The Issues With Crowdsourced Medicine

When people experience aches, pains, or strange rashes, their first line of defense has become the Internet. Each month, 74 million people visit WebMD, the number one website portal for healthcare (Bogart). Older than Google itself, WebMD is one of many other websites professing to provide medical diagnoses based on patient search queries. WebMD offers symptom checkers, allowing users to input things like, “shortness of breath,” or “trouble sleeping” and receive an instant diagnosis.

Unfortunately, the diagnosis a person receives when using WebMD is unlikely to be accurate. Worse yet, using WebMD and other websites with symptom checkers can lead to what Crane calls “cyberchondria,” a type of hypochondria related to the fact that symptom checkers often yield diagnoses like “cancer” for having a bellyache.
Besides, medical conditions are not possible to diagnose accurately online, without a full physical evaluation by a qualified physician. Even “crowdcoursing” medicine, using tools like CrowdMed.com, can be problematic because patients do not see a doctor in person. Using CrowdMed or any other crowdsourcing tool, the patient is under the illusion that they are being seen by a group of qualified healthcare providers when in fact, these sites offer no safeguards against quackery. Online symptom checkers and even the more robust “crowdsourcing” methods of medical diagnoses are problematic because they subvert the rigorous methods used by qualified physicians to address patient concerns.
When discussing the issues with crowdsourcing medicine and online diagnoses, it is important to differentiate between the types of online healthcare tools. WebMD and other healthcare media sites can include symptom checkers, but not necessarily live access to a team of doctors and nurses. Because of the limitations of WebMD in providing patients with virtual human interaction, Jared Heyman founded a company called CrowdMed.com. CrowdMed.com is unlike WebMD in that instead of using a database of articles in an encyclopedia or reference guide format, CrowdMed.com is a service-based solution involving interactions between patients and a community of online individuals.
Based in San Francisco, CrowdMed.com is different from WebMD in several ways. First, users pay to access the system, and the “medical detectives,” as they are called, get paid to provide advice. MedMD offers some means for patients to seek actual interactions with people, and has links to commercially viable healthcare interventions, but interactions between patient and doctor are not the primary business model of the website.
Second, the “medical detectives” on CrowdMed.com can be “everyone from surgeons to acupuncturists to patients who have become experts on their own conditions,” (Couch 1). WebMD also hires random writers and editors rather than relying fully on physicians and scientists to write and monitor the content on the site, but CrowdMed does offer the possibility for patients to seek solutions from actual doctors (Sanghavi).
Third, there is a greater level of interactivity when using CrowdMed.com versus using WebMD, which is a media-based system including pre-written articles on various medical conditions and topics. Unlike users of WebMD, the person using CrowdMed has a two-way conversation with the “medical detectives,” (“Blind Spot”). The conversation is virtual, much different than it would be in a face-to-face medical scenario. Yet for many patients, this is preferable, particularly for those who live in rural regions without access to physicians or experts, or for people with debilitating or embarrassing conditions. The CrowdMD model might also be helpful for patients who do not have insurance.
Because of the way crowdsourcing works, even some doctors have supported the CrowdMed model and work on the side as “medical detectives” to increase the accuracy and credibility of the diagnostic method (Sanghavi). Healthcare workers are not necessarily in violation of the Hippocratic Oath when they participate in online medical diagnosis sites, when their goal is to improve patient outcomes and increase access to healthcare resources. Critics of both WebMD and CrowdMed, however, claim that physicians are violating the Hippocratic Oath—the principle philosophical doctrine guiding the medical practice (Bogart). Healthcare workers need to guard against unsafe or unethical uses of the crowdsourcing or online diagnostic tools like WebMD. Making medicine more accessible to all people is ultimately a good thing, but needs to take place within the rubric of evidence-based practice.
Both WebMD and CrowdMed are profit-driven models, paralleling the American healthcare system in general. In fact, WebMD has become the market leader with annual revenues as high as $700 million (Bogart 1). These sites capitalize on the fact that all people experience some physical or mental ailment and are interested in self-diagnosing, and self-healing in some way. Because of the many barriers to seeing an actual doctor, such as cost restrictions, time constraints, and embarrassment, these websites are attractive alternatives to making an appointment. In fact, some patients realize that their doctors are unable to make a rapid diagnosis, leading them to suffer for months or even years (Couch; Sanghavi). In fact, the cost and convenience barriers embedded in the American healthcare system make it so that many people are more likely to go online for medical advice than they are to see a doctor. The online environment comprises hundreds or even thousands of people that can offer instantaneous advice, which can in some cases lead to more accurate diagnoses than simply consulting one or two medical practitioners (Sanghavi). As useful as they can be in some situations, these sites are not adequate substitutes for seeing a real healthcare worker. A team of “medical detectives” on CrowdMed means well, but can also mislead a gullible, desperate person. Granted, some physicians also occasionally make incorrect diagnoses or prescribe the wrong pills, but the chances for error are much greater in a virtual environment, when total strangers who cannot see the person’s face or hear their voice are offering advice.
Another problem with online diagnoses and crowdsourced medicine is cyberchondria. Like hypochondria, cyperchondria means believing the “worst case scenario” about one’s health based on symptomology (Crane 1). Cyberchondria is characterized by anxiety, and can lead to people making poor choices about their health including investing in costly interventions that have no scientific basis. Instead of taking credible action to ameliorate or prevent a problem, a cyberchondriac might fret for hours, reading everything they can about a disease they do not even have. In extreme cases, “Cyberchondria can disrupt everyday life, even causing people to miss work and ignore friends,” (Crane 1). Even when a person does not develop cyberchondria, using WebMD and other online sources of medical information can reduce a person’s ability to think critically about the information they are reading. An abundance of pseudoscience and false claims exist on the Internet, not to mention the proliferation of infomercials and advertisements for pharmaceutical interventions and medical treatments.
Occasionally, crowdsourcing medicine or using online searches can result in positive outcomes. Both Sanghavi and Arnold point out that rare conditions are the ones most likely to be misdiagnosed. As a result, persons who have struggled to receive an accurate diagnosis from a physician might turn to crowdsourcing as a last resort. Most people, though, will not benefit from crowdsourcing or WebMD and could even make their situation worse through anxiety and stress related to cyberchondria. To prevent cyberchondria, Crane advises that people first make an appointment with their doctor and then avoid using the crowdsourcing sites for some time. Instead, people can read credible sources, or ask their doctors for advice on how to proceed. From the perspective of doctors and nurses, it may be important for healthcare professionals to participate in crowdsourcing if for no other reason than to offer patients more credible information. Crowdsourced medicine is inevitable. Although some of the articles written on WebMD are written by qualified individuals, and although some of the medical “detectives” on CrowdMed are also licensed and qualified, a large number—if not the majority—of online sources are not accurate or reliable sources of information. The most dangerous websites to use when consulting the virtual community for advice are forums that are not connected with any medical institution or organization. As Crane points out, blogs and forums, even those that are designed as support groups with other sufferers, can be the worst culprits in proliferating misinformation.
The temptation to use crowdsourcing for self-diagnosis is understandable. Going online is quick and easy, and in the case of WebMD, it is also free. On the other hand, seeing doctors can be expensive, time consuming, and uncomfortable. However, doctors are trained, licensed, and qualified individuals. Only a doctor can offer a screening, test, or other measures of detecting the presence of a suspected illness. Doctors take the guesswork out of diagnosis, using evidence-based practice. Only when doctors are stymied, in those rare cases where it has taken years for them to offer an accurate diagnosis or a solution that works, will crowdsourcing be of much use. Crowdsourcing medicine potentially transforms the nature of healthcare, but with a great caveat to the patient.






Works Cited

Arnold, Carrie. “Can the Crowd Solve Medical Mysteries?” NOVA Next. 20 Aug, 2014. Retrieved online: http://www.pbs.org/wgbh/nova/next/body/crowdsourcing-medical-diagnoses/
“Blind Spot” Transcript online: https://docs.google.com/document/d/1cjGkHtZdjB-6ockpKCsoNiizU4Lig2oHjeocTZWyA_M/edit
Bogart, Laura. “The Cure for Cyberchondria.” Good. Issue 38. Retrieved online: https://www.good.is/features/issue-38-webmd-and-the-changing-world-of-online-health-care
Crane, Kristine. “Cyberchondria: How the Internet Can Afflict Your (Mental) Health.” U.S. News and World Report. 16 June, 2014. Retrieved online: https://health.usnews.com/health-news/patient-advice/articles/2014/06/16/cyberchondria-how-the-internet-can-afflict-your-mental-health
Couch, Christina. “Crowdsourced Medicine Is Transforming the Diagnosis of Rare Disorders.” NBC News. 6 Mar, 2017. Retrieved online: https://www.nbcnews.com/storyline/the-big-questions/how-crowdsourcing-transforming-diagnosis-rare-disorders-n728306
Sanghavi, Darshak. “The Doctors Will See You Now.” Slate. Oct 6, 2010. Retrieved online: http://www.slate.com/articles/health_and_science/medical_examiner/2010/10/the_doctors_will_see_you_now.html