Argumentum Ad Populum: Medical Wikis 101

Frank Ferrara
Published: Thursday, Mar 19, 2009
What exactly is a medical wiki, and for that matter, a wiki in general? Are these resources useful to you and your patients?

Our story begins, as do many great things, with jellybeans.

Suppose the existence of a large jar of jellybeans in a room. Into the room we bring a mechanical engineer and a jellybean executive. We also bring in 1,000 other people (the room is quite large). We ask all in attendance to estimate the number of jellybeans, and offer you a choice: will you bet on the engineer’s estimate, the jellybean expert’s estimate, or the mean of the guesses of the remaining 1,000?

In his 2004 book, The Wisdom of Crowds, James Surowiecki finds that the combined individual efforts of a group outperform any single individual effort over a series of trials. He describes a related experiment, in which a group of volunteers travel through a maze. According to Surowiecki, investigators “figured out what a majority of the group did at each node of the maze, and then plotted a path through the maze based on the majority’s decisions.” This “collective solution” resulted in a path through the maze shorter than the path taken by any individual participant, including those who had already completed the maze once (ie, “maze experts”).

Surowiecki goes on to argue that properly interpreting and harnessing the wisdom of crowds can produce desirable outcomes in fields ranging from economics to sociology. But what about medicine? Can reliance on the collective knowledge of a large group produce value in a discipline in which precision is paramount? Medical Wikis—practical collections of this kind of knowledge—exist and confer advantages that cannot be duplicated by any other media. But there are pitfalls, as well. Remember, Surowiecki’s optimistic title is a play on a much earlier work by Scottish journalist Charles MacKay: Extraordinary Popular Delusions, and the Madness of Crowds.

What on earth is a wiki?

You’ve almost certainly heard of Wikipedia, the largest and most famous collective effort at online information distribution. Wikipedia has become so iconic that it would be easy to assume that the terms Wikipedia and wiki are functionally equivalent, but this is not so. Which brings us to:

KEY POINT #1: Wikipedia is but one example of a wiki, and by no means the definitive one.

Broadly speaking, a wiki (from the Hawaiian word for “quick/fast”) is a group of Web pages on a particular subject that allows open modification of the content, using a simplified interface that requires only a standard Web browser. Most wikis use extensive hyperlinking (again, easily accomplished by all contributors) within each article to connect subjects and enable quick and intuitive research. The concept and the name were both products of Ward Cunningham, whose WikiWikiWeb (“fast fast Web”) went live in 1994.

Ideally, a wiki article on, say, jellybeans, would be written by a contributor with extensive specific knowledge on the delectable treats, with fact-checking by additional experts. A contributor with a n in-depth understanding of the jellybean manufacturing process might add detail on that subject, while another provides a well-researched history of the Jelly Belly Company. An expert on traditional holidays might add a section on Easter, and link to a larger article on the same subject. Contributors with language expertise would polish the grammar. The result: a clean, detailed, referenced article, freely accessible to all, which can be instantly updated with breaking jellybean news. However:

KEY POINT #2: Allowing open contribution to a Web page introduces the inevitability that some contributors will make undesirable changes, additions, or deletions.

These may range from simple vandalism (inserting profanity), spreading of misinformation (Wikipedia carried false news of the death of Ted Kennedy for some time), or even well-intentioned additions of incorrect information. The wiki approach is to make no particular effort to prevent misinformation or other damage; rather, it relies upon a community of users to quickly catch and correct damage as it occurs. In this way, says the Encyclopedia Britannica, the wiki is a rare example of “an Internet counterculture that has a basic assumption of the goodness of people.”


Wikipedia is the most prominent wiki, with more than 12 million articles covering every subject imaginable. At this point, encounters with Wikipedia are essentially inevitable; if one of your patients decides to Google a condition or medication, a page from Wikipedia will almost surely be one of the top five hits.

KEY POINT #3: Wikipedia, like many wikis, is a truly open reference source.

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