wiki)(Bible Wiki)

5.5. Archiplanet Archiplanet (Architecture Wiki)(Architecture Wiki)

6.6. Local.wikia Local.wikia (Local news Wiki)(Local news Wiki)

7.7. ArmchairGM ArmchairGM (Sports Wiki)(Sports Wiki)

8.8. ValueWiki ValueWiki (Investing Wiki)(Investing Wiki)

9.9. WikiDocWikiDoc (Medical Wiki)(Medical Wiki)

9th Largest English Language Wiki in the World


WikiDoc: ReachWikiDoc: Reach

Top 60 Countries That Use The SiteTop 60 Countries That Use The Site


WikiDoc: Medical TextbookWikiDoc: 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


WikiDoc: Example of a PageWikiDoc: Example of a Page


WikiDoc’s Search ToolbarWikiDoc’s Search Toolbar


WikiDoc: Social NetworkWikiDoc: Social Network


WikiDoc: NewsWikiDoc: News


WikiDoc: Example of History FunctionWikiDoc: Example of History Function


WikiDoc: Comparing Versions of a PageWikiDoc: Comparing Versions of a Page


WikiDoc: Expanded Differential DiagnosisWikiDoc: Expanded Differential Diagnosis

WikiDoc: ImagesWikiDoc: Images

WikiDoc: VideoWikiDoc: Video

WikiDoc: PathologyWikiDoc: Pathology

WikiDoc: Board ReviewWikiDoc: Board Review

• There will be the capacity to add board review questions on each page

• Board review software will generate random questions

WikiPatientWikiPatient


WikiDoc: The Living GuidelinesWikiDoc: The Living Guidelines

Amazon Like FunctionalityAmazon Like Functionality

• Software that displays top pages Software that displays top pages viewed by others viewed by others beforebefore coming to the coming to the present pagepresent page

• Software that displays top pages Software that displays top pages viewed by others viewed by others afterafter coming to the coming to the present pagepresent page

WikiDoc: Is it Achieving Consciousness?WikiDoc: Is it Achieving Consciousness?

• WikiDoc looks like a webpage, but it is notWikiDoc looks like a webpage, but it is not

• WikiDoc is really a SQL database, and the WikiDoc is really a SQL database, and the content is being displayed from this SQL content is being displayed from this SQL database.database.

• This SQL database is updated by bots that This SQL database is updated by bots that continually gather new information from continually gather new information from publically accessible databases on the publically accessible databases on the internet regarding proteins, genes etc.internet regarding proteins, genes etc.


WikiDoc as a Research Tool: WikiDoc as a Research Tool:

• WikiDoc now searches itself to find WikiDoc now searches itself to find associations between symptoms, associations between symptoms, physical exam findings and disease physical exam findings and disease states. states.

Example of WikiDoc Searching Itself to Create a Full Differential Example of WikiDoc Searching Itself to Create a Full Differential Diagnosis of the Causes of HeadacheDiagnosis of the Causes of Headache

WikiDoc searches 64,000 chapters to find all pages with the word WikiDoc searches 64,000 chapters to find all pages with the word Headache in themHeadache 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 Hundreds of diseases associated with Headache classified by organ system, and published in a table in WikiDocsystem, and published in a table in WikiDoc

WikiDoc continues to search for any new reference to Headache and adds WikiDoc continues to search for any new reference to Headache and adds this to the databasethis to the database

Differential Diagnosis of HeadacheDifferential Diagnosis of Headache

Differential Diagnosis of Headache (cont.)Differential Diagnosis of Headache (cont.)



WikiDoc: Database of Differential Diagnoses Can WikiDoc: Database of Differential Diagnoses Can Be Used for Artificial IntelligenceBe 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 How Many Hyperlinks Connect Headache to Other Diseases?Other Diseases?

33

23

CV

53

Toxin

Drugs 12

ENT12

Endo

3

GI

5

Heme

53

ID

27

Neuro

5

ObGyne

15

Onc

HeadacheHeadache

Can Artificial Intelligence Guess Meningitis? Can Artificial Intelligence Guess Meningitis? www.20q.netwww.20q.net

WikiDoc: Expert AlgorithmsWikiDoc: Expert Algorithms


WikiDoc: Open Source Journal of MedicineWikiDoc: Open Source Journal of Medicine

““Front End” for submission of Front End” for submission of materials to be placed on Wikimaterials to be placed on Wiki

Open source journal that can be cited Open source journal that can be cited by ISBN numberby ISBN number

Peer reviewed, reviews published for Peer reviewed, reviews published for complete transparency, slides and complete transparency, slides and video available, discussion of article video available, discussion of article availableavailable

Similar to PLOS (Public library of Similar to PLOS (Public library of Science) effort at UCSFScience) effort at UCSF

No adds, no pharma or device No adds, no pharma or device supportsupport

The OSJM

WikiDoc’s Business ModelWikiDoc’s Business Model

• There is no business modelThere is no business model

• WikiDoc accepts no financial support from WikiDoc accepts no financial support from the pharmaceutical or device industrythe pharmaceutical or device industry

• There are no advertisementsThere are no advertisements

• A 501C3 non profit foundation has been A 501C3 non profit foundation has been createdcreated

• NPR model: Viewer supported, NPR model: Viewer supported, philanthropy, volunteer effortsphilanthropy, volunteer efforts


We Must Take Back Our CredibilityWe Must Take Back Our Credibility

• Concerns regarding the relationship Concerns regarding the relationship between industry and doctors has eroded between industry and doctors has eroded the confidence of our patientsthe confidence of our patients

• There must be a mechanism(s) whereby There must be a mechanism(s) whereby independent and unbiased education of independent and unbiased education of physicians and patients occurs that is physicians and patients occurs that is free of industry supportfree of industry support


Who Can Get Involved?Who Can Get Involved?

• Anybody! You do not need to be a doctorAnybody! You do not need to be a doctor– StudentsStudents– NursesNurses– Research assistantsResearch assistants– Physician assistantsPhysician assistants– TechniciansTechnicians– AdministratorsAdministrators– LaypeopleLaypeople


How Can A Student, Resident, or Fellow Get How Can A Student, Resident, or Fellow Get Credit?Credit?

• If you click on the “Permanent Link” button, If you click on the “Permanent Link” button, this will provide you with a permanent this will provide you with a permanent internet address for your contributioninternet address for your contribution

• You are listed when the main contributors You are listed when the main contributors button is clicked and the number of your button is clicked and the number of your edits are tallied thereedits are tallied there

• Should you contribute sufficiently, you can Should you contribute sufficiently, you can be designated an Assistant Editor- in-Chief be designated an Assistant Editor- in-Chief of a topicof a topic


WikiDoc: Quantitating Main Contributors WikiDoc: Quantitating Main Contributors To A PageTo A Page

What Can You Do To Help?What Can You Do To Help?

• First, register, then you can:First, register, then you can:• Clean pages, add templates, fix linksClean pages, add templates, fix links• Help with the differential diagnosis projectHelp with the differential diagnosis project• Help build the Clinical Trials WikiHelp build the Clinical Trials Wiki• Write a news articleWrite a news article• Become an editor of a textbook page: add to it, Become an editor of a textbook page: add to it,

watch over itwatch over it• Add a copyleft imageAdd a copyleft image


WikiDoc Scholars ProgramWikiDoc Scholars Program

• Improving functionality (cleaning pages and fixing links)Improving functionality (cleaning pages and fixing links)• Building the Clinical Trials WikiBuilding the Clinical Trials Wiki• Building the differential diagnosis databaseBuilding the differential diagnosis database• Teaching others how to edit pagesTeaching others how to edit pages• Creating content in other languagesCreating content in other languages• Adding copyleft pictures and imagesAdding copyleft pictures and images• Adding questions to the board review courseAdding questions to the board review course• Writing news stories and integrating news content into the Writing news stories and integrating news content into the

textbooktextbook• Improving WikiPatient pagesImproving WikiPatient pages


Documents

Warning!Warning! You may not copy, display, reproduce, retransmit, store, distribute, disseminate, modify, publish, broadcast, circulate, create derivative