Wikipedia, an online open-source encyclopedia, can boast 470 million visitors each month, making it one of the most popular websites on the internet. It is an incredibly useful resource – I think it’s fair to say it is the online reference of record. For that reason people care how topics important to them are represented in Wikipedia.
Wikipedia, in fact, has become no less than a battleground over certain controversial topics. In essence people generally want Wikipedia to reflect their opinions on controversial topics, and if it doesn’t then there must be something wrong with Wikipedia (rather than there being something wrong with their opinions). I don’t mean to imply that Wikipedia always gets it right – it is a crowdsourced reference and the content is only as good as the editors. But at least they make honest efforts to be neutral and to have standards.
Those standards are the real conflict here, and it is part of a broader conflict over standards. In medicine there is a standard of care, which in turn is based on an underlying system of professional and scientific standards. Medical education is standardized, students have to pass standardized exams, post-graduate clinical training is standardized, there are standardized exams for specialty certification, there are ethical standards enforced by institutions, hospitals, professional organizations, and the state boards of health, and peer-reviewed journals have standards.
This is all meant to ensure that individual patients receive the highest quality of care.
There is a movement, however, specifically designed to erode the standard of care and to replace it with a “wild west” system in which there are no standards. This may seem like an extraordinary claim, but the evidence is unequivocal. The elimination of the standard of care is packaged and sold as “health care freedom.” A number of states have already passed health care freedom laws which specifically eliminate the standard of care. What they say, in essence, is that the state board of health cannot act against a health care professional’s license simply because they are engaging in a practice which is deemed below the standard of care. All the practitioner has to do is proclaim their practice “alternative.”
The same is happening in medical education. Special courses are being carved out to teach medical students “complementary and alternative medicine,” and these courses are often not being held to the usual academic standard. Our colleague in the UK, David Colquhoun, has been successful in getting certain CAM programs removed from universities just by using freedom of information requests for their curricula, and then showing them to the board of trustees. This reflects the lack of effective oversight of CAM courses in medical school. I have had this same experience myself – no one is looking, and forcing them to look at what is actually being taught is often enough to embarrass them into action.
There has been an erosion of standards in government regulation as well. The 1994 Dietary Supplement Health and Education Act created a separate non-standard for supplements – since then sellers can make pseudo-health claims for their supplements without providing any evidence of safety or effectiveness.
I would argue that pressure to license naturopaths in every state also represents part of this war on standards. Naturopaths do not appear to follow any science-based standard, and they are lobbying for the right to essentially regulate themselves, to be a licensed profession not held to any external science-based standard.
This war on standards, sold in the name of freedom, has encompassed medical practice, licensure, regulation of products, academia, and publishing. Wikipedia is just the latest battle ground – the erosion of standards in public reference material.
I admire Wikipedia for holding the line. They have stated that on scientific issues Wikipedia will reflect the scientific consensus. If you want the content of Wikipedia to reflect a different point of view, then you better be prepared to back it up with science. The relevant policy regarding the scientific consensus is that of a neutral point of view, specifically the sections on due weight and fringe theories/pseudoscience; an essay on the topic gives the following helpful summary:
When writing about ideas around which scientific consensus has coalesced, Wikipedia editors should strive to describe those ideas as plainly as possible.
It may be that there are certain parties which dispute the consensus view. It is up to the editors of articles to determine, through careful examination of the sources, how notable the views of these parties are and whether they are relevant to articles on scientific matters. It is important to note that in forming its consensus it is the members of a particular scientific discipline who determine what is scientific and what is questionable science or pseudoscience. Public opinion or promoters of what is considered pseudoscience by the scientific consensus hold no sway in that determination.
Promoters of unscientific views don’t like this approach. When a fair and neutral referee disagrees with their pseudoscience, they cry conspiracy and censorship. Take, for example, this recent article on Natural News: “Unbiased: Help support a writer as he exposes the truth about Wikipedia’s censorship of alternative medicine.” In it the author claims:
As a matter of policy, Wikipedia actively denies the existence of science with which it disagrees.
No – it ignores pseudoscience with which the consensus of scientific opinion disagrees. Read their policy. The writers at Natural News are upset that Wikipedia does not reflect their pseudoscience, specifically discussing alternative medicine and GMOs.
Standards matter. Establishing and enforcing quality standards is not censorship or a violation of anyone’s freedom, as long as the process of determining standards is transparent and fair.
The people whose job it is to establish, enforce, and maintain high quality standards within medicine have largely been failing in the last few decades, at every level. They have allowed pseudoscience to infiltrate and erode the standards. It is not clear to me how this has happened. Specifically I don’t understand how so many academics and professionals have allowed themselves to be quelled by the rhetoric of charlatans.
It is disturbing that all it took was some platitudes about freedom, “holistic” care, “patient-centered” care, and other fairly empty slogans to get the defenders of academic and scientific standards to drop their guards. It is ironic that the editors of Wikipedia are the ones holding the line for scientific standards.
Wikipedia, in this sense, is putting academic institutions to shame. It is not too late, however, for the academic and scientific communities to come to their senses when it comes to pseudoscience in medicine.