Online Medical Sources: is my headache from brain cancer???

Have you ever Googled a symptom you’re having? Don’t lie… the answer is probably yes. Because over half of Americans have gone to the internet for medical information (Pew Center 2011). That’s not a bad thing- I applaud you for trying to educate yourself and become involved. The problem is, unlike healthcare providers, there’s no rules as to who can give medical advice on the internet, leaving you to figure out who is providing accurate information.

What makes medical information credible? Modern medicine is evidence-based, meaning it’s supported by research (controlled environments have shown a significant result).  Anecdotes are not research; my mom knows somebody who was struck by lightning twice, that doesn’t mean I tell everybody to run inside at the sight of a cloud.

So how do you intelligently evaluate this on the internet? Let’s talk about being a critical consumer of online medical information, and the ABCs of evaluation- Accuracy, Authority, Bias, Currency, and Comprehension. Or AABCCs I guess…

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Accuracy

This generally refers to a resource’s use of evidence, but not just any evidence- peer-reviewed scientific literature. Peer-reviewed means other scientists read it and believe that it’s well-done and important enough that others should read it. These studies can be found on PubMed.gov, or on the scientific journal’s website. Reputable resources should cite or link to the articles they are discussing, so you could read it if you want. Beware of sites that only use their own pages or popular media articles as citations.

But just as important is that what the article you’re reading quotes the study as showing is actually what the study shows. This is most commonly an issue when an article doesn’t differentiate a correlation (X and Y happen in the same people), and causation (X factor causes Y to happen). I cannot stress this enough- correlation does NOT mean causation. For example; a study showing that people who eat avocados also tend to get fewer UTIs. That does NOT mean avocados prevent UTIs- these two could be correlated for a variety of reasons, due to demographics or other habits. To establish causation, you would have to have a randomized study, where people are randomly assorted into groups. In this example, you would randomly be told to eat avocados or not, to control for other causes. Take a look at the study they cite, specifically the conclusion of the abstract. What do the researchers say? Do they use words like correlated, related to, or associated? Or do they go on to say that they established a cause?

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Authority

The next question is- what are the chances this person knows what they’re talking about? This is the time to look at the author’s name (super big red flag if it’s not listed). Look for letters after their name- are they a licensed provider? This not only includes MDs/DOs, but also PharmDs (pharmacists), RDs (dieticians), and CNPs (nurse practitioners). Some articles are written by science journalists, who aren’t in healthcare but have experience writing about medicine in an intelligent, appropriate manner. Google them, and find out how many articles they’ve written and for which magazine/newspaper. If they don’t fit any of these, proceed with caution- while personal medical experience can be valuable to reflect on, it’s not something you want to base decisions on. Good for Linda from Michigan for curing her high blood pressure with crystal therapy, but that has nothing to do with your body. Do NOT use forums that people post on without review as a source- in general, these will be based on people’s personal understandings of health, not evidence.

You also want to make sure that who sponsored the information is reputable. Most medical information from the US government (a .gov domain) or university (.edu) is credible. As much as it pains me to say this, you can’t necessarily trust a .org, as there is no accreditation needed to register for that domain. Look on the About Us, what is their mission? Does it fit with yours? If they’re talking about things they sell, probably not. But if their focus is promoting healthy lifestyles for their readers and providing quality information, then hopefully that’s your mission too.

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Bias

Everybody has a bias, including you and I. But it’s important to recognize it, so that you can take it into account.

Financial bias– For sale, the cure your doctor doesn’t want to tell you about! (Hint: if it was real, they’d probably tell you.) If they get paid more because you follow their advice or buy a product, then the information they give you will be shaped by that incentive. That doesn’t mean it’s not useful- but you should be aware that they have other goals besides just informing you. Sometimes it will be very clear if they are selling something, but they can be sneaky. Most unbiased sources will not endorse specific products (a particular brand of vitamin or a name-brand medication), or post a link to a sales site. Beware sites that have only good quotes or comments, or where you can’t leave your own comments. Nothing is perfect, and informative sites should reflect that.

Author bias– Be conscientious if the author also wrote the research article they are quoting. We all tend to be less critical of our own work, so they may not point out the pitfalls and limitations. The article may still be useful- many scientists will do this to spread their research to the public, but make sure to have this in mind

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Consumer’s bias– Be aware of your own bias! We all have years of experience in this world that has shaped how we see new information. While this can be helpful, make sure to try and view things objectively. Don’t throw out articles just because you disagree with them. If you find yourself agreeing with the content, view it with an even more critical eye. Don’t blind yourself to new and changing information.

Currency (not the money kind)

Medicine moves crazy fast. Some of the information I learned at the beginning of medical school four years ago is already out-of-date. This is incredible and exciting, but also makes it very difficult to navigate. Look for the date of publication (usually at the top or bottom of the page, or look at the copyright), and try to limit your searches to the last five years if possible.

You can also check to see if other sources (like news or popular journals/sites) have picked up this information. Beware of treatments that sound amazing that are not covered elsewhere- the news talks about rats carrying pizza, you think they would skip out on a new cure for fatigue?

Comprehension

Information is only useful if you know what to do with it. Make sure that you are confident that you understand the material, and the ramifications. Just because it sounds smart doesn’t mean it is, so don’t chalk it up to it being too “science-y” for you. Healthcare professionals/journalists know they are writing for people who are usually not familiar with the subject, and if they are responsible, will adjust the explanation as such.

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Finally, trust your own judgement- does it seem too good to be true? Then it probably is. Medical advances aren’t usually made in leaps and bounds- most discoveries are going to seem small, but they can still make a big impact on your health.

Let’s practice our A(A)BC(C)s

I Googled “Acai berry benefits,” and picked two pages- articles A and B. Which one is better than the other? Let’s systematically review each together- the links are below.

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Article A– Super Berry: Is Acai a “Superfood”?

Accuracy- This article links to multiple PubMed pages of research studies, as well as the NIH (the Queen B of medical information). They quote most of the studies effectively, and don’t attribute causation falsely.

Authority- The author is the Media Communications manager for the International Food Information Council (sounds fancy, but I honestly don’t know what that is). The website’s about page shows that it is “dedicated to the mission of effectively communicating science-based information on health, nutrition and food safety for the public good.”

Bias- On the About page, the website states it’s a 501(c)3, meaning not-for-profit, and it only posts non-commercial content. That makes me less worried about financial conflict of interest. The author is not a scientist, so probably not the author of any of the cited research.

Currency- This was posted in April 2016 (listed at the top of the page). I didn’t see any other places that specifically commented on this post, but acai in general is pretty big in the health community discussion.

Comprehension- I feel that I understand this information well, and it seems realistic about acai, as tasty as they are.

Article B- Acai Berry: 6 Proven Scientific Benefits

Accuracy– Most of the links are not to research studies, but to other pages on that website or non-medical expert sites (like Oprah). If you click on enough of them, there are a couple research studies, but most don’t establish health benefits; they talk about the nutritional content, not if it’s helpful. One study shows benefits, but it is not controlled, meaning we don’t know if it was truly the acai that made a difference.

Authority– There’s no author stated, but I’m assuming it’s this Dr. Axe guy. On his About page, he is a doctor of natural medicine. This is NOT the same as a medical doctor (MD or DO)- they are not eligible for medical residencies, their licensing process is not well-standardized, and the field is based more on folk and homeopathic medicine than evidence. This reinforces that if you don’t know the abbreviations at the end of their name, Google it!

Bias– The giant “Shop” tab at the top tipped me off that this guy is selling something. In his About Us, he also mentions a variety of products he sells. On the acai page, he links mostly to his own pages, worrying me about the objectivity of what he is citing.

Currency– The copyright is from 2017, making me believe that’s when it’s from. I didn’t see any other places that commented on this post, but similar to the other one, there’s a lot of stuff out there about acai, making it relevant.

Comprehension– I feel confident that I understand what he’s saying.

And the winner is…..

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Article A!!! With it having a less obvious bias, as well as quoting multiple peer-reviewed studies, it provides the best information. They also acknowledge the limitations of acai berry benefits, and offer other alternatives. No source is perfect, but this appears to have better information of the two pages.

While these two don’t differ that much in what they’re saying, that’s not always the case. To the naked eye, they may look just as credible, so remember to dig deeper. If you’re going to make healthcare decisions based on this information, this is not the time to be lazy. So remember to be careful and critical.

When in doubt, print it out

What if you’ve gone through all of these steps, and you’re still not sure? At your next doctor’s visit, bring a printed copy of it. They can discuss why or why not they believe this source, and maybe both of you will learn something.

While there are great websites to help inform you, your doctor has to diagnosis you. It’s not a good idea to use them to figure out what’s wrong with you before you see the doctor, as you might play up or forget to mention certain symptoms to fit Dr. Google’s diagnosis. However, it’s also important for everyone to keep up on medical advances and learn about their body. There’s A TON of information out there, which is both empowering and terrifying. But with this basic outline, I hope that you find it a little less frightening, and feel ready to take on the internet!

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