Intended for healthcare professionals

Rapid response to:


How Web 2.0 is changing medicine

BMJ 2006; 333 doi: (Published 21 December 2006) Cite this as: BMJ 2006;333:1283

Rapid Response:

The imperfect and evolving knowledge base

I would like first to commend Dean Giustini for his excellent
editorial; he has given a very useful overview of the evolving Web 2.0
tools that are now available.

While these new Web 2.0 tools provide us with significant and
exciting opportunities, a number of the Rapid Responses also recognize
some of the challenges they pose. I would like to raise an issue that has
not been mentioned and that applies not only the clinical medicine but
also to public health.

In very many, if not most, cases the traditional evidence base is not
as strong or as unequivocal as we would like. Consequently, we routinely
draw on other sources of knowledge to support our decison making.
Knowledge managers refer to the importance of 'tacit' as well as
'explicit' knowldge. Experiential knowledge and local contextual
information play a key role.

For me, one of the very exciting things about Web 2.0 is that it
provides us with tools to share the different types of knowledge that are
needed to support decision making.

But accessibility is not always enough! Having provided access to all
this additional information, we cannot ignore the need to support
practitioners as they struggle to use it in their daily professional
lives. How does a practitioner seeking particular guidance judge the
quality of the different pieces of information available to them? How do
they assess the relevance of the various pieces? What weight do they give
to them, and how do they bring them all together? These are real issues
not only for public health but also for clinical practice.

I believe that if we are to fully realize the potential of Web 2.0 we
must not focus only on the technology but must also pay some attention to
the people who we hope will use it! As practitioners, we need web skills
to actually use the technology. We must be encouraged to contribute our
knowledge and experience - we mustn't think that "publication bias" is not
an issue for Web 2.0! We need training to use the information that will
become available. And we must not ignore how all this can contribute to
the traditional evidence base.

The future is very exciting. There are great gains to be had if we we
keep an eye on the bigger picture! Thanks again to Dean Guistini for his
valuable contribution.

Competing interests:
None declared

Competing interests: No competing interests

27 January 2007
Kevin P Balanda
Associate Director
Institute of Public Health on Ireland