Don’t believe everything you read on the internet

The internet is an incredible resource that provides easier and more immediate access to medical information than ever before. However, keep in mind that unlike peer-reviewed scientific publications, much of what is written on the internet is biased in terms of what information is selected for presentation, and is not reviewed by experts for accuracy. Hence, it is important to use critical thinking and discernment when consulting with “Dr. Google”. We at the Society of Integrative Oncology (SIO) are advocates for patient education and informed decision making, so we prepared this article to help sharpen your ability to retrieve accurate information from the internet.

Approaches we recommend when reading medical information on the internet

  1. Question the source of the information. What are the author’s credentials? If the credentials are vague or missing, consider this to be a red flag. What conflicts of interest might be at play? In particular, if the article is written as a build-up to selling a particular product, it is only natural for that author to be biased in selecting information or misinformation supporting the use of that product. These are basically just sales pitches, so approach them as such!
  2. Consider the website’s editorial policy. Websites that provide health or medical information as a general purpose should have a Medical Editorial Board and a written Editorial policy. Is the website maintained by a reputable health organization or reviewed by board certified physicians or other health professionals? Remember that no one regulates information on the internet and anyone can set up a website and claim anything.
  3. Check the level of evidence behind the claims. In medicine we have many tiers of evidence to support whether or not an intervention is justified or worthwhile for a certain condition. The gold standard is a prospective randomized controlled clinical trial that demonstrates improved efficacy compared to a current ‘standard of care’ treatment. Interventions based on an accumulation of this high-level of evidence are called “evidence-based medicine”. But such trials can be extremely costly to complete and not available for every specific clinical problem. Because high quality evidence isn’t available for all the therapies people want to try, SIO supports both “evidence-based medicine” and “evidence-informed medicine” where in absence of the highest tier of evidence, other scientific information (such as a single group study, retrospective analysis, laboratory-based studies) can be utilized to make a decision regarding whether or not a treatment might be considered for an individual.
  4. Beware of polarized over-simplistic theories on cancer. No one questions that receiving a cancer diagnosis is difficult and often comes with emotional distress such as feeling overwhelmed with too much information. It is only human nature to desire a simplistic explanation of cancer and the best available treatments for it, and to find alternatives to some of the more toxic cancer treatments such as chemotherapy. But if an author is making generalized statements such as “Natural chemicals are good, synthetic chemicals are bad” or “Health care providers are part of a conspiracy of hiding cures from patients” then be mindful that such statements are often over-simplistic narratives that inappropriately excuse the author from really understanding the complex science of what is really going on in cancer science. For example, some chemotherapies actually come from natural sources (i.e. taxol from the yew tree), and other “natural” chemicals are extremely harmful or can even be fatal. In high doses even essential vitamins like vitamin E can cause significant toxicity. Also consider that if someone has minimal to no medical credentials, spouting theories that western medicine is a vast conspiracy that does not care about your well-being may be a tactic to gain an attentive audience through fear. The truth of the matter is that health care professionals want to help patients and find better treatments for cancer, but so far there is no “silver bullet” out there.
  5. Watch for logical errors. “Correlation but not causation” means that just because someone has a remission of a disease after taking a supplement doesn’t mean the supplement was the cause of it. Some diseases and types of cancer can have very benign trajectories (i.e. part of their natural history might be spontaneous improvement over time). Also many other treatments might have been given at the same time and might more likely be the reason for improvement. “Over-extrapolation” is a conclusion made that is out of line or proportion to the evidence being discussed. Common versions of this on the internet include citing a study that showed a certain supplement can kill a cancer cell line in a test tube, then concluding that it is effective for “cancer” in general or all cancers, and that the finding translates directly to humans. Sadly, if this were true, we would have cured cancer a long time ago, as many studies have shown a certain intervention could cure a specific cancer in an animal model. Laboratory studies often do not translate to real life results, but they are important in setting up the scientific groundwork to justify a human clinical trial. Over-extrapolation is a common error seen in online forums where an individual’s successful case leads to an over-generalization that everyone should follow similar suit.
  6. Don’t forget your medical team is there to answer your questions. Medical information, especially material originally written for health care providers, can be confusing and sometimes frightening. As you read through your materials, make a list of any concerns or questions so that during your next office visit, your doctor, nurse, or other health professional can review the list with you, enhance your understanding, and together make the best informed decision for you. Also, you might want to consider joining a support group in your community or cancer center. You may find it helpful to be able to talk with others who have the same health concerns and have already been through treatment for it.

 

Cautionary information on buying products online:

  1. Unfortunately clinical research has shown that much of the supplements sold online or in stores are not what they claim to be (roughly 30%).
  2. Look for companies that have quality control behind their products (for example, testing to validate that the active ingredient is present at expected concentration in the product). Keep in mind some countries including Canada do regulate natural health products more strictly.
  3. If the ingredients are proprietary and/or not disclosed, be very cautious taking the supplement concurrently with conventional treatment since your medical team will have no way of knowing whether there is an unsafe or inappropriate ingredient that would put you at risk for dangerous drug interactions or other serious health consequences.
  4. Disclose the use of any complementary medicines or supplements with your medical team. If you do not feel that type of conversation is acceptable to your health care providers, either find health care providers who are comfortable or include someone on your healing team who is more qualified to do so.

Ultimately, the information you gather from print and electronic resources can help you make informed decisions about your health care - how to prevent illness, maintain optimal health, and address your specific health problems. Armed with this knowledge, you can more actively work in partnership with your doctor and other health care professionals to explore treatment options and make better lifestyle choices. In an upcoming article, SIO will list the most reliable websites for medical information, but in the interim Health on the Net (https://www.hon.ch/) is a useful tool and search engine to filter out the ‘noise’. Health care experts predict that today's computer and telecommunication systems will result in a new era--the health care system information age--built around health-savvy, health-responsible consumers who are the primary managers of their own health and medical care.

Portions of the above information has been provided by the National Institutes of Health, Department of Health and Human Services.