Back in the Fall of ’07, Mindsite scored what seemed to be a major coup for a small startup operating with very little operating capital: we licensed about half of the Diagnostic and Statistical Manual of Mental Disorders. Also known as the DSM-IVTR and published from the American Psychiatric Association, we got a license to display ten of the most popular chapters on our website, the full text freely available to both consumers and professionals on our site.
Our plan was to get the DSM-IV online, generate big traffic, and then have people click through on lucrative Google Adsense ads leading to huge revenues for us – a content arbitrage play if you will…
We didn’t really understand why the APA was taking us seriouslyy – no major book publishing house had ever done a deal like this, where they put a limitted amount of their valuable goods online with few restrictions. It turns out the DSM-IV is somewhat unique in the world of academic medicine texts in that it is self-published by the APA, an independent non-profit, as opposed to a major publishing house. Perhaps that gave them a little more flexibility? Maybe they were trying to further disseminate the DSM-IV given the advancements of the competing system run by the World Health Organization? In the end, APA motivations mattered little to us - the DSM-IV is the most comprehensive map of psychopathology available anywhere and we wanted it.
There were lots of reasons to be excited to do a deal. Firstly, this book is a big, big seller. Amazon’s sales rank for the book ranges from 229 to 443, making it one of the most consistently sold books on the mind since 1994. Second, the APA generates huge money off of this book in the form of sales – they also sell access to a full online version. Thirdly, in the field of mental health, the DSM-IV is the gold standard for defining symptom clusters around common human problems such depression and anxiety. For a company that was focused on improving clarity for consumers around mental health issues, it would seem that we had struck gold - a seemingly game changing deal that would reverse some significant information asymmetry.
Once we finally got the DSM-IV online, many months after signing the contract, we found ourselves extremely busy working on our online diagnostic tests and community features – we didn’t really have a lot of time to push awareness that the book was now online. I sent some half-baked emails to a few big-time journalists, including a bunch to the NY Times. I guess we were sort of like Kevin Costner in Field of Dreams. Danny Sullivan’s Search Engine Watch accurately described our strategy as destined to fail since it seemed to follow a “license and be found” approach. Truer words had not been written – immediately after our launch we had little traffic and no ad revenue.
After our second major release for Mindsite during Summer ‘08, we decided it was high time to get cracking on generating some traffic against our content since we had also written our first 6 month installment check for $20k to the APA. To maximize our exposure and kick start some traffic, we decided to take our content proposition straight to the heart of the Internet, Wikipedia.
Knowing absolutely nothing about the the behind the scenes workings of Wikipedia -I had not even looked at a discussion page before - we did some online reading to make sure that we understood protocol for new entrants. It was clear from a quick review that it would not be a good strategy to start editing Wiki pages directly as a commercial entity, adding links to Mindsite’s DSM-IV pages; Wikipedians were aggressively allergic to this type of behavior. Understandably so – Wikipedia is one of the most trafficked sites on the Internet, adding links to commercial sites is a temptation for anyone who wants to get a little slice of that traffic for themselves. Knowing we were offering a legitimate value (free content in exchange for seeing ads) we proceeded ahead though, cautiously.
Formulating a strategy consistent with these findings and electing not to graffiti wikipedia, we decided to drop a note on the discussion for both the schizophrenia and major depressive disorder pages, indicating that we had the full text of the DSM-IV for each of these disorders online, and that perhaps a link to our webpage may benefit people looking for this type of information since it was now free without registration.
This is where the story starts to get interesting.
Immediately, one of the top Wikipedia editors, SandyGeorgia descended into our discussion and started to help us figure out what was going on. There was no precedent for a book being published on the Internet like this and it was recommended that we make a proposal, we chose to focus on the updating or creating Wiki pages based on the index from the DSM-IV; we proposed that other wikipedians make those changes to avoid a conflict of interest. Once it was established that we were in fact hosting the DSM-IV content for most mental health disorders, we ran into some unexpected, albeit legitimate, issues.
First off, many top Wikipedians did not believe that we had a valid licensing agreement from the APA. As an example Fvasconcellos started a thread on our discussion page asking us to show us the goods, proving that we were legit (note that we think these were valid questions to ask):
Can you provide an explicit, externally published source confirming that you have indeed licensed this content, such as a statement from the APA?
- Can you provide evidence that our linking to this content would not constitute a copyright violation?
- Wikipedia is very serious about fair use. Any additions of fair use excerpts to articles would probably have to be assessed on a case-by-case basis to ensure they meet our criteria for inclusion of non-free content
Other Wikipedians had different responses. User PaulGene, apparently sporting a higher risk threshold and tolerance for excitement, indicated that he was comfortable adding Mindsite links to the Major Depressive Disorder article:
- Being a laissez-faire person, I added your site to the External Links list for the MDD article. It will stay there unless we hear from APA that your use of DSM-IV-TR is not legitimate. Also, as other people here noted you would want to make it explicit on your site that you are using DSM-IV-TR. (It implicitly follows from the copyright dates.) Good luck!
Many other users chimed in on our discussion page, exemplifying the hard hitting no-nonsense spirit common on Wiki including Steve Carlson who gave us tips on transparency:
My biggest concern about any edit to an article is whether the articles benefits from said change. This concern is intensified in reaction to the idea of a whole program of edits, particularly one whose stated goal is to integrate content from a single third-party source instead of to improve these articles. I'm not saying these goals are mutually exclusive, but the interests of wikipedia should be primary. Merely acknowledging your potential WP:COI is not enough, I need to be convinced that this is not a veiled advertising campaign, a practice which very much ruffles my feathers here on wikipedia. Also, as has been pointed out above, I have yet to see a fair use statement and, in fact, your terms of use seem to forbid reprinting of the material licensed from the APA.
That said, I do think that citing Mindsite as a reference instead of BehaveNet or the DSM itself would benefit articles on psychopathology, because providing a link to the text in addition to the diagnostic criteria may prove useful to someone who wants to dig deeper without having to shell out $$ for the DSM. However, generally speaking, the text itself is too technical for a general audience, and I would balk at the idea of blockquoting even short bits of it. It is better for an editor to take the time to digest and restate the material for a general audience. Steve CarlsonTalk 03:49, 11 July 2008 (UTC)
The net result was that SandyGeorgia punted the issue of whether links to Mindsite were legit to the Wikipedia copyright team, so they could clear this up before any real work was begun, starting a large thread. A solid and cautious step demonstrating that Wikippedia is a professional organization. Moonriddengirl volunteered to check with the APA to see if Mindsite was, in fact, the real deal. After no responses from the APA to Moonriddengirl’s inquiry, we decided to send the APA an email ourselves, explaining the situation at Wikipedia and indicating that this may be a good time to issue that press release that had been talking about (sadly something that was overlooked by me in our original contract). A few days later and still no response, the individual who had worked with at the APA was no longer employed. Finally, we managed to get some higher ups on the line. Following the discussion with the APA, we summarize the outcome, somewhat embarrassed, on the main copyright thread.
The short summary from the APA: no press release for Mindsite, no public endorsement of our licensing deal, AND further a distrubingly convoluted commentary about the widespread use of the DSM-IV criteria on the Internet.
The last issue was really the most troubling, not necessarily for Mindsite, but for the Internet and the state of mental health information on Wikipedia - despite some heroic effort of a few top editors, most Wiki material on mental health is not hte best. Apparently the APA had told Wikipedia, back in 2005, that the inclusion of all diagnostic criteria constituted a copyright violation, and for that reason some Wiki pages on mental health issues do not include the full criteria as defined by the APA. However, other Wiki pages include this information already, many sites publish it all over the Internet. Any academic paper on mental health mentions and uses operationalized DSM-IV criteria as well. Clearly the issue of copyrighting a disease was not a simple issue nor even remotely resolved. Unrelated to mental health, user SteveStevnfruitsmak mentions similar problems he is encountering writing about spesis:
This probably doesn't apply to DSM-IV alone. I've been working on sepsis today, basically the definition of sepsis and criteria could be seen as copyrighted by the American College of Chest Physicians. Many clinical guidelines are protected by copyright which in some cases hinders writing an article about them. Basically, all medical knowledge is in the copyright hands of medical journals
So to wrap up our long story, a few weeks after it became clear that we were not going to get any traction with Wikipedians on our proposal to map the Mindsite DSM-IV links into relevant Wikipedia articles, at least not with any of the credible and authoritative editors receiving objective external validatiion of our license, we gave up. Also, at one point later on, the APA had said they were not happy with how we were displaying the content, but we only received emails - it was nothing serious and quickly resolved after we made a few small changes to the site.
Later we put on our best poker face. Recognizing that the APA wanted the material down and would not renew the contract next year, we indicated that we may consider taking down the content if we got our money back. A rapid agreement was reached and we took the information down the same day we got our money back. No harm no foul. Everyone was happy - we tried something and it didn't work. Oh well.
An unresolved question: can a disease or disorder be copyrighted? If the working definition for many mental health disorders are based on the diagnostic criteria (the inclusion and exclusion criteria for a specific diagnosis) where does that leave people who want to find out if they meet the criteria for a specific condition without seeking professional treatment or just to get an objective summary of how their experiences stack up against the DSM-IV? It becomes a circular question since the criteria defines the 'disorder.'