Oct. 29, 2009— -- With more information at their fingertips than ever before, people have taken to the Internet to find out about their health and in some cases act as their own doctor.
While the Web has made answers to medical questions easier to find , it has not done as much to ensure the quality of the data, according to some health care professionals. And cases where patients have caused themselves harm have illustrated the potential perils of a society where health information and products can be gotten without the benefits of a medical degree or a prescription. Critics say Web sites have cropped up selling dubious or dangerous health products, while others simply misinform.
This change in the workings of medicine has left some wondering whether all of this advice and product availability is a good thing, but also whether it can be harnessed to improve health care.
"It's a good thing if it enables patients to make more informed decisions about their own health care and to interact more effectively with their doctors and the health care system," said Doug Evans, a research psychologist and director of public health communication and marketing at the George Washington University School of Public Health and Health Services.
"What's less clear to me is whether people taking health care into their own hands is a good thing," he said. "There's a lot of misinformation out there. The social media world, the world of blogging and Web sites that are popping up...are the Wild West."
The Web has made information more democratic, but much of it may not be good, particularly when people use it to bypass speaking with their doctors.
"I don't think people are really understanding the expertise that doctors are bringing," said Lisa Gualtieri, an adjunct clinical professor at Tufts University School of Medicine's health communications program. "I think that's part of the problem with something like this. People are thinking, 'Oh, this is less expensive or this is easy, or you don't need a medical professional for something like this.' People don't really understand the complexity of it."
In July, ABC's "Good Morning America" reported on the case of a woman who had injected herself with silicone, and ultimately needed expensive corrective surgery that still left her scarred.
But that has not dissuaded all would-be amateur plastic surgeons. Wired Science reported Tuesday about a Web site that sold botulinum-derived drugs (similar to Botox) -- without requiring a prescription -- and displayed videos of how customers could use these products on their own.
"There have been so many shows on television like "Nip/Tuck" that have really promoted nonessential cosmetic surgery, and I think that also reduces the barriers to something perhaps people wouldn't really know about…all of a sudden becomes much more accessible to people," said Gualtieri.
But then came the economic crash, which reduced incomes, but perhaps not the desire for physical improvement.
"People wanting treatments, they can't really afford it through a doctor," Gualtieri said. "I think that the shows increased people's interests in these kinds of procedures. People see this as a way to satisfy that desire to have these treatments done."
Harnessing the Power of the Web
Dr. Kevin Pho, an internal medicine doctor in Nashua, N.H., is among the most prolific physician bloggers in the United States. He uses his blog and his Twitter account in part to steer patients toward the good medical information the Internet makes available.
"I don't necessarily interact with patients directly [on the Web], but a lot of my patients read my blog," he said. "I can direct them with links pointing them to reputable sources."
Pho said another benefit of his blog is that it allows him to comment on breaking news and give patients his perspective.
"A lot of news that's being reported is not done with a lot of context," he said. While it may not be the reason he started his blog, "I think that over the years, it's certainly evolved to become a big part of why I do it."
And while some doctors may worry about patients bringing in reams of paper they have printed from various Web sites, Pho feels otherwise.
"I know there are a lot of doctors who are apprehensive, but I encourage that. I would rather have them come to me with information than act on their own."
In fact, Pho said, by being an online presence, he and other doctors can make sure that much of the information patients find is the information they would like their patients to read.
"I think it is imperative for doctors to participate with social media," he said. "We need to flood Google with more legitimate information."
Evans noted that the information currently on the Web had helped patients in some ways, particularly when it comes to alternative treatments or medications they may not have known about or that were not done in the U.S. that they can discuss with their doctor.
"My point is not that alternative medicines are a panacea…quite the contrary, but they are a potential source of treatment that people would not have had good access to without the Internet, but they are not things people should think they can use on their own and bypass the health care system, he said. "People can't just think because there's a lot of information out there and they can do Google searches, that they can be doctors."
Getting to Healthy
But sometimes even when patients know which Web sites to go to, they may not get the information they want.
"The [sites] that are most reliable are from the government -- like the NIH, the CDC, the FDA -- certainly tends to be very reliable information, and also up to date," said Gualtieri. "At the same time, it's not always the best-designed information."
"If a physician is using the site, I think he or she is able to plow through it and figure things out, but I think if a health care consumer is using the site, it's difficult to find answers to the questions that are on peoples' minds. I think all the information people want is there, but I think by providing everything to everybody, they don't make it really easy for health care consumers to get answers to their questions."
Of course, some of the most compelling information can be misleading, said Gualtieri.
She tells of reading a story online about attention deficit disorders and then seeing in the comments someone claiming a gluten-free diet helped her to overcome her ADHD.
While the story was compelling, she said acting on it would be a bad way to go about things.
"People, of course, do listen to other peoples' experiences," she said. However, the echo chamber that exists on the Web could sometimes blow a rare case out of proportion.
"That again, I think comes back to poor health literacy skills. Especially if you don't have a trusting relationship with a physician, people are more easily swayed by this kind of information."
Given the power of anecdotes, whether deliberately misleading or a personal story someone believes, "I find it very scary that people could be doing things that are potentially very harmful or disfiguring and basing their decisions on information that they read online," said Gualtieri. "I think a lot of people can be swayed by information, can be swayed by advertising, and can be swayed by other people's experiences."