Patient Information: Unhealthy Half Knowledge

30. August 2016

'The empowered patient' has become a household term since medical knowledge became available without limits on the Web. Yet such forms of information have a downside. Researchers point to a number of risks coming from modern media.

Dr. Google has a 24 hours-a-day clinic and Wikipedia provides advice in almost all life situations. The presumed diseases are autodiagnosed, including with them the “correct” therapy. Laypersons in the press also jump in on medical questions only too happy. Readers, or rather patients, show great interest. Now scientists have investigated the possible effects of this flood of information on non-professionals.

No, I will not swallow my pill

Krishnan Bhaskaran from London addressed the question as to what effect media reports on statins have on patient adherence to therapy. The background to this was the appearance of two critical reports in the British Medical Journal. John D Abramson of the Harvard Medical School in Cambridge (Massachusetts), and Aseem Malhotra from Croydon University Hospital, London, have made their voices heard. In their articles from 2013 they express doubt that patients with low or medium risk benefit from pharmacotherapy. British media took to the issue with great interest and up until the spring of 2014 reported on statins.

Bhaskaran did not find great impact on the way doctors prescribe. However patients did react. Of all those who were already taking statins as part of primary prevention, on the basis of these reports eleven percent ceased taking their medication. In the case of statins used as part of secondary prevention the figure was even twelve percent. Converted to national proportions, this corresponds to an additional 200,000 people in the UK not adhering to their program. Over the next ten years, researchers expect 2,173 additional deaths from heart attacks or strokes. This value increases to 6,372, should patients abandon their medication completely.

Death and the Devil

Boxed warnings (or Black Box warnings, more colloquially) have similar adverse consequences associated with them. Background events: The US medications and surveillance authority, the FDA, urges manufacturers to print black-bordered warning on package inserts, should studies show evidence of severe or life-threatening risks.


Black-Box-Warning from the FDA. Screenshot: DocCheck

Each boxed warning attracted enormous media interest – which creates a vicious circle, as Christine Y. Lu shows. She does research at Harvard Medical School, Boston. Among children and adolescents antidepressants lead to suicidal tendencies – even if this only occurs in individual cases. Reason enough for FDA experts to impose on manufacturers the need for boxed warnings.

The action left untold consequences in its trail. Mainstream media, especially the New York Times and the Washington Post, reported in detail on the subject. Medical prescriptions declined by 31 percent. The phenomenon also affected young adults (minus 24.3 percent) and older patients (minus 14.5 percent), which were actually not the target of the FDA’s focus. At the same time the cases involving presumably deliberately induced overdoses increased among youth (21.7 percent) and young adults (33.7 percent).

Adverse effect pregnancy

An earlier case of adverse impacts of public discussion was presented at a press conference by Professor Dr. Gerd Gigerenzer of the Max Planck Institute for Human Development and the Harding Center for Risk Literacy. In 1995 the British Committee on Safety of Medicines (CSM) presented information about life-threatening thrombosis associated with third generation oral contraceptives. The risk was said to have doubled with certain third generation birth control pills – information which lay people per se were able to make little use of.

“Of the 7,000 women who took the the second generation pill, one woman suffered thrombosis”, says Gigerenzer. “This figure increased with the third generation of the medication to two”. Had the media worked with absolute figures, little would have been happened. Due to misleading reporting, the effort backfired. Quite a number of unplanned pregnancies and approximately 13,000 additional abortions were the outcome.

Knowledge pulled out of the hat

Is information given through non-expert media therefore wrong? Dr. Fiona Godlee, Editor-in-Chief of the BMJ, does not hold this view. For her, having public debate on the benefits and harms of drugs is “absolutely correct”, so as to enable patients to make conscious decisions. Nevertheless scientific data are hardly going to help them in this, as the case studies have shown.

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Add bad nutrition advice into the mix. The lists of pills and potions being “prescribed” by some, compounded by the real medications to elderly, leaving out entire food group nutrient… And these folks showing up for surgery and cancer therapies… It’s a mess.

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