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In December, I saw a patient who had been concussed after hitting his head while falling off the back of a treadmill; he’d been reading the book Wikinomics: how mass collaboration changes everything.1 He brought the book to the appointment while still symptomatic. Not surprisingly, he forgot it in my office; in the spirit of Dr House I snitched it for the week. What is the core of wikinomics? And does it apply to our field?
“Wikinomics” describe extensive collaboration and user participation. Authors Tapscott and Williams claim four powerful new ideas: “openness, peering, sharing, and acting globally”. Openness refers to tapping the global talent pool—ensuring, for example, that potential collaborators from Abu Dhabi to Zagreb have equal ready access to information. It might mean providing data, questionnaires or videos of exercise interventions. Journals such as BJSM can embrace openness in peer review, and, where possible, in providing open-source material. Of course this must be balanced with the challenges of a sustainable business model. Toyota hasn’t popped their hybrid engine blueprints on the Web with instructions on how to make one at home.
Peering refers to replacing top-down leadership with an egalitarian community—everybody may pitch in. Think Wikipedia: no owners but tens of thousands of volunteers. Apparently that encyclopaedia has only five full-time employees yet is ten times the size of the Encyclopaedia Britannica! Imagine a sports medicine text updated daily by thousands of clinicians. Better than the tome keeping your monitor at eye level?
The Hippocratic oath encouraged physicians to “give a share of precepts and oral instruction” (Wikipedia’s Hippocratic oath comes up first on Google in 0.21 seconds). Hippo was ahead of his time—sharing in wikinomics contrasts with the traditional proprietary approach to intellectual property and scientific knowledge.
The International Conference on Concussion in Sport in Vienna (2001) and Prague (2004) provided clinicians and athletes with this type of shared knowledge at no cost. In addition, various journals “shared” the final statement to provide the widest possible knowledge translation.2 Citations for these papers have far outweighed what one “expert” in concussion could have achieved even if they had published in the most influential general medical journal (JAMA, oops, I mean BMJ). The 2008 concussion conference is being hosted by FIFA together with the IOC, International Ice Hockey Federation and International Rugby Board in Zurich on October 30th. The agenda promises original data, refined guidelines for both simple and complex concussion and insight into the challenge of paediatric concussion. Do you want to be part of this important process? One hundred and twenty registrants can combine a visit to FIFA headquarters while contributing to the conference. But what almost knocked me out was that the first day's proceedings will be webcast free! Details will be posted on http://bjsm.bmj.com as well as the BJSM blog (http://blogs.bmj.com/bjsm). Congratulations to all involved for embracing the wiki spirit—openness, peering, sharing and global action.
On that note of global action—“ignoring physical and geographical boundaries”, we zip from Zurich to the Arnold School of Public Health in South Carolina, USA, the new academic home of Professor Steven Blair. During our phone conversation, he lamented that despite the rapid accumulation of evidence for the health benefits of regular physical activity, uptake remained suboptimal, alarming or appalling depending on your mood. In this issue Hamer and Chida highlight the effectiveness of walking (see article on page 10.1136/bjsm.2007.039974), yet exercise prescription has been virtually absent in clinical medicine (let’s be honest). Certainly for physicians, the sum total of university medical education related to physical activity could be captured in one episode of Grey’s Anatomy.
But with Professor Blair’s leadership, BJSM aims to be part of the solution. To encourage clinicians to pay more attention to promoting physical activity during patient consults, the January 2009 issue of BJSM will review the current state of the science and provide practical recommendations as to how clinicians can implement effective physical activity interventions. Full details are on the new BJSM blog (http://blogs.bmj.com/bjsm).
In this spirit of mass collaboration, for the theme issue (Integrating Physical Activity into Clinical Practice) guest editor Blair encourages submissions from the world over. He’ll oversee open peer review and we’ll work with the BJSM publishers to see how much we can share for free. Let’s see whether this wikinomic approach of “openness, peering, sharing, and acting globally” can contribute to mass participation against physical inactivity.