Seeking Online Health Advice is very Common
People love on-line technology. About 80% of people search the internet for health information and nearly 40% seek self‐treatment advice online.1Cheng C, Dunn M. Health literacy and the Internet: a study on the readability of Australian online health information. Aust N Z J Public Health. 2015;39(4):309-314. doi:10.1111/1753-6405.12341,2Healthdirect Australia. About health direct symptom checker.
Sometimes, people then attend a doctor’s appointment requesting “give me that medicine for the condition that Dr. Google told me I have!” Some doctors have reported feeling like a vending machine when people make these requests based on health misinformation.
Is Online Health Information Accurate?
In 2020, researchers assessed the accuracy of thirty-six symptom checkers compared to experienced specialist doctors. They found that the symptom checkers were only correct 36%.3Hill MG, Sim M, Mills B. The quality of diagnosis and triage advice provided by free online symptom checkers and apps in Australia. Med J Aust. 2020;212(11):514-519. doi:10.5694/mja2.50600
Let’s pause to let that sink in … this means that you are more likely to get the wrong advice compared to simply tossing a coin!
There has been a significant increase of health misinformation since the COVID-19 pandemic.
Why Stories Feel Better Than Facts
It is not uncommon for word of mouth or a social post to feel like better information than sound clinical advice provided by your doctor.
However, in spite of evidence, word-of-mouth is all it takes to alter one’s judgement. Why is that?
This phenomenon is beautifully explained by Nobel laureate, Daniel Kahneman in his book “Thinking Fast and Slow”.
The Fast & Slow Brain Systems
Kahneman describes two primary (and competing) characters in our brain:
- System 1 (the Fast Brain)
- System 2 (the Slow Brain)
The Fast Brain System
System 1 is the fast, intuitive and story-based decision-making process. System 1 calls upon memories, associations and quickly retrieved information.
When humans were roaming the plains of Africa, the brain had no time to judge whether the rustling in the grass is just the wind or a lion ready to pounce.
System 1 acts quickly and bases itself on previous experience, emotions and intuition. It builds upon stories we tell ourselves: “Watch out, rustling in the grass means a lion!”.
Unfortunately, System 1 tends to make mistakes as it shortcuts the brain’s systems to save time.
The Slow Brain System
System 2, is the slower system – it takes time to think using science, logic and statistics.
System 2 requires time to process the information and checks System 1. Unfortunately, System 2 is slow and is often over-ruled by the quicker, System 1.
Kahneman, D. (2014). Thinking, fast and slow. Farrar, Straus and Giroux.
How Social Media is Hacking Our Brains
The algorithms of social media platforms are optimised to increase user engagement. These multi-billion dollar companies make more money out of more interesting, compelling or inspiring stories. Our brains are naturally wired to engage with these stories more than the mundane facts and figures of medical science.
Neuroscientists have even discovered that compelling narratives cause oxytocin to be released in the brain which can then affect people’s attitudes, beliefs and behaviours.4Zak PJ. Why inspiring stories make us react: the neuroscience of narrative. Cerebrum. 2015;2015:2. Published 2015 Feb 2. PMCID: PMC4445577
Doctors Losing to Social Media: The Rise of Health Misinformation
With the rise of social media, doctors may be losing the health misinformation battle because our brains are being hacked with countless stories on social media.
“Misinformation is often framed in a sensational and emotional manner that can connect viscerally, distort memory, align with cognitive biases, and heighten psychological responses such as anxiety”.5Office of the Surgeon General (OSG). Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment [Internet]. Washington (DC): US Department of Health and Human Services; 2021. Available from: National Library of Medicine
As an example, when Paleo Pete tells people about a $15,000 light system to cure coronavirus, people buy into that. Why?
- There is a face (Paleo Pete),
- he tells us a story of his experience, and
- he shows you with his emotionally cladded voice that it works.
The brain thinks “This guy is famous (he is on TV so he must be credible) and I can see the facial expressions on his face”. This stimulates a rush in oxytocin and we believe him.
In contrast, doctors are trained with decades of experience with one purpose: to protect you.
Social media platforms then incentivise people to share content, get likes, comments and other indicators of engagement resulting in viral spread.6Lindström B, Bellander M, Schultner DT, Chang A, Tobler PN, Amodio DM. A computational reward learning account of social media engagement [published correction appears in Nat Commun. 2021 Mar 16;12(1):1802. doi: 10.1038/s41467-021-22067-6]. Nat Commun. 2021;12(1):1311. Published 2021 Feb 26. doi:10.1038/s41467-020-19607-x
Prominent Examples of Health Misinformation
While there are countless examples of medical misinformation, these are some of the more prominent examples of false claims:
- Isotretinoin causes depression. In fact, isotretinoin has been shown to reduce rates of mental illness.
- Isotretinoin causes sexual dysfunction. Incorrect! There is no evidence of sexual dysfunction with isotretinoin.
- Steroid phobia: Topical steroids are safe and when used appropriately have few side effects.
- Steroid withdrawal syndrome
- Ivermectin works for COVID-19
- The MMR vaccine causes autism
Alternative Therapies
A 2007 study showed that up to 68.9% of people engage in some form of complementary and alternative medicine.7Xue CC, Zhang AL, Lin V, Da Costa C, Story DF. Complementary and alternative medicine use in Australia: a national population-based survey. J Altern Complement Med. 2007;13(6):643-650. doi:10.1089/acm.2006.6355
What are Alternative Therapies?
Alternative therapies are treatments that are not part of standard medical care. The key differences between conventional medicine and alternative therapies are:
- Standard medicine is often referred to as evidence-based medicine.
- Alternative therapies have a lack of evidence for benefit
If an alternative therapy did have evidence that it worked, then it would likely become part of standard medical care.
The Harms of Alternative Therapies & Health Misinformation
Alternative therapies are not only costly and ineffective, they may harm the individual who uses them. Some quick facts:
- The annual out of pocket expenditure on complementary medicine is about $4.5 billion dollars.
- There are potential side effects and drug interactions with alternative medicines.
- Antioxidant supplementation appears to increase death rates.8Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev. 2008;(3):CD004183. Published 2008 Jul 16. doi:10.1002/14651858.CD004183.pub3
- Botanical ingredients can cause allergic dermatitis. This includes aloe vera.
- The most harmful consequence of alternative medicine is probably the delay to effective therapy. For instance, a newly diagnosed woman with breast cancer has decided to treat it with herbs for 6 months – that delay to treatment could cost her life.