Effect Measure

Everyone knows that people commonly use the internet for health information. “Commonly” means almost half (45.6%) of adults over 18 who were interviewed by the National Health Interview Survey (NHIS) during the first 9 months of 2009. The estimate is made from household interviews of a national sample of adults who don’t live in institutions, like a nursing home, school or prison (euphemistically called a correctional facility). The question asked by the NHIS was: “Did you look up health information on the Internet in the past 12 months?”

The percentage by age group is fairly even, except for the oldest (65+, 23%), but within each age group women consult the internet for health information more frequently than men and the highest age specific percentage was the 25 – 34 age group. We don’t know why the respondents consulted the internet, but a plausible explanation for this pattern is that it is used by young parents worried or curious about the health of their children. Concern for children is probably hard wired into our brains. If we didn’t have it, we might not have survived as a species. Here’s the breakdown, via CDC’s MMWR QuickStats:

i-2efc33bce0376cbbead0e6b1754c5ce2-healthinternet.jpg

Source: Morbidity and Mortality Weekly Reports, CDC

Is the use of the internet for health information a good thing or a bad thing? Probably some of each, but it seems to me it is on balance much more of a good thing than a bad one. It is common to wring our hands over the amount of misinformation on the internet and dangerous memes about health certainly can circulate much faster and reach more people. But it’s not as if people would be going to their doctors for advice or the library for information if it weren’t for the internet.

Main stream media outlets carry general health news, often promoted by press releases, and it is usually superficial, uninformative and sometimes misleading. Those traditional sources are not now, nor have they ever been, a reliable source of information about health. What the internet provides, on demand, is specific answers to specific questions. Easy access through search queries and fast availability almost certainly has increased health literacy, even if at the cost of some health lunacy as collateral damage. It’s much easier to remember information with personal salience than the bland buzz of background news stories. Most of the health information linked on high traffic sites is conventional and, if addressing a specific issue, usually helpful. Yes, you can find steaming piles of crap about health on the internet. But in the pre-internet days people either went without any information at all or got it from often ignorant or misinformed friends, family or colleagues at work.

Bottom line: health advocates should be celebrating the internet. It’s made unprecedented amounts of reliable health information available to unprecedented numbers of people. You heard it here. On the internet.

Comments

  1. #1 Snowy Owl
    April 23, 2010

    Flu shots suspended after kids hospitalised

    Updated Thu Apr 22, 2010 10:40pm AEST

    The Western Australian Government has suspended all flu vaccinations for children under five while it investigates a spike in admissions to Princess Margaret Hospital in Perth.

    The Health Minister, Kim Hames, says 45 children have been taken to hospital suffering high temperatures and febrile convulsions after receiving the vaccination.

    http://www.abc.net.au/news/stories/2010/04/22/2880521.htm?section=justin

  2. #2 revere
    April 23, 2010

    Snowy: A reader from southern Australia tells us it’s seasonal flu vaccine. Since we have a lot of experience with that in general it sounds like it might be lot or manufacturer specific. We’ll hav to find out more.

  3. #3 Snowy Owl
    April 23, 2010

    My purpose was to pick up in few seconds, medical news from a certain level of credibility as a source.

    That is why I have always said that we need a pool of raw informations in the process of validation.

    Unless Scientifics, Communicators, Influencers and a Credible site take on the process of full open access, 24 hours 24.

    We will witness surge of alarmists becoming the locomotive of MSM.

    I am convince that this is a must when we see the freedom of expression regulate by security reasons leading to more and more censorship.

    Thank you again for everything

    Snowy

  4. #4 Athena
    April 23, 2010

    As a former RN, I often use health websites to verify information, add to my knowledge base, and satisfy my sense of curiosity. Because of my educational background, I’m able to assess the validity of what is on the Internet. Many people can’t, and believe everything they read. That’s the bad part of information overload.

    What is your opinion re: the fungus that is showing up on the Northwest Coast?

  5. #5 Gaythia
    April 23, 2010

    This is a good post! I think it is important to realize that alarmists and rumor-mongering existed well before the internet.

    The internet provides many people with access to much higher quality sources than were available previously.

  6. #6 Sarah P
    April 23, 2010

    I think the NLM did a great job pulling these guidelines on evaluating health information online together.

    healthfinder.gov is another credible resource (full disclosure – I work for a company that has developed some of the content) with the benefit that the info is easy-to-read – good for anyone who’s busy filtering thru the high signal-to-noise on the web!

  7. #7 Wellescent Health Forums
    April 23, 2010

    Access to information on the internet has, at a minimum, made it possible for patients to be more involved in their health care than they have ever been. Though most of us won’t have a medical education, we can determine intelligent questions to ask of our doctors when we meet them. We can also find other people with relevant experiences which is of considerable value especially when the condition is rare and few others will have it.

  8. #8 DemFromCT
    April 23, 2010

    This is an intriguing topic, and two comments come to mind.

    First, when the reveres and the late Melanie Mattson and I started Flu Wiki together, the library information science folks were split over pseudonyms… credentials vs sources and accuracy of materials. Still rages, but relatively settled in the blogosphere: you can be pseudonymous, but you’re more accepted if you’re not.

    Second, there are some good science reporters who also do media (try Joanne Silberner at NPR, for example, or these folks.)

    It’s always caveat emptor on line. Verify, and click those links!!

  9. #9 Rachel W
    April 23, 2010

    Sarah P’s comment reminded me that the Medical Library Association also has a guide to finding and evaluating online health information – http://www.mlanet.org/resources/userguide.html – it includes a “top ten” list of sites like MedlinePlus, familydoctor.org, and so on.

  10. #10 Paula
    April 23, 2010

    Today’s blog, with its comments containing links, forms itself an excellent starting resource to suggest to people seeking health info on the Net.

  11. #11 Snowy Owl
    April 23, 2010

    Here’s a good news from Sherbrooke Univeristy in Québec

    Novel Riboswitch Ligand Analogs as Selective Inhibitors of Guanine-Related Metabolic Pathways Jérôme Mulhbacher, Eric Brouillette, Marianne Allard, Louis-Charles Fortier, François Malouin, Daniel A. Lafontaine (PC1) binding guanine riboswitches that shows … inhibited suggesting that PC1 targets a different … the administration of PC1 and the reduction of Staphylococcus … ), and 1 µM or 10 µM for both PC1 and PC2. Sites of substantial ligand-induced … of various ligand concentrations. We obtained a PC1 dose … interaction between an exogenous ligand and its RNA target … ), and 1 µM or 10 µM for both PC1 and PC2. Sites of substantial ligand-induced … of various ligand concentrations. We obtained a PC1 dose … Research Article Biochemistry/Biomacromolecule-Ligand … Novel Riboswitch Ligand Analogs as Selective Inhibitors of Guanine-Related Metabolic Pathways

    http://www.plospathogens.org/search/simpleSearch.action?query=ligand+PC1&x=12&y=16

  12. #12 Namnezia
    April 23, 2010

    Of course all this health info, reliable or otherwise, can create a new breed of person: the self-diagnosing cyberchondriac.

  13. #13 Paula
    April 23, 2010

    Yes, SnowyOwl, and there’s also the great plos article today re the pretty new Pacific NW fungi–sorry, I haven’t the link but it’s on the comments to the Reuters story—particularly great for us Oregon residents (for the moment). No, I don’t follow all the microbio tech details but it’s better than guessing vaguely from the general news reports, mostly.

  14. #14 hjmler
    April 24, 2010

    when a 3 minute “consult” with an M.D. costs $180+ and a few routine tests go $500+/- [your insurance doesn't kick in until you pass $5,000 out of pocket] and none of these costs are going to be relieved by the recent fairytale HCR bill people will be using the web for primary care and get their meds in quackery potions hustled by woomeisters hanging out at Huffington Post or the Alt “Medicine” gurus at Mayo Clinic.

  15. #15 caia
    April 24, 2010

    Thanks for the links, people! Here I’d just been going to WebMD.

    I know I don’t know enough to self-diagnose anything complex, but the internet helps with two things:

    1) Home remedies for things like burns or insect bites that don’t require medical attention, but do require quick answers to alleviate symptoms. Responsible sites will also specify how to tell when these usually minor problems do require urgent medical attention. Which leads me to

    2) Deciding whether something merits a particular trip to the doctor, or can just be mentioned at the next regular appointment.

    Assuming someone has insurance and can afford to go to the doctor.

  16. #16 caia
    April 24, 2010

    P.S. — And, of course, 3) getting more information and support once a doctor tells you you have something. No matter how much time they spend with you, no doctor can answer every possible question, or know about every clinical trial, etc.

  17. #17 Cath the Canberra Cook
    April 24, 2010

    Even in a place with good health care, of course I use the internet. It’s been useful for background information to help me ask better questions to my doctor (who is great, but busy).

    The main problem is the amount of woo, but I’m fairly educated about that by now thanks to Orac, Randi et al. I’ll stick to real medicine for my migraines, thanks. (I <3 my zomig!)

  18. #18 Comrade PhysioProf
    April 24, 2010

    My colleagues and I have browsed extensively the Emedicine.com Web site, and consider it reputable enough to recommend it to our students.

    http://emedicine.medscape.com/

  19. #19 revere
    April 24, 2010

    CPP:Yes, agreed. This is an excellent and reliable site.

  20. #20 Paula
    April 24, 2010

    I am sending a copy of this whole discussion to a couple of persons with need now for this information. A great thread.

  21. #21 pft
    April 25, 2010

    The Merck Manual has been available for ages, including the dumbed down version, so people have been getting information outside their doctors even without the internet.

    In fact, it (and the internet) is a great way to double check if your doctors are doing what they should be. My father has been in and out of hopsitals for the last year, and I have caught mistakes being made in medications and questioned why certain tests were not done, and sometimes got done as a result of my questions (I happened to be in the US at the time of his first ER trip and hospital stay).

    It’s amazing what they miss. An 80 yo patient with UTI, ascites (liver), a temp of 92 and low BP and his primary care said all was well (just needed some meds ). When I asked about the low temp and BP he said the it’s hard to take old peoples temp and BP, it’s not that low, so don’t worry about it (I was visiting and did not have my Merck handy or internet access). Three days later he has kidney failure (at the same time the blood tests came back from the primary care showing problems) and septic shock and is off for a 3 week stay in the hospital (he had a 10% chance of making it out of the ICU ). In Boston no less (but thats probably the only place he makes it out of the ICU).

    Now I have a couple of Merck equivalent manuals on my Kindle keeping Doctors on their toes when I visit. You can also use your wireless to connect while in a hospital as it seems they have relaxed the restrictions they once had.

  22. #22 stripey_cat
    April 25, 2010

    I routinely check the prescription guidelines for any medication I’m given online, ever since a doctor missed migraine as a contraindication for combined hormonal contraception. Ten mintues (tops) with google for my peace of mind. Also good for double-checking first aid and seeing whether the accident or the random drug side effects need an A&E visit, a doctor’s appointment tomorrow morning, or will go away if I endure them. Much easier and more reliable than the erratic standards of helpfulness at NHS direct.

  23. #23 Jim Purdy
    May 15, 2010

    When I was a teenager in the 1950s, I often spent way too much time using library card catalogs (remember them, anybody?) to try to track down books (remember them?), which might or might not have (outdated) information.

    Compared to the old days, the internet is awesome. As always, the reader must use caution in deciding which sources are credible.

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