[WikiEN-l] Rx Dosage Instructions in Wikipedia

[Daniel P. B. Smith]

> From: Bryan Derksen <bryan.derksen at 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."