Trip is that rare exception, a David in a world of Goliaths. In the real world, the Goliaths usually win, but in Trip’s case, it has survived and gone from strength to strength.
What is Trip? It is a database of clinical content that provides evidence-based answers. I recently interviewed Jon Brassey, where he talked about his background and the history of Trip. The story is a fascinating one. Trip has recently been augmented by the launch of Ask Trip? A medical question-and-answer service.
Why the need for medical question answering?
Imagine a typical scenario. You visit the doctor, and describe your symptoms. Often the doctor can diagnose the problem from your description, but frequently, the doctor will have questions of their own they will want to answer before proceeding. At this point, you could ask Google, but most of us would want a more curated resource, I think you will agree. Hence Trip! It seems almost too simple to describe the Trip Database as “medical question answering”, but that is exactly what it is. Created by Jon Brassey and Chris Price in 1997, it emerged from research that looked into the way that medical practitioners (GPs or physicians) asked clinical questions. The research (by John Ely, published 2005) reviewed how 48 physicians asked over 1,000 medical questions during their patient sessions, but only pursued answers to just over half of them (55%) – and the biggest single reason for not continuing with the question was that the physicians didn’t believe they would find a useful answer.
In light of this research, Jon recounts how he interviewed 220 GPs in Wales, and asked them how they appraised medical evidence through searching. Their collective response, remarkably, was that they didn’t want to do their own searching: “we want to send you questions and we want you to answer them”. Since the searching at the time (this was the 1990s) required using Medline stored on 6 CD-ROMs, it was not surprising the doctors wanted someone to do the search for them. And so Trip was born … with the questions sent via fax, and then recorded on an Excel spreadsheet. At first, each question took around two days to answer.
Today, the service is entirely online. The business model is freemium, with basic access free, but with additional functionality for subscribers. The most recent innovation is the Ask Trip Q&A service, providing evidence-based answers from the Trip Database. Since 2024, it has been using LLMs to get to the answers. The system uses an algorithm to filter the answers found. This, and the initial selection of content from reliable sources, represents the curation.
The startup exception
Most startups either fail rapidly, or are acquired by a large corporation and are then seen no more, but the Trip Database was founded by one person, and is still run by that one person, and is successful. How can Trip survive when surrounded by large-scale clinical reasoning products such as DynaMed and UpToDate? Brassey differentiates Trip from its competitors:
things like Up To Date and Dynamed are predicting the questions that doctors and other health professionals will have and try to answer them. So they’re answering their questions with a view that it will answer 90 % of the questions. Our view is the other way around. It’s like we will allow you to answer, we will facilitate you answering your own question.
In addition, Trip contains thousands of clinical questions that doctors have asked, which they find a useful resource.
Trip, and AskTrip, do not replace systematic reviews; but there will never be enough of these. In the meantime, Trp and AskTrip demonstrate that even in a contentious domain like medicine it is possible to harness available information and to create something trustworthy.
Leave a Reply