Medical
Scans
Health insurers are hiring radiology
benefit managing companies to pre-screen and give prior authorization
for computed tomography (CT) and magnetic resonance imaging (MRI)
scans. By employing these companies, insurers reduce the number
of unnecessary tests and cut spending. Costs for these procedures
can vary widely, depending upon the test facility and the purpose
of the test. MRIs cost between $400 and $3,500 (www.comparemricost.com),
and CTs cost between $270 and $4800 (www.comparectcosts.com).
Medicare spent $14.1 billion on outpatient imaging in 2006 –
double the amount spent in 2000. Bloomburg.com says that doctors
prescribed 115 million scans in 2007. Nearly half of these scans
provided no additional useful information that affected diagnoses
or treatment, according to a July 28, 2008 report from America's
Health Insurance Plans (a trade group).
Radiology benefit managing companies approve most requests for MRIs
and CTs, but the use of pre-screening and prior authorization has
slowed runaway use of imaging technology. Pre-screening encourages
practitioners to use less costly, equally informative tests (e.g.,
ultrasound for suspected appendicitis) before using more expensive
tests. One insurer told Bloomburg.com that the radiology growth
rate among its clients had decreased from over 20% "to the
low single digits." Medicare may eventually turn to pre-authorization
service, also. At this time, the agency pays scanning facilities
less for their services if a patient receives more than one procedure
in the same day. In addition to pre-screening, the agency may begin
to negotiate for discounts from imaging facilities and publicize
facilities that charge less for their services.
Goldstein A. Medical scans waste $30 billion a year, insurers say
(update 1). Bloomberg.com.
July 28, 2008. Available at: www.bloomberg.com.
Accessed September 29, 2008.
Autism-Chelation Study
Canceled
In September 2008, the National Institute of Mental Health canceled
a scheduled trial that was designed to evaluate succimer (DMSA)
chelation therapy as a treatment for autism. The trial would have
tested the hypothesis that mercury exposure contributes to autism,
according to MedPage Today. Researchers
would have recruited 120 autistic children, ages four to ten years,
"with detectable but not toxic levels of mercury or lead in
their blood." The FDA has already approved succimer as a treatment
for lead toxicity. NIMH decided to pull the study because of a 2007
rat study, conducted by Diane E. Stangle and colleagues. That trial
showed that succimer chelation causes "lasting and pervasive
cognitive and affective dysfunction, comparable in magnitude to
[the dysfunction caused by lead exposure]" (Environmental
Health Perspectives; February 2007). These findings raised
concern that children in the study, who had low levels of lead or
mercury, would be harmed by succimer. An NIMH review board decided
that "…there was no clear benefit to the children who
would participate in the chelation trial and that the study presents
more than a minimal risk." Instead of pursuing further data
collection and review, which would have taken about four more years,
NIMH decided to cancel the study: "During those four years,
it is quite likely that additional research on the basic pathology
of autism will provide deeper understanding of the causes of autism
and more refined avenues for developing treatments."
The NIHM cancellation of this chelation therapy trial is puzzling.
First, the rat study "provides clear evidence" that succimer
chelation relieves cognitive and behavioral problems in rats with
lead toxicity, according to its researchers. In addition, the cognitive
and affective dysfunctions in lead-exposed rats parallel the dysfunctions
found in children with lead toxicity. Stangle and colleagues conclude:
"The present findings thus suggest that if a succimer treatment
protocol that produced a substantial removal of [lead] from the
brain could be identified for humans, a functional benefit might
be derived." The researchers, however, were concerned to find
that succimer caused adverse effects in normal rats – that
is, rats with no exposure to lead and no sign of dysfunction. The
NIMH study did not have a cohort of metal-free children in its design.
According to the NIMH study's design, recruited children would have
had a diagnosis of autism and blood mercury levels of 0.1 to 44
mcg/dL or blood lead of 0.1 to 10 mcg/dL. "The upper bounds
are the accepted thresholds for toxicity requirement," according
to MedPage Today. This statement
is not accurate, according to the Risk Assessment Information System
(RAIS) from the Department of Energy's Office of Environmental Management.
In RAIS toxicity summaries for mercury and lead, symptoms of CNS
toxicity becomes noticeable at about 10 mcg/dL of mercury and 30
mcg/dL of lead. The site says that "…toxicity values
presented in these toxicity profiles….are subject to change."
In the case of lead, "…no clear threshold is evident."
Another problem with NIMH's decision is that it ignores research
on toxic metals in tissue other than blood. A June 2007 study, for
example, found that the baby teeth of children with autism spectrum
disorder have "significantly (2.1-fold) higher levels of mercury
but similar levels of lead and…zinc" compared to the
baby teeth of "typically developing children." These Arizona
State University researchers say, "Baby teeth are a good measure
of cumulative exposure to toxic metals during fetal development
and early infancy, so this study suggests that children with autism
had a higher body burden of mercury during fetal/infant development."
Hair mineral analysis is another way to gauge metal toxicity. Several
studies, including a 2003 study sponsored by SafeMinds, have found
lower levels of mercury in hair samples belonging to children with
autism: "Hair mercury levels in the autistic group [n=94] were
0.47 ppm versus 3.63 ppm in controls [n=45]." The mothers of
children in the autistic group "had significantly greater exposure
to mercury from amalgam filings and thimerosal-containing Rho D
immunoglobulin injections than did a control group." Other
studies with similar findings have resulted in a hypothesis that
some autistic children cannot excrete heavy metals as efficiently
as unaffected children.
Another puzzling aspect about the NIMH decision is that many parents
have already reported positive results with chelation therapy. In
response to the study's cancellation, Talk About Curing Autism,
a support and advocacy group, stated: "Anecdotally, Talk About
Curing Autism has either seen or heard of thousands of children
[who] have had many of their autistic symptoms decrease due to this
therapy. By discontinuing this study, the NIMH will not prove the
effectiveness of chelation therapy one way or another." Parents
will continue to seek chelation for their children, and health authorities
can continue to say that no scientific evidence supports its use
– simply because no government-sponsored study has been performed.
Adams AJ. Elemental hair analysis test for heavy metal toxicity
and mineral deficiencies. The Patients'
Voice. Spring/Summer 2008:6,8. Available at: www.pfamhealth.net.
Adams JB, Romdalvik J, Ramanulam VM, Legator MS. Mercury, lead,
and zinc in baby teeth of children with autism versus controls.
(abstract) J Toxicol Environ Health A.
2007 Jun; 70(12):1046-51. Available at: www.ncbi.nlm.nih.gov/pubmed/17497416.
Accessed October 27, 2008.
Gever J. NIMH cancels autism chelation trial. MedPage
Today. September 19, 2008. Available at: www.medpagetoday.com/neurology/autism/tb/10979.
Accessed October 13, 2008.
Holmes AS, Blaxill MF, Haley BE. Reduced levels of mercury in first
baby haircuts of autistic children. (abstract) Int
J Toxicol. 2003 Jul-Aug;22(4):277-85. Available at: www.ncbi.nlm.nih.gov/pubmed/12933322.
Accessed October 27, 2008.
Meletis CD; Zabriskie N. Is autism the coal miner's canary of America's
health status? The Patients' Voice.
Spring/Summer 2008:5,7. Available at: www.pfamhealth.net.
Stangle DE, Smith DR, Beaudin SA, Strawderman SM, Levitsky DA, Strupp
BJ. Succimer chelation improves learning, attention, and arousal
regulation in lead-exposed rats but produces lasting cognitive impairment
in the absence of lead exposure. Environmental
Health Perspectives. February 2007;115(2): 201-209. Available
at: www.ehponline.org/members/2006/9263/9263.pdf.
Accessed October 13, 2008.
Bioenergetic Devices and Functional Medicine
Some functional medicine practitioners use energetic techniques
and devices to help them assess (and sometimes treat) patients.
Pulse diagnosis, used in Chinese and Ayurvedic medicine, and applied
kinesiology, developed by George Goodheart, are two such techniques.
Like pulse diagnosis, applied kinesiology and similar muscle testing
techniques give clues to body functioning. Pulse diagnosis, however,
has a far longer history and takes a skilled practitioner years
to learn. More recently, computerized energy devices have become
popular.
Reinhold Voll, a German physician, developed Electro-Acupuncture
according to Voll (EAV), the grandfather of many energy devices
used in functional medicine, in the 1950s. EAV measures reciprocal
resistance between two electrodes. Patients hold a passive cylindrical
electrode in one hand while the practitioner applies low voltage
current to specific acupuncture points with the second electrode.
The current flowing between the two electrodes is measured in microamperes
by an ohmmeter. Measurements above the set norm indicate inflammation
or over-activity, and those below the norm indicate blockage or
weakness. Dr. Voll used an extensive number of acupuncture points
in his assessments. Helmut Schimmel, one of Voll's students, simplified
the process by using fewer acupuncture points and placing ampules
of organ tissue, homeopathics, or other "medicaments"
into the circuit. This VEGATEST-Method allows practitioners to see
the effect of a supplement, treatment, or possible allergen on a
patient's system. In recent years, computer programs have made the
VEGATEST ampules unnecessary. Neither Voll nor Schimmel viewed electro-dermal
screening as a replacement for standard testing. Rather, these devices
are meant to help clinicians "[expand] clinical diagnostics
into a previously unreachable range of functional disturbances."
The diagnostic methods of functional medicine. 1 November 2005.
Available at: http://tokranmed.ru/en/box/public.php?subaction=showfull&id=
1130832900&archive=&start_from=&ucat=1&.
(one link on two lines)
Accessed September 29, 2008.
Kessler WD. Computerized segment electrography. Available at: http://www.dr-kessler.com/segment_electrography.php.
Accessed November 17, 2008.
Washington State Targets
Energy Devices
In December 2007, the Food and Drug Administration (FDA) decided
to block the importation of the Electro-Physio-Feedback-Xrroid system
(EPFX), an energy device manufactured in Hungary by William Nelson,
because of a Seattle Times probe.
Seattle Times reporters Michael
J. Berens and Christine Willmsen painted Nelson and the EPFX as
frauds that prey on the ignorant and ill in their November 19, 2007
article. Much of the article focuses on dangers caused by non-professional
EPFX operators and on Nelson's sales tactics. Nelson left the US
in 1996, after he was indicted for felony fraud. He refused to stop
making claims that the EPFX, registered as a biofeedback device,
can heal serious illness. Maybe the EPFX is a scam. I don't know.
I could not find any non-commercial evaluations of this device or
online case reports from health care professionals. The Seattle
Times did not include any interviews with medical practitioners
who use the device. Instead, the reporters present a few anecdotal
cases in which very sick people, who were treated by EPFX non-professional
operators, died. The reporters call them "victims…causalities
in the growing field called ‘energy medicine'…."
The reporters made no attempt to look at the decades (centuries,
in the case of Chinese and Ayurvedic medical traditions) of energy
medicine research.
If the reporters had bothered to check PubMed, they would have quickly
found at least two clinical studies involving energy devices. A
2002 Russian study by B.I. Islamov and colleagues report, "Changes
in the lymphocyte antioxidant system indicate that bioresonance
therapy activates nonspecific protective mechanism in patients with
rheumatoid arthritis." A 2006 German placebo-controlled study
found that "[t]he MORA bioresonance therapy can markedly improve
non-organic gastro-intestinal complaints." (Bioresonance uses
frequency to lessen or cancel dysfunctional frequencies emitted
by the body or organisms in the body.) If energy medicine is simply
a matter of the placebo effect, why did the "main outcome parameters"
in this study's control group respond "only slightly"
when the active group show marked improvement?
Seattle Times' biased investigation
was powerful enough to push the FDA into action and to incite Rob
McKenna, Attorney General for Washington State, to write the FDA
and ask the agency to extend its EPFX investigation to other energy
medicine medical devices. The FDA reply, dated January 28, 2008,
did not leap onto the bandwagon: "FDA is always active in its
surveillance of the medical device industry and watchful for risks
to health," Timothy A. Ulatowski, Director of Office of Compliance,
replied. "We triage the risks to health that we detect or that
come to our attention and allocate our resources depending on the
degree of risk." He adds, "I've increased our surveillance
of Internet promotion and advertising. Consumers must also be vigilant,
and any educational communications you can make available will help."
Even though electrodermal screening and its offspring have been
used for over 50 years in Europe, legitimacy for energy devices
is going to be a hard-won battle in the US. Claims that FDA registration
signifies effectiveness is deceptive. Kiran Schmidt, Director of
Inergetix, Inc. (device manufacturer), explains on the company website,
"…establishment registration and medical device listing
do not mean the FDA has approved or cleared a product for marketing
as a medical device or found it to be safe and effective for its
intended uses." At this time, "bioresonance," "informational
medicine," and "energy devices" bring up zero search
results on FDA's database.
Berens MJ, Willmsen C. How one man's invention is part of a growing
worldwide scam that snares the desperately ill. The
Seattle Times. November 19, 2007. Available at: http://seattletimes.nwsource.com.
Accessed September 29, 2008.
FDA Reply. Available at: www.devicewatch.org/eav/fda_reply.pdf.
Accessed October 7, 2008.
FDA urged to curb bogus "energy medicine" devices. Available
at: www.devicewatch.org/eav/letter_to-fda.shtml.
Accessed October 7, 2008.
Islamov BI, Balabanova RM, Funtikov VA, Gotovskii YV, Meizerov EE.
Effect of bioresonance therapy on antioxidant system in lymphocytes
in patients with rheumatoid arthritis.(abstract) Bull
Exp Biol Med. 2002 Sept;134(3):248-50. Available at: www.ncbi.nlm.nih.gov.
Accessed October 11, 2008.
Nienhaus J, Galle M. Placebo-controlled study of the effects of
a standardized MORA bioresonance therapy on functional gastrointestinal
complaints (abstract; article in German). Forsch
Komplementmed. 2006 Feb;13(1):28-34. Available at: www.ncbi.nlm.nih.gov.
Accessed October 11, 2008.
Schmidt K. Registering a device with the Food and Drug Administration
(FDA). Available at: www.energy-medicine.info/fda-registration.html.
Accessed October 29, 2008.
Willmsen C, Berens MJ. FDA bans import of unproven machine. The
Seattle Times. December 9, 2007. Available at: http://seattletimes.nwsource.com.
Accessed October 7, 2008.
Computed Tomography
Scan Hazard
Computed tomography (CT) exposes patients to higher levels of radiation
than most doctors realize, according to a review article in the
New England Journal of Medicine.
In CT (also known as CAT) scans, a computer integrates X-rays taken
from different angles to form a detailed cross-section picture.
Radiation dosage varies with the organ being scanned, the size of
the patient, and the scanner being used. (The 64-slice scanner emits
more radiation.) A CT scan of the abdomen exposes patients to 10
mSv of radiation, 500 times the radiation produced during a single
chest X-ray. Studies of radiation workers in the nuclear industry
and of Japanese survivors of atomic-bomb blasts show a significant
increase in cancer risk among people who receive between 5 and 150
mSv.
Most practitioners and patients are unaware of CT's risks. In the
NEJM review article, Columbia University
researchers David J. Brenner and Eric J. Hall report that about
75% of surveyed radiologists and emergency room physicians "significantly
underestimated the radiation dose from a CT scan" (Radiology,
2004;231:393-8). When disease symptoms are present, CT scans often
help determine a diagnosis. However, too many people without any
symptoms at all undergo CT screening "just in case." Even
the FDA discourages this growing practice of CT screening: "…the
FDA has never approved CT for screening any part of the body for
any specific disease, let alone for screening the whole body when
there are no specific symptoms of disease at all." Another
concern is the growing use of CT scans to diagnose appendicitis
in children. Children are more sensitive to radiation than adults.
Ultrasonography, for the most part, is just as accurate as CT but
does not cause radiation damage.
Brenner and Hall suggest three ways to lessen CT radiation exposure.
First, newer scanners have an automatic exposure-control option
that helps reduce radiation dose to patients. Brenner and Hall also
suggest using magnetic resonance imaging (MRI) or ultrasonography
whenever possible. (CT is the most accurate diagnostic technology
for some conditions.) Finally, Brenner and Hall recommend prescribing
CT only when symptoms and a lack of diagnostic alternatives justify
its use. They write, "…if it is true that about one-third
of all CT scans are not justified by medical need, and it appears
to be likely, perhaps 20 million adults and, crucially, more than
one million children per year in the United States are being irradiated
unnecessarily."
Brenner DJ, Hall EJ. Computed tomography – an increasing source
of radiation exposure. The New England
Journal of Medicine. November 29, 2007; 357(22):2277-2284.
Available at: www.nejm.org.
Accessed October 5, 2008.
Ozner M. Avoiding the radiation dangers of cardiac CAT scans. Life
Extension. March 2008:51-59.
US Food and Drug Administration. Whole body scanning using computed
tomography (CT). April 17, 2002 (last update). Available at: www.fda.gov/cdrh/ct/screening.html.
Accessed October 5, 2008.
Functional Medicine
Functional medicine deals with the body's regulatory functions,
which underlie chronic illness and promote good health. Like Chinese,
Ayurvedic, and other traditional medicine systems, functional medicine
considers disruption of the body's innate regulatory systems to
be the cause of illness. Serious illness can be prevented by maintaining
good function in these regulatory systems. "Functional medicine
sees disease, not as an enemy," writes Elizabeth Lipski, PhD,
CCN, "but as an opportunity for change and growth."
The primary goal of functional medicine is sound cellular metabolism
and healthy mitochondrial respiration. To achieve this goal, practitioners
begin by assessing and supporting intestinal function. Normally,
the intestinal mucosa allows absorption of desirable nutrients and
evacuation of toxic waste in a timely manner. Diet choices, stress,
toxins in food and water, and pharmaceuticals (e.g., non-steroidal
anti-inflammatory drugs and antibiotics) contribute to leaky gut
(hyper permeable mucosa) and dysbiosis (too few beneficial microorganism
and too many harmful ones). As a result, toxins are absorbed into
the bloodstream, straining the liver's detoxification function.
As tissue toxicity and oxidative stress increase, cellular function
declines. Repairing intestinal function and supporting the liver
are cornerstones of functional medicine. Addressing immune/inflammatory
imbalance and hormone imbalance are others.
Functional medicine practitioners use laboratory tests that examine
blood, hair, stool, urine, breath, and/or saliva to assess functional
status. Instead of trying to diagnose a disease, these tests assess
underlying conditions: nutritional status, digestive function, food
and environmental allergies, amino acid balance, energy metabolism
function, hormone balance. A lactulose/mannitol challenge, for example,
evaluates intestinal permeability. Saliva tests assess hormone status.
Some practitioners have also found bioresonance and electrodermal
screening devices helpful complements to laboratory measurements.
The Institute for Functional Medicine, founded by Jeffrey and Susan
Bland in 1991, offers workshops and other educational opportunities,
including continuing medical education (CME) courses for physicians.
For more information, contact www.functionalmedicine.org.
Brady D. Functional medicine. Dynamic Chiropractic.
April 5, 1999. Available at: www.chiroweb.com.
Accessed September 29, 2008.
Institute for Functional Medicine. The History of Functional Medicine
and The Institute for Functional Medicine. Available at: www.functionalmedicine.org.
Accessed November 2, 2008.
Institute for Functional Medicine. What is functional medicine?
Available at: www.functionalmedicine.org.
Accessed November 2, 2008.
Lipski E. Understanding functional medicine. Available at: www.innovativehealing.com.
Accessed September 29, 2008.
Harry Oldfield
What does an energy field look like? How do we study it if we can't
see it or measure it? British biologist Harry Oldfield is one of
many scientists who have turned their interest to energy fields.
He has developed three devices so far that provide a way to explore
bioenergetic fields: Polycontrast Interference Photography, Electro-Scanning
Method, and Electro-Crystal Therapy. In recognition of his work,
the International Society for the Study of Subtle Energies and Energy
Medicine (ISSSEEM) awarded him The Alyse and Elmer Green Award for
Innovation in 2006.
Oldfield worked with Kirlian photography for several years before
developing Polycontrast Interference Photography (PIP). PIP shows
pulsating bands of color and changing variations in light quality
emanating from living organisms and from crystals on a computer
screen. In humans, these images tend to correspond to energy meridian
pathways, defined by traditional Chinese medicine, and chakras,
defined by Ayurvedic medicine. (Pictures taken with PIP imaging
are available at www.electrocrystal.com.)
Eventually, PIP may lead to a new diagnostic tool. "In certain
circumstances," according to the Managing Director of Oldfield
Systems Ltd., Evy King, "…PIP technology is able to pinpoint
disturbed energy states before they become evident by standard diagnosis,
allowing practitioners and healers the chance to nip problems in
the bud." In addition to PIP, Oldfield developed another way
to assess energy fields called Electro-Scanning Method (ESM). ESM
uses sound and radio frequencies to create three-dimensional numerical
information in decibel levels about a subject's energy field. Oldfield's
Electro-Crystal Therapy uses electronic oscillator equipment linked
to select crystals to shift a stressed energy field towards equilibrium.
In the US, Oldfield has worked with Dr. Brian Dailey, a physician
and member of the Monroe Institute's professional and advisory boards.
The Monroe Institute (Faber, Virginia) is a non-profit research
and educational organization "dedicated to the exploration
of human consciousness." Oldfield has also worked with Dr.
Claude Swanson, Dr. Norman Shealy, and Bruce Moen.
King E. Harry Oldfield's amazing imaging technologies. Nexus
Magazine. April-May 2007;33-37+. Available at: www.nexusmagazine.com.
Accessed September 29, 2008.
The Analyst™
Patient health histories have always played an important role in
diagnosis. Now, health history services are being offered online.
In some cases, these services are simply a way to get consumers
to buy products being sold from the same website. I found one, however,
that sells no products and has such an extensive questionnaire that
I wonder whether if it might actually provide some benefit. The
Analyst™ (www.diagnose-me.com)
uses an extensive health history questionnaire and statistical probability
to identify likely health problems and dismiss others. Users also
have an option of receiving pertinent information about "mainly
natural treatments that have benefitted others in a similar situation."
The service offers users the option of having a licensed practitioner
(MD, DC, or ND) review the computer analysis and any laboratory
results or images they choose to send in.
The Analyst™ has two questionnaires with up to 900 multiple-choice
questions, one for men and another for women. It took me about an
hour and a half to complete the women's. The questions cover all
physical systems and include diverse questions such as "When
you exercise (run, walk fast, cycle, etc.), do you easily get a
stitch in your side?" and "Do you have a sense of humor?"
Hyperlinks to a glossary and related topics make the questionnaire
user-friendly for lay people. The computer-only analysis costs $25
US. The computer analysis reviewed by one of the company's practitioners
costs $55 US. A full report, in which a doctor reviews and summarizes
the computer report, "adding his or her insights and [answering
a patient's] specific questions," costs $77 US. A preliminary
report, mostly a teaser, is available by e-mail for no cost. (When
I didn't sign up for a report within a few days after taking the
test, another e-mail offered a discount rate.)
Practitioners may find The AnalystTM or a similar in-depth questionnaire
helpful for acquiring useful patient histories. A well-designed
computer program will consistently ask a compilation of questions,
derived from many reputable sources, without taking up a practitioner's
already cramped time. It can also bring some objectivity to a history
– depending upon the biases of the people who write text for
the program. I am leery, however, of using online questionnaires
to quantify health risks. How does the program add up factors to
formulate whether a person has a high, moderate, or low risk or
no risk of a disease? I am concerned that the program can plant
negative seeds of worry in a naïve user who is relying on the
program for health evaluation. Suggestion, positive or negative,
is a powerful force. Also, the program's analysis of health risks
can be skewed by inaccurate patient responses. Objectivity and statistics
are useful, but I believe these factors give only part of a picture.
No computer program can supersede the value of human intuition or
the therapeutic value of human touch and human interaction that
occurs with a caring, attentive practitioner.
Wikipedia
Reliability
Wikipedia,
a free and very popular online encyclopedia, gained legitimacy in
December 2005 when the prestigious journal Nature
reported that Wikipedia's
accuracy for science-based articles nearly equaled the highly regarded
Encyclopedia Britannica.
Nature's
assessment was based on a study in which experts reviewed 42 pairs
of scientific articles. Each pair, devoted to a single topic, consisted
of one article from Britannica
and one from Wikipedia.
The experts, "most of [whom] chose to remain anonymous,"
were academic scientists, according to Britannica's
refutation of the study. Nature
asked the reviewers to look for factual errors, critical omissions,
and misleading statements. The study reported four serious errors
and 123 lesser problems in the Britannica
articles compared to four serious problems and 152 lesser problems
in Wikipedia's.
Philip Coppens, in an article for Nexus
Magazine, compared the average
number of mistakes per article: "2.92 mistakes per article
for Britannica
and 3.86 for Wikipedia,
or three versus four mistakes." That is, Wikipedia
had nearly one-third more errors or misleading statements according
to this study. Nature
presented the results as a vindication of Wikipedia,
saying "…high-profile examples [of major errors in Wikipedia]
are the exception rather than the rule" and that "the
difference in accuracy [between Britannica
and Wikipedia]
was not particularly great." In actuality, the difference between
the two may be much greater.
Britannica
asserts that the comparison is "fatally flawed" for several
reasons. The Britannica
articles used in Nature
were, in some cases, manipulated. Britannica
said Nature
re-arranged and re-edited some articles. Reviewers of other articles
criticized Britannica
for important omissions, but Nature
had given the reviewers only part of the article (e.g., its introduction
instead of the entire piece). Nature
also pulled articles from Britannica's
children's version and from its yearbook series, which has more
latitude for personal opinion than the encyclopedia itself. Further,
Nature
did not fact-check nor ask reviewers for sources that supported
their criticisms. Some "errors" were simply a matter of
opinion. Britannica
staff says, "…where reviewers found genuine inaccuracies
in the Britannica,
we corrected them, but dozens of the so-called inaccuracies…were
nothing of the kind; they were the result of reviewers expressing
opinions that differed from ours about what should be included in
an encyclopedia article."
Why does this matter? First, Nature
is highly regarded as a science journal. By giving Wikipedia
its approval, it boosts the credibility of an already influential
source. The widely used Google search engine places Wikipedia
entries at the top. Whatever appears in Wikipedia
automatically feeds into Reference.com
and Answers.com.
"The problem with Wikipedia
is not that it exists," writes Coppens, "but that it has
become the cornerstone for researchers scanning the Internet for
information and blindly copying from Wikipedia
entries, wrongfully assuming that they are neutral and correct."
Wikipedia is compiled through
the use of wikis, software that lets anyone edit, add, delete, or
replace an entry. Wikipedia's changes are usually performed in anonymity
under the cover of pseudonyms. Even its editors who monitor content
use pseudonyms. The system lacks transparency and accountability.
Wikipedia
claims to have corrected problems that led to inclusion of inaccurate,
even damaging, accusations on biographical sites, but manipulation
of entries still occurs. Virgil Griffith developed Wikipedia
Scanner to track Wikipedia
edits to their source organizations. For example, he found that
someone at Diebold (a maker of voting machines) deleted 15 paragraphs
that criticized the company's machines. Politicians and government
agencies have also edited Wikipedia
files to their own advantage, according to Wikipedia
Scanner. The biases of Wikipedia's
anonymous editors are less easy to trace. They are the people who
decide what will or will not be included.
Larry Sanger, co-founder of Wikipedia,
left the organization in 2002, a year after its creation. In October
2006, he started a competitor. Citizendium
(http://en.citizendium.org)
requires real names -- no pseudonyms or anonymity. Draft versions
of articles are easily edited by readers, but "expert editors"
approve "stable versions" of an entry and arbitrate the
inevitable content disputes that arise. At the very least, Citizendium's
transparency holds contributors and editors accountable for the
facts and their biases (which we all have). Out of curiosity, I
compared Citizendium's
entry on homeopathy – a somewhat controversial topic –
to Wikipedia's
entry. I found Citizendium's
information more detailed and without dismissive language. I hope
Citizendium
continues to grow.
Coppens P. The truths and lies of WikiWorld. Nexus
Magazine. October-November 2007;11-15,77.
Available at: www.nexusmagazine.com.
Accessed October 5, 2008.
CZ:Why Citizendium?
Available at: http://en.citizendium.org/wiki/CZ:Why_Citizendium%3F.
Accessed October 5, 2008.
Encyclopædia Britannica, Inc. fatally flawed. Available at:
http://corporate.britannica.com/britannica_nature_response.pdf.
Accessed October 5, 2008.
Wikipedia
study "fatally flawed." BBC News. March 24, 2006. Available
at: http://news.bbc.co.uk/go/pr/fr/-/2/hi/technology/4840340.stm.
Accessed. October 5, 1008.
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