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February 23, 2011
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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 that 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.
About the Author: Dr. Valerie Jones (aka, "Dr. Val") has been a leader in social media, medical blogging, and online health programming for over 10 years. She is a sought after speaker, blogger, and health and fitness expert, with expertise in weight loss and physical rehabilitation. She has been a regular contributor to ABC News Channel 8’s Medicine’s Cutting Edge and Let’s Talk Live segments in Washington DC, and founded the peer-reviewed journal Clinical Nutrition and Obesity at the Medscape Journal of Medicine. She has also appeared on over 40 radio shows, and CBS News in DC. As Senior Medical Director of Revolution Health (a health website that had over 100 Million page views/month in its network), Dr. Val led the most popular online community, "Lose 20 Pounds With Dr. Val," established an award-winning blog, and managed over 120 medical expert contributors. She is a regular contributor to the Science Based Medicine blog, and founder and CEO of getbetterhealth.com. Dr. Val is a graduate of Columbia University College of Physicians and Surgeons in New York City.
The views expressed are those of the author and are not necessarily those of Scientific American.
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At the end of the day, though, it’s still true that what doesn’t kill you makes you stronger. In allopathic medicine, too, the cure is often a deadly poison in its own right. If people survive their naive little flirtations with the snake oil peddlers, they’ll hopefully emerge a bit more savvy and the appropriate lifestyle changes will occur.
Link to thisHaving done vaccine research, this is a topic near and dear to my heart. I have considered writing a book about it. But I will note that at CalTech there has been very good work on a rat model that replicates autism well. It has shown that by dosing the mother during gestation, autism can be produced in the pups. This happens at the same point in gestation that thalidomide produces autism. This effect happens with vaccine, illness, etc. It fits all the sensible cross-checks.
So, I think there is probably a link, but it’s not to dosing the child, it is dosing of the mother in the period of the fist 6 weeks of pregnancy.
Mothers should not be vaccinated and should avoid getting ill with influenza or anything else in the first 6 weeks of pregnancy. After that, it should be fine.
Link to thisBlaming the media is like witchcraft accusations. The media only "feeds" us what the most people "pay" time, money and attention to hear/see, etc. We project our beliefs onto the media.
There is an experiential reality here however, that has been glossed over. Apparently the symptoms of these brain impairments — primarily in boys — co-c=occur when children typically visit the doctor’s office for vaccines. So it is natural that an urban myth has developed that correlation = causality.
Better to treat the causes – parent’s tragic experiences of early brain impairment symptoms – than hyper-focusing on the symptoms of the standard ways to make sense of complex personal experiences: easy answers-easily(cheaply)accessible, demonizing and celebrity involvement.
If this real problem didn’t exist all the fraudsters, lawyers and media couldn’t create it. Sorry.
Empathy and evidence are always better (more accurate) than blaming.
Link to thisCould the so called corrupt scientists be aware of the population explosion and be trying to dampen population growth by encouraging people to keep using asbestos, smoke and not vaccinate their children?
World population growth is driving the sixth extinction. We have known about the impacts of population for a long time.
Link to thisGood review… I’ll look for the book. But I think the reviewer is too soft on medical quakery. It’s not just bad science, it’s unscrupulous get-rich-quick scheming that knowingly and cynically adds to human suffering for the sake of personal enrichment.
Link to thisAnytime Congress creates regulations for individual corporations that prevents lawsuits and limits damages, there is a conflict in the making. From all the reports there probably is a connection from vaccinations in a very few of the cases. However, this is a case of protecting the many at the expense of the few.
Link to this"[V]ery good work on a rat model that replicates autism well".
This is a pretty ridiculous claim. I find it difficult to stomach some of the stories about animal models. Certainly animal models are useful. And a number of them can be used to provide insight into the underlying pathology of a disease. However, all studies using animal models must be taken with a grain of salt, as the disease state seen in the model has a different origin (and potentially a vastly different pathological mechanism) than the human pathology. What is more, autism is a complex human disease with a possible heterogeneous origin. Diagnoses are based upon clinical measures of behaviour, with broadly defined criteria and a vast continuum of dysfunction. How exactly can these behaviours be modeled in rats? I find it patently ridiculous that someone can directly link social behaviours in rodents to human social behaviour.
Taken as a whole, I simply cannot understand what possible evidence might exist to convince you that "autism can be produced in the pups" or that these studies should indicate anything about the time line of potential vulnerability in humans.
Link to thisDiscussing from the broader perspective, I am thoroughly against freedom of the Internet. It used to be said that information was power but so is convincing misinformation. Rather than have the freedom to deceive, since there is so much fraud today and so little sanction against it, I’d much rather see impartial policemen manage the Internet.
I say that with considerable regret but George Orwell, Aldous Huxley and Alvin Toffler all correctly foresaw an age in which people at large would be manipulated and deceived from the cradle to the grave. Marshal McLuhan also commented on it. And it is true, the Internet has become the message and I have just stopped using Google search because their machinations obstruct what ought to be its primary purpose. It now is obstructed by their diversions left, right, up, down, forwards, back and soon no doubt into the fourth dimension. I am sick of it.
That does leave a problem. Even in free, democratic countries, what is the truth? An American history of WW2 will not be the same as a European one. The intent may not be deceit but there will be bias. The truth about Guantanamo is more likely in Wikileaks than from American sources, unfortunately.
Maybe we could have the UN police the Internet. That would ensure a consensus but hardly objectivity. After all, until just over a week ago stability in the Middle East was better served by military regimes than democracy or so a vote in the Security Council would probably try to have us believe.
I am even beginning to wonder if we would be better off without cyberspace altogether, what with virtual friends, real cyber paedophiles, fraudsters, terrorist incitement and not just a few. Other than for despotic regimes beginning in certain parts of the world to show signs of potentially starting to fall like dominoes, I might be tempted to argue that ignorance is bliss!
Link to thisThe Internet is also used by the pharmaceutical companies to promote their often dangerous drugs. But talk about blaming the messenger! This is just another attempt by the establishment to shut down any dissenting views.
Link to thisThe internet is not the problem nor is newspapers, magazines or TV. The problem is corporations controlling all the major media outlets and disinformation is their primary tool against the internet at the moment. However, as you can see all governments are hard at work removing sites they disagree with including the entire internet. Your advice only adds another layer of corruption.
If you have ever watched film clips of politicians months after. They completely contradict what they said and snub it with the media’s help. The same is true for advertisements, the government organizations responsible are receiving two paychecks, one from the people and a much higher one from corporations. Too prove my point, none of the people involved in the Wall Street scams are in prison and business is back to normal.
Link to thisI have always hated the "what doesn’t kill you makes you stronger" BS. If I chop both of your arms off and you survive, how does that make you stronger? Without arms you are far less capable of doing every day activities such as brushing your teeth. You clearly can’t lift or carry as well.
I much prefer a realistic approach to life; what doesn’t kill me doesn’t kill me. What makes me stronger makes me stronger. My enemy’s enemy is my enemy’s enemy.
Link to thisI really don’t see how anyone can choose an 80% death rate before adulthood over a 1% chance of autism. Before vaccinations 80% of children died by their 18th birthday. For children living to their first birthday the survival rate was only 50%.
Link to thisWell said!
Link to thisI am surprised and disappointed that you did not mention the excellent book by Seth Mnookin, The Panic Virus. Not only does Mnookin explore the current, manufactured vaccine crisis, he also offers an excellent historical perspective. Mnookin’s book is a compelling read — you won’t be able to put it down until you’ve read the last word. Highly recommended reading for everyone, especially parents-to-be.
Link to thisI am surprised and disappointed that you did not mention the excellent book by Seth Mnookin, The Panic Virus. Not only does Mnookin explore the current, manufactured vaccine crisis, he also offers an excellent historical perspective. Mnookin’s book is a compelling read — you won’t be able to put it down until you’ve read the last word. Highly recommended reading for everyone, especially parents-to-be.
Link to thisDr. Val says, "In other words, good science doesn’t make good television. We are suckers for an emotional story." Ah yes, and the great Dr. Val also recommends other "anti-quackery" books in order to make us part of her initiate. Sadly, this doctor, as dedicated as she may be, is a hypocrite.
Would she REALLY claim that many of the "mental health" drugs, for one example, have been "scientifically proven" to work "safely and effectively?" If yes, that would be a lie.
Was bypass surgery proven scientifically BEFORE millions of men and women were operated on? Not according to Henry McIntosh, former president of the American College of Cardiology, who predicted in 1978 that bypass surgery would be extinct within ten years.
So please don’t apply your broad-brush attacks on those you deem to be "corrupt scientists" and paint us to be "sheep following Hollywood starlets" unless you’re willing to stand before us and admit of the tremendous corruption in so-called scientific medicine. For, the path much of orthodox medicine seems to following today is anything but scientific.
Medicine is not pristine…nor is it without its profit-at-all-costs charlatans. To disavow these facts illustrates why so many consumers are disconnecting from "Conventional Medicine:" it hasn’t worked, it’s killing too many, it’s bankrupting the nation, and our doctors speak to us like children.
To sum up your ‘review,’ Dr. Val, I quote you: "And that’s how a lie becomes an urban legend."
Indeed.
Link to thisNo question that there is strong case to be made over medical fear mongering and hucksterism. Trouble is that fear, misinformation, withheld information, and profit incentive remain pretty strong motivations in what is purported to be scientifically pure medical research.
That doesn’t and shouldn’t change the main message of this book, but the conclusion that closing the loop only takes moving the medical industry into personalized medicine perhaps downplays the extreme difficulties in doing that. The pharmaceutic industry and allopathic medicine is currently built upon large scale studies and the mass market impacts they support. Individualized medicine is pretty much anathema to the whole system, especially one built upon fighting diseases that affect populations of patients.
Link to thisThat does leave a problem. Even in free, democratic countries, what is the truth? An American history of WW2 will not be the same as a European one. The intent may not be deceit but there will be bias. The truth about Guantanamo is more likely in Wikileaks than from American sources, unfortunately.
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