ArticlePDF Available

Medical journals and Wikipedia: a global health matter

Authors:
  • Institute of NeuroDevelopment

Abstract

Approximately 7000 stillbirths occur daily worldwide, and the vast majority of them (98%) take place in low-income and middle-income countries (LMICs).1 Despite this enormous burden, progress to reduce the death toll is slow and insufficient.2 WHO released its Making every baby count3 guide in 2016, which includes strategies aimed at addressing the challenge of stillbirths. Given the flurry of activity and attention on stillbirths from the Lancet Stillbirth Epidemiology investigator group and WHO, we expect that the wealth of information about stillbirths that is generated will filter down in a timely manner to where it is needed most: the general public. As is often the case for Wikipedians, we found that the stillbirth page4 on the English language Wikipedia was missing important information—eg, the major causes of stillbirth (malaria and syphilis) were not mentioned, and details on epidemiological aspects were scarce.1 Unsurprisingly, the Wikipedia pages on stillbirth in about 20 other languages were less detailed than the English language version. This worried us because not only is Wikipedia the world's most used source of health information online, but it is also one of the most widely used sources by medical students, doctors, and other health-care providers.5, 6 It is not difficult to imagine that the first online port of call for a woman, her partner, or her family following a stillbirth would be Wikipedia. Furthermore, many policy makers and other key stakeholders also read Wikipedia. Wikipedia is particularly relevant for LMICs, where internet access is often slow and expensive. We have been involved in developing mobile apps for offline use which contain all of Wikipedia's anatomy, pharmacology, medicine, and sanitation content in an attempt to address this issue. We have seen tens of thousands of downloads of the apps, with the majority from LMICs.7 There is clearly a huge unmet need for health-related information, to the extent that some mobile network operators in LMICs do not charge for data costs when users are accessing Wikipedia (Wikipedia Zero8). However, this generous practice has been cautioned against because some people feel it infringes upon internet neutrality (the principle that internet providers should treat all data equally). In addition to the stillbirth article there are many others on Wikipedia associated with global health that require further attention. Wikipedia has the potential of being bolstered as a key tool for global public health promotion.9 However, Wikipedia struggles to attract medical doctors or other trained health professionals as editors. We echo previous authors in inviting the medical community—and in particular medical journals—to incentivise Wikipedia editing with the goal of bringing about increased access to reliable, understandable, and up-to-date health information9 in multiple languages. PLoS Computational Biology, for example, encourages its authors to post topics on Wikipedia.10 Promoting inclusive and equitable learning opportunities for all speaks to the aspirations of the Sustainable Development Goals. We suggest that medical journals actively promote and incentivise Wikipedia editing by the health-care community so that the most commonly used source of online health information is as reliable as possible.
Correspondence
www.thelancet.com/lancetgh Vol 4 November 2016 e
791
Irish Centre for Fetal and Neonatal Translational
Research, Department of Obstetrics and
Gynaecology, University College Cork, Cork, Ireland
(GM); Gravida: National Centre for Growth and
Development, University of Auckland, Auckland,
New Zealand (GM); Division of Epidemiology and
Biostatistics, School of Public Health, Faculty of
Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa (GM); Oregon Health
and Sciences University, Department of Family
Medicine, Portland, OR, USA (LK); Department of
Paediatrics, Kothari Medical Centre, Kolkata, India
(DD); Department of Biochemistry and Genetics,
La Trobe Institute for Molecular Science, La Trobe
University, Melbourne, VIC, Australia (TMAS);
Department of Geriatrics, University Hospitals
Leuven, Leuven, Belgium (MRL); and Faculty of
Medicine, Department of Emergency Medicine,
University of British Columbia, Vancouver, BC,
Canada (JMH)
1 Lawn JE, Blencowe H, Waiswa P, et al, for
The Lancet Ending Preventable Stillbirths Series
study group, with The Lancet Stillbirth
Epidemiology investigator group. Stillbirths:
rates, risk factors, and acceleration towards
2030. Lancet 2016; 387: 587–603.
2 Blencowe H, Cousens S, Jassir FB, et al, for
The Lancet Stillbirth Epidemiology Investigator
Group. National, regional, and worldwide
estimates of stillbirth rates in 2015, with
trends from 2000: a systematic analysis.
Lancet Glob Health 2016; 4: e98–108.
3 WHO. Making every baby count. Geneva:
World Health Organization, 2016.
http://apps.who.int/iris/bitstream/
10665/249523/1/9789241511223-eng.
pdf?ua=1 (accessed Aug 19, 2016).
4 Wikipedia. Stillbirth. https://en.wikipedia.
org/w/index.php?title=Stillbirth&old
id=730929233 (accessed Aug 19, 2016).
5 Heilman JM, West AG. Wikipedia and
medicine: quantifying readership, editors,
and the signifi cance of natural
language. J Med Internet Res 2015; 17: e62.
6 Laurent MR, Vickers TJ. Seeking health
information online: does Wikipedia matter?
J Am Med Inform Assoc 2009; 16: 471–79.
7 Google Play. Medical Wikipedia (Offl ine).
https://play.google.com/store/apps/
details?id=org.kiwix.kiwixcustomwikimed
(accessed Aug 19, 2016).
8 Wikimedia Foundation. Wikipedia zero.
https://wikimediafoundation.org/wiki/
Wikipedia_Zero (accessed Aug 19, 2016).
9 Heilman JM, Kemmann E, Bonert M, et al.
Wikipedia: a key tool for global public health
promotion. J Med Internet Res 2011; 13: e14.
10 Wodak SJ, Mietchen D, Collings AM, Russell RB,
Bourne PE. Topic pages: PLoS computational
biology meets Wikipedia. PLoS Comput Biol
2012; 8: e1002446.
Medical journals and
Wikipedia: a global
health matter
Approximately 7000 stillbirths
occur daily worldwide, and the vast
majority of them (98%) take place
in low-income and middle-income
countries (LMICs).1 Despite this
enormous burden, progress to reduce
the death toll is slow and insuffi cient.2
WHO released its Making every baby
count3 guide in 2016, which includes
strategies aimed at addressing the
challenge of stillbirths. Given the fl urry
of activity and attention on stillbirths
from the Lancet Stillbirth Epidemiology
investigator group and WHO, we expect
that the wealth of information about
stillbirths that is generated will fi lter
down in a timely manner to where it is
needed most: the general public.
As is often the case for Wikipedians,
we found that the stillbirth page4 on
the English language Wikipedia was
missing important information—eg,
the major causes of stillbirth (malaria
and syphilis) were not mentioned,
and details on epidemiological aspects
were scarce.1 Unsurprisingly, the
Wikipedia pages on stillbirth in about
20 other languages were less detailed
than the English language version.
This worried us because not only
is Wikipedia the world’s most used
source of health information online,
but it is also one of the most widely
used sources by medical students,
doctors, and other health-care
providers.5,6 It is not difficult to
imagine that the fi rst online port of
call for a woman, her partner, or her
family following a stillbirth would be
Wikipedia. Furthermore, many policy
makers and other key stakeholders
also read Wikipedia.
Wikipedia is particularly relevant for
LMICs, where internet access is often
slow and expensive. We have been
involved in developing mobile apps
for offline use which contain all of
Wikipedia’s anatomy, pharmacology,
medicine, and sanitation content in an
attempt to address this issue. We have
seen tens of thousands of downloads
of the apps, with the majority from
LMICs.7 There is clearly a huge unmet
need for health-related information,
to the extent that some mobile
network operators in LMICs do not
charge for data costs when users are
accessing Wikipedia (Wikipedia Zero8).
However, this generous practice has
been cautioned against because some
people feel it infringes upon internet
neutrality (the principle that internet
providers should treat all data equally).
In addition to the stillbirth article
there are many others on Wikipedia
associated with global health that
require further attention. Wikipedia
has the potential of being bolstered
as a key tool for global public health
promotion.9 However, Wikipedia
struggles to attract medical doctors
or other trained health professionals
as editors. We echo previous authors
in inviting the medical community—
and in particular medical journals—to
incentivise Wikipedia editing with
the goal of bringing about increased
access to reliable, understandable,
and up-to-date health information9
in multiple languages. PLoS
Computational Biology, for example,
encourages its authors to post topics
on Wikipedia.10 Promoting inclusive
and equitable learning opportunities
for all speaks to the aspirations of the
Sustainable Development Goals. We
suggest that medical journals actively
promote and incentivise Wikipedia
editing by the health-care community
so that the most commonly used
source of online health information is
as reliable as possible.
MRL reports a Research Foundation Flanders PhD
Fellowship grant, and personal fees from Flanders’
Agricultural Marketing Board, Alexion
Pharmaceuticals, and Novartis. All authors are
members of Wikimedia projects including Wikipedia
and Wikiversity.
Copyright © The Author(s). Published by Elsevier Ltd.
This is an Open Access article under the CC BY license.
*Gwinyai Masukume, Lisa Kipersztok,
Diptanshu Das, Thomas M A Shafee,
Michaël R Laurent, James M Heilman
gwinyai.masukume@ucc.ie
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... Of note, the article on "exome sequencing" was edited by the same author as the 2010 published paper. Although I am grateful for any scientist who contributes to the biomedical content of Wikipedia [3], this case can be considered a form of Cocaine Pomora et al. [14] Exome sequencing Pussegoda [15] Hospital-acquired infection Lai et al. [16] (retracted article) ...
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... 12 Wikipedia is the fifth most popular site on the web with 2,125,792 visits per day 13 and is the most popular online healthcare resource globally. [14][15][16] Indeed, the use of Wikipedia among students, [17][18][19] physicians, 17,20,21 pharmacists 22 and nurses 23,24 to fulfil their information needs is widespread. Medical-related Wikipedia articles are accessed over 10 million times per day across all languages. ...
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The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia's medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia's health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia's biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information.
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An estimated 2·6 million third trimester stillbirths occurred in 2015 (uncertainty range 2·4–3·0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1·3 million (uncertainty range 1·2–1·6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7·4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8·0% and syphilis 7·7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6·7%). Prolonged pregnancies contribute to 14·0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
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Objective: To determine the significance of the English Wikipedia as a source of online health information. Design: The authors measured Wikipedia's ranking on general Internet search engines by entering keywords from MedlinePlus, NHS Direct Online, and the National Organization of Rare Diseases as queries into search engine optimization software. We assessed whether article quality influenced this ranking. The authors tested whether traffic to Wikipedia coincided with epidemiological trends and news of emerging health concerns, and how it compares to MedlinePlus. Measurements: Cumulative incidence and average position of Wikipedia® compared to other Web sites among the first 20 results on general Internet search engines (Google®, Google UK®, Yahoo®, and MSN®), and page view statistics for selected Wikipedia articles and MedlinePlus pages. Results: Wikipedia ranked among the first ten results in 71–85% of search engines and keywords tested. Wikipedia surpassed MedlinePlus and NHS Direct Online (except for queries from the latter on Google UK), and ranked higher with quality articles. Wikipedia ranked highest for rare diseases, although its incidence in several categories decreased. Page views increased parallel to the occurrence of 20 seasonal disorders and news of three emerging health concerns. Wikipedia articles were viewed more often than MedlinePlus Topic (p = 0.001) but for MedlinePlus Encyclopedia pages, the trend was not significant (p = 0.07–0.10). Conclusions: Based on its search engine ranking and page view statistics, the English Wikipedia is a prominent source of online health information compared to the other online health information providers studied.