Peter Sellers’ 1964 magnum opus, Dr. Strangelove, sees the comic genius play three roles, American president, RAF officer, and the titular ex-Nazi scientist. Political satire and black comedy, it has all the answers, except most are wrong, leading to grim circumstances.
Two years before, Dr. No, the first James Bond movie, was released. The titular role was similarly misanthropic and misled innocent locals with stories of deadly dragons and scary, mysterious deaths.
Both “gentlemen” were doctors, although probably neither attended medical school. And neither did Google or any other search engine!
I remember my first computer and freely admit I distrusted email and searches, finding the latter clumsy and slow, preferring the embrace of medical libraries with their massive, dusty, leather reference tomes. But that was the 1980s and things have changed!
The term computer was first used in The Young Man’s Gleanings, a book by Richard Braithwaite published in the early 17th century, referring to “a human who performed calculations or computations.” This definition remained until the industrial revolution led to mechanical calculating machines, which embraced this name. At NASA, in the 1960s, the brilliant souls whose calculations enabled Apollo’s missions were known as “computers,” and I commend the 2016 film Hidden Figures and the book by Margot Lee Shetterly on which it was based that tells the story of the women who worked there.
There were many other developments in hardware and software, but it was the introduction of the World Wide Web in 1989 that really kicked things off!
The internet birthed the least athletic sport known to humanity, surfing, which, unlike its California namesake, consists of sitting in a dark room, staring at a keyboard. Every day more than 8.5 billion online searches occur, driven by a desire to shop, a desire to satisfy desire, to post photographs of funny felines, to send emails, and to do research, approximately 1/3 of which are for health-related topics. Although knowledge is synonymous with power, it is critical to note that information is not the same as knowledge. Used properly, the internet can be a power for good, but it can also lead to dangerous rabbit holes!
Initially multiple search engines were dominated by Google and improved connection speeds allowed better user interfaces. The challenge and cost of seeing doctors probably contributes to roughly 25% of people reporting that Googling a topic is their first act when experiencing new symptoms, being prescribed medications, or even hearing about a health issue. Self-reassurance that there is nothing life-threatening or serious at play is a prime mover. But sometimes there is!
However, is one searching using proper terms, and are resultant websites reliable and accurate? For instance, if a person believes they have diarrhea, they might search for that. But what if they do not have diarrhea? The word means “stool containing a higher-than-normal water content” and does not refer to frequency of passing bowel motions. Garbage in, garbage out, if you will forgive the pun!
Understanding agendas of visited sites is important; are they sponsored (they have paid for search engine optimization)? Are they selling something? That is fine if seeking a book or new pair of shoes, not so fine if seeking a cancer treatment center.
Using searches to locate experienced clinicians, or only relying on sites adhering to stringent regulations imposed by FDA, Centers for Disease Control, the National Institutes of Health or recognized medical centers is safe and wise. Yes, they have something to sell, but they are regulated and what they say must be evidence-based.
Finding information about planned procedures or screening tests is helpful, again, relying on recognized organizations. Several years ago, Katie Couric sadly lost her husband to colon cancer and leveraged her celebrity to drive awareness to screening colonoscopy. I am a big fan of Ryan Reynolds and his Deadpool movies—he used that celebrity to promote self-exam for testicular cancer. These are great uses of the internet.
If one develops a headache and searches online, the conclusion might be that this is brain cancer. Or a rare, and inevitably fatal, disease. Paralyzed by fear, the poor soul chooses either to avoid doctors, hence delaying treatment if it is cancer, or building up stress, which has its own consequences. In fact, in one survey of 2,000 Americans, 40% got the diagnosis wrong using search engines and in three-quarters, searching increased anxiety rather than reducing it! This even has a name, cyberchondria, a new form of concern induced by keystrokes!
A patient I recall presented with hemorrhoids, an obvious case. I offered the usual conservative advice, local treatments, to increase dietary fiber, and to use one of several surgical options if these methods did not work. However, he had searched online and was convinced he had anal sarcoidosis. Sarcoidosis is an inflammatory condition primarily afflicting the lung and I had never even heard of anal sarcoidosis, so I conducted a search, discovering that in recorded medical history it had been seen twice—and this case was not a third. It took me a long time to reassure him this was garden-variety hemorrhoids!
When prescribed a new drug, the doctor or pharmacist will alert one to common or dangerous side effects (“report back if such-and-such happens”). Searching is a surefire way to guarantee one experiences every side effect ever reported. For instance, some medications such as to lower cholesterol are broken down by enzymes, which might be affected by eating grapefruit or drinking juice, diminishing active dosing and, therefore, clinical effect. Other drugs use transporting chemicals which grapefruit interferes with, so there is too much drug in the body. However, an ill-advised computer search might suggest grapefruit are deadly!!!
One can also buy drugs online, often far cheaper than in pharmacies, however in addition to there being legal issues, one must question whether one should even take the medicine, or if it is legitimate. Several years ago, a study revealed several online pharmacies trading on American perceptions that Canada is synonymous with decency and morality (and, I would add, very nice people!). Some pharmacies included “Canada” in their name but were based distant from these shores. Buying erectile dysfunction drugs online without a prescription is not recommended as this condition may be due to serious cardiovascular disease and one should be examined before taking any drugs!
As for attending a doctor or other suitable healthcare provider, that will allow for a proper medical history, physical examination, and tests to prove or exclude a given ailment. Brain tumors? Headaches are ubiquitous, but as a first and isolated symptom occurs in only 2–16% of malignancy, and a capable doctor will see other signs of serious illness such as papilledema (swelling in the retina). Becoming convinced that one has brain cancer may demand unnecessary investigations to abate the fear. As Arnold said, “It’s not a tumor!”
The first video posted to YouTube was in April 2005 (Me at the zoo), a 19-second clip of one of the founders in San Diego commenting on elephants. There are some great videos online; just prior to writing this I sought assistance to fix a washing machine and resolve a spreadsheet problem (no, it wasn’t damaged in the dryer). And yes, doctors post videos showing various procedures, but they are not for general consumption. I vividly recall a young man coming to our ER seriously ill with widespread sepsis, high fever, and lymphangitis (red lines showing spreading infection) on his legs and toes that were starting to die. As was he. The cause? He had watched a video on dealing with an ingrown toenail and had operated on himself. Which of us, without an A&P certificate, would watch a video and endeavor to fix our aircraft?
Search engine data has been used by CDC to map where to distribute flu vaccines, by researchers to identify candidates for clinical trials, and by many others for sensible applications. As pilots we filter data provided by weather radar and other sources; as patients we should do the same.
I recently saw an online interview where the commentator was waxing lyrical about risks posed by artificial intelligence: “Ask it to stop world hunger? It could recommend killing a billion people, that would stop world hunger.” As I said before, knowledge is not the same as information. Information lets us know that a tomato is a fruit, knowledge advises us to not put it in a fruit salad!
I am excited to announce a new podcast I am doing with my old medical school colleague and dear friend, Dr. Nigel Guest.
You can subscribe free at www.jointhedocs.com, on YouTube: @JoinTheDocs,
Instagram:@JoinTheDocs, TikTok: @JoinTheDocs, Facebook: @JoinTheDocs,Twitter: @JoinTheDocs
....and on Spotify or Apple or wherever you get your podcasts @jointhe docs. I hope you enjoy!
You can send your questions and comments to Dr. Sackier via email: [email protected]
