Wednesday, April 09, 2008

UpToDate OutOfDate

Where do most academic medicine providers get their information about the latest understanding of disease and treatment?

A web search engine called UpToDate. This service provides review articles of the medical literature that range from pretty good to excellent.

Imagine the horror medical students, residents and providers across the University of Washington system experienced today when they read this email:
"As a result of extraordinary price increases to provide UpToDate access for our distributed community of UW Health Sciences students, faculty and staff across the Pacific Northwest Region I have had to make the painful decision to cancel this heavily used resource. In spite of extensive negotiations with the publisher over the past two years we simply were unable to negotiate a price that our Health Sciences Libraries budget could afford. The price for UW is much higher than for other institutions, in large part, because we are a regional health sciences center with regular faculty and students across Washington State as well as in other states throughout the WWAMI region. This means that simple onsite access as provided by some Health Sciences Libraries (e.g. walk into the Health Sciences Library physically and access the resource) will not work for many of our students and faculty who would need to get into a car to come here or worse, fly for several hours!"
For more details about the specifics of this situation at the University of Washington, visit the UW UpToDate alert page. As a medical student spending the majority of his third year outside of Seattle, I am particularly aware of the crux of this issue. What I want to know is how they can charge so much money for what is basically a bunch of review articles. Just how much are their writers being paid? Do the authors get paid per hit? I kindof doubt it. The last time I checked, basic science professors don't get paid jack for writing review articles. (Actually, I just (this evening) reviewed the preprint proofs for a review article I was the first author on. Far from being paid, we had to pay the journal because we include color plates...)

Johns Hopkins refused to subscribe last year, and now the UW. As of July 1, 2008, UW students, residents and faculty will no longer have access to the most used resource for medical decision-making. In a way it is too bad, because the articles on UpToDate were the best annotated and easiest to read of any online medical resource. Because I am a (small potatoes) employee of WebMD, I've done a little bit of research in to the reference services provided by that company. So far, I haven't been able to use it for comprehensive reference information as seamlessly as UpToDate, but I think that will have to change. And, the WebMD portfolio includes a large amount of other cool information that is more media-friendly than UpToDate. Other services available to providers in the UW system include:

MDConsult (WebMD's healthcare provider page)

If you are logged into your browser with your UW password, these links will send you directly to all of the subscription services.

Despite the inconvenience it will be for me not to have an UpToDate subscription, I am glad that UW just said no to big publishing. This info should be open access, anyway!

Anyone out there have tips for an UpToDate-free world?

As I discover tips, I'll try to post them under the tag, OutOfDate. But that reminds me, I've got a series about presidential health care politics I was going to write, too...


Ben said...


Are you familiar with eMedicine (also by WebMD)? Totally free, and pretty comprehensive, although not quite as detailed or as basic-sciencey as UTD can sometimes be, but still a good-looking resource.

Might want to check it out.

George said...

Very thoughtful perspective on your part Thomas -- as usual. Yes, the University of Washington will be dropping its subscription to UpToDate but so have Johns Hopkins University and Duke University (in April 2007).

In my own informal surveys with third year medical students, I have been impressed with how quickly UpToDate was adopted by them as a "go to" resource. It is so easy to read an expert's summary opinion to help guide when it comes to diagnosing and treating patients -- something that is paramount in the minds of clinicians-to-be and clinicians themselves. But I have lamented the apparent loss of interest in more "classic" textbooks of medicine such as Harrison's, Cecil's (found in the MDConsult collection) or even ACP Medicine which provide a different perspective. Those texts may not be completely as current but I believe they remain very valuable resources from which to learn.

I agree that as painful as it might be to those relying on UpToDate, universities should not be held hostage to exorbitant price increases. In some ways, it will be a back to the future experience. Back to the online versions of classic textbooks, back to online versions of full-text original articles and reviews, back to online Current Medical Diagnosis and Treatment, back to other review compendiums such as ACP PIER, etc. In the end, I bet we'll still succeed in finding the information.