It's a rash. Or a flesh-eating microbe

November 29, 2008

Murray Whyte

Staff Reporter

In the study released this week, researchers Ryen White and Eric Horvitz – of Microsoft, no less – acknowledge in their very first paragraph that "The World Wide Web provides an abundant source of medical information."

However, they go on to say, "the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure."

Oh, really? Like, say, for those of us who, having returned from travelling in West Africa for six weeks – and having suffered a bout of projectile-vomit-inducing Giardia while there – return home and, a few months later, wake up in the middle of the night with a slight pain in their mid-section?

And then, on consulting a leading medical website after being fitfully unable to sleep, it becomes clear that it couldn't possibly have anything to do with the sinus-clearing Indian meal eaten only hours before but rather, must be one of an array of microscopic tropical parasites, ranging from relatively benign, if ineradicable, to far more sinister microbes destined to devour all your organs, one by one, bringing you to the conclusion that a grisly end, not unlike John Hurt's intestine-shredding experience in Alien, is only a matter of time.

Is something eating my spleen? Oh my God, what the hell is eating my spleen?

All this to say that I know of what White, an information-retrieval specialist, and Horvitz, a computer scientist with a medical degree, speak. Like 80 per cent of North Americans, I've jumped online when confronted by any number of aches, twinges, spots or sneezes.

And, like an alarmingly large portion of them, confronted with an overwhelming selection of disaster scenarios, I've jumped to some rather irrational conclusions. Cyberchondriacs, they call us. And we are legion.

We are also, in this respect, not very bright . Consider the sheer stupidity: conflating a not terribly intense, non-specific symptom – that side twinge, for one – with certain death. But then there's the bedside manner of Dr. Google to be considered. Tact isn't built into the code, to say nothing of the leavening effect of the possibility that it could be nothing at all.

The notion of cyberchondria has been around since 2000, when the term was coined; and there's been no shortage of consideration about the ease of wrong, obsessive self-diagnosis using the resources of the Web. But the researchers call their study the first comprehensive treatment of the anxiety produced by health-care-related online searching. The results suggest a kind of hypochondria on (metaphorical) steroids, its effects amplified by the staggering number of disastrous outcomes the Web can provide in the blink of an eye.

The researchers found that typing "headache" into a search engine brought up certain dominant diagnoses – for instance, "caffeine withdrawal" and "brain tumour" came up with the same frequency (26 per cent of the time).

Similarly, when searching for information about "chest pains:" indigestion, 35 per cent, heart attack, 37 per cent. Or "muscle twitches," which many of us experience from time to time. The most gentle diagnosis – benign fasciculation (minor spasms) – is delivered by search engines only 12 per cent of the time. ALS, a progressive, usually fatal neurodegenerative disease, comes in at 50 per cent.

Needless to say, no medical professional would rush to any diagnosis, major or minor, so quickly and sight unseen. And this is where the surfeit of online medical information – one hesitates to describe it as "knowledge," divorced, as it is, from its ability to analyze a patient's particular circumstances – crystallizes the cliché that a little knowledge can be a dangerous thing.

In this case, a massive amount of knowledge can be devastating, enabling the most anxiety-wracked hypochondriacs of us to dig a hole so deep we may never climb out.

This is a dark, dark place. After several sleepless nights, I had every bodily fluid I had to give tested at my doctor's office. It all came back clean. But the shadow of doubt remained, that one of those unwelcome passengers lay dormant somewhere, hiding behind my appendix, waiting for the right moment to strike.

If I wanted to – and, through sheer force of will, I don't anymore – I could give myself no end of specific, undetectable tropical parasites to worry about. What's more, said parasites usually come with pictures, gruesome and in full colour, dragging dark, abstract anxiety screaming into the light of the very, very real.

So it can be a little perturbing to know that hypochondria is enshrined in popular culture as a harmless joke, from the Rock Hudson/Doris Day vehicle Pillow Talk in 1959 through to the recent animated Madagascar movies (the giraffe is a relentless pill-popper).

But clinical psychology has wrestled with hypochondria as a serious anxiety disorder for decades. It spiked significantly in the better-living-through-chemistry era of the '50s and '60s, when home remedies and the most effective cure for most minor maladies – rest – were replaced with synthetic chemical compounds, suddenly available in staggering numbers and brightly displayed on the shelves of pharmacies all over the world, to say nothing of the constantly evolving prescription drug industry.

Combine that with instant access to a staggering number of medical papers describing every possible malady, usually written by prominent specialists, and the very hazardous combination of expertise, ignorantly applied, has likely never been more prevalent.

This is a hypochondriac's perfect storm. As the researchers describe it, "Hypochondriasis is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body."

They go on to explain that hypochondriacs "are often undiscerning about the source of their medical information."

Worse, "Studies have shown that hypochondriacs express doubt and disbelief in their physicians' diagnosis, and report that doctors' reassurance about an absence of a serious medical condition is unconvincing."

With Dr. Google always at the ready with a smorgasbord of serious afflictions applicable to any vague symptom, real or perceived, it's never been easier to shrug off your actual doctor's diagnosis specific to you, not to mention be undiscerning about the source of medical information .

In their conclusion, the researchers write that "Directly tackling cyberchondria is an opportunity to leverage readily available expertise in the information-retrieval and medical-informatics communities in areas such as document ranking, user modelling, machine learning, and user-interface design for the direct benefit of the many people turning to the Web to interpret common medical symptoms."

I read that as: "You can stop freaking people out with irrelevant horrors if you try hard enough."

That would be nice. Because, you see, I have this pain in my side...