fake medical news

The New York Times had a recent opinion piece written by Dr. Haider Warraich, a cardiologist, highlighting the increasing threat of fake medical news (see https://www.nytimes.com/2018/12/16/opinion/statin-side-effects-cancer.html ). Thanks to Dr. Dickey Jones for bringing this article to my attention.

Details:
-- he highlights a woman who had a heart attack, likely related to a very high cholesterol level. He prescribed a statin but she never picked it up because of scary things she read on the Internet
-- he mentions a 2009 study looking at YouTube videos related to immunization, finding that though 48% of the videos were positive vs 32% negative (i.e. contradicting the known medical knowledge about immunizations), the negative videos had a significantly higher number of ratings (86% vs 63%), and were rated significantly higher (4.4 vs 3.5 stars out of a maximum of 5 ). And public service announcements were the least likely to be rated and have the fewest views (see https://jamanetwork.com/journals/jama/fullarticle/209631 )
-- in terms of statins, there are an array of postings for alternative therapies, exaggerated rare statin risks and unfounded claims (eg: that statins cause cancer), and even suggesting that lower cholesterol is bad for your health
-- needless to say, such “fake medical news” does have real consequences. People, as his patient, do not start statins when the benefits clearly overwhelm the risks. Other patients may stop statins, with some studies suggesting a spike in heart attacks with cessation
-- and, perhaps not so surprising in our current political climate, Dr Mark Green, a Republican physician just elected to Congress in Tennessee, in a town meeting brought up the recurrently demonstrated incorrect claim that autism results from preservatives in vaccines (though, in this era of fake news, he later changed his tune and said that his comments were misconstrued, even though there were clear recordings of what he really said. See https://www.washingtonpost.com/politics/rep-elect-mark-green-walks-back-claim-that-vaccines-cause-autism/2018/12/12/9f43d1b4-fe62-11e8-ad40-cdfd0e0dd65a_story.html?noredirect=on&utm_term=.2329c781a884 )
-- HPV vaccination rates fell from 70% coverage rate to less than 1% in recent years in Japan because of false concerns about the vaccine causing seizures
-- cancer patients seem to be particularly susceptible to unsubstantiated advertisements for alternative therapies

Commentary:
-- these issues about incorrect information on the Internet are real concerns and do seem to be quite prevalent. And, perhaps it is not so surprising in our nation, so gripped by sensationalism and conspiratorial theories, that the most extreme and contrary information tends to be the most viral (to coin a medical phrase)

-- then, there is the "nocebo" effect: where the more a person hears about the potential adverse effects of a medication, the more likely that he/she will actually experience them. And the mind does have a pretty strong influence over the body; for example: a patient took an overdose of a medication (not knowing it was placebo) and had significant hypotension (see http://gmodestmedblogs.blogspot.com/2012/08/nocebo.html  ). so, one other issue of reading about "fake" adverse effects is that the patients may actually be more likely to experience them.
-- however, I do have a slightly different slant on this fake medical news issue, given that I work in a community where most of my patients do not access the Internet
    -- I have had several patients who refuse to take a statin because they heard the television advertisement that one could get liver disease (such a rare complication that drug makers reversed their former advisory to check liver function tests after starting a statin). In most cases I have been able to counteract this fear, but only after significant time spent, additional time that the patient was less covered from a recurrent clinical event
    -- I also have recently seen a pretty health-literate patient who refuses to use a GLP-1 agonist for her diabetes, which is quite poorly controlled. her pharmacist told her that it could cause pancreatic cancer, a claim pretty substantially rebuffed by several recent studies. However, her fear of cancer has repeatedly outweighed my repeated explanations (and her clear understanding) that she is far more likely to die from cardiovascular disease from her diabetes.
    -- And, though I have felt it was important to spend a lot of time discussing these important interventions with my patients, these prolnged and unnecessary discussions do detract from my having time to deal with their many other medical/social/psych problems, in the context of a time-limited primary care visit….

So, this NY Times opinion piece adds to yet another obstacle in our taking care of patients. And there are plenty of them. lots of paperwork/prior approvals/forms to fill out/etc/etc. And as mentioned in a recent blog, a major concern is the increasing cost of medications, highlighting the large number of diabetics who are unable to afford their insulin (eg see:  https://gmodestmedblogs.blogspot.com/2018/12/generic-drug-prices-skyrocketing.html ) and general issues of drug affordability, including generics (see https://gmodestmedblogs.blogspot.com/2018/12/high-insulin-cost-leads-to-underuse.html ).  All of these are time-consuming, but necessary to be dealt with in order to best serve the patient. But would be lots better if we had more time to actually deal directly with the important medical/social/psych issues of the patient.....

The issue of huge amounts of information on the Internet has its positives and negatives: it does allow access for individuals to post their opinions about all kinds of things and learn from each other. However, there is a significant price to pay, as noted in the above NY Times editorial: unsubstantiated contrary medical information may well influence people to pursue suboptimal or even harmful choices in their medical care....

geoff

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