Open Access to a High-Quality, Impartial, Point-of-Care Medical Summary Would Save Lives: Why Does It Not Exist?

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Citation: James Heilman (2015/08/25) Open Access to a High-Quality, Impartial, Point-of-Care Medical Summary Would Save Lives: Why Does It Not Exist?. PLOS Medicine (RSS)
DOI (original publisher): 10.1371/journal.pmed.1001868
Semantic Scholar (metadata): 10.1371/journal.pmed.1001868
Sci-Hub (fulltext): 10.1371/journal.pmed.1001868
Internet Archive Scholar (search for fulltext): Open Access to a High-Quality, Impartial, Point-of-Care Medical Summary Would Save Lives: Why Does It Not Exist?


Huge increase in access to scientific knowledge wrought by OA has benefited researchers with time to search literature but less helpful to working health providers. Point-of-care (POC) medical summaries are collections of review articles designed to be quick to search and browse for providers of patient care.

UpToDate and Dynamed are the best known POC summary resources aimed at medical professionals but are closed access and expensive. OA or freely accessible summaries are not aimed at a professional audience, funded by advertising and thus vulnerable, or geographically limited.

Attempts to create OA POC summary resources such as Medpedia and have failed to gain adequate contributions, as have broader efforts to create professional encyclopedias such as Nupedia, Citizendium, and Google Knol.

Wikipedia is widely accessed for health information but is not geared toward health care professionals, and with a small active medical community, fewer than 1% of its medical articles have passed through a semiformal review.

Google searches for health information, access to Wikipedia for same, and demand for closed access POC summary resources indicate demand.

Suggests it is feasible for a new OA POC summary resource to match scope of UpToDate (10k topics). Existing material includes 7k disease- or symptom-related Wikipedia articles, hard to find OA content from medical regulators and institutes, and 2.5k medical OA publishers. Each of the latter commissioned a single review each year. Editors would have to edit, review, and verify.

This work has to be paid for, confer prestige, and lead to career advancement. Wikipedia may have a small number of contributors party because contributions lack academic prestige; if that could be solved, contributions to an OA POC summary resource would be self-reinforcing. Wikipedia's $50m annual budget is small compared to $4.7b for UpToDate's parent company.

Copyright, non-free terms, and incompatibility among free licenses create obstacles to using available material. Internet access is an obstacle to global impact.

Options going forward:

  • low cost, risk, control: commission OA summaries from prestigious journals; happening to limited extent through institutions working to improve Wikipedia medical content
  • medium cost, risk, control: new non-profit and MediaWiki website editable by approved users, set up monetary and authorship rewards, encourage reuse of and by Wikipedia
  • large cost, risk, control: new website and software built for purpose, hire authors and others; would require hundreds of employees and commensurate major funding in perpetuity


To seriously undertake the establishment of a global clinical knowledge database, of sufficient quality to become self-sustaining through acquiring status and accepted utility, would require inputs of tens of millions of dollars a year. Arguably it might also be an incredibly cost-effective way of improving global health, simply by making sure the best medical knowledge was freely available to those who needed it.

Theoretical and Practical Relevance

Published with a companion editorial in which PLOS Medicine editors suggest that journal could contribute some patient-care oriented reviews, but also note issues concerning keeping reviews updated and accurate.

Previously UpToDate discussed in editorial about first Wikipedia article published in a peer-reviewed journal (Heilman lead author of the article); random blog commentary.

Also see AcaWiki:Similar projects.