Dr. Google and Other Misanthropes!
Peter Sellers 1964 magnum opus, Dr. Strangelove, sees the comic genius play three roles, American President, RAF officer and the titular, deranged ex-Nazi scientist. Political satire and black comedy, it has all the answers, except most are wrong, leading to grim consequences.
Two years before Dr. No, the first James Bond movie was released. The titular role was similarly misanthropic who misled innocent locals with stories of deadly dragons and scary, mysterious deaths.
Both “gentlemen,” were doctors, although neither probably 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 musty medical library with its massive, dusty, leather-bound reference tomes. But that was the 1980’s and things have changed!
The term computer is 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 and mechanical calculating machines which embraced this name. At NASA, in the 1960’s, the brilliant souls whose calculations enabled Apollo’s missions, were known as “computers,” - I commend Hidden Figures, a film from 2016 and Margot Lee Shetterly’s book on which it was based, telling the story of the women who worked there.
In the early 1800’s, Charles Babbage built a large calculator that he called “Difference Engine No.1” and Ada Lovelace, his co-worker, is recognized as the first programmer. A few years later, in 1830, he designed, but never built, the next version which would have required 25,000 parts, stood 8 feet tall and weighed several tons.
In 1936 Alan Turing defined principles that generated further advances and of course, his Bombe machine doubtless contributed to an earlier conclusion of World War Two. The Atanasoff-Berry Computer (ABC) in 1941 was the first to store information and, a few years later, in the early 1950’s, COBOL and FORTRAN computer languages were released. Development speed advanced, and in 1971 Shugart invented the floppy disc, in 1975 we had the Altair computer, and Bill Gates & Paul Allen provided BASIC. A year later the Apple 1 appeared, courtesy of Steve Jobs and Steve Wozniak. And in 1989, Tim Berners-Lee at CERN developed HTML and the world wide web, the internet was born.
The web birthed the least athletic sport known to humanity, surfing, which, unlike its Polynesian 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 conduct research; approximately 1/3 of these 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!
Multiple search engines were commercialised but Google became the dominant player and migrated from noun to verb. Faster connection speeds and improved user interfaces drove traffic, and money, leading to ever faster connection speeds and improved 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 diarrhoea, they might search for that. But what if they do not have diarrhoea? 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 centre.
Using searches to locate experienced clinicians, or only relying on sites adhering to stringent regulations imposed by the National Health Service in the UK or FDA, Centres for Disease Control, the National Institutes of Health in the USA or globally recognised medical centres 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 recognised organisations. 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-examination for testicular cancer. And glamour model Rhian Sugden, made an edgy video on the same topic that also lit up YouTube. 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. Paralysed by fear, the poor soul either chooses to avoid doctors, hence delaying treatment if it is cancer, or builds up stress, even if it is not cancer 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 haemorrhoids, an obvious case. I offered the usual conservative advice, local treatments, increasing dietary fibre and to consider one of several surgical options if these interventions did not work. However, this chap 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 haemorrhoids!
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 tumours? 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 Schwarzenegger said, “it’s not a tumour!”
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, lymphangitis (red lines showing spreading infection) and cellulitis (inflamed tissue) 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.
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!
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