Self-Diagnosing: On the Proper Role of Sites Like WebMD

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Despite increasingly significant influence on care, Internet health resources should be taken for what they are: in their infancy.

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Pre-Internet, physicians and clinicians wielded the knowledge and power, and patients waited passively for their diagnosis. By 2012 the Web had transformed the relationships between patient and clinicians. Informed and inspired by health websites, many patients research their own symptoms and often enter the doctors' office knowing which questions to ask. While acknowledging the benefits of these websites, some physicians question their overall effect and veracity.

These physicians claim that health websites can be inaccurate, incomplete or outdated and patients can be misled when self-diagnosing. How beneficial are Web MD, Everyday Health and the other sites, and how skeptical should consumers be?

Nielsen reported that in July of this year, 97.5 million Americans (nearly one of three adults) used health websites to obtain information. The most popular among them, Web MD Health Network, attracted 25.2 million monthly visitors. Close behind, Everyday Health Network saw 23.4 million, and Livestrong 11.8 million.

Perskin said one out of every 20 of his patients suffering from extreme fatigue, visit sites and conclude that they have lupus.

Susannah Fox, the associate director of the Pew Research Center's Internet Project who oversaw its 2011 "Peer-to-Peer Healthcare" study about chronic illness and Internet health use, says, "People often go online before they see a doctor and after they see a doctor, preparing for an appointment or recovering after a doctor's appointment." Patients search online to familiarize themselves with medical terms, obtain information on medications, or research questions that they neglected to ask their physician or nurse. In many cases, consumers dig for material on behalf of someone else (mothers, spouses, friends).

Consumers minimize their anxiety by researching data on minor ailments such as acid reflex and upset stomachs, or chronic diseases like cancer and diabetes. Patients tell the Pew Center, "It's a way to jump from square one to square five," Fox says. Rather than entering the physician's office uninformed and like a blank site, the patient researches Web MD and Everyday Health to grasp a general sense of the illness' effect, origin and treatment. "Instead of experiencing the shock of diagnosis, they can start to work through that at home," Fox asserts.

In Pew Research studies covering the last decade, 33 percent of respondents report that online health sites are helpful and only 3 percent have been damaged by them.

But the business drive to generate huge numbers of readers on these sites has also diluted the content. Some articles on Web MD and Everyday Health are written like snappy stories in glossy magazines, emphasizing sizzle over substance. Web MD's "22 Best Diet Tips" and "19 Embarrassing Male Body Parts," which offer tips such as choosing nighttime snacks carefully, adding spices to meals to reduce intake, and avoiding beer bellies, isn't the sort of advice you would get from established medical sources like, say, the Journal of the American Medical Association (JAMA).

Dr. Michael Smith, chief medical editor at Web MD, sees the expansion into lifestyle as a strength, not a limitation. After researching arthritis or heart problems, the audience started "opening up to beauty, health, fitness and family. Our goal is to help inspire our audience with information to help you live a healthy lifestyle."

In the article on "22 Best Diet Tips," every recommendation has a scientific basis, even the one on spicing up one's food to decrease appetite, Smith says. If studies show that two thirds of Americans are obese, articles offering specific tips to reduce food intake can make a difference, Smith suggests. The article lists sources and, in some cases, studies, though often spokespeople from organizations such as the American Dietatic Assocation are quoted. It's still hard to know exactly what studies have been conducted on how eating "flavorful food" reduces one's appetite from reading the article, though in a follow-up interview the American Dietiatic Association said Purdue University did a 2011 study of 25 people that found consuming red peppers can help curb one's appetite.

Unlike JAMA, which targets doctors and scientists, most sites are written for mass audiences in appealing prose. "Our in-house writers, editors and physicians are trained in deciphering these complex health issues and communicating them in plain language to a lay health audience," Smith says.

In fact, readers don't usually visit one site, but check out multiple, explains Paul Slavin, general manager of Global News at Everyday Health Inc and a former ABC-TV news producer. "We give them information to dig deeper," he says. The information won't overwhelm them and is easily digestible. He said most users start with Web MD for initial diagnosis and then turn to Everyday Health for additional information as the patient moves forward. Everyday Health runs 25 different websites including collaborating on the Mayo Clinic Health site and runs MedPage Today, which targets medical professionals and has every article reviewed by a University of Pennsylvania physician.

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Gary Stern is a journalist based in New York City.

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