From: Bryan Derksen bryan.derksen@shaw.ca

Seems to me that having people trust information from Wikipedia about drug dosages at face value _at all_ is the scary prospect.

I think many Wikipedians have enough of an academic background to know that it is not necessarily true just because I Read It In A Book." And they are familiar enough with Wikipedia to use it cautiously.

I do _not_ think this is true of the general public. The general public takes advice from the Reader's Digest, pharmaceutical direct- to-consumer advertising, and paperback books in racks at health-food stores quite seriously.

I think the whole medical-advice business is potentially quite dangerous to Wikipedia's health.

I worked for an extended period of time with the spiny black Caribbean sea urchin, Diadema antillarum. During that time I got innumerable spines and bits of spine stuck, embedded, etc. in my flesh and regarded them as no more than a nuisance. I didn't do anything in particular about them, and in a few days they would apparently dissolve or get absorbed or go away, leaving not much more than a purple tattoo-dot. They never got infected or caused much pain. On a scale of 0 to 10, where a bee sting is 5, brushing lightly against fire coral is 4, and an ordinary wood splinter is 3, these were about a 1. These are of course _my_ results. Your pain and suffering may vary.

I knew that the locals "treated" sea urchin spine injuries by urinating on them, but, well, that was gross, and I didn't bother.

I also knew that a Diadema spine injury plays a role in Ian Fleming's novel "Thunderball," in which James Bond indulges in what seems to me to be a bit of sadomasochistic foreplay by biting a sea urchin spine out of a lovely young woman's foot; in reality I'd think a human bite would be far more dangerous to a lovely young woman's foot than an urchin spine wound. But I digress.

In our sea urchin article, over the years people keep dropping in hints and tips about treating injuries from sea urchin spines. At first I thought it was the sort of entertaining and possibly useful folklore that should say in the article.

When I started checking things out, I found that the range of published opinion on recommended treatment of sea urchin wounds was astonishing. But what really freaked me out was that the range of published opinion on their _seriousness_ was even more astonishing. Thus http://scuba-doc.com/irritants.htm says

"Sea urchin spine injury is usually a benign process that rarely comes to the attention of a physician. Aside from the transient episode of excruciating pain which responds dramatically to hot water soaks, there is usually no residual disability.

Pretty innocuous-sounding, right? I wonder, incidentally, whether "hot-water soaks" is a euphemism for the folk remedy I mentioned. Of course, it goes on a little ominously to say "As in any puncture wound, tetanus prophylaxis and observation for latent infection is advised. Complications arise, however, when spines are embedded over bony prominences, within joints, or in contact with nerves. Cases are associated with sea urchin injuries has not been previously reported in the literature. When such injuries necessitate exploration, aseptic surgical technique is required."

And an emergency medicine text (whose online link has, alas, gone dead) said:

"External percussion to achieve spine fragmentation is contraindicated" and "Spines within a joint or adjacent to a neurovascular structure should be referred to a surgeon to extract all fragments as soon as possible, and surgical exploration for embedded particles should be delayed until a diagnosis can be made by soft tissue radiography or magnetic resonance imaging (MRI)"

And I just Googled a book called "Learning from Medical Errors," http://books.google.com/books? vid=ISBN1857757688&id=3EMWy_Hj9EYC&pg=PA194&lpg=PA194&dq=sea+urchin +spine+injury&sig=OdSzTSr7c0_oxp6rjcLAPa33TxM which describes a sea urchin wound that wasn't properly diagnosed (and, yes, was part of a biggish laceration), as a result of which the patient "underwent a long and complicated hospital course of course" involving multiple surgeries, skin grafts, and ultimately a lawsuit that was settled for $450,000.

In other words, a sea urchin spine is usually no big deal, but sometimes it _is_ a big deal. It is exactly the sort of thing for which it is worth while spending the money for a doctor's advice.

And exactly the sort of thing for which I would hate to have _any_ connection with a Wikipedia page that said "no big deal, just pee on it."

I'm not saying it's likely that anyone could successfully sue Wikipedia for the bad consequences of bad Wikipedia advice, but, as with l'affaire Seigenthaler, the potential for serious unpleasantness is real.

I intend to make sure that the sea urchin article does _not_ discuss treatment of sea urchin wounds... or, at the very, very most, if it says anything at all, says something uselessly vague and CYA like "sea urchin wounds have the potential for being quite serious, and advice should be sought from physician or a reliable book on treatment of wounds from venomous marine animals."