Can Our Brains Handle the Information Age?

Bret S. Stetka, MD; Daniel Levitin, PhD

Disclosures

September 24, 2014

In This Article

Patient-Driven Healthcare

Medscape: Patients are increasingly gaining access to their own medical information via digital means such as Websites and smartphone diagnostic applications. Do you think patients having more control over their own healthcare is a positive development?

Dr Levitin: Absolutely. When we talk about informed consent in the research laboratory and in patient care, doctors ask patients to sign a consent form, and the assumption is that they have been informed. Well, ethically speaking, the better informed a patient is, the better decision that patient can make about their own healthcare in consultation with their doctor and with loved ones. Patients arming themselves with information is important and a good idea, and websites like yours, Wikipedia, and the National Institutes of Health website make the information available.

However, the problem is that the layperson isn't trained, necessarily, to know how to distinguish a good source of information from a bad or biased source. The hazard is that somebody who hasn't engaged in critical thinking can end up at, say, a biased website and not realize it, and that is where consulting with medical professionals can help. I actually devote a chapter of the book to this kind of information literacy that I think is increasingly important. Here are two examples:

One involves patients increasingly asking their doctors the right questions. Suppose you go to your doctor and she says, "You know, your cholesterol levels are a little high. I'd like to start you on statins." Now, you've heard of statins, and you have friends who take them, so the recommendation may not surprise you. Your doctor explains that high cholesterol is associated with an increased risk for coronary heart disease, heart attacks, and other things, and the statins should bring down your cholesterol to safe levels. She writes a prescription.

From the way it is presented, you might think that the choice is to lower your cholesterol levels or have a heart attack. But to be fully informed, you want to ask your doctor for a particular statistic that doctors don't usually offer to you on their own—the number needed to treat, or the number of people that have to take the drug before one is helped. Some laypeople might think, "What kind of crazy statistic is that? The number must be 1. Why would my doctor prescribe something that won't benefit me?" But as you know, it doesn't work that way.

For one of the more popular statins that I researched, the number needed to treat is 300. So 300 people need to take it in order for 1 person to benefit. Still, you might say, "Why not? I'm not paying for it. My insurance covers it, and I will take a 1 in 300 chance in reducing my cholesterol as reasonable." But that same drug has a 5% probability of side effects, which include severe muscle and joint pain and gastrointestinal distress. So what I recommend in the book is to work through the math. For every 1 person helped, 15 people— that is, 5% of the 300— will experience side effects. So you are 15 times more likely to experience the harm of the medication than the benefit of it. I am not saying you should take it or not take it. I am just saying that you should be informed and have this conversation with your doctor.

The other example has your doctor mentioning a new drug, and you're trying to decide whether you want to take it. You look it up online and go to the first hit that Google gives you. The first question a patient needs to ask is, "Whose website is this? Has it been created by the drug manufacturer or maybe by the manufacturer of a competing drug? What biases might exist?" Also is the page current or a shill site? Some unscrupulous people will set up a site with a nice neutral-sounding name like, say, AmericansforBetterHealthcare.com (I'm making this up), and patients might assume it's legit. But they could be a shill for a pro or anti site regarding a particular treatment.

It could be assumed that any .gov site is probably more neutral than a .com, as we assume it goes through some kind of vetting. You should also look at other sites that link to the site. If the Centers for Disease Control and Prevention (CDC) is linking to it, that tells you it's probably a good source, although maybe the CDC is saying don't trust this site. These are all good questions to ask.

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