Creating a “Living Text of Medicine”: A Q&A with WikiDoc’s Dr. C. Michael Gibson

Dr. C. Michael Gibson is an Interventional Cardiologist & Professor of Medicine at Harvard Medical School. He founded www.wikidoc.org, the world’s most widely viewed open source textbook of medicine where he is Editor-In-Chief of 7,000 contributors. He also served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the Internet to improve medical search results, founded www.clinicaltrialresults.org, and has led his own academic research organization (PERFUSE) for over 25 years. He has been principal investigator of, or has led, core services for 106 clinical trials.

MedTech Boston sat down with Dr. Gibson to discuss his work at WikiDoc and the future of medicine.

Let me start by asking you about the WikiDoc. What made you want to start it?

WikiDoc is a living text of Medicine. By living, I mean that it’s regularly updated and many people from around the world can contribute. It is created on what is called “Wiki” to facilitate collaborative working and horizontal organizational structure where information flows freely to everybody rather than a packed down structure. So, it is bi-directional and participatory process and intended to harness the wisdom of masses.

Having said that if we think back to the middle ages, wisdom was the world is flat and masses got it wrong. So, we need ‘Moderated Wisdom’ where experts moderate on what people are collaborating on in order to have the right answer. Also, standard textbooks don’t really have a peer review. You have one “expert” who pronounces what the truth is but, here, you hold the truth up to the world and allow people to edit and comment.

Dr. C. Michael Gibson

Dr. C. Michael Gibson

And there isn’t any other quality resource that is built on the idea of free to share, copy-left content especially in academia, right?

Yes. The other overriding feature is that it’s Copy-left and redistributable. I think, the world is moving towards “Open Access”. There are some great medical text books out there but someone in a developing country with a salary of $50/month is not going to afford them or access good quality online information. So, I wanted to make something great and free without extra pharmaceutical money or influence. There are plenty of free websites where content on the page is of the size of a postage stamp and advertising constitutes 70% of it.

Now, the other thing is, a lot of people mightn’t have a computer and what they generally have is a smartphone. So, much of our effort is centered around on how can we provide the medical content on what I call the “Micro-chapters” that are tiny bits of information that will download quickly for free and are displayed on universally available mobile devices. That way, a doctor in the office or a field in undeveloped country can readily access the information.

Great. So it does have a mobile application?

Yes, it’s a lot like Wikipedia. Obviously, we can’t transfer all 4 terabytes of information to a smart device. We are working on downloadable ‘Resident Survival Guides’ which are a kind of algorithms to help put things in terms of checklists onto a mobile device that can live there without internet connectivity.

Did your background in clinical research influence you in some way to start that project?

Yes. Some of this was born back in the 1990s when I created a website called “Clinicaltrialresults.org” where everyone could download all the trials from the major studies at one spot. And everyone loved it. And this is where it kind of expanded over to the medical content. Also, having been a chief resident at the Brigham and Women’s Hospital, I never gave away any of my notes. Everyday chief residents around the country are creating content over and over again. So, I realized, why don’t we all share it and come up with the best way to create content on any given topic. You can see websites like Khan Academy doing this these days.

What do you see the future of WikiDoc? Any challenges or opportunities?

We are working a lot on drug pages at present. We want to take all the content that is in the FDA labels and print around the sides so that we have very well-vetted drug pages that are free from any pharmaceutical bias. We also want to improve our Patients’ pages by having world class experts on different diseases who are also expert communicators and can talk to the patients in a YouTube like videos at 6th grader’s level. So, we have a lot of plans and need help from young energetic people. So, anyone who is excited about this is welcomed.

How many people have you employed and how many are the volunteers? And are you a non-profit organization?

Yes, no profits are made from it. We rely on voluntary contributions, most of which has been mine. We have a total staff of 35 including about 20 very dedicated, full-time volunteers who do nothing but work with me on the Wiki day and night. We meet every morning at 8:30 sharp as a team and watch everyone’s progress a day before. We bring up the pages they have been working on and look them over as a team and then comment. We spend a lot of time on how to be entrepreneurial while working on something non-profit and come up with ‘SWOT'(Strengths, Weaknesses, Opportunities, Threats) plan. So, they learn much more than medicine, they learn how to work in teams, communicate and so forth.

Let’s talk a little about contemporary medicine. How is it different today verses when you started out as a medical resident?

Well, everything is completely different and almost unbelievable. When I started out, the doctor was a keeper of the sacred medical information which only he/she had access to and no one questioned the authority of that doctor. Fast forward 30 years, and now we have open-source movement. It is not a one-way conversation anymore. Now, you have an educated patient questioning the doctor about all the options. It is much more participatory and less paternalistic. The vertical command and control structures are failing and there has been great equalization in the power gradient between doctors, nurses and patients.

How do you see the future of medicine especially in this post Affordable Care Act era?

We are in a period of very rapid transition. Medical Information is going to be a commodity, essentially free. And sadly, doctors are treated more and more as shift workers and their autonomy is being neglected. I think you‘ll see them becoming more and more like coaches. They will act as a coach of a team of healthcare providers like NPs and PAs and use their wisdom to integrate all the knowledge to answer difficult questions. So, you will see a lot of primary and preventive care done by paramedical people and doctors would be reserved for situations where you need the specialized knowledge and procedures.

Moreover, I hope, we don’t stop investing in our future through innovation. In our pursuit to curb costs, we have to remember that innovation isn’t free. We are beneficiaries, in the Cardio-vascular space, of the drugs that were developed in past 30 years that have now gone generic. The future innovation, frankly, is going to be in niche areas like Orphan diseases. It is going to require global governmental endeavors and generous efforts of philanthropists to help fund the cures of people with orphan diseases. We’ve learned a lot about those diseases but I sure hope, drugs don’t cost $50,000 or more to treat them.

What advice would you give to the young physicians today especially to Physician-Entrepreneurs?

Let me first say that ordinary people do ordinary things. If you want to be that, you can settle with modestly well paid job as an employee in Healthcare. But if you want to do something extraordinary, then do something different. That’s where entrepreneurs come in. And I hope that our system rewards people who want to be risk-takers and visionaries to make the changes.

Usman Sattar MD

Usman Sattar MD

Usman Sattar is an aspiring Physician/Entrepreneur, former Associate Editor-in-Chief of WikiDoc, Active Member of Society of Physician Entrepreneurs (SoPE) and currently pursuing Masters in Information System & Design at the University of Toronto's iSchool.

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