Cyberchondria or Coincidence? How Iatrogenic Death Shadows the Growth of the Internet

1% of all Google searches are health queries. Cyberpsychologist Mary Aiken explains how artificial intelligence diagnostics lead to psychosomatic symptoms, and potentially explain the fourfold increase in iatrogenic death in the US since 1999.

Mary Aiken: Everybody knows somebody who searches health related information online. Well there’s actually a name for it and it’s called cyberchondria. Cyberchondria is defined as anxiety induced by escalation during online search to review morbid or serious content. So what does this mean? Well it means that you have a headache and you end up reading about brain tumor. And there’s a very good reason behind it. Humans have a propensity to escalate, to review the worst possible scenario probably to dismiss it. So come back to the headache. If you went to your doctor and you said I have a terrible headache and your doctor said well, you could have anything from a hangover to a brain tumor. You would say oh my goodness, talk to me about the brain tumor. And essentially that’s what happens online. People click on the worst case scenario and therefore those scenarios get driven up the search rankings. So the point about search it’s based on a frequency model, things that are frequently clicked are those things that actually rise to the top of search results. That’s fine if you’re looking at best beach in Florida but when it comes to health related matters it’s problematic. Why? Because it causes anxiety and you could be perfectly well but end up with a nasty case of health anxiety as a result of search.

So the thing is if there’s something wrong with your car and you Google it or search it inherently you’re not going to do any damage to the car. But in terms of bodily symptoms, the very act of searching can bring about or instigate psychosomatic factors. Psyche being mind and soma being body. So you can believe to feel that you are actually suffering from some terrible condition. If you put any body part now into search what you will see is pages of tumor and cancer. And, in fact, just a month or so ago on Google’s official blog they have well, owned up to the issue and have also told us that one percent of all online search actually relates to medical search, people Googling symptoms. I’ve published in this area and I’ve published a paper which actually looks at a phenomenon which I name as cyberchondria by proxy. And that is people searching health results of others. And the thing is if you survive the initial search and you get to the intuitive diagnostic websites that prompt symptomatology it actually can make the problem worse. Why? You’ve got a pain in your arm. Could be from carrying a heavy bag or a harsh workout in the gym. You go online and you’re led through this decision pathway. Is the pain radiating across your chest? Well it could be. Do you feel tingling in your fingertips? Well when I think about it I do.

Are you palpitating? Well of course I am. You then rush to your GP, your doctor, and you present with a cluster of symptoms that actually mimic a cardiac event. The point is that doctors don’t prompt symptoms but artificial intelligence based systems diagnostic tools do. There’s a great paper called hypochondriacal hermeneutics and the paper argues that the doctor-patient relationship is a hypochondriacal exercise in its own right. One person sitting there talking about symptoms and the other trying to interpret them. And effectively if you appear or manifest with this perfect cluster your doctor has got no choice but to put you in the pipeline for intrusive, diagnostic, investigative procedures which are all inherently risky. A report came out recently that was published in the BMJ that has stated that iatrogenic death is the third cause of death in the USA. Iatrogenic would cover – it’s a catchall for problems in terms of taking medication, medical error, infection. So it’s death by accident within the medical system. But in my book I note and of course I’m aware of causation correlation but there’s a very interesting trend that iatrogenic death has increased fourfold between 1999 and 2011 and actually shadows the growth of the internet. Let’s think about that.

The internet is full of information. It is a data piñata so stuffed that if you hit it, your baseball bat would split in two. But remember that old adage about quality vs. quantity? It’s never been more relevant than now, in the age of digital health searches and rampant self-diagnosis.

Way back when, by which we mean less than 20 years ago, if you had a strange rash or a suspicious lump or a pain, you either had to visit a real doctor, pluck up the courage to ask a friend or relative, go to the library in disguise, or die in silence and shame.

Most people seeking answers then were genuinely sick, but some would have been hypochondriacs. The condition, described as abnormal anxiety about one’s health and imagined illness (even to the point of psychosomatic symptoms), has been around for centuries, and recently it has grown a new branch: cyberchondria. "Before the internet, it was called medical student's disease," says Dr. Aaron Krasnow, associate vice president of Arizona State University’s Counseling Services and Health Services, in an interview with The State News. "The thing about medical students is that they learn about so many diseases and disorders, they start to think they have them… The internet is filled with an enormous amount of fantastic information. It is also filled with an enormous amount of terrible information. One of the things the internet does poorly is filter the information."

The more people click on a certain search result , the higher it rises in the ranks. Mark Aiken, forensic psychologist and director of the Cyberpsychology Research Network explains why you may have a headache but end up reading about a brain tumor. "There’s a very good reason behind it. Humans have a propensity to escalate, to review the worst possible scenario – probably to dismiss it. … If you went to your doctor and you said, ‘I have a terrible headache,' and your doctor said, ‘Well, you could have anything from a hangover to a brain tumor.’ You would say, ‘Oh my goodness, talk to me about the brain tumor.’ And essentially that’s what happens online. People click on the worst-case scenario and therefore those scenarios get driven up the search rankings."

These frequency-based search models are fantastic if you want to know where to eat in Texas, but they are devastating when it comes to health queries. Intuitive diagnostic websites can actually have negative health impacts, escalating and prompting symptoms, leading a person to imagine feelings that aren’t there and rushing to the doctor with a cluster of symptoms that mimic a real disease. The doctor has a responsibility to refer you to the next medical stage for testing and diagnostics and potentially risky investigative procedures.

A recent report published in the BMJ states that iatrogenic death – a catchall term for problems with taking medication, medical error, infection, or death by accident within the medical system – is the third cause of death in the USA. Noting that correlation does not imply causation, Aiken notes an interesting trend: iatrogenic death has increased fourfold between 1999 and 2011 and actually shadows the growth of the internet. Perhaps cyberchondria is a more serious problem than we all thought.

Mary Aiken's most recent book is The Cyber Effect: A Pioneering Cyberpsychologist Explains How Human Behavior Changes Online.

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