Monday, December 14, 2009

UpToDate's grant program: free software and information.

Information wants to be free, or so say the hackers. And while good medical information has long been expensive, some of it will soon become free for some of those least able to afford it.

On December 4th I mentioned that UpToDate, the eponymous medical-article service, has rolled out a grant program. Today I talked to Drs. Ellie Baron and Denise Basow--respectively, UpTo Date's Deputy Editor for Infectious Diseases and Editor-in-Chief--about the service's plan to give away free subscriptions to its giant article database for low-resource practices.

"We've been providing donated subscriptions for several years," said Dr. Baron, who told me that they get about 20 requests a year, many of them from UpToDate authors who are doing medical work abroad. "What's changed is that recently the application process has become more formalized." To wit, they've formed a partnership with a group called the Global Health Delivery Project (GHD), which was started by low-resource godfather Paul Farmer and colleagues. If you run a medical organization in a low-resource setting and can't afford the pricy subscription to UpToDate, you can fill out an application, whereupon GHD doctors will decide whom to grant subscriptions to. This is the first year of the program and Dr. Baron wasn't able to say how many subscriptions they plan to give. It may depend in part on the number of applications they get. One hopes there will be a lot more than 20.

On the other hand, since most of UpToDate's articles are written by and for physicians in high-resource settings, it's worth asking what good they are to our low-resource colleagues. Does it help to read about the latest chemo recommendations for breast cancer when all your hospital has to offer is a surgeon? To UpToDate's tremendous credit, they are studying this. Low-resource sites affiliated with Partners In Health (also a Farmer organization) are using UpToDate and recording which articles and what kinds of information seem to be most useful. Their ultimate goal, said Dr. Basow, is to publish this information. For the moment, Dr. Baron told me, though people may not have access to the most costly resources mentioned in an article, they can adapt what they do have to the article's recommendations (which, in my experience, often offer multiple suggestions ranging from the simple to the complex). And I would submit that all health-care workers are entitled to the best information, period. If they don't have the ideal chemo cocktail, at least they will know something about how to use it if their clinic does gain capacity in the future. Which it would seem more likely to do if its leadership has a clear idea of what the clinic needs.

Also to be applauded is the fact that UpToDate is developing more content geared toward low-resource practitioners. Baron told me that the company is gradually adding authors and articles to the existing database, and once they have enough, they plan to make it a dedicated section within their contents. With the subscriptions and the articles, she said, "We're trying to get at [low-resource medicine] from more than one angle." Bravo, UpToDate.

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