The Cochrane Collaboration has played a pioneering role over the past 20 years in the production and dissemination of high-quality, timely, synthesised research evidence across many areas of health care. However, in order to fully realise Cochrane's vision of a world where this can lead to better health for everyone, proactive strategic alliances are needed to ensure wider dissemination of Cochrane evidence in a manner that better meets the needs of users worldwide.
Wikipedia, the web-based, multilingual, free-content encyclopaedia, is the sixth most visited site, and the most used medical resource, on the Internet.[1,2] In the 12 years since its creation, Wikipedia has grown into one of the largest reference websites, attracting over 500 million unique visitors monthly. With more than 80,000 active voluntary contributors working on over 26 million articles in 285 languages, the potential for Cochrane to reach previously unreached audiences by forging a strategic partnership with Wikipedia is enormous.
There are remarkable similarities in the vision, mission, principles, and strategic goals of the Wikimedia Foundation (the not-for-profit, charitable organisation that manages Wikipedia) and Cochrane. This sets the stage for a working partnership that could help realise the aspirations of both organisations. Wikimedia Foundation's vision of "a world in which every single human being can freely share in the sum of all knowledge," echoes the altruism and hope enshrined in Cochrane's vision, and its values of freedom, accessibility and quality, independence, commitment to openness and diversity, transparency, and community as an asset mirror many of Cochrane's founding principles.[5,6] The core policies governing Wikipedia content are that articles should state a neutral point of view (be unbiased); be verifiable (supported by high-quality secondary sources), and contain no original research.
WikiProject Medicine is a collaborative project founded in 2004 by a group of Wikipedia editors with a common interest in improving the reliability of Wikipedia medical content. Members of this project (about 350 in June 2013) include doctors, medical students, nurses, scientists, patients, and laypeople. Wikipedia endorses the primacy of independently-produced, peer-reviewed, published, systematic reviews of quality-appraised, randomised controlled trials in the hierarchy of evidence. Project members have helped create guidance on finding and selecting such high-quality sources, and help manage and edit articles aimed at providing reliable and easily understood medical and health-related content.
In May 2013, there were 225 million page views for the 28,447 articles on Wikipedia pertaining to medicine; with more than 440,000 monthly views of the top-viewed articles, such as tuberculosis and schizophrenia. Wikipedia's peer-review process grades the quality of articles, and many popular topics have been improved considerably over time. However, less than 1% of articles have passed a formal peer-review process, and many more content and methods experts are required to bring Wikipedia to a consistently high standard. This presents Cochrane with a unique opportunity to collaborate with WikiProject Medicine.
Over the past year, Wikipedians and Cochranites have ventured to amalgamate the strengths of Wikipedia's successful community-driven model and global reach with Cochrane's reputation for methodological rigour. The aims are to improve the evidence-related content in Wikipedia articles, to provide resources or assistance to Wikipedia editors interpreting scientific data, and to encourage academics and scientists to add evidence to Wikipedia articles.
From Cochrane's perspective, the benefits to underpinning medical articles in Wikipedia with Cochrane evidence include:
1. Increasing the number of citations to Cochrane evidence in Wikipedia. By October 2013, the Cochrane Database of Systematic Reviews (CDSR) was cited about 1436 times in 859 articles but ranked only about 50th in the list of most-quoted academic journals.
2. Increasing the uptake of Cochrane evidence: Evidence is more relevant when presented in the context of a disease condition. Evidence in medical articles on Wikipedia is embedded in the larger perspective of the health condition, rather than the more focussed (narrow) perspective of the research question in a systematic review. Redirects from Wikipedia could also result in more people reading Cochrane evidence in the CDSR.
3. Increasing the relevance of Cochrane evidence: Wikipedians are equivalent to a large pool of consumers who ensure relevance to the average person, and Wikipedia statistics can provide global estimates of the interest in various healthcare-related topics. Cochrane can glean insights from Wikipedia content about priority questions and outcomes relevant to patients; developing better plain language summaries; and review-specific, user-friendly access to Cochrane evidence.
4. Increasing interactive learning: The comments sections of Cochrane Reviews are under-utilised, whereas the 'talk' pages of many Wikipedia articles are busy with conversations and provide a potential interface between readers, Wikipedia editors, and Cochrane contributors. Such an interface may facilitate open critique of the evidence, and relevant comments could be responded to and linked to comments sections in Cochrane Reviews.
5. Harnessing the power of crowdsourcing: Wikipedia's approach to creating and updating articles could be a powerful tool for Cochrane to discover novel approaches in review production, multi-lingual translation, improving quality and relevance, and increasing global contribution to Cochrane reviews.
6. Rapid dissemination of critical information: Wikipedia's ability to update content almost instantly may complement Cochrane's current ability to 'publish when ready' and facilitate the delivery of Cochrane evidence to users more quickly and effectively.
From Wikipedia's perspective, Cochrane represents a group of experts in medicine and research methods. Contributions from Cochrane in adding conclusions and results from systematic reviews to medical and health-related articles would serve the goals of WikiProject Medicine.
The Cochrane Collaboration and John Wiley & Sons, the publishers of The Cochrane Library, have an active interest in this venture, and as a first step, have provided 100 free accounts to The Cochrane Library to interested, experienced Wikipedia editors.
There are concerns about the potential impact of this collaboration on the work and philosophies of both organisations. While Cochrane has evolved a set of methodological standards for developing evidence, Wikipedia relies on community-led progressive improvement of articles. Wikipedia's open editorial system, allowing almost anyone to edit most of the content, risks evidence being re-edited or potentially vandalised. However, one of Wikipedia's core working principles - the assumption of good faith - assumes that any edit provides some additional value to an existing article, unless otherwise proven. The growth of Wikipedia can be partly attributed to this assumption. Vandalism and unconstructive edits occur infrequently compared with constructive edits, and most are removed or corrected rapidly. Good faith aside, Wikipedia has evolved a set of guidelines and policies to govern content production, and several editorial mechanisms filter out negative or unproductive edits; with more in development, the quality, readability, and accuracy of content would further improve. The goal in Wikipedia is easy-to-read, thoroughly referenced articles that are broad in scope. Edits should improve the accuracy of the article, by adding up-to-date, relevant evidence, while permitting alternative views and positions.
These differences in approaches suggest that there will initially be a steep learning curve for Wikipedians in terms of understanding systematic reviews, and for Cochrane regarding Wikipedia's methods and policies. An additional problem is the lack of academic credit awarded for contributing to Wikipedia, which may deter some contributors.
However, the heady mix of altruism, good science, social relevance, and collaboration that draws many volunteers to contribute to Cochrane evidence is also apparent in WikiProject Medicine editors. This synergy has immense potential to resolve difficulties and attract more contributors. It could lead us closer to a world where all people can freely share in the sum of all knowledge and where all health decisions are informed by high-quality, reliable, up-to-date, synthesised research evidence.
Manu E Mathew1, Anna Joseph2, James M Heilman3, Prathap Tharyan4
1Manu Easow Mathew (email@example.com), Research Scientist, South Asian Cochrane Network & Centre, Christian Medical College, Vellore, India; 2Anna Joseph (firstname.lastname@example.org), Communications Officer, South Asian Cochrane Network & Centre, Christian Medical College, Vellore, India; 3James M Heilman (email@example.com), Clinical Faculty, Department of Emergency Medicine, University of British Columbia; Emergency Physician, East Kootenay Regional Hospital, Cranbrook, British Columbia, Canada; 4Prathap Tharyan (firstname.lastname@example.org), Professor, Department of Psychiatry, and Director, South Asian Cochrane Network & Centre, Christian Medical College, Vellore, India
How to cite: Mathew ME, Joseph A, Heilman JM, Tharyan P. Cochrane and Wikipedia: the collaborative potential for a quantum leap in the dissemination and uptake of trusted evidence [editorial]. Cochrane Database of Systematic Reviews 2013;10:ED000069. dx.doi.org/10.1002/14651858.ED000069
2. Heilman JM, Kemmann E, Bonert M, Chatterjee A, Ragar B, Beards GM, et al. Wikipedia: a key tool for global public health promotion. Journal of Medical Internet Research 2011;13:e14 dx.doi.org/10.2196/jmir.1589
7. Wikipedia. Wikipedia: core content policies. en.wikipedia.org/wiki/Wikipedia:Core_content_policies (accessed 9 October 2013).
8. Wikipedia. Wikipedia: WikiProject Medicine. en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine (accessed 9 October 2013).
9. Wikipedia. Wikipedia: Identifying reliable resources (medicine). en.wikipedia.org/wiki/Wikipedia:Reliable_sources_(medicine-related_articles) (accessed 9 October 2013).
10. Wikimedia Toolserver: Popular pages list. Pageview statistics for WikiProject Medicine – June 2013. toolserver.org/~alexz/pop/view.php?proj=medcn&month=Jun13&limit=100&count=true&offset=0 (accessed 9 October 2013).
11. Wikipedia. WikiProject Medicine/Evidence based content for medical articles on Wikipedia. en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine/Evidence_based_content_for_medical_articles_on_Wikipedia (accessed 9 October 2013).
12. Wikipedia. WikiProject Academic Journals/Journals cited by Wikipedia/C21. en.wikipedia.org/wiki/Wikipedia:WikiProject_Academic_Journals/Journals_cited_by_Wikipedia/C21 (accessed 9 October 2013).
Acknowledgements: We are grateful to Chris Mavergames, Vinu Mathew George, and Richard Kirubakaran for their valuable comments and suggestions towards improving the readability and content of this editorial.
Competing interests: The authors have completed the ICMJE form for disclosure of potential conflicts of interest (forms available on request) and have made the following declarations. MEM worked in the South Asian Cochrane Centre for 18 months, leading a project that involved adding evidence-based content to Wikipedia articles. MEM has worked with The Cochrane Collaboration for over 3 years and is an active Wikipedia user and editor. AJ works as Communications Officer at the South Asian Cochrane Network & Centre, on a project of the Effective Health Care Research Consortium (www.evidence4health.org), funded by the UK Department for International Development (DFID). AJ is also a member of the Cochrane Consumer Network and a consumer referee for the Cochrane Acute Respiratory Infections Group. JMH has been a volunteer Wikipedian since 2008 and is president of the not-for-profit Wiki Project Med Foundation; he has never received any payments for this position. PT is the recipient of a grant from The Cochrane Collaboration to build capacity to undertake research synthesis in authors in South Asia; the grant pays part of PT's salary while on sabbatical. PT is also a Cochrane review author, an editor with the Cochrane Schizophrenia Group, and a programme partner in the DFID-funded Effective Health Care Research Consortium.
Image credits: The Cochrane Collaboration logo is a registered trademark of The Cochrane Collaboration. The Wiki Project Med Foundation logo is by Isarra, via Wikimedia Commons (CC-BY-SA-3.0).
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