Sunday, March 14, 2010

Digital medicine?

So here's my problem with the information age (yes, I do teach Information Technology myself!): it assumes that access to information leads people to make good decisions. I'm afraid that is a very robotic view of the human psyche. I do not think the human mind works by a set of rules without any other influence.

In contrast with India, the US "freely" allows pharmaceutical advertisements on TV about prescription drugs. They range from the specious-sounding "restless leg syndrome" all the way to heart, alzheimer's and depression medicine. They are complete with side effects (mostly for legal reasons according to me) and the euphemistic "talk to your doctor about xxx". I truly pity the doctors of this country: imagine the patient coming to them with a medicine in mind and wondering why the doctor is not prescribing it.

But I concede that most people will believe the doctor more than an advertisement. The much bigger evil is digital medicine. One can find many web sites, some even managed by medical professionals, that provide details on all kinds of ailments. They also mention possible treatment options that a doctor may follow and any side effects of that treatment. They are complete with pictures. In true web 2.0 style, they also offer ways for readers to leave comments on their own experience with these ailments! I'll assume that their intentions are utterly noble: the patient wants to be informed and needs a 24x7 source of information to understand better what is happening to him/her. Doctors can't be "on-call" for every patient, so maybe this reduces patient anxiety....

Here's the problem: the web sites are truthful when they list a vague list of symptoms for a particular ailment. Indeed a trained medical professional uses extra knowledge and judgment to determine whether a particular list of symptoms likely points to a particular ailment. But the world is full of people who think they are smarter than they actually are! So isn't it plausible that one reads about an ailment, the symptoms sound vague and after reading them once or twice, one starts to wonder if they have them? If you don't believe me, try this: did you get up last morning and feel light-headed? In India we get an "upset stomach" after eating food; we never think twice about it. What if you find entire articles on indigestion that mention it as a symptom of 10 complicated ailments (albeit with a disclaimer that most of the times it is just indigestion and only a doctor can tell if it means more)? In fact to an untrained eye, the worse the disease, the more vague the symptoms seem to get. Moreover I fail to understand the benefits of reading about someone else's experience with a particular disease unless I have been officially diagnosed with it myself. Many of these online fora end up being ranting grounds of patients complaining about the supposed inabilities of their doctors.

I've been told people who like to read about medicine as a hobby and come to their own conclusions aren't unique to our generation: they have existed all along. But here's the problem: the information wasn't nearly as accessible to them as it is now. How many of us would take the trouble of going to a library to read about something like this? How many of us are likely to open one more tab of our internet browser and "google" for it? I assume everybody who can read this blog is perfectly capable of doing this in a second.

To those who think there aren't many people who would do this, and would be swayed by whatever they read, here's a reminder. In India people vote for a politician in return for a pressure cooker or even hard cash. In the US people dump French wine down the drain and start calling things "Freedom fries" because some politician decided it would be a good way to show displeasure. There are still far too many people falling victim to phishing attacks or online viruses because they clicked on something out of charity, intrigue or human desire. Let's face it: as a human race gullibility is part of our sense of community. Very few of us make decisions on our own based on an objective analysis of facts that we alone have taken the pains to gather. Most of us are influenced by people and their versions of facts and opinion. So while I'm delighted to learn about the history of film-making, the El-Nino effect and a video demonstrating a chemistry experiment that bored me in school, some things are better kept within the confines of those qualified to understand and interpret them. Medicine is an esoteric field: only the brightest become doctors after years of training and experience. No amount of copious information available on the internet can replace that training and experience. It simply does not belong to the same category as all the other information that is out there, and its readers cannot be trusted to believe the disclaimers as much as the information itself. The risks of such information being so accessible to everybody far outweigh the benefits of "well-informedness".

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