By: Sasha Fretwell
It goes without saying that the internet has revolutionised countless areas of life, largely due to the high-speed long-distance communication it enables and its role as an information resource. The latter is useful in a myriad of ventures, ranging from artificial intelligence to finding a cupcake recipe. It has also had a massive impact on healthcare, with studies having shown that 60–80% of internet users have utilised it to find health information (Powell, 2003).
The wealth of information offered by the internet is frequently used by doctors to get a second opinion for the cases they’re presented with. This is particularly relevant in primary care, where GPs are expected to be familiar with a massive range of symptoms and their potential causes in order to be able to direct their patients to the relevant specialists. Furthermore, easy online access to medical information is incredibly helpful in acquiring informed consent for treatments, which is a massive part of the current patient-centred approach to healthcare. Historically, doctors have taken more of a paternal approach, wherein decisions made by one’s physician (the expert) are final and not to be questioned. However, the more modern take on healthcare involves patients playing a role in deciding which treatments to receive and how best to receive them; the rational behind this approach is that if patients feel as though their treatment plan is a collaborative effort, they may be more likely to follow it. In this case, patients being able to learn more about their conditions and the treatments on offer stands out as a clear positive—after all, a limited amount of information can be delivered in a standard 10 minute GP appointment, and on average 50% of this is forgotten shortly after the appointment.
However, one of the major drawbacks to the general public having access to such a large amount of medical information is the risk of patients believing they know better than doctors. Of course, medical professionals don’t know everything, but no amount of internet browsing is going to equate to a medical degree. The problems that can arise from such a belief range from missed vaccinations to abandoned treatment plans, the second of which is particularly likely if said treatments seem worse than the condition itself (as is often the case with chemotherapy) or don’t appear to be doing anything at all; for example, antidepressant and antipsychotic medications usually take several weeks before the benefits become apparent.
The latter becomes significant on an international scale when antibiotics are the treatment of choice, as near the end of their course of treatment patients often feel as though they have fully recovered and therefore question why they need to finish their prescription in its entirety. Along with an increased risk of reinfection, not taking a full course of antibiotics also boosts the chances of bacterial resistance to the drugs being used. Thankfully, however, public understanding of antibiotic resistance and the dangers it brings has been growing in recent years, in part due to the publicisation of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. Alongside S. aureus, strains of bacteria such as Mycobacterium tuberculosis (the pathogen responsible for TB) have been known to acquire resistance to antibiotics, with the World Health Organisation estimating that there were over half a million new cases of multidrug-resistant TB in 2017. This poses major problems for TB treatment in areas where funding is sparse, as the second- and third-line drugs used to treat the condition become increasingly expensive and can be hard to access at all in less-developed countries.
As mentioned above, another of the major problems that is (at least in part) due to members of the general public educating themselves about healthcare online is the rise of the anti-vax movement. Global vaccination rates have flatlined at approximately 86% over the last ten years (Ghebreyesus, 2019), and while it’s promising that rates are holding steady in the face of fear-mongering sceptics spreading misinformation, vaccination rates of around 95% are necessary to prevent outbreaks of preventable diseases such as measles. Despite the relatively unchanged global average, changes in vaccination rates in some areas are reflected in the increase in frequency of measles outbreaks in countries such as the US, France, Ukraine, and Israel. To demonstrate the breadth of the issue, 20 US states reported cases of measles in the first few months of 2019 alone.
While factors such as vaccine supplies, time needed off work to visit clinics, and monetary expense all have a role to play in the discrepancy between ideal and actual vaccination rates, the internet is likely the single largest factor contributing to the growth of the anti-vax movement. The world-wide web makes it easy for anti-vaxxers to target select groups of people in order to turn them into crusaders against vaccination, in a practice that is comparable to cult recruitment. Those who are seen as vulnerable include the parents of autistic children and grieving parents whose babies died unexpectedly—most notably Catelin Clobes, whose 6-month-old child Evee died 36 hours after receiving several vaccinations as part of a checkup. Despite the fact that first responders and an autopsy confirmed the cause of death was accidental suffocation, Evee has become a poster child for the anti-vax movement over the past few months. The internet’s potential use for the dissemination of misinformation is further highlighted by individuals such as Larry Cook, a social media activist who hosts the largest anti-vaxxer community on Facebook. Since 2018, he’s published over 20 articles alleging a baby’s death was due to vaccines, despite medically supported explanations such as accidental asphyxiation and pneumonia. The success of articles like these in converting parents into anti-vaxxers is largely due to their emotional content, which touches on the deep-rooted fear parents harbour when it comes to the safety of their children.
As well as increasing the prevalence of various infectious diseases, the internet can also likely lay claim to an increase in the number of physical symptoms that can’t be explained by medical causes. These medically unexplained symptoms (MUS) constitute approximately 15–30% of all primary care consultations, and can be exacerbated (or even caused) by information found on healthcare websites or forums. For example, searching for a handful of flu-like symptoms such as ‘headache, muscle pain, and fever’ would ideally bring up a list of home remedies and over-the-counter medications for the flu, along with a warning to seek medical assistance if symptoms worsen dramatically or if the affected individual is immunocompromised (i.e. the elderly). In reality, however, one would likely find several websites adamantly stating that the symptoms in question point unerringly to meningitis and therefore impending doom without urgent treatment. Despite the absence of any other tell-tale symptoms, one might begin to imagine feeling more sensitive to light, or perhaps that one’s neck is stiffer than usual, contributing to the growing (very likely false) belief that death is just around the corner. Symptoms such as these are psychological in nature, and while there are of course exceptions to the rule, the role the internet plays in worsening pre-existing symptoms (or even encouraging the appearance of new ones) is not to be dismissed.
Ghebreyesus, T A. “Anti-Vaxxers Distract from a More Serious Threat.” Financial Times, 2019, www.ft.com/content/dba430d4-a6e8-11e9-90e9-fc4b9d9528b4.
Kachikis, A, and L Eckert. “The Return of Measles.” Obstetrics & Gynecology, vol. 134, no. 1, 2019, pp. 4–6.
Kirmayer, L J, and Et al. “Explaining Medically Unexplained Symptoms.” The Canadian Journal of Psychiatry, 2004.
Powell, J A. “The Doctor, the Patient and the World-Wide Web: How the Internet Is Changing Healthcare.” Journal of the Royal Society of Medicine, vol. 96, no. 2, 2003, pp. 74–76.