Online medical information: A blessing or a curse?

The internet age has enabled patients to access a plethora of medical information. However, a potential drawback is that some of this information is inaccurate or misleading—causing unnecessary anxiety or false hope to patients. Adam Hartley reviews the advantages and disadvantages of online medical information and looks at reliable sources that can be recommended to patients.

Medicine has whole-heartedly embraced the internet: from telemedicine, access to online evidence-based practice, to the use of smartphone applications to record lifestyle habits. Indeed, digital health interventions, through web-based resources have been found to have a positive impact on cardiovascular disease risk factors.¹ The internet will continue to provide opportunities to revolutionise clinical practice; however, one avenue that warrants urgent attention is the effect of having an abundance of medical information freely available to patients. It is commonplace for patients to assess their symptoms via an online search engine prior to seeking medical attention, or obtain responses to unanswered questions after a consultation. The unsuspecting patient will be met by a plethora of websites, forums and chatrooms, of varying reliability and quality, full of medical information and misinformation from non-professionals and experts alike.² Medical misinformation is not restricted to the cyber-community, but is found throughout mainstream press. The unregulated nature of the internet can explain ill-informed websites with unconventional and inappropriate information, but poorly researched or sensationalised articles in newspapers and magazines, with an established editing process, are more worrisome. Often designed for marketing purposes, press articles or popular websites can generate significant public attention and a large readership—dangerous if misleading or incorrect information is displayed.

Medical misinformation, whether online or in the press, can have devastating consequences. Principally, weakly-researched data has the potential to heighten health anxiety, resulting in over-presentation to medical services, or more alarmingly, delayed presentation or reduced uptake of services. An obvious example of this is the Measles Mumps Rubella (MMR) vaccination controversy, where a paper by Andrew Wakefield and colleagues stated a causative link to the development of autism.³ Clearly unsubstantiated on retrospective analysis, and has since been retracted, this paper was publicised by mainstream press, and resulted in significantly lower immunisation rates. This effect is still being felt today, more than 10 years later.⁴ Thus, the result of medical misinformation has the potential for significant consequences: increasing health risks, recommending inappropriate treatments and ultimately, augmenting morbidity and mortality. Profiteering from this vulnerable patient population by unscrupulous organisations is also feasible. Targeting desperate individuals via the internet with marketing for potentially inappropriate treatments has not been seen to any great extent in cardiology, but exists in other medical fields.⁵

Whilst educating patients is the aim of modern medical practice, trusting unreliable sources can lead to increased demands on healthcare workers, and worse, reduced confidence in healthcare workers, jeopardising the important physician-patient relationship. The information displayed, aside from lacking reliability, often lacks clarity and understanding, resulting in greater confusion. Moreover, as we strive to allow patients to make informed decisions, freely-available misinformation has the potential for false patient empowerment and unsupported decision making.

Despite these drawbacks, there are diverse benefits of medical information being available to patients. It can form an invaluable resource for informing appropriate medical attendances, supplying patient education, as well as motivating patient autonomy and increasing patient healthcare control. Moreover, recommended internet resources may have the power to improve surgical outcomes.⁶ The free availability of information, a key strength of the web, requires regulation to safely harness these advantages. It is with this in mind that “The Information Standard” has been established by the National Health Service (NHS) in England.⁷ This provides a hallmark on medical websites, signifying that the contained material is of sufficiently high quality, satisfactorily trustworthy and is up-to-date, so as to be recommended to patients.

Over 200 members produce endorsed health information, which can be readily proposed to patients as ‘safe’ resources by medical practitioners. Other reliable resources can be found at “NHS Choices”,⁸ a website (www.nhs.uk) funded by the UK’s Department of Health, providing a broad range of health information aimed at patients, as well as the “Patient Information Forum”,⁹ an independent body supporting high quality medical information for organisations. A system of “red flags” when reviewing cancer websites, based on the presence of patient testimonials and referencing cancer cures amongst other factors, has also identified unreliable information sources.¹⁰ Another suggested approach is computer-derived algorithms assessing information quality, in combination with peer review.¹¹ Above all, as healthcare workers, we must be prepared to offer reliable internet resources for patients.

There is fantastic potential for media and the internet to improve healthcare and outcomes. However, reliable sources of information are essential. Greater awareness amongst healthcare practitioners and patients of reliable sources, “The Information Standard” for example, is imperative to promote the benefits of internet resources.

Adam Hartley is at Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK

References

1. Widmer et al. Mayo Clin Proc 2015; 90(4): 469–80.
2. Culver et al. J Gen Intern Med 1997; 12(8): 466–70.
3. Wakefield et al. Early report 1998.
4. Brown et al. Vaccine 2012; 30(10): 1855–64.
5. Bozic et al. Relat Res 2007.
6. Danquah et al. Int Surg 2006;
7. NHS England. https://bit.ly/1stYmco (accessed 6 June 2016).
8. Choices N. How we work: NHS Choices Content policy. Department of Health.
9. Patient Information Forum. https://www.pifonline.org.uk/about-us/ (accessed 6 June 2016).
10. Matthews et al. Psychosomatics 2003; 44: 100–03.
11. Eysenbach et al. BMJ 1998; 317: 1496–500.