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Health.SE is dying. Continuing the medical analogies, we are suffering from multiple organ failure:

  • bad questions
  • bad answers
  • not enough activity by experienced users
  • not enough experienced users

We are slowly entering dangerous territory where bad answers (like a recent example from me) gather 2 upvotes or even get accepted just because low activity.

We as a Community have tried multiple different treatments. Just to list a few:

We even had to defibrillate it at some point:

I personally think the site is not salvageable, that death is final and very close.

Now, it is time for us as a very small community to come to a conclusion? Should we actively unplug life-sustaining machines and basically perform assisted suicide, or should we watch the site rot and die in agony?

Obviously I'm a bit biased because - I admit - this post is partly encouraged by my frustration of how many treatments have failed or weren't put into effect. I will refrain from voting, but I think it is important that we make such a decision.


Maybe I need to clarify: I don’t want the site to die, but I think it is important to have this discussion. Hopefully, we can extract a plan on how to improve this site and act it out, something we weren’t able to do with previous plans.

  • Also relevant: We are at no. 8 when it comes to badness on SE sites, with 173 total sites. Pretty good ranking.... – Narusan Mar 7 '18 at 18:02
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    For what it's worth, that query puts Health in just about the place I'd expect it to be. Getting bad questions is annoying, but not a fatal problem. Getting bad questions and not downvoting, closing or deleting them is a fatal problem. – Jon Ericson Mar 7 '18 at 18:13
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    @Narusan-in-coma - You're reading it backwards. We are the 8th worst site for bad questions, not the 165th. – JohnP Mar 7 '18 at 18:16
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    Would combining with the Fitness StackExchange help? Health questions are often asked on there despite being considered off-topic. – JustSnilloc Mar 10 '18 at 16:09
  • @JustSnilloc Doubt so. It’s a different interest group (one for people who exercise, the other one for medical professionals). – Narusan Mar 10 '18 at 16:11
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    From my perspective, this post is poorly timed. A year ago I would have agreed with it completely, but in the last few months things have actually improved significantly. Bad questions are finally getting closed, good answers are becoming more common. So I think there's hope, but as I've maintained all along, I think simply changing the name would make a big positive difference. The name "Health" is simply too generic and attractive for people looking for medical advice. – Carey Gregory Mar 19 '18 at 17:23
11

Yes and No

I think the site could still be viable. As the site currently stands, it is a pool of dreck, constituting a lot of the worst beliefs and misconceptions about health. I think that is one of the things that drives away a lot of potential contributors, as they don't want to sit in their office all day fielding "Dude, what is this pimple looking thing" kind of questions, to come here and field the same things. So if we continue with the same model, no, I don't think health can survive under its own weight.

If we change the scope of the site (Which has been discussed before), and align it more along the lines of the Medical Sciences propsal, then it has a chance. It would take a lot of heavy lifting at the start, and would require both participation from the user base as well as the moderators (To include possibly replacing absentee/tired mods). It has been done before, Fitness carved off Nutrition as being off topic, also amid some calls for the site to be shut down.

https://fitness.meta.stackexchange.com/questions/186/is-this-site-in-a-state-of-chaos

https://fitness.meta.stackexchange.com/questions/306/fitness-and-nutrition-is-now-physical-fitness

(Among others, search "scope" if you are interested)

Also, on an established site Movies & TV, there was a recent initiative to declare ID questions off topic. This required a coordinated heavy lift between CM team members as well as site members. It can be done.

As Robert says in the fitness thread, it's not a silver bullet. However, given that the medical science proposal is 6 months in, still needing 19 followers and 36 10+ questions just to get to commitment phase. I don't think it is going to make it, but the interest shows that it could be viable. I would be in favor of shifting the focus, changing scope, etc. We would probably need to replace one mod, possibly more, depending on how they feel about the site change and the effort needed. There would be some heavy handed policing until we can attract more traffic of the kind that we want.

Would it be 100% fix? No, but I think it would be the best chance for survival, and create a useful, professional oriented site, rather than a dead beta and a soon to be dead A51 proposal.

  • My personal mark for this is quite simple. At least two answers here need to get more than 15 upvotes each within the next 3 weeks. If we do not manage that… – LаngLаngС Mar 6 '18 at 19:47
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    @LangLangC - You realize, of course, that that criteria would shutter probably 70% of all beta sites? – JohnP Mar 6 '18 at 19:49
  • Well, I looked a bit around. There are sites in worse condition. These numbers are based on my personal estimates of something like a possible core user group of frequent flyers here/on main. This bar is actually lower than that estimate. Your positive outlook mentions "heavy lifting". If you have more mod insight into the real user base of regulars that results in this criterion as too pessimistic/optimistic I am even more afraid. Voting is not a huge effort. – LаngLаngС Mar 6 '18 at 19:58
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    @LangLangC - You can't force people to vote. Take a look at Stack Overflow. They get hundreds upon hundreds of questions, have like 15 moderators and a gabillion high rep users. Tons of those questions get answered quickly, and only very few get any votes at all. – JohnP Mar 6 '18 at 20:00
  • And I do not want to force anybody. All I am saying is that if this literal "life or death" question also suffers from "no opinion on that" that that might very well invite some conclusions about the user base and the remaining motivation. – LаngLаngС Mar 6 '18 at 20:04
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    @LangLangC - That's also a possibility. – JohnP Mar 6 '18 at 20:09
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    How will This time be different than all the other times? This is the most important part the yes-fraction needs to explain to me so that I will invest my time and energy. I see some points regarding a possible mod change (who will volunteer?!) It would be great if we had like a 10-step Marshall Plan on rebuilding this site. If we manage to come up with something, get help from the CM‘s and and making it seem like a sound task to tackle, then I‘m all in. But right now, I‘m not convinced. I cant see the plan that will lead to a better solution. – Narusan Mar 6 '18 at 20:41
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    @Narusan-in-coma because the site never decided to change scope. Y'all dashed off to create the Area 51 site and essentially said "That will fly, who cares about this site?" – JohnP Mar 6 '18 at 22:04
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    @Narusan-in-coma why do you stick around and repeatedly call for the site's demise instead of just walking away? What's keeping you here? I'm not asking this to be snarky but to try to find that core of goodness that makes you still care, in case that suggests a path forward. – Monica Cellio Mar 6 '18 at 22:43
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    @JohnP That it is not really correct: nobody "dashed off". Those who tried MedSci going, that includes you & me, thought that was a viable option, yes, and one that could be initiated by a few, get done now, and then hopefully cross-pollinating to Health, never leaving anyone or anything behind. To the contrary. We all do not know, where, who and not even how many users stand and really try to bring some needed change about. Reforming How to Ask was a struggle, and we have not that much more to show for all the ideas and efforts that went into this site. To really start, this Q is brilliant. – LаngLаngС Mar 7 '18 at 1:07
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    @MonicaCellio The few users whom I have interacted with. If it wasn’t for them, I‘d be long gone. – Narusan Mar 7 '18 at 5:57
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    @@JohnP Given that I suggested the name MedSci for a new name in November 2017 and with that the Area51 proposal was pretty much given up, I don’t think it’s fair to say we gave up and didn’t want a change here. That proposal now has 10 upvotes, but hasn’t been afternoon by CMs or anyone. I don’t know what the procedure for a site name change is, but I think we‘ve gone quite far. – Narusan Mar 7 '18 at 6:17
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    I'm down for the site name/scope change. @JohnP I have been leaning in this direction for a while, thanks for this answer. But note that our Area51 wasn't a jump ship, it was an attempt to revive ALL of it by cultivating a pool of active experts. At least MedSci Area51 has shown us that there's not the energy or critical mass for an entirely new site, but we might revive this one by pouring new life into it. – DoctorWhom Mar 7 '18 at 6:57
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    Another thing to consider is by renaming/scoping the site and doing a purge, even if we aren't successful in warding off all poor questions, the # of poor questions will be greatly decreased, and that in and of itself will stimulate growth. We'll need to actively engage in determining purge criteria together, but it's do-able I think. – DoctorWhom Mar 7 '18 at 6:59
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    We desire quality and not quantity. – Graham Chiu Mar 7 '18 at 17:36
8

I'm all for dying with dignity, and I want to be able to do that in my personal life as well. But not everyone feels that way, There are always those that cling to the small possibility that the dying patient will pull through, even if they've been in a coma for 5 months. In that case, you wonder what things will look like if they awaken... Ok, enough medical analogy.

Back when the call went out 39 moons ago, I expressed my doubts.

A tiny bit of history maybe behind the scenes is that those most interested in such a site were most interested in getting their personal medical questions answered. I've never seen so many differently worded questions on lateral epichondylitis in my life!

In any case, I was asked to be a mod, and I accepted with reservations. One of my requests was that I not be the only medical professional on the mod team. Two docs were selected (the other had already gotten the request email, so that was easy.) When faced with actual moderation, though, it was a rough and tumble fight between those who wanted a professional site and those who didn't (e.g. fought against sources, wanted to allow personal medical questions), and that mod quickly jumped ship. She even quit once. I don't quite understand why she reapplied for the position. But, suffice it to say, she believes to a destructive degree that the role of mods is to do as little as possible. On this site, that is not wise.

I have expressed this elsewhere. SE is not a good fit for medical questions. People upvote answers that sound good, especially if there's the obligatory reference tossed in there somewhere. It's not good enough. People with T1DM die, not live a long life without knowing that they have the disease (an accepted answer.) People who have odd encounters with bats need prophyllaxis, no question about it. People do not get tired after a meal because blood flow is diverted from the brain to the gut, or that insulin causes serotonin and melatonin secretion to increase. (That last answer, initially submitted without sources, was from the site's main CM, who ignored all of the recommendations he approved of.)

As a conscientious physician who was afraid of this from the very start, it was impossible for me to stand by and see this (often upvoted) misinformation fly freely. That means confrontations ensued: post notices, down votes, and a lot of comments pointing out that the sources weren't reliable, or worse, that the source didn't say what they claimed it said. Arguments in comments, complaints in meta and even on Meta.

That was at the beginning. What hasn't changed: bad questions, bad answers, answers without references even from medical professionals here and here on the same question (note the reasoning in the deleted answer: "as an MD, I rarely have the time to look for references though I know where exactly to find them. The American College of Cardiology (I'm a member), www.uptodate.com (I have a subscription) and several other serious medical sites have plenty of material to cover almost any question here but my problem is time. Therefore, I choose not to answer questions anymore.") (That was not the first doc to react to a request for sources that way. My reasoning is if you know exactly where to find an answer in the literature, why not provide a quick link? It's an extra minute of your life.)

Good questions won't happen because the community hopes they will. Docs won't stay who a) are too uppity to provide a link, or b) get tired of the poor-quality questions and stop coming to take a look.

I was gone for a year and I remained the highest rep user. That should say something.

I know many are fighting for the site. But the plain truth is that SE users, both those familiar and those unfamiliar with the SE model, don't like the 'rules' imposed on this site. I don't think making the rules plainer, or restricting the scope further will help the site. What will help the site is outside of the SE model, and therefor the CMs won't allow it.

If I were a semi-comatose patient on a vent for two years, I would want the plug pulled. This site is very much like a semi-comatose patient on a vent. You can't pull off a miracle.

Edited to add: As I'm not a regular here any more, the reason I posted an answer is the sense of responsibility I felt and the enormous amount of time I gave in trying to keep it alive. The re-incarnation of this site will require the same, but there are no interested medical professionals who have the time to commit to it that it will need. I don't know how many part-time medical pros it would need, but they will need to be of the same mind with regards to the site. If history repeats itself, nothing will have changed. I also want to commend the currently active mods who have stuck it out and devoted their energies to this difficult site. They have my respect.

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    The problem is that even with apparently good answers, it would take me as a non-professional (and possibly MD's from different fields) quite a long time to read through the literature and decide whether it's solid or not. This is not a problem if we have 10 questions and 30 active users per day, and each has to cover a third of an article. But we have more questions and a low amount of qualified users... – Narusan Mar 7 '18 at 16:37
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    This is a very well reasoned viewpoint. As an emphasis, the poster is a current MD, a former moderator of this site, and a longtime moderator on the SE platform. This should be heavily considered. – JohnP Mar 7 '18 at 16:40
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    I think we agree that the current medical users want the same, a professional site. If we're all on the same page we might be able to move forward but we can't if we all have different objectives. – Graham Chiu Mar 7 '18 at 17:33
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    @GrahamChiu - "...the current medical users..." are not the majority of users here, they are a small minority. A small minority must make a huge and sustained effort to change the majority, and will probably still fail. You are overlooking this fact – anongoodnurse Mar 7 '18 at 17:56
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    You got to start somewhere. Consider us the thin edge of the wedge. – Graham Chiu Mar 7 '18 at 18:03
  • @GrahamChiu - Hey, it's ok with me. I'm not going to do any of the heavy lifting. – anongoodnurse Mar 7 '18 at 18:26
  • Sure. we understand that you're suffering with RSI as a result of your previous work. I suggest tricyclics, and cognitive based therapy to help ease your return to health. – Graham Chiu Mar 7 '18 at 18:28
  • One thing I' really like to read spelled out is what exactly it is that you consider needed but runs strictly against SE policy in general. There are some of those policies that might need changing on the SE level, for other sites as well. SE model is not perfect and I am not very content with the dismissive "but it's the best around" (to not quote "the worst, except for all the others".) – LаngLаngС Mar 7 '18 at 19:20
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    Thank you for writing this, @anongoodnurse! I can understand, I had seen what you put into the site and why you would feel this way. And I wouldn't expect you to do any heavy lifting regardless of what we end up doing. I wanted to highlight "A tiny bit of history maybe behind the scenes is that those most interested in such a site were most interested in getting their personal medical questions answered." THIS is so true. This was what I fought so much about in Area 51, as it was why Health and Medicine were collapsed into one site, which I think is what doomed the entire thing. – DoctorWhom Mar 7 '18 at 22:21
  • To qualify my comment, although I certainly mirror some of Anon's well written sentiments, I still would like to see an aggressive reboot. I just won't be reliably able to offer lots of time, or regularly scheduled, since my schedule remains highly variable. – DoctorWhom Mar 8 '18 at 5:57
  • I have a comment on your part saying about users opposing the site's rules in my answer: health.meta.stackexchange.com/a/889/99 – Ooker Mar 27 '18 at 16:31
6

Just to add a perspective:

Over at Psych & Neurosci we have very similar issues. Your stats on Area51 are in fact pretty comparable; not enough questions (not enough users), a failing %answered ratio (not enough hi-rep users / many poor questions) and not enough answers per question (something that the SE network desperately wants to cling to their voting system).

There we have 2.4 questions/day, you're at 5. There we have 85% answered, you're at 62% There we have 1.4 answer ratio, here you have 1.3. There we have 370 avid users (a gross overestimate imo) and you have 226. There we have been in beta for about 7 years, you're only at three years.

All in all pretty similar and given that we are two times as old as you are, it's pretty much identical, and we are still standing over there! Instead we have been actively improving our site, by changing our site's name recently (slightly increasing #questions, perhaps...) and we have been adding a well-thought close-reason (slightly increasing %answered). This has put us in regular (but not frequent) contact with the SE team in terms of our site's name and so forth, making sure we are noticed at the top.

Bottom line, you're only dead when you give up.

  • bad questions --> close them
  • bad answers --> comment and downvote
  • not enough activity by experienced users --> try to encourage folks to do more by getting together folks in chat to reach common goals
  • not enough experienced users --> try to lift the site's standards overall

I'm not saying this will save your site, it's just to put things in perspective.

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    yeah, pretty much what we are attempting. – Graham Chiu Mar 13 '18 at 3:21
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I"d like to see if a last ditch measure can be made to save this site.

To this end I've asked a couple of questions. If the others can do the same, then we can get some exemplars up to show what type of questions we're looking for. But that means all those interested need to rapidly downvote those questions that don't meet our new criteria so that they can disappear quickly.

PS: A surgical resident answered my question on PCP prophylaxis. So, there may be hope after all with this way of going forward.

1

While we are trying to resuscitate this site can those who vote to close a question just tell them to see a doctor and not give a spiel about seeing their GPs, better management etc. Their questions are off topic, and the added information is just confusing to them as it looks as though we are conflicted.

Edit: Come on people, there must be more than 4 people who are active daily who can vote to close these off topic questions!!

  • Maybe I do not really understand: is this a reminder/reinforcement of "Do not answer in comments?" (If yes, I'm all for it.) – But most of those "answering" (some comments come to mind) seem to me quite often just preempting the close-reason, while "trying to help (anyway). If your input here goes beyond that, I'd suggest a new meta-Q for that. – LаngLаngС Mar 8 '18 at 1:49
  • Yes, it's a variant of do not answer in the comments. And do not attempt to help. – Graham Chiu Mar 8 '18 at 1:50
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    "Do not attempt to help" is maybe concept or a type of language not really suitable for SE or even this site, but I guess I understand now. Nevertheless, I think this deserves its own meta-post! (If the language / precision of what is meant by this is made clear.) Unless I am not uptodate on this meta. Please recheck. – LаngLаngС Mar 8 '18 at 1:56
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    Oddly, if we do end up going this route, I think a consult with the Skeptics mods might be in order, as they are a slightly odd duck in SE waters and have pretty stringent requirements for posting. Not surprising, given the the tendencies of conspiracy theorists. And they are also graduated. – JohnP Mar 8 '18 at 3:53
  • @DoctorWhom please do this. – Graham Chiu Mar 8 '18 at 6:13
  • Actually, I started writing a meta on closing questions that became more general, but I think that's a better direction to go. So if you can please PM me your ideas ahead of time so I can incorporate them. Thanks :) – DoctorWhom Mar 8 '18 at 8:48
  • @DoctorWhom nope ... which room? – Graham Chiu Mar 8 '18 at 17:24
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If the problem is users not following the rules, not because of the SE model, or the lack of qualified users, as @anongoodnurse says:

I know many are fighting for the site. But the plain truth is that SE users, both those familiar and those unfamiliar with the SE model, don't like the 'rules' imposed on this site. I don't think making the rules plainer, or restricting the scope further will help the site. What will help the site is outside of the SE model, and therefor the CMs won't allow it.

...then I don't think it's necessary to unplug it. Eventually some other new users who accept the model and the rules here will come and stay. Until then, bad answers with positive votes will survives, and we have to accept it as how we have to accept our unfair history. We can only do what we can.

If you really want to see bad answers be downvoted harder, my proposal is to let the required rep to have that privilege much lower, so that qualified users can act immediately. Further discussion: Why should downvoting be a privilege?

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    Compounding the problem is that there are so few answerable questions that it's hard to gain rep. – Graham Chiu Mar 26 '18 at 15:11
  • I think we shouldn't require rep to downvote at all. See Why should downvoting be a privilege? – Ooker Mar 26 '18 at 15:35
  • @Ooker - I disagree. See my answer to Why should downvoting be a privilege? – Chris Rogers Mar 27 '18 at 14:29
  • @Chris are you disagreeing that the site needs not be unplugged, or the proposal of eradication of downvoting privilege? – Ooker Mar 27 '18 at 16:18
  • @Ooker - I disagree with eradicating the need for reputation before able to downvote. - See the answer I linked – Chris Rogers Mar 27 '18 at 18:48

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