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Online encyclopedia provides free health info for all Within a decade, has become one of the most popular health-content web sites in the world. James Heilman talks to Fiona Fleck about how the once free-wheeling website is moving closer to a formal publication model.

Q: How have the health and medical articles evolved since Wikipedia was established? James Heilman is one of the primary editors of A: Wikipedia was started in 2001 by Wikipedia’s health and medical content, who – like all a group of volunteers interested in shar- the online encyclopedia’s collaborators – contributes ing knowledge and had some health-care on a voluntary basis. He was appointed head of the content from the start. The medical side department of at East Kootenay of things was more formally organized Regional Hospital in Cranbrook, Canada, in October of in 2004, when internist Dr Jacob Wolff, last year, after having worked there as an emergency who is based in the United Kingdom, since 2010. He also teaches at the University started Wikiproject Medicine. I joined WHO/F Fleck the project in 2007. Wikipedia is trying James Heilman of British Columbia. In 2000 he graduated in Anatomy to summarize all human knowledge, from the University of Saskatchewan, where he earned which includes health knowledge. Most his medical degree in 2003. Since then, he has spent most of his career working topics are covered and, if one is not, us- in emergency medicine, teaching and writing. ers can create it – as long as they provide suitable references. Wikipedia’s medical and health content is driven by its edi- tors and what they are interested in. A: We have several efforts to im- top importance, the content must be of prove the quality of the content. As global interest, covering a health condi- Q: How did you become so involved in part of one of those, we have selected 80 tion that causes high morbidity and/or editing health-care content? articles in English, each covering core mortality. We are currently working to A: We work hard to ensure that health or medical topics, and we are improve the quality of these 80 articles Wikipedia’s content is accurate and up to working to raise these up to a profes- of top importance, to eventually give date. With the open editing platform, we sional standard. This work is followed by them “good article” status. That means can donate as much or as little time as we a semi-formal peer review by volunteers they must undergo a semi-formal like, and we encourage other volunteers – so far we have completed 20 articles peer review and pass certain quality to join us. I personally became involved – and, finally, translation into as many criteria involving accuracy, scope and when I found some poor quality content other languages as possible in collabora- referencing. and realized that I, myself, could fix it. tion with Translators Without Borders. Later on, when I realized what a key We have already begun translation into Q: What’s the difference between Wiki- source of public health information more than 30 languages and hope that pedia and other encyclopedias? What Wikipedia had become, I became even we can eventually translate this content is its added value, apart from being free more involved. into all of the 285 languages in which and online? Wikipedia exists. Some of our 80 core A: One of the benefits of Wiki- Q: What have you and your colleagues articles are also going through a more pedia is that it’s easy to access and built up in these eight years in terms of formal peer-review process via Open update. Print-based encyclopedias are health-care content? Medicine, our open-access journal part- often years out of date and can take a A: Wikipedia’s health-care content ner. This means that some of the content long time to correct. Some online re- is made up of about 25 000 articles in will be indexed in PubMed and there sources have excessive advertising and English and this content is viewed about will be opportunities for the authors to there are reasonable concerns that this 200 million times a month. The articles get formal recognition. If put together as can introduce bias into their articles. range from a few hundred to more than a textbook, these 80 articles, would run Other online sources charge member- 10 000 words in length. Wikipedia is cur- to about 2000 pages. While Wikipedia ship fees. And, of course, no resource rently the most used online health-care contains much content supported by the is available in as many languages as resource globally, as measured by page Cochrane Collaboration, we are devel- Wikipedia. view and by unique visitors, and is used oping a mechanism to update this in a extensively by professionals and the lay timely fashion. Several editors are also Q: Have you ever considered taking public alike. It is the web site most used working to persuade more health-care advertising? by medical students except for Google professionals to join us in our efforts. A: Many claim that they can main- and it is consulted by most practising tain neutrality in editorial content while in the developed world. Q: How did you select these 80 core topics? running advertisements, but we doubt A: We rank our articles by quality whether this is possible and we don’t Q: You have amassed a vast body of work and importance. We have four levels want to take that risk. Many people that is clearly useful, but you yourselves of importance − low, middle, high and rightly recognize the effect of advertis- admit that the quality is “hit and miss.” top importance − and there are criteria ing and this is one reason why we are so What are you doing to address this? for each category. For an article to be of widely read.

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Q: You mentioned the importance of good article on “refractory chronic gout.” or a cell phone. Within this project we references, what is your policy on these? Savient Pharmaceuticals manufactures are concentrating on content that is of A: Before 2007, references were pegloticase, an intravenous medication particular importance to those in the recommended but not strictly required. for the treatment of this condition. The developing world and on translating Since then, there has been a push to community of editors felt that the topic it into the languages people speak in increase referencing. Those of us who did not merit being treated separately those countries. We have entered into deal with medical subject matter pre- from “gout” and so the article on “refrac- agreements with several cell phone fer secondary over primary sources tory chronic gout” was deleted and its companies, who have agreed to allow because reviews, insofar as they sum- readers were redirected to the article on browsing of Wikipedia content without marize the primary literature, provide gout. All Wikipedia contributors need data charges to all of their customers in a more comprehensive understanding to support what they add with credit- Africa, the Middle East, South-East Asia of a given topic than primary sources. able sources. This example shows that if and eastern Europe. Once fully rolled They are, therefore, more in tune with references for a new disease or condition out, this will be of benefit to more than our efforts to portray the most current are not supported by reliable secondary 200 million people. As of October 2012, state of knowledge on a topic. As an sources, then the article in question will rollout had started in 10 countries and is encyclopedia written by contributors, be deleted. set to continue through 2012 and 2013. most of whom are anonymous, Wikipe- We are also beginning to create spoken dia is now extremely densely referenced. versions of the articles, in English and Added text must stand entirely on its other languages. English is currently sources rather than on the expertise of Someone once the main language on Wikipedia, with the contributor. Thus, it is very much an said“ ‘Wikipedia doesn’t more than four million articles, and is evidence-based effort. work in theory, it only followed by German, French and Dutch works in practice’ and each with more than one million articles. Q: How do you do due diligence on anonymous contributors? it’s true. Q: In which developing countries do you A: There are arguments in favour of have contributors and who are they? and against the anonymity of Wikipedia ” A: Wikipedia has contributors from editors. Some feel that no one should use all over the world. Anyone with internet his or her real identity because the idea Q: Does all content that is backed by access can potentially get involved. is to create an encyclopedia based ex- strong evidence merit inclusion? The Wikipedia Foundation is working clusively on sources. Even when people A: We have policy and guidelines with universities in Egypt to improve do use their real names, we, as an orga- on this as well. What we include is ul- our Arabic language content. An office nization, have no method for verifying timately based on consensus, attained has recently been opened in India to that contributors are who they say they through discussion on the article’s “talk get more people involved there. Many are. A few years ago, an editor claimed page.” We have found that the number of countries or regions have national chap- he was a religious studies professor. It people who want to contribute positively ters – we are up to 39 – that promote the turned out to be a fabrication. We have is far greater than those who wish to locally. nearly 18 million registered editors and contribute nefariously. We allow every- many more anonymous ones. We do one to edit and we assume everybody Q: Tell us more about the Wikipedia not have the resources to verify each has good intentions until they prove us Foundation. one’s identity and prefer to concentrate wrong, in which case we take preven- A: The Wikimedia project is sup- our efforts on writing an encyclopedia. tive measures by blocking the offending ported entirely by donations from Text, thus, must be supported by cred- party’s IP address or restricting the edit- the general public. Money is raised itable references. We, as a community, ing of an article to established editors. through an annual fundraising event keep track of changes and look out for Someone once said “Wikipedia doesn’t every November. The organization runs conflicts of interest. We have a dedicated work in theory, it only works in practice” on a very small budget. In 2011, the group of trusted volunteers with the and it’s true. Wikipedia is based on the budget was about US$ 20 million and ability to block or ban people who cause philosophy that the majority of people had come from more than one million problems. We also have mechanisms to have good intentions. individuals. This money primarily goes determine from what institution some towards paying for band width, keeping people are editing and to analyse their Q: Not every one reads in English, how the servers running, and improving the edits. A few years ago we caught several are you addressing that? underlying software. The development pharmaceutical companies removing A: As mentioned, we are working and maintenance of the content itself is content discussing concerns about their on a collaborative effort with Transla- done entirely by volunteers. ■ products. tors Without Borders to translate 80 priority English-language articles into Q: Have you identified other attempts to as many other languages as possible. manipulate the contents of Wikipedia? As this content is on Wikipedia, it is A: Yes, an employee from Savi- freely accessible to people who have ent Pharmaceuticals tried to create an access to the internet via a computer

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