WikiProject Medicine: a Useful Tool for Medical Education?

There is an ongoing discussion amongst doctors in the 'heavyweight' medical press about the advantages and disadvantages of using the medical information found on the open source, openly edited encyclopaedic web resource Wikipedia.

 Wikipedia is run by a non-profit charity in the US and is available in several languages.

It is essentially written by its own readers, everyone writing about subjects that lie within their own areas of expertise and which they feel should be included in the encyclopaedia. Naturally at first there are disagreements about what is written in a particular article and after one author has finished another is free to alter or comment the article. After several rounds of debate a consensus is reached, references are linked in and the level of editing drops considerably as an article stabilises.

The net effect has been to provide articles (nearly 4 million English articles at the last count) that are arrived at via collaboration, albeit in a system where we have little idea of the status or reliability of the authors in question. The articles can be constantly updated as new information crops up.

 In practice Wikipedia does have an active panel of moderators who work to limit obvious acts of vandalism and misinformation - many changes have to conform to an editorial policy and while anyone can make a change those changes are checked quite quickly - within hours in my experience.

 This is all very well and has been a highly successful approach, largely consigning encyclopaedias produced in more traditional ways to the past

Pretty much anyone who uses the internet does so to look for information. Most use Google to find that information and Google ranks Wikipedia articles very highly, increasing the numbers of readers Wikipedia has and therefore the number of editors & authors. This 'virtuous circle' has helped form a very effective free, collaborative tool that is highly comprehensive and does pretty well with regards to accuracy and detail. Articles tend to be written from the 'non-expert' point of view and are easy to understand for the average man in the street.

 But what of subject that may ultimately put our lives at risk? Medical information has been the subject of a special sub-category of Wikipedia for some time - WikiProject:Medicine. The goal of this project is given here:

To produce reliable and neutral information on medical conditions, diagnosis and treatment in a readable and standardized format. It aims to deal with these diseases in every context, from molecular biology, symptomatology and diagnosis to therapeutical issues and historical and geopolitical ramifications. To this end, the WikiProject will collaborate with other WikiProjects relating to the health sciences.

There is much debate. One author contends that there is something to be gained in working with Facebook on this project, not least that it attracts 150 million viewers a month, arguing that this impetus could be harnessed by improving quality guidelines a little and with more involvement from moderators on 'unstable' pages.
There is a feeling that as long as contributors remain anonymous there will be a problem of verification of quality - but the involvement of laypeople is a good thing opening up many subjects to a wider audience in plainer English and may act as useful feedback from laypeople as to what is an important issue for ordinary people, bringing doctors back into writing for the needs of their patients.

Once suitable safeguards are in place this resource could become even more successful across the world, English speaking and otherwise, especially where money and facilities are minimal. It is already estimated that 70% of junior doctors (and the vast majority of medical students) use Wikipedia more than once per week, in its own way validating much of what is written.
Wikipedia is simple to use, simple to read and provides short clear summaries that are as useful to doctors & teachers as they are to the layperson. The writing is on the virtual 'wall' - there is a huge amount to be gained from engaging with this massively successful enterprise.

Other articles in the medical media on the use of Wikipedia:

• Wikipedia versus Facebook: Social networking holds the key
• Medical Wiki audience issues were not considered

Mold Remediation Products - None Completely Effective

A recent research paper describes testing a range of ten products sold to remove and remediate mould and mycotoxin.

Method: Manufacturer

1. Ozone: Ozone-generator device Airmaster 
2. Peroxide: ALRON Chemical Ltd. 
3. Hot air: Black & Decker 
4. Flaming: Commercially available burner 
5. Steam: Karcher Ltd. 
6. Boron-based chemical 1: Svenska reimpregnering Ltd. 
7. Boron-based chemical 2: WSJ Sanitation Oy Ltd. 
8. Ammonium chloride based chemical: BlOkleen Ltd. 
9. Sodium hypochlorite based chemical: Colgate-Palmolive Ltd. 
10. Drying

None were completely effective in removing all viable molds or mycotoxins, raising the point that none of these methods which are widely used in the remediation of buildings is completely effective. The authors suggest:

1. that more research is needed to identify new protocols and/or sterilising substances in order to improve the end result of remediation
2. manufacturers need to be under more obligation to prove the efficacy of their products under conditions that represent remediation more closely so as to get a genuine guide of the effectiveness of their product when in use

I would also suggest that this is a strong hint to move towards replacement of mouldy materials (particularly mouldy wood and plasterboard) rather than make attempts to clean them.

EU Tightens Limits of Mycotoxins in Food

Mycotoxins are highly toxic chemicals produced under some environmental conditions by a number of fungi. When growing crops in a field it is inevitable that the crop will be exposed to the fungi that produce mycotoxin but the toxins are only made if the crop happens to be affected by specific weather conditions so most crops are not effected while others can be heavily affected.
To counter the potential health problem if these toxins get into the food chain the EU sets strict limits to the amount permitted in food for humans and guidelines for animal feed and implements strict testing procedures to identify affected batches of grain.

More recently new countries have entered the EU with their own regulations and some countries have been arguing for even lower limits to permitted levels of mycotoxin, despite there being no evidence to suggest that existing permitted levels are toxic to humans.

The snag is that this is a careful balancing act between mycotoxin levels and farmer's incomes. As soon as a harvested crop is declared to have too much mycotoxin its monetary value drops. Therefore as soon as the EU reduces the permitted levels of mycotoxin in a crop there will be crops that will suddenly be worth less, even though the farmer has not changed how he grows the crop. The levels of mycotoxin vary according to weather conditions and thus tend to affect some countries more than others.

This news article features a representative of EU farmers resisting pressure on the EU to reduce permitted levels of some mycotoxins as this will cost their members money while at the same time having no apparent justification based on known health risks - perhaps this is part of a long term drive to reduce toxin levels in our food as far as is possible & feasible?

NOTE: Farmers Guardian article on same issue

Salt Caves Not Proven for Aspergillosis

Salt caves are generally disused salt mines that have been hollowed out of rock some distance below ground level, some of which are elaborately decorated and run for long distances underground becoming popular tourist attractions.
Other salt caves have started to take on a new, innovative function. Various stories believed to have originated from miners working in salt caves in Roman times have lead to a conception that visiting a salt cave is beneficial if you are suffering from respiratory problems. There are several claims of reduction in symptoms consistent with a reduction in lung tissue inflammation, some of which have been tested and are published in the scientific media 10 - 20 years ago.

Referred to as Halotherapy there is an assumption that people who visit a salt cave will tend to inhale very fine particles of salt (sodium chloride) deep into their lungs and that this can be a good thing for illnesses such as asthma and chronic obstructive pulmonary disease (COPD).

Despite this being used as a therapy in some parts of Europe and some reports appearing to confirm some beneficial effect (leading to several expensive therapy's being offered widely on the internet)  this is still a largely untested practice with few proven benefits - which isn't to say that it doesn't work for some but is a warning that those who try it shouldn't expect positive results.

Offering this type of therapy is very much the domain of those who seek to try to help vulnerable people but who offer no guarantees as to whether or not it will have any beneficial effect. It is not something that the major medical professional regulatory bodies currently support as illustrated by a recent case of malpractice brought against a doctor in Ireland.

In this report a qualified doctor had apparently helped set up a clinic to offer salt therapy and had set out to publicise this clinic using statements that made it appear that there were several proven benefits of using this clinic, including benefits to aspergillosis sufferers. The irish Medical Council  judged that he should not have been actively promoting this type of therapy in the way that he did and should not have been raising expectations unnecessarily as the benefits that he claimed for the therapy are unproven, finding him guilty of the lessor charge of poor professional conduct (not malpractice).

Newsbite: "Management of Chronic and Pulmonary Aspergillosis": Masterclass

An interactive masterclass on the "management of chronic and pulmonary aspergillosis" is now available to view on the Aspergillus Website - as presented at the 5th Advances against Aspergillosis conference in Istanbul on 26th- 28th of January 2012. Further notes and case histories to follow. more...