Dr. Web Lied
By Fadi Braiteh, MD, medical oncologist
Fake news: It’s a recently adopted term that, by its means of adoption by politicians, both in some Western democracies and other authoritarian regimes, has permeated and affected so many aspects of society. And, here in 2019, the medical realm is unfortunately not yet immune to an influx of false and potentially harmful information.
The internet can be a useful and powerful source of education for everyone that touches healthcare – not only healthcare providers, students and researchers, but particularly patients and their caregivers, often left at the mercy of search engines, advertisers, and non-curated postings. That’s where the majority of people are spending a good chunk of their time these days. A 2018 Pew Research Center poll found that more than 26 percent of Americans are “almost constantly” online and 43 percent of Americans go online several times a day.
So, with the internet being an integral and often time-consuming component of the average American’s day, some folks are naturally seeking out medical guidance as part of their searches, too.
It’s where this guidance evolves into a self-diagnosis and, often self-treatment, where the specific information harvested (literally without tools to judge veracity, value, context by a layperson) can be harmful. According to a 2018 survey conducted by Seattle’s Tinker Law Firm and published by Becker’s Hospital Review, 44 percent of Americans self-diagnose online instead of visiting a medical professional. Thirty percent of respondents also said they prefer home remedies to address health issues and 41 percent said they believed in homeopathic remedies.
In the oncology realm, turning to “Dr. Web” – and trusting the advertised therapies or remedies that can stem from a rabbit hole of searching – can be the difference between life and death.
As healthcare practitioners, we are custodians and guardians of the welfare of our patients. In addition to providing recommendations and courses of meaningful action, to treat and prevent ailments, our duty is to shelter patients from harm to health, including misguidance to wellbeing. This practice is the essence of modern medicine in United States, rooted at the turn of the 20th century with drastic reform of medical education in 1910 with the Flexner Report, the establishment of laws in 1906 leading to the birth of the Food And Drug Administration, and the foundation of the National Institute of Health in the 1880s. This was, in part, in response to the spread of information (including advertisements, journalism, items off the printed press and the pouring in of new mechanical devices), equally spreading verified facts and falsified claims.
A century later with the boom of the web, information – which is most often not curated or verified, often with an ill intention – in the hands of everyone. Anyone who ventures on the internet can acknowledge that such a flood of advertised information sometimes isn’t even the result of a guided search but imposed through pop-ups. There is plenty of information out there, but unfortunately there is little solid knowledge that can result spontaneously: it requires a tremendous effort to verify and verify with trusted sources!
The layperson must navigate a furious ocean of information when it comes to his/her health – similar to navigating the seven seas and doing so safely. In most cases, this is no easy task – there is simply not enough time or expertise for the average person to decipher all of the information out there on an existing or prospective condition and make a responsible decision. This is the case with trusted sources, the problem becomes catastrophic when it’s a source that strives for financial gain, sells futile treatments or creates sensational misinformation to profit from inflated visitor statistics.
This is where the physician-patient relationship has never been more important. It is the physician’s responsibility to know and summarize the latest information and help the patient make an informed decision. It all must start by addressing the questions of, “How do you surf the internet for information and who helps you with that?”
How We Got Here
Two-thousand years ago, there was a near absence of medical information. Within our lifetime, a plethora has emerged. This abundance of information unfortunately consists of some intentionally misleading information by third parties.
For example, think of a popular news site you have visited recently. Below the article you intended to read, there are clickbait-esque pieces trying to lure you in, with headlines like “Where are these 10 child prodigies now?” and “How to lose 50 pounds in one week!” If you click on something of interest, the process to get to any information whatsoever can be painful, often involving 20-plus different pages or clicks. Those clicks equate to marketing value which is primarily why they exist.
Unfortunately, when you scour the internet enough about a certain condition – e.g., cancer – the third parties can start to leach on to you, promoting fake items and these bogus stories. Before you know it, seemingly everything you engage with online is surrounded by inaccurate information and messages. Here is where a patient can easily be misled by promises of herbal medicines or the harm of traditional cancer treatments, like chemotherapy or radiation.
Some of these sites are pushing for one among many of its “conspiracy theories” such as claiming that doctors or pharmaceutical companies have the cure for cancer, but they hide it. Other sites or stories are getting sophisticated and laying down a few facts – with study-driven evidence – and then complementing them with an abundance of lies.
To everyone, these sites are distractive. But, to some, it can very easily become literally destructive, if one is not vigilant. It is time to recognize the enemy. And, unfortunately, it is not just one enemy inundating our lives – it is several that are creating chaos.
Determining Real Versus Fake
Fortunately, we can combat the chaos with a proactive approach. When it comes to deciphering helpful versus harmful information, there are some tips to keep top-of-mind:
- If it’s too good to be true, it’s probably not true.
- Has the claim been clinically researched or proven time and time again? By whom? Are the sources trustworthy?
- Understand the word “trial,” especially the differences between a “research clinical trial” and a “30-day free trial of product X.” While both phrases have the word “trial” in them, they are fundamentally different.
- If a website is asking for money or your credit card information, run away.
- If it is torturous to get information – e.g. clicking through 20 brief pages of photos – the end result likely isn’t trustworthy.
- If more than half the page is comprised of advertisements, be skeptical.
- What do reputable sources say in comparison to what you’re reading. Some great go-to sources in the oncology realm include net(comprised of doctor-approved patient information from the American Society of Clinical Oncology) and cancer.org (the American Cancer Society’s website).
The Harm in Trusting ‘Dr. Web’
There are certainly downsides to trusting “Dr. Web” over a physician or second opinion. Most importantly, opting for alternative therapies may equate to missed treatment opportunities. The difference between weeks or months exploring an Internet-sourced treatment way be life-altering, when one could have been receiving a reputable and fully researched treatment all along.
And, alternative medicines can certainly be costly. The time and money wasted on therapies with little proven value can be invested in proven and impactful treatments from the get-go. This is a perfect time to remind you: The Food and Drug Administration (FDA) exists for a reason. Formed in 1906, its mission statement reads:
The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation… FDA is responsible for advancing the public health by helping to speed innovations that make medical products more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need to use medical products and foods to maintain and improve their health.
The FDA and industry regulations exist to protect Americans. But unfortunately, amid the guidelines and pertinent warnings, some folks continue to opt for what they find online. Unfortunately for the cancer patients that I have encountered that have insisted on their own unproven findings, many are not alive to tell their stories.
An example: Two years ago, I had a young man, in his early 20s, visit me with an early, treatable stage of cancer. During our visit, he told me that he went online and found numerous articles that said he would die from chemotherapy and not from the cancer itself. In fact, he insisted that if we did any sort of surgery, the cancer would spread. I explained why this was wrong and how cancer did not resemble a wasp’s nest. He researched serious and valid pre-clinical laboratory papers about effect of some of the cannabis products on certain cancer cells in certain conditions. But he ignored the context and the limitations, even when stated by the authors, and instead he chose to stretch these basic observations to become as they were verified outcomes in patients. He did not recognize that such validations require decades of research, thousands of researchers, and potentially hundreds of millions of dollars of funding, before a compound or interventions are proven helpful.
His mother decided to visit me with him at a subsequent appointment. Unfortunately, her views aligned with his. Following that visit, he chose not to return to the clinic, and disappeared. Eight months later, after adopting alternative approaches (fundamentally non-medical) he returned very sick, bleeding to near death, with stage four widespread cancer, relentlessly and graphically eating away at his body. He finally accepted and came to terms with science and modern medicine and accepted chemotherapy and radiation. Since it was late in the course of his disease, it was palliative in nature to alleviate his suffering and control his symptoms, until his passing few months later.
Unfortunately, this is certainly not an isolated rare case. A study of 840 cancer patients, published in the Journal of the National Cancer Institute in January 2018, found that patients using alternative medicines were 2.5 times more likely to die than those that opted for conventional cancer treatments.
There is real danger in exploring and ultimately trusting fake medical news. While it is always important to stay informed, it is equally as important to turn to reputable sources and obtain a second opinion.
Fadi Braiteh, MD is a medical oncologist and director of the Translational Oncology Program Phase I and GI Malignancies Program for Comprehensive Cancer Centers. He is a clinical associate professor at University of Nevada School of Medicine and is board certified in Medical Oncology and Palliative Medicine and specializes in the area of Gastro-intestinal and Thoracic oncology. Dr. Braiteh is also a principal investigator of numerous clinical research studies available at Comprehensive