In the fall of 2000 I spoke at a seminar in a big US research hospital on the Internet and its impact on health care. Another participant was a senior scientist from the National Institute of Health, the US federal medical research agency. He was asked what he saw as the biggest challenge for health professionals over the next 10 years. “The biggest problem,” he replied quietly, “will be how to cope with Internet-informed patients.” The audience (mainly health professionals) laughed appreciatively and went about their daily business.
They might have been less amused if they’d realized what was going on even as the seminar was taking place. In November that year, the Pew Internet and American Life survey found that 55 percent of Americans with Internet access were using the network to get health information. At the time, that corresponded to 52 million people. Two years later the number was up to 73 million. I’m pretty sure that trend has continued. A detailed academic study some years ago estimated that 4.5 percent of all Internet searches were health-related, which at the time translated into 16.7 million health-related queries a day. Again, I’m sure that number has gone up.
All of which suggests that people worry a lot about their health and see the Web as a great way of becoming better informed. The medical profession is, to put it mildly, not over the moon. The more literate practitioners shake their heads and quote Mark Twain’s adage: “Be careful about reading health books. You may die of a misprint.” But others are more righteous and wax indignant about what they see as the errors and misinformation peddled by many sites that purport to deal with health issues.
It’s tempting to regard this as the blustering of an elite threatened with the kind of “disintermediation” that has wiped out travel agents. But quite a few studies suggest that the quality of Web health information is pretty variable. For instance, several estimate that about 5 percent of sites dealing with cancer are inaccurate, while those dealing with nutrition are especially suspect.
But there is a lot of really good stuff on the Web and many doctors see it as a force for good. It can transform patients from being passive recipients of health services and encourage them to become more active participants. And it can sometimes aid the diagnostic process, because the patient has thought more about symptoms beforehand. For those and other reasons (including excellent US resources such as www.pubmed.gov), I’ve always thought that Dr Internet was, on the whole, a good thing.
I still think that, but a report by Microsoft Research in Redmond suggests the picture is more complicated. In Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search (available as a PDF download from bit.ly/15Q9h) it claims that “the Web has the potential to increase the anxieties of people with little or no medical training, especially when web search is employed as a diagnostic procedure.” The finding is based on a large-scale study of search-engine logs showing how people seek medical information online, checked against a conventional survey of 515 individuals’ health-related search experiences.
The Microsoft researchers focused on the extent to which common, probably innocuous symptoms can escalate into the perusal of Web pages on serious, rare conditions that are linked to the common symptoms. By “escalation” they mean the process by which a query about “headache” brings up a (reputable) Web page that mentions they can sometimes be symptomatic of a brain tumor (which is true). This leads to a frenzied search on topics such as “brain tumor treatment” and results in a terrified user starting to think about drawing up a will.
The research suggests search engines have the potential to escalate medical concerns. This is partly because they were never designed to be diagnostic tools and partly because reputable Web pages always provide comprehensive listings of possible diseases linked to specific symptoms. But cyberchondria is probably mainly a product of users’ predisposition to escalate rather than settle for more reasonable explanations.
The moral? If you’re a hypochondriac, stay off the Web. And remember that, as the man said, the best cure for your condition is to forget about your body and become interested in somebody else’s.
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