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Book Review: “Tabloid Medicine: How The Internet Is Being Used To Hijack Medical Science For Fear And Profit”

This was the Guest Blog at Scientific American on February 23rd, 2011. 

In his new book, “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit,” Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information. On the one hand, the Web can empower people with quality medical information that can help them make informed decisions. On the other hand, the Web is an unfiltered breeding ground for urban legends, fear-mongering and snake oil salesmen.

Goldberg uses case studies to expose the sinister side of health misinformation. Perhaps the most compelling example of a medical “manufactroversy” (defined as a manufactured controversy that is motivated by profit or extreme ideology to intentionally create public confusion about an issue that is not in dispute) is the anti-vaccine movement. Thanks to the efforts of corrupt scientists, personal injury lawyers, self-proclaimed medical experts, and Hollywood starlets, a false link between vaccines and autism has been promoted on a global scale via the Internet. The resulting panic, legal feeding frenzy, money-making alternative medicine sales, and reduction in childhood vaccination rates (causing countless preventable deaths), are sickening and tragic.

As Goldberg continues to explore the hyperbole behind specific “health threats,” a fascinating pattern emerges. Behind the most powerful manufactroversies, lies a predictable formula: First, a new problem is generated by redefining terminology. For example, an autism “epidemic” suddenly exists when a wide range of childhood mental health diagnoses are all reclassified as part of an autism spectrum. The reclassification creates the appearance of a surge in autism cases, and that sets the stage for cause-seeking.

Second, “instant experts” immediately proclaim that they have special insight into the cause. They enjoy the authority and attention that their unique “expertise” brings them and begin to position themselves as a “little guy” crusader against injustice. They also are likely to spin conspiracy theories about government cover-ups or pharmaceutical malfeasance to make their case more appealing to the media. In many cases the experts have a financial incentive in promoting their point of view (they sell treatments or promote their books, for example).

Third, because mainstream media craves David and Goliath stories and always wants to be the first to break news, they often report the information without thorough fact-checking. This results in the phenomenon of “Tabloid Medicine.”

Fourth, once the news has been reported by a mainstream media outlet, the general population assumes it’s credible, and a groundswell of fear drives online conversation on blogs, websites, and social media platforms.

And finally, celebrities take up the cause while personal injury lawyers feast on frightened consumers who now believe that they are victims of harm perpetrated on them by the “medical industrial complex.” Meanwhile flustered government health officials have no scientific evidence of harm, but cannot prove a lack of association without further research (and that takes time). So they offer what seems like tepid reassurances, which are perceived by some to be tantamount to an admission of guilt.

And that’s how a lie becomes an urban legend. Perception is nine tenths of reality.

How is it that we fall for manufactroversies again and again? Goldberg argues that the answer may be found in our own psyches:

“People aren’t programmed to respond to [science]; we are made to be moved by the individual and the identifiable and to generalize from the single to the many.” (p. 177)

In other words, good science doesn’t make good television. We are suckers for an emotional story, we aren’t good at understanding relative risks, and we will always be more scared of sharks than automobiles, even though the latter kill exponentially higher numbers of us.

Beyond the fact that we are internally programmed to listen more closely to hysteria than reality, Goldberg suggests that there’s another barrier to medical progress. And that is our fundamental belief that medicines should present us with zero risk. As a culture we have developed a risk aversion to treatment options that is so strong that we expect the FDA to discontinue a drug at the first whiff of a concern — real or perceived. We have adopted the “Precautionary Principle:”

“The Precautionary Principle does not merely ask us to hypothesize about and try to predict outcomes of particular actions, whether these outcomes are positive or negative. Rather, it demands that we take regulatory action on the basis of possible ‘unmanageable’ risks, even after tests have been conducted that find no evidence of harm. We are asked to make decisions to curb actions, not on the basis of what we know, but on the basis of what we do not know.” (p. 40)

And thanks to the Internet’s ability to decrease the signal to noise ratio, perceived harms of various medications can result in full blown manufactroversies with lightening speed. Goldberg cites several cases where life-saving drugs have been withdrawn from the market because of a negligible risk in a small sub-population of patients, leaving those who would benefit to search for the drug overseas or to simply suffer without treatment. In other cases, tiny risks are blown out of proportion, so that the benefits that outweigh them are ignored at patients’ peril.

In this new Internet era, Goldberg suggests that Americans need to develop more highly developed critical thinking skills, so that they can detect the difference between a true health benefit (or threat) and an exaggerated one (promoted by “Tabloid Medicine”). There has never been a greater need for physician and scientist “voices of reason” to speak out via online media to provide guidance to a public assailed daily by claims of “miracle cures” and “deadly environmental hazards.”

In the end, Goldberg argues that personalized medicine, and a search for biomarkers that can predict patient response before they begin a medical treatment, may be the best way to reduce the risk of harm and maximize health benefits. His theory is that if drug side effects can be reduced to near zero, there won’t be as much hysteria and misinformation online about them.

As for me, I know that I still think about sharks when I go to the beach. I can’t help it. It’s hard-wired. However, I also have an inner dialogue about how irrational I’m being, and how I’m more likely to be hit by lightning than eaten by a great white. I think that if we can help people (including the mainstream media) to add that second sanity narrative back into our health conversations, we’ll have more true patient empowerment.

In my opinion, personalized medicine is part of the solution, but it doesn’t solve the deeper issue within each of us — that we will always be drawn to exaggerated claims and “sexy” news headlines. Healthy skepticism comes with education and self-awareness, the pursuit of both is what makes a true Scientific American.

Related books I also recommend:

Snake Oil Science: The Truth About Complementary And Alternative Medicine – Barker Bausell takes a look at how we draw false conclusions from scientific studies and how snake oil salesmen justify what they do.

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All – Paul Offit delves deeply into the greatest manufactroversy of recent times.

Bad Science: Quacks, Hacks, and Big Pharma Flacks – Ben Goldacre describes some modern day snake oil salesmen in Britain, and how they pull off their lies.


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One Response to “Book Review: “Tabloid Medicine: How The Internet Is Being Used To Hijack Medical Science For Fear And Profit””

  1. Prudence says:

    Here in my country, some people believe more in what their neighbors are advising than in what their doctors are prescribing. Then if the neighbors’ advice didn’t work or worsened the condition, they go to the doctor. If the doctor can’t fix the problem, they blame the doctor.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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