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

Slavin says its target audience is often "the Chief Health Officer Mom -- the one who pays the most attention to family health, makes people go to the doctor, sand erves as the decision-maker."

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When asked why an Everyday Health article during the heat wave, "Mother Nature Delivers Heat Wave Wallop" advises "eating ice cream" and "drinking slushy drinks" when the elderly were dying of heat exhaustion, Slavin defends it, saying the site carries several articles on heat and hydration. "We're like a general interest newspaper; some things go deeper than another." Consumers can pick and choose the advice they want.

Everyday Health and its various vehicles "offer 360 degrees of health information, for the consumer and health care professional," Slavin asserts.

Nonetheless, physicians are skeptical about most online sites' impact on patients. Michael H. Perskin, an assistant professor of Internal Medicine at the NYU Langone Medical Center, questions the veracity of online data. He asks, who's writing the articles on the websites and which physicians are reviewing the data. "Do they pay the physician? Is he a full-time guy? How much time is being spent on the review?" Perskin says patients inform him about the latest cure they've just read about online that he says can be 15 years old, attesting to the lack of timeliness on some sites. Smith counters that each story is reviewed by a board-certified physician.

When patients perform their own research on complex illnesses, they're often misinformed. Perskin said one out of every 20 of his patients suffering from extreme fatigue, visit sites and conclude that they have lupus. Perskin says nearly all of them are incorrect and only one in 500 patients with those symptoms suffer from lupus. Nonetheless, he says in many cases doing the research educates consumers, makes them more informed and ask better questions.

Another consumer risk is thinking that the Internet will immediately solve their problems and instead "missing an opportunity to get a diagnosis when it matters in time," Perskin says. A patient with severe chest pains should be calling 911, not doing an extensive Internet search that can contribute to a delay in getting assistance and the possibility of death.

Arnold Wald, a professor at the Wisconsin School of Medicine and specialist in gastroenterology, says patients can easily fall into traps if they rely solely on the web. He says many patients use websites in an "unfiltered" way, act on its advice, without consulting a physician. "If I read an article on a legal issue, I'd want to talk to a lawyer," Wald concludes.

Indeed, both WebMD and Everyday Health caution readers to consult with healthcare professionals. Web MD recommends that "You should always seek the advice of your physician or other qualified healthcare provider." However, its mission is to provide the "most objective, trustworthy and accurate health information." But does it?

Wald says patients need to view these medical sites skeptically and not take everything posted on the site as fact or gospel. For example, he says the headline of an August 30, 2012 Web MD health article, "Linzess Relieves Constipation, Pain of Irritable Bowel Syndrome" is misleading and contradicts the info in the article (Wald is quoted in it). The article clearly states that only one in five patients that use Linzess returns to having normal bowel movements. Even though the Web MD article was reviewed by physician Louise Chang, Wald says it doesn't indicate her specialty (she's an internist). Smith says there's no cure for irritable bowel syndrome, and if 20 percent of patients have an improvement in their symptoms, then the headline is warranted.

Wald says health websites play a role by providing general knowledge, "but there's no substitute for medical care or personalized evaluations. Ten different people will have disease X but each has ten different illnesses based on their particular symptoms."

While most consumers use health sites because of an immediate medical problem, such as a fever in the middle of the night or their child is sick, people with chronic diseases find comfort and support through peer groups. "When you're cornered, some come out fighting and they use the Internet as a secret weapon," Fox said.

For example, patients already receiving treatment for cancer can speak from experience about handling the disease in ways that physicians often cannot. "If someone has had surgery and can tell you what to expect in term of preparation and recovery, that's even better than the doctor performing surgery," Fox says. Sometimes assistance transcends medical advice. Knowing the X-ray table will be cold can help a patient bring a blanket or an extra pillow post-surgery to ensure sufficient rest.

But for physicians like Perskin, the proof is always in the research, and so far little has been done about the impact of these websites. Therefore, he says health websites have not been incorporated into NYU Medical School's curriculum. Perskin says, "Medicine is a conservative enterprise. Studies haven't been done yet," and in his view, online sites are only in their infancy.

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Gary Stern is a journalist based in New York City.

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