HIMSS19: Mayo Clinic expands voice capabilities to provide care, potentially diagnose disease

Consumers who own smart speakers, Amazon Alexa or Google Assistant, already use these devices for online searches to self-diagnose health symptoms or for minor first aid.

Now Mayo Clinic is looking to leverage its presence on voice assistants to be the go-to source for health information, exploring how voice technology could help patients adhere to postdischarge instructions or a diagnostic tool.

The Rochester, Minnesota-based health system—which first launched a first-aid voice application on Amazon Alexa devices in 2017—announced at the Healthcare Information and Management Systems Society’s (HIMSS) annual conference and exhibition that it expanded that content to Google Assistant-enabled devices and an AI-powered voice chatbot.

“From a healthcare perspective, voice offers capabilities that we may not otherwise have,” Jay Maxwell, senior director of health information content at Mayo Clinic, told FierceHealthcare. For instance, speaking is three times faster than typing or texting, he said.

Setting up the technology

Voice technology is expected to play a large role in healthcare, especially as the baby boomer generation ages. At the HIMSS conference, an Intelligent Health pavilion showcased the latest in home health internet of things and voice technologies.

RELATED: Hospitals want to use Amazon’s voice recognition software, but real-world hurdles remain

A “smart home” demo included a kitchen with an Amazon Alexa device and Pillo, a voice-activated, hands-free medication dispenser that is HIPAA-compliant. The smart home bathroom included a hands-free IoT device that can be used by elderly patients in the case of a fall.

Mayo Clinic has been working with Orbita, a company that says it provides the only HIPAA-compliant platform for voice and chatbot applications in healthcare, to build the voice-enabled first-aid platform.

The platform incorporates 50 medical topics for consumers with low-acuity problems such as minor burns or insect bites to receive hands-free answers to first-aid questions. They also created a chatbot on their website for consumers. The use of voice technology helps Mayo meet patients where they are, Sandhya Pruthi, M.D., a general internal medicine physician and associate medical director of Mayo’s global business solutions, told FierceHealthcare.

“People will still go to print, mobile, and digital content on the website to get health information, but they will also be looking to get health information through voice,” Pruthi said. “We wanted to provide accurate, trusted, evidence-based health content to address consumers’ health concerns when they have them and when they need the information.”

Recent data shows that 32% of consumers own a smart speaker, up from 28% in January 2018, according to Adobe Analytics, and 71% of smart speaker owners say they use the device daily, with 44% using it multiple times per day. Gartner predicts that by 2020, 30% of web browsing sessions will be done without a screen. Given that consumers are looking up their health symptoms through online searches, organizations like Mayo are putting their clinical expertise behind first-aid instructions and symptom checkers.

Other hospitals are exploring the technology as well. Boston Children’s Hospital piloted several voice applications, including to improve the efficiency of ICU care and streamline the preoperative organ transplant process.

What’s next

One exciting development, Pruthi said, is the work that Mayo Clinic researchers are doing around voice analytics and the potential to use voice as a biomarker for detecting disease. “There are diagnostic clues hidden in our voice that could serve as a diagnostic aid,” Maxwell said, citing a Mayo study that found voice characteristics are associated with the presence of coronary artery disease.

By leveraging artificial intelligence, changes in voice tone or cadence could potentially be predictive of an outcome, such as high blood pressure, stroke or heart attack, Pruthi noted. This holds the potential for voice analysis to be used as a noninvasive diagnostic tool, which could be particularly beneficial for diagnosing conditions through telemedicine.

It’s an emerging area and one digital health company, Sonde Health, is developing a voice-based technology platform to monitor and diagnose mental and physical health conditions.

RELATED: Novant Health’s physician search is now available through Google Assistant

Mayo has also collaborated with startup Sensely to build out a virtual nurse platform, called Molly, that offers patients self-service symptom triage. The nurse is a chatbot interface that runs symptom assessment algorithms and then recommends the appropriate healthcare services, with the aim of assisting patients at home, if possible.

The health system piloted voice technology for patient education and procedure follow-up care, specifically focusing on a small group of patients who had a dermatology procedure. There are plans to develop interactive care plans as well.

Ongoing research within the nursing department seeks to leverage voice for patient discharge instructions, and there are efforts to use voice assistants to interact with electronic health records to improve provider-patient interaction and increase provider efficiency, Mayo officials said.

Use of commercial voice assistant devices in clinical settings is limited, however, as consumer devices are not HIPAA compliant. And concerns about patient privacy are ongoing. But, as consumers continue to adopt smart devices, there are potential uses beyond the doctor’s office.

Pruthi envisions a future in which biometric data collected throughout the day, such as from wearables, smart speakers and other devices, will trigger a voice-enabled device to alert the consumer to a potential problem or even to remind them to take their medication.

This is all part of a drive to make healthcare more consumer-centric and personalized, Pruthi said. “We need more high touch, more interaction and engagement with the patient,” Pruthi said, noting that voice technology provides another tool for patients to interact with their providers. “We need to be more proactive in how we deliver care to improve the patient experience.”

Best Symptom Checkers Comparison

Does this scenario sound familiar? Your alarm goes off and you wake up in a feverish sweat. As your head throbs, you shoot off an email to your boss saying you won’t be in. You search for a symptom checker online, and a host of online disease diagnostic tools and symptom checker apps populate the page.

Which symptom tracker do you use? After all, they all promise a simple interface, and, more importantly, accurate diagnoses.

Searching for an accurate online self-diagnosis tool, be it to confirm flu symptoms or to uncover the reason behind your back pain, is an arduous task. Many symptom checker apps paint with broad strokes and can give you an overwhelming amount of diagnostic possibilities. Others don’t have the ability to check multiple symptoms at once.

Here are some of the most popular symptom checkers on the market and how they stack up. We rated them out of five, with 5 being the highest score and 1 being the lowest.

K Health: 5/5

K Health

Pros: It’s super accurate. Every time I’ve used it, I get the right diagnosis.

The reason is because K Health uses artificial intelligence, paired with millions of anonymized medical charts, to show people how doctors in the real world diagnosed people similar to them. According to TechCrunch, the app uses “a data set of two billion historical health events over the past 20 years.” The app also connects you with an actual doctor, and, if necessary, they can prescribe medication right over the app. Even better? Users can continue to chat with their doctor after the initial exchange – at no extra cost. Not bad.

Cons: As of now, it can only be accessed through a mobile app. If you consider yourself more of a desktop person, you may have to wait on K Health. The app is free for informational purposes but some services, like professional help from board-certified doctors, costs $49 annually. The fact users can communicate with the doctor continuously after the initial appointment negates this downside.

WebMD Symptom Checker: 3/5

WebMD/Wikimedia Commons/Public Domain

Pros: The interface is intuitive and simple to use. Users first enter their sex and age. They are then asked to add multiple symptoms they are experiencing. Users have the option of adding any prescriptions they are on, which can also play into a diagnosis. Once you have finished adding all of your information, the WebMD Symptom Checker gives you a list of results, and you can click on each diagnosis for more information.

Cons: The platform has been ridiculed for inaccurate diagnoses regarding eye issues. When we put in symptoms of the common cold, eight results – including common cold – popped up. When we inserted typical knee pain symptoms, the WebMD symptom checker gave us 12 potential diagnoses, ranging from a meniscus tear to septic arthritis. The disparity in diagnoses can be vast and somewhat vague, depending on your symptoms.

Mayo Clinic Symptom Checker: 3/5

Tony Webster/Wikimedia Commons/CC BY 2.0

Pros: The symptom checker allows users to check symptoms for both adults and children. It also has a smaller amount of symptom choices at the beginning, which could be helpful to a user who doesn’t know where to start. Once a user has finished filling everything out, the Mayo Clinic Symptom Checker outlines potential diagnoses. In addition, it lists related symptoms that could mean you require immediate medical attention.

Cons: Despite being an authority in the medical world, Mayo Clinic’s symptom checker doesn’t translate well to mobile. The checker is only available online – not in app form. It also doesn’t give the user as much wiggle room when it comes to selecting symptoms. Once you pick from the pre-chosen symptoms, the symptom checker asks about “related factors,” like frequency of the issue.

Family Doctor: 2/5

iStock

Pros: The symptoms in step one are listed in alphabetical order, making it easier for some users to select a symptom. It also asks in-depth followup questions regarding the user’s symptoms and alerts you if an emergency visit is deemed necessary. The site is powered by the American Academy of Family Physicians, or AAFP, which makes their medical advice diagnosis or treatment feel reassuring.

Cons: The interface has limited choices when it comes to selecting symptoms. In fact, users can only select one symptom, not multiple symptoms. Once you choose a main symptom, Family Doctor lists followup questions to narrow down a diagnosis – and it only gives you one. For example, we put in all the symptoms of a common cold, and it said it was likely allergies.

RxList Symptom Checker: 2/5

iStock

Pros: This website can be helpful for those who are more visual. Users start by selecting the part of the body they are experiencing symptoms. The followup questions are specific, and the possible conditions listed once you are finished are ranked by likelihood.

Cons: This is another symptom checker from WebMD. Again, we put in the standard symptoms of the common cold, and RxList Symptom Checker spat out 25 possible conditions, with allergies at the top, even though we did not list any allergies when asked. A lot of the proposed conditions range in severity as well.

Mercy Symptom Checker: 2/5

iStock

Pros: Mercy Symptom Checker does offer a lot of information, but the interface is not as intuitive as other health checkers. The causes and background information provided for each symptom provides answers to questions commonly asked with that ailment. For example, if a user selects “pelvic pain,” the Causes and Info tab provides more insight as to who this affects and what it could mean for their health.

Cons: Users cannot input multiple symptoms into this checker. Instead, users select one main symptom and then answer followup questions in order to help narrow down a diagnosis. Unfortunately, some symptoms can be common with several ailments and, unless you have been tracking your symptoms very carefully, it could be difficult to answer some of the followup questions. Depending on how you answer, Mercy Symptom Checker will tell you whether or not you should seek medical attention – but it doesn’t suggest what the ailment could be.

In the end, K Health is the most comprehensive of all the symptom checker and disease diagnostic tools available.

Downloading the app is free, and for $49 annually, users get to talk to real doctors and get real expert advice – not algorithmic answers. The cost itself is lower than some co-pays or how much it would cost to visit a general practitioner out of pocket.

Neuropathic Pain: Principles of Diagnosis and Treatment

Neuropathic pain is caused by disease or injury of the nervous system and includes various chronic conditions that, together, affect up to 8% of the population. A substantial body of neuropathic pain research points to several important contributory mechanisms including aberrant ectopic activity in nociceptive nerves, peripheral and central sensitization, impaired inhibitory modulation, and pathological activation of microglia. Clinical evaluation of neuropathic pain requires a thorough history and physical examination to identify characteristic signs and symptoms. In many cases, other laboratory investigations and clinical neurophysiological testing may help identify the underlying etiology and guide treatment selection. Available treatments essentially provide only symptomatic relief and may include nonpharmacological, pharmacological, and interventional therapies. Most extensive evidence is available for pharmacological treatment, and currently recommended first-line treatments include antidepressants (tricyclic agents and serotonin-norepinephrine reuptake inhibitors) and anticonvulsants (gabapentin and pregabalin). Individualized multidisciplinary patient care is facilitated by careful consideration of pain-related disability (eg, depression and occupational dysfunction) as well as patient education; repeat follow-up and strategic referral to appropriate medical/surgical subspecialties; and physical and psychological therapies. In the near future, continued preclinical and clinical research and development are expected to lead to further advancements in the diagnosis and treatment of neuropathic pain.

The truth about WebMD, a hypochondriac’s nightmare and Big Pharma’s dream

Welcome to Dear Julia, a column where readers submit everyday health questions. Which over-the-counter painkillers work best? Will intermittent fasting help you lose weight? Julia Belluz sifts through the research and consults experts in the field to figure out how science can help us live happier and healthier lives.

Dear Julia: Can I trust WebMD?

WebMD is the most popular source of health information in the US, and is likely to ​dominate your Google search results for almost any medical question you have. According to its editorial policy,WebMD promises to empower patients and health professionals with “objective, trustworthy, and accurate health information.”

But is WebMD actually trustworthy?

While there have been some investigations into WebMD’s potential conflicts of interest, there’s a remarkable dearth of independent information on this question. The site generates revenue primarily through advertising and sponsored content for pharmaceutical, biotech, and medical device companies, as well as hospitals, health insurance providers, and lifestyle and wellness brands.

The only high-quality study I could find that related to the question of WebMD’s independence was published in JAMA in 2013. The researchers looked at which medical communication companies targeting doctors received the most money from 14 pharmaceutical and device companies. They found WebMD, along with its sister site Medscape, were the top recipients of industry dollars:

Top medical communication company recipients of company grants. JAMA

They’re not alone in that regard. Many health companies rely on industry dollars as part of their business model. But those links raise thorny ethical questions, said James Yeh, a physician-researcher based at Brigham and Women’s Hospital who has studied the influence of industry funding on medical information.
“This puts in a conflict of interest,” he said. “Maybe they are trying to educate the clinician or the public, but at the same time there’s the marketing side: They are also trying to sell a drug.”

The site’s editorial policy says that it upholds the journalistic principles of honesty and independence. When asked about how the site ensures independence, a WebMD spokesperson said, “The strict editorial practices we have in place ensure that the content we produce is unbiased, and the production of such content done so independent of third party control or influence.” They also keep editorial staff separate from advertising staff.
But over the years, others have questioned — and found reason to critique — the site’s relationship with drugmakers. In 2010, Sen. Chuck Grassley sent a letter to the site after finding that a WebMD quiz for depression, sponsored by pharmaceutical company Eli Lilly, was rigged to suggest everybody who took the test was at risk for major depression. Naturally, that would make them a potential candidate for antidepressants, conveniently manufactured by Eli Lilly.

In my own perusals of the site, I was bombarded with a dizzying number of ads for pharmaceuticals, hospitals, and sponsored content brought to me by drug companies. On some pages, there were so many ads that actual medical information was difficult to navigate. I also had to click through multiple pages to read anything on a single topic, forcing me to spend more time on the site and see more ads. All in all, it was user unfriendly, and awash in advertising that might confuse someone looking for a solution to a health problem.

Some parts of the site seem to be designed to turn users into patients. The site’s popular symptom checker, which allows users to insert basic information about their age, sex, and symptoms, is a hypochondriac’s worst nightmare. A search for bloating in the lower abdomen suggested one could have anything from menstrual cramps to ovarian or colon cancers. A query on back pain spit out this terrifying list of potential possibilities: gas pains, shingles, ovarian cancer, acute kidney failure, and tick bites. No context — just a list of scary diagnoses.

The pages on weight loss were a mixed bag. Information about weight loss supplements suggested green coffee supplements might help.* Last time I checked, the government had cracked down on the maker of these pills for bogus peddling, and there’s no good evidence behind them. On the other hand, while the site dubiously claims it has “10 easy, painless ways to lose weight,” the page actually included some reasonable, if obvious, tips: walk more, hydrate, share restaurant meals.

I also found problems with how the site conveys the effectiveness and possible side effects of some prescription drugs. When I visited the page on weight loss pills, an advertisement on meal replacement shakes popped up, as did an ad for the drug Qsymia — which is among the six drugs featured in the article:

WebMD’s diet pill page.

While the site’s content is produced by a team of doctors and medical writers, the article failed to mention any basic information about the drug’s effectiveness or how many people the drug was likely to help (the number needed to treat, in medical parlance). And some of the information was worryingly incomplete. For example, WebMD didn’t note the serious side effects associated with the drug Contrave — it can cause severe, potentially fatal skin reactions and liver failure.

What independent doctors think of WebMD

But those were just my observations after spending a few hours on the site. In the absence of better evidence, I decided to get the views of independent doctors. To do this, I turned to physicians who write or edit pages for UpToDate, which is sort of the anti-WebMD. The subscription-based website, used mainly by doctors to access summaries of the latest medical information, accepts no advertising money as part of its editorial policy and pursuit of independence.

Overall, the doctors I spoke to said they didn’t find anything exceptionally egregious about WebMD. But they noted the lack of context around some of the site’s medical advice, as well as a smattering of misinformation.

On WebMD’s treatments for depression, University of Pennsylvania psychiatrist K. Ryan Connolly found “a few less-than-evidence-based medications listed (Risperdal, Zyprexa).” These anti-psychotics are not approved for major depressive disorder, he said, and both failed to show significant benefits in a number of clinical trials.

Vagus nerve stimulation, a medical treatment that involves delivering electrical impulses to the vagus nerve, was also listed — even though it’s no longer considered evidence-based and is almost never done, he said. Meanwhile, one recently approved drug for depression, brexpiprazole, was left out.

Connolly’s conclusion: WebMD’s depression treatment information is not totally unreliable but is sloppy and incomplete. “It looks mainly like something someone dashed off in an hour,” he said. And it could easily give patients a skewed view of their treatment options.

University of Michigan’s Sandeep Vijan thought WebMD’s cholesterol treatments page was “oversimplified” and “often phrased in an overly frightening way.” For example, WebMD suggests cholesterol is “precariously” high in 100 million Americans. ” sounds terrifying, but they fail to note that, while is not ideal, it’s not the kind of thing that means you’ll die tomorrow.”

He also noticed inconsistencies in the evidence supporting the use of some treatments that the site recommends: Some were evidence-based (like statins), while others (like fish oil/omega-3 supplements) have no clear evidence of benefit. “It’s somewhat superficial, and they don’t really get into evidence-based discussions or much about current treatment guidelines,” Vijan said.

Again, Vijan noted a range in the quality of the site’s information. Some of it “may be fine for an initial introduction for patients,” he said. “Hopefully doctors are using something a bit more scientific.”

Within the group of doctors I surveyed, some spoke highly of the site. Of the page on psoriasis treatments, Robert Dellavalle, the chief of the dermatology service at Denver’s VA medical center, said he didn’t spot any errors and thinks WedMD “is doing a great job for a free online publication.”

All in all, is WebMD trustworthy? It depends on which page you land on and what you’re looking for. The site may be an okay starting point for information, like Wikipedia. But the information isn’t always reliable, and unlike Wikipedia, the site’s business model relies on the same industry it reports on.

If you want independent information about drugs, check out the Informulary out of Dartmouth. (I’ve written about it here.) For all medical questions, UpToDate is a great source. (It’s mostly paywalled though patient information summaries are free, and again, it has no advertising.) In contrast to WebMD, the nonprofit Mayo Clinic, the UK government’s NHS Choices, and the National Institutes of Health’s MedlinePlus all have patient-friendly information that’s not overrun with advertising. Another nonprofit, Cochrane, is also a solid source with easy-to-understand, “plain language” summaries of clinical evidence. I’d go to all these sites before WebMD, but none is a substitute for seeing a doctor you trust.

PS: Free study idea for researchers — please follow up on my mini survey and test the reliability of medical websites that millions of patients rely on.

Update: On Thursday, WebMD published a statement on their editorial integrity. They also updated their page on weight loss supplements to reflect new information from Natural Medicine, a source for evidence on complementary and alternative medicine. In response to WebMD’s statement, Vox has also updated parts of this story, adding more context about WebMD’s business model.

VERIFY: How accurate are WebMD results?

Salvatore H. asked the VERIFY team “Is Web MD a reliable source for researching medications and their side affects?”

With the rise of online symptom checkers to help us diagnose our ailments, it’s a good idea to figure out exactly how trustworthy they are.

WebMD’s about page states they get their information from, “the latest medical findings published in peer-reviewed medical journals, such as The Journal of the American Medical Association, The New England Journal of Medicine, The Lancet, Pediatrics, Diabetes Care, Circulation, and many others.”

A 2013 study found that WebMD received more money from pharmaceutical and device companies than any other medical communication company.

WebMD logo WebMD

Therefore, they are reporting on the very companies they are receiving money from. However, their about page specifies their editorial team is separate from their advertising team and they seek to make a clear distinction between editorial information and advertising

A 2015 study found that across all symptom checkers they studied, the correct diagnosis was listed first in 34% of standardized patient evaluations, listed in the first three diagnoses 51% of the time and listed in the first 20 diagnoses 58% of the time.

It’s important to note that this data was not strictly about WebMD, but about many symptom checkers including WebMD.

A 2019 study focused just on WebMD’s accuracy in regard to eye diagnoses. That study found the correct diagnosis was in the top three results just 38% of the time.

The 2015 study found that symptom checkers were generally risk averse. They generally urge users to seek professional care, even for conditions where self care is considered reasonable.

In fact, on WebMD’s about page they state, “However, the original editorial information we provide is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the WebMD Site!”

In an article analyzing the reliability of WebMD, a Vox writer said, “Overall, the doctors I spoke to said they didn’t find anything exceptionally egregious about WebMD. But they noted the lack of context around some of the site’s medical advice, as well as a smattering of misinformation.”

Simply put, WebMD (as well as other symptom checkers) is fine as a place to start when it comes to anything — whether it is studying medication and their side effects or if it’s diagnosing symptoms. However, WebMD should not be a final source for anything and further studying or professional opinions are often necessary.

Something you’d like VERIFIED? .

Digital Health: Advancing Innovation Through Technology and Strategic Partnerships

It’s hard to gauge the impact of The New York Times’ critique of WebMD. Is it just one columnist’s opinion? Or is it a signal that standards for online health advice are going to change?

Times columnist Virginia Heffernan cracked WebMD as “synonymous with Big Pharma Shilling” and the ultimate place for “hypochondria time suck.” The commercialized nature of WebMD, Heffernan said, can’t hold a candle to the likes of MayoClinic.com, which takes a more straight-forward, calm and clinical approach backed up by the reputation of Mayo itself.

Mayo’s storied past as the country’s premier research hospital, in Rochester, Minn., and its storied present as one of Fortune’s “100 Best Companies to Work For” surface in the integrity of the site itself, which — though not ad-free — is spare and neatly organized, with the measured, learned voice of the best doctors. The byline for most entries is “Mayo Clinic staff.” The integrity of the whole institution is on the line with this site, and the Mayo Clinic has every motivation to keep its information authoritative and up to date.

Mayo’s response to the piece is as staid as Heffernan’s description of its site. “The general consensus at Mayo Clinic regarding the New York Times article from the weekend is that we’re pleased to be recognized for our quality and integrity, and as a credible source for health information online,” Mayo spokeswoman Ginger Polumbo said Monday.

But health systems, which were late dispensing online health information and are now trying to catch up, have to be rubbing their hands. The rule has typically been that content vetted by physicians and other experts meets the standard for top-tier health information (and WebMD follows this rule). And there are so many atrocious health sites offering dangerous and poor medical advice (anorexia, anyone?) that few would think to knock WebMD’s approach.

But Heffernan suggests a higher standard: that advice directly from reputable health systems beats third-party reporting coupled with a review, particularly when there is a greater financial motive behind the latter approach.

News flash: WebMD is a business that wants to make money. Its advertising is clear but can be too subtle. Banner ads are obvious and clearly labeled with small type, though the WebMD-based advertiser pages are easy to mistake for WebMD content.

Heffernan dislikes the amount of pharmaceutical advertising on WebMD and the fact advertising related to the affliction is in and around related content. I think that’s a bogus assertion that runs counter to the online targeting that makes the Web so great (and, as John Sharp points out, this happens at MayoClinic.com as well). Both WebMD and Mayo have fair and transparent advertising policies, though the real issue is how the sites practice what they preach. In look, Mayo has less of a commercial feel.

Though I wonder if that’s all by design. Heffernan underestimates the financial motivation behind any health site run by any institution. Seeking health information is the third most popular activity on the Web behind checking e-mail and using a search engine, according to a new study from Pew Research Center.

Mayo has been making money from its health content by creating personalized portals for private organizations or licensing its health articles to media organizations. In late 2009, it connected with the Everyday Health Network to increase online advertising revenue.

Then there’s the bigger opportunity: using a health site for national and global brand building to attract a number patients who will travel for good healthcare.

MayoClinic.com’s Web traffic enjoyed a surge over the past several years as it jumped ahead of other health information providers. But its numbers and WebMD’s have stabilized, according to the likes of Compete.com and Quantcast. MayoClinic.com has about one-third of WebMD’s traffic, according to those measurement tools.

That flattening of numbers could be due in part to the increase of hospital-made WebMD-like sites, which I believe will be essential for any major health system as part of their marketing efforts.

But amid a glut of health content, good and bad, the idea that direct-for-the-health system content is the best would be a major change. I used to hear people argue the opposite: that there are pluses to having outlets besides hospitals, which have the potential conflict around driving referrals and preference toward certain treatments and research, produce third-party advice (a practice formerly known as journalism).

But increasingly I hear the opinion echoed by the journalist Heffernan. And such a change would mean that health systems, which lost some of its influence for health information before the Internet revolution, would suddenly regain mindshare they lost to the Web and the WebMD’s of the world.

And you can’t put a price on that.

staid

  • Mayo Clinic names 17 members to social media advisory board (medcitynews.com)

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The New York Times Magazine on Sunday included a rather befuddling column by departing writer Virginia Heffernan. It recommended that people seeking medical information online block WebMD’s results from their searches, because “with the site’s (admitted) connections to pharmaceutical and other companies, WebMD has become permeated with pseudomedicine and subtle misinformation.”

Noting that WebMD has become “synonymous with Big Pharma Shilling” in certain circles, Heffernan promoted the use of the Mayo Clinic’s Symptom Checker instead, where you get: “No hysteria. No drug peddling. Good medicine. Good ideas.”

For instance, the column compares search results for “headache” from both MayoClinic.com and WebMD.com. A Google search for “headache” and “WebMD” takes you to WebMD’s photo- and advertisement-heavy Migraine and Headaches Health Center, where a video headline asks, scarily, “Headaches: When Is It an Emergency?” and which spotlights medications as headache treatment. By contrast, the same Google search for “headache” and “Mayo Clinic” takes you to a more subdued Mayo page on tension headache, which discusses headaches more generally and suggests ways to prevent them with nondrug alternatives.

But is the WebMD approach really a problem? Who searches online for “headache” unless they suspect their condition is more serious than usual? And while WebMD mentions drug treatments, it doesn’t promote any particular brand of drugs over another. The Mayo Clinic’s headache pages are more complete, containing information on treating pain with both lifestyle changes and drugs, but it too discusses a vast variety of drugs for treatment and advertises its own DVDs for lifestyle improvement.

The NYT Magazine story says that WebMD frames its health information commercially, its pages designed largely to increase user traffic and ad sales. That’s clearly true from a glance at the site. But is there a for-profit media organization that isn’t trying to do that?

And aside from noting that WebMD was investigated in 2010 by Senator Chuck Grassley for its cozy relationship with pharmaceutical companies, the column provides little other real evidence for its main thesis that WebMD is just a hawker for Big Pharma. Nor does it include the specifics of Grassley’s investigation of WebMD, which focused on the site’s ties to drug maker Eli Lilly.

While WebMD.com does disclose on its site that Lilly is a “partner,” as Heffernan suggests, the fruits of that relationship can misguide the unsophisticated reader. For instance, from WebMD’s general depression information page, an editorial link to a “Depression Quiz” takes you to a depression screening page, funded by Lilly, which makes the antidepressant Cymbalta. Worse, a banner ad from the same depression home page takes you directly to a Cymbalta-sponsored page titled Learning to Treat Depression, whose layout and design are hard to distinguish from non-sponsored content. The top of the page does note that it is a “sponsored resource” and that the sponsor of the content has “sole editorial control.” But naïve Web users could potentially be misled.

Of course, the same could be said for some of the advertorial pages that have appeared in the New York Times Magazine and other major media. And, as WebMD’s senior vice president of corporate communications pointed out on Twitter, the Times Magazine also has a competing ad-supported medical site — which was not disclosed in Heffernan’s story.

To top it all off, the bottom of the story linked to eHow.com as a site for information to block WebMD permanently from appearing in your searches. That’s right — Demand Media’s content farm eHow, which has been described as “digital media’s Dickensian sweatshop” because of its poor pay for writers and low quality content. (Check out the lack of barriers between ad and editorial and the weird recommendations for “natural” headache treatment on eHow.)

To be fair, Heffernan did not suggest getting health information from eHow — only information about how to block WebMD permanently from your browser. But linking to a content farm, which Google recently implied it would downgrade in its searches, does not inspire confidence.

Finding reliable health information online can be a challenge — it’s always important to maintain skepticism and to look very carefully at whether or not content is sponsored by industry, no matter which website you use. Both WebMD and the Mayo Clinic’s site are ad-supported, including pharma ads; without a much more in-depth investigation, I wouldn’t recommend one over the other for every search. Instead, it’s generally best to rely on multiple sources — not block them.

Is an Online Diagnosis from WebMD, Mayo Clinic, or Other Sites Safe?

Corbis Images

At the first sign of a cough, an ache, or a few too many sleepless nights, do you dial your regular doc or just Google the symptoms? Probably the latter: 88 percent of Americans turn to the web, apps, and other sources to get more information about a health problem before visiting a professional, according to a new survey from SleepRate, a company that partners with Stanford University to address sleep issues. (When should you worry? 7 Symptoms You Should Never Ignore.)

We all know WebMD isn’t as good as a real doctor: 43 percent of adults surveyed admit they have concerns that this online info might lead to a mis-self-diagnosis. The good news? 88 percent still report seeing a doctor at least once a year for professional care.

The risk of self-diagnosing is real, but reliable medical sites may actually be making us healthier: “As a practicing physician, I think any way people want to take charge of their health is a good thing,” says Robert Wergin, M.D., Nebraska-based family physician and president of the American Academy of Family Physicians. “I often have patients that come in with questions or printed pages from research they’ve done, and I like that they care about their health.” (Take your health into your own hands: 5 DIY Health Checks that Could Save Your Life.)

The only issue? There’s two, actually: The first is the reliability of where you’re getting your information from. If you’re using an inaccurate site, it can magnify your symptoms and cause you to panic, give you false reassurance that your 102-degree fever is normal, or cause you to self-medicate, Wergin explains. Stick with reliable sites like WebMD, Johns Hopkins’ Medicine, and the Mayo Clinic.

The second important part of maintaining a healthy medical research habit? Having an established relationship with an in-person physician. “Relationship-based care is incredibly important so you have someone to answer your questions and personalize the information to your pre-existing conditions and medical history,” Wergin adds. (They can only be helpful if you’re honest, though. Remember these 6 Things You’re Not Telling Your Doc But Should.)

If you have a primary care doc, you can usually just call their office and talk to a nurse about your symptoms, what you’ve read online, and if it’s serious enough that you need to come in for a visit (and the answer’s not always yes-they’ll know if this sounds like something you can treat with OTC medication). If you don’t have a regular doc, your local hospital or clinic will often have a call-a-nurse line as well, Wergin says. And if your office has electronic health records, it’s even easier: You can send a question in through an online portal and your doctor or a nurse will answer you.

And if you’re thinking about skipping the check-up and just following the treatment plan WebMD suggests, reconsider: Your symptoms can fit a lot of different diagnosis’, so while starting with a site can help form your questions, only a licensed, in-person doctor who is aware of your medical history can make an accurate diagnosis. Google can’t do that…yet.

  • By Rachael Schultz

MD vs WebMD: Does Online Health Info Help or Hurt?

According to research from the Pew Internet & American Life Project, 80 percent of Internet users (making up 59 percent of U.S. adults), look online for health information.

Sure, the ubiquity of Internet access in modern society has changed the way Americans seek out information, in general. But in the case of healthcare, the widespread online availability of medical information is both helpful and troubling.

Online Health Information Can Be Good
Patients have more tools than ever to investigate medical issues and become educated about their personal health. Increased awareness of such matters can enhance overall health literacy, which, on a grand scale, is critical to lowering U.S. healthcare costs.

Effective use of high-quality healthcare resources on the Internet by interested individuals can positively impact medical outcomes. Often, patient research opens up a more informed, intelligent dialogue between patient and provider.

In fact, in a 2010 Epocrates study, the majority of physicians surveyed said that they found the online health information patients brought with them to encounters was helpful and increased enhanced doctor-patient communication.

Vetted, trustworthy online health services, like the Mayo Clinic Symptom Checker or iTriage’s Symptom-to-Provider™ Pathway, are effective means for patients to not only investigate an issue, but learn what action should be taken to resolve it.

A friend of mine used online tools to investigate his abdominal pain. After a few mouse clicks, he was told to seek immediate medical attention. His appendix was removed just hours later. Had he not used the Internet, he might have waited until his symptoms were unbearable and his condition had far worsened.

Being proactively informed and educated about healthcare is very important for patients, and services that help them find and take the right medical action at the right time have the power to save lives. So… what’s the big downside?

Online Health Information Can Be Bad
Unfortunately, the online health information interaction model isn’t always as positive as “proactive patient wants to become better informed.” Sometimes it’s more like “hypochondriac seeks validity of invented medical condition.”

“Ordinary consumers don’t have the training to interpret the vast amounts of medical information available online,” wrote an analyst in Euro RSCG’s 2012 trendspotting report. “Some react by worrying and bugging their physician unnecessarily.”

Others may self-diagnose or self-medicate without seeking a physician’s opinion, which can allow serious conditions to go unrecognized or mistreated. Plus, the risk of “psyching” oneself out through online searching also abounds – especially when a less-than-tech-savvy patient turns to a disreputable source.

Consider a patient who opens up a piece of mail from her gynecologist’s office that reveals abnormal Pap smear results. The letter says to call the practice, but it’s after-hours. She searches Google, finding forum discussions about painful procedures and cancer diagnoses. That could be enough to scare her out of making the phone call.

So-called “cyberchondria” takes many forms. Some also say that, on the whole, the prevalence of online health information has weakened patients’ trust in the physician’s medical authority.

If a second diagnosis opinion or alternative treatment plan is just a mouse click away, how do you know that your doctor is right about your condition and care? What’s stopping you from taking matters into your own hands?

Leverage Expertise to Your Advantage
For better or worse, the Internet, and its ever-growing mass of content, is here to stay. You can’t beat the easy access it grants your patients to online health information, but you can join it – and if you haven’t yet, you should.

The key is to become the expert outlet your patients look to for information. In the example above, consider if that letter had directed the woman to go to her gynecologist’s practice website, where she’d find an unfrightening article on the next steps to take regarding the pap test results.

Providing Internet resources on healthcare is critical to ensuring that your clinicians are perceived as the ultimate medical authority in their patients’ lives. Patients need convenient access to health information. If you don’t provide it, they can’t turn to you, and they will go to other (sometimes less reputable) sources.

Look at the wealth of helpful links, friendly blog content, and useful healthcare information provided online to patients of Women’s Care of Wisconsin for an example of what to emulate.

And during a patient encounter, resist the urge to judge or get defensive with an oversearched “cyberchondriac.”

“Don’t look at it if your expertise is being challenged,” says Erin Sharaf, clinical coordinator and a clinical instructor in the PA program at Northeastern University. “See it as an opportunity to have a discussion with the patient, to educate them, explore what they are thinking, and to understand their beliefs and concerns.”

How has your practice positioned its online health information offerings?

Mayo clinic self diagnosis

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