Conoscenza aperta in Medicina
Il termine “Conoscenza aperta” in Medicina fa riferimento a tipologie di informazione molto diverse liberamente accessibili sul Web:
- Abstract di tutti gli articoli pubblicati su riviste mediche (PubMed etc)
- articoli fulltext di riviste mediche con referee (in parte su riviste Open Access, in parte su depositi aperti)
- numerosi siti gestiti da enti pubblici (NIH, EMBL, San Diego Supercomputer Center SDSC etc)
- associazioni di ammalati
- case farmaceutiche
- produttori di prodotti per ricerca
- trials clinici
- associazioni scientifiche
- semplici blog di pazienti con una loro opinione
Il Web quindi è ricchissimo di informazioni mediche ma....
The knowledge in Medicine has many bias
Many Actors with different targets
- National Health Services (Cost Effective Actions)
- Private Practitioners (Profit)
- The Physicians (Patient or disease care?)
- The Patient (Personalized Care)
Scholarly Communication in Medicine
- Reproducibility
- Authoritative (ipse dixit/opinion maker)
- Peer Review
- Advertising
Come fa il lettore a sapere quali sono le informazioni per lui più utili?
E' possibile classificare il Web?
Non è meglio che ciascuno impari a decidere per se stesso (Creazione del Flipper e la Nuvola, 2007)?
Sulla capacità di giudizio del lettore secondo John Willinksy (Stanford, padre del principio di accesso)
J.Willinsky, Open Access and academic reputation, «Annals of library and information studies», 58, Sept. 2010, pp.296-302
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How to change the perspective
Most actors share the approach to the disease.
the primary aim is to identify the disease
and afterword to supply to proper drug or treatment
Advantages
- Simple
- Reproducible (the doctor behavior, not the patient behavior))
- Testable (the 70% of the patients improves; the others?)
- No personal responsability of the physician (Defensive Medicine)
Disadvantages
- what to do with non-responder?
- what about drugs induced diseases (> 40%)?
- how to manage multiple disease in one patient?
Evidence Based Medicine (EBM) is the up to date form of this approach
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An alternative approach based on the search for the molecular mechanism of symptoms
I have a symptom:
To answer these questions we need a different type of knowledge structured according to specific rules
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An objective definition of disease
The disease as inadequacy of the living organism to afford the environmental stresses (inhability to adapt)
- Exogenous causes:
- nutritional
- pregnancy
- infections
- working
- atmospheric changes
- drugs
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Diseases affect only living organism, therefore we have to define them to properly understand diseases.
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The living organism
DISSIPATIVE (life takes place only in environments with excess energy: in our case in the sunlight)
EVOLUTIONARY (formation of evolutionary trees for any molecule, organism mediated by irreversible bifurcations followed by selection. The driving forces of bifurcation and selection depend on the environment and can be considered “local”)
CYCLIC (at any level from the molecules to the species specific feedback mechanisms can be identified that regulate the relative number of the objects involved in the equilibria)
OSCILLATING (in any self-regulatory cyclic system the number of any item is changing with time with a periodicity which depends on the size of the system – from seconds for chemical reactions to years for prey/predator
relationship – and the time the feedback signals need to diffuse across the system)
COMPETITIVE (as biological system tend to expand exponentially in a finite environment they – earlier or later – became limited in their growth by scarcity of some essential factor (“nutrient”) and the competition for the limiting nutrient will locally drive the selection).
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It is a Web application based on the Web 2.0 logic, which implies also a different attitude towards scholarly communication. It is structured in
- Reports
- The reality is represented by Reports, descriptions of clinical cases whose fate can be changed by a correct interpretation of symptoms, allowing a validation of the method. Each user edits with a simplified Wiki writing language its own Report and links it with the fitting involved Item or Pathway, and then can tag it or associate it to a MeSH term. That creates a tag cloud which allows unprecedented links and a critical reuse of the content. Comments are always possible.
- Rules
- Items
- The Items and the Pathways mark out the framework of this innovative channel of communication, and the user generated content – dealing with diseases, drugs, proteins, metabolic paths and so on – consists of texts, images, links to scientific literature, links to biomedical websites, in a creative and critical approach as learned during classes. The use of tags and/or controlled PubMed MeSH terms to categorize allows and fosters a free and personal use of information to create original knowledge. Tag clouds also apply to the most linked and handled Web sites, generating a sort of shared validation.
- Pathways
- Tools
- The information, or better, an interpreted gateway to the information is collected in Tools, Items and Pathways, where the link to the contents is categorized with an indexing visually very similar to classical textbooks, but structurally based on a relational database and easily modifiable if needed. The Database is also searchable with the Google search engine allowing a search by argument independently from the type of indexing. Indexing itself carries a lot of information as different branches of learning usually aggregate differently the same set of contents.
Searchable with Google
search by student name
search by topic: Mandibular osteonecrosis
search by topic and author: Pescarmona Multiple Sclerosis
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The Tools
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From the Patient to the Web multiple sources of information
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Hair Loss
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From the beginning
Degree in Medicine cum laude in 1967
L'imagination au pouvoir (1968)
to now.................
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