A Prescription for Fear/ internet symptom check sites

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http://www.nytimes.com/2011/02/06/magazine/06FOB-Medium-t.html

New York Times

By VIRGINIA HEFFERNAN

Published: February 4, 2011

If you’re looking for the name of a new pill to “ask your doctor about,” as the ads say, the Mayo Clinic Health Information site is not the place for you. If you’re shopping for a newly branded disorder that might account for your general feeling of unease, Mayo is not for you either. But if you want workaday, can-do health information in a nonprofit environment, plug your symptoms into Mayo’s Symptom Checker. What you’ll get is: No hysteria. No drug peddling. Good medicine. Good ideas.

This is very, very rare on the medical Web, which is dominated by an enormous and powerful site whose name — oh, what the hay, it’s WebMD — has become a panicky byword among laysurfers for “hypochondria time suck.” In more whistle-blowing quarters, WebMD is synonymous with Big Pharma Shilling. A February 2010 investigation into WebMD’s relationship with drug maker Eli Lilly by Senator Chuck Grassley of Iowa confirmed the suspicions of longtime WebMD users. With the site’s (admitted) connections to pharmaceutical and other companies, WebMD has become permeated with pseudomedicine and subtle misinformation.

Because of the way WebMD frames health information commercially, using the meretricious voice of a pharmaceutical rep, I now recommend that anyone except advertising executives whose job entails monitoring product placement actually block WebMD. It’s not only a waste of time, but it’s also a disorder in and of itself — one that preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.

But if careering around the Web doing symptom searches is your bag (and, come on, we’ve all been there), there’s still MayoClinic.com. Where WebMD is a corporation that started as an ad-supported health-alarmism site with revenues of $504 million in 2010, the Mayo Clinic is a nonprofit medical-practice-and-research group that started as a clinic. 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.

Contrast this with WebMD, which — with every reason to amp up page views, impress advertisers and drive traffic to commercial sites — has the junky, attic-y look of your standard ad-chocked Web site. Amid so-called information about cancer and depression are banner ads for brands like Crest, L’Oreal, Bounce and Clorox.

Health sites are hugely influential in how Americans think about their health and may even play a part in public debates over health care, as they aggressively shape how would-be patients consume medical information and envision treatment. Consider the human headache. If you plug “headache” and “Mayo Clinic” into Google, you get directed to information about the “tension headache.” The first page is absent photos and hype. Instead you read: “A tension headache is generally a diffuse, mild to moderate pain. . . . Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.” Sounds right.

By contrast, if you plug “headache” and “WebMD” into Google, the Web opens to the glamorous, photo-dominated “Migraines and Headaches Health Center,” a sound-and-light show that seems itself like a headache trigger. There’s the requisite picture of a tastefully made-up young woman holding her head in exquisite agony. The headache “news,” flush right on the page, comes with more artful photos of lovely people in pain and includes scare headlines like “Headaches: When Is It an Emergency?” The first page contains no hard facts — you have to click and thereby drive up the site’s lucrative click-throughs — but instead quickly transforms visitors from Web users with headaches to hard-core migraineurs and drug consumers. According to WebMD: “Migraines and other types of headache — like tension headache and sinus headache — are painful and can rob you of quality of life. Migraine symptoms include a pounding headache, nausea, vomiting and light sensitivity. Headache remedies include various types of pain relievers. Migraine treatments may also include antinausea drugs and medications to prevent or stop headaches.”

On the Mayo Clinic’s site, no specific drugs are mentioned for garden-variety headaches until Page 8, when over-the-counter analgesics are mentioned. This came well after I read a fantastic how-to called “Preparing for My Appointment” — a guide that Mayo includes with every entry. This edition encouraged me to ask about headache types and about alternative therapies and generic medications. Mostly it just didn’t rush me to hysteria, or to drugs. I marveled again at the mellow design of the site and at how Mayo manages to stay reliable in the world of infotainment that is the commercial Web. I admired the site for a minute more, and my headache dissipated.