The Cyber Effect (48 page)

Clutching their “Google stack”
: M. Aiken and G. Kirwan (2012), “Prognoses for Diagnoses: Medical Search Online and ‘Cyberchondria,' ”
BMC Proceedings
6 (suppl. 4): 30.

unnecessary medical visits
: A. Nazaryan, “Internal Affairs: On Hypochondria,”
The New Yorker
, August 2, 2012.

In a large international survey
: D. McDaid and A. Park (2011),
BUPA Health Pulse 2010. Online Health: Untangling the Web
, 3:
bupa.​com.​au
. See also
Bupa Health Pulse 2011: International Healthcare Survey. Global Trends, Attitudes and Influences
, 16:
bupa.​com.​au
.

“Health and long life to you”
: The Old Irish blessing has many permutations;
this version probably derives from the time of the Great Famine (1845–1852), when land confiscation, high rents, and the potato blight forced mass Irish emigration. The phrase “and death in Old Ireland” expresses the wish that immigrants might live to return to their home country.

When does a normal desire for health
: M. P. Aiken and G. H. Kirwan (2014), “The Psychology of Cyberchondria and ‘Cyberchondria by Proxy,' ” in A. Power and G. Kirwan (eds.),
Cyberpsychology and New Media: A Thematic Reader
(New York: Psychology Press), 158–69. See also C. McMahon and M. P. Aiken (2015), “Introducing Digital Wellness: Bringing Cyberpsychological Balance to Healthcare and Information Technology,” in
Proceedings of the 14th IEEE International Conference on Ubiquitous Computing and Communications
,
computer.​org/​cps
, 1417–22.

people make judgments online in a number of ways
: C. L. Corritore, B. Kracher, and S. Wiedenbeck (2003), “On-line Trust: Concepts, Evolving Themes, a Model,”
International Journal of Human-Computer Studies
58: 737–58. See also L. C. Vega, T. DeHart, and E. Montague (2011), “Trust Between Patients and Health Websites: A Review of the Literature and Derived Outcomes from Empirical Studies,”
Health and Technology
, 1(2–4): 71–80.

the criteria that online searchers use
: A. N. Joinson, K. Y. A. McKenna, T. Postmes, and U-D. Reips (eds.) (2007),
The Oxford Handbook of Internet Psychology
(Oxford: Oxford University Press), 351.

online medical websites
: WebMD.​com, NIH.​gov, and MayoClinic.​org monthly unique visitor metrics:
alexa.​com
(2016).

people killed by lightning strikes
: There were 235 lightning fatalities in the United States in the years 1999–2003, an average of 47 people per year, according to the National Oceanic and Atmospheric Administration's Weather Service. Interestingly, the average has dropped to 26 per year in the period 2011–2015, per
nws.​noaa.​gov
.

“an active center for Online Support Groups”
:
mdjunction.​com
.

Lyme might be passed from a pregnant mother
: M. Lavelle, “Mothers May Pass Lyme Disease to Children in the Womb…but Public Health Experts Say the Science Isn't So Clear,”
Scientific​American.​com
, September 22, 2014.

the disease could be sexually transmitted
: “Recent Study Suggests That Lyme Disease Can Be Sexually Transmitted,”
lymedisease.​org
, January 25, 2014. See also Centres for Disease Control and Prevention, “Lyme Disease Frequently Asked Questions: Can Lyme Disease be Transmitted Sexually?,”
cdc.​gov
.

Medical misinformation can also leak
: S. Usborne, “Cyberchondria: The Perils of Internet Self-Diagnosis,”
The Independent
, February 17, 2009.

A Pew Internet Project study
: S. Fox and M. Duggan, “Health Online 2013,”
Pew Research Internet Project
, 3.
pewinternet.​org
.

The term
cyberchondria
: “ ‘Cyberchondria' Hits Web Users,” BBC World News, April 13, 2011. The Harris Poll first used the word
cyberchondriac
to describe people in 1998, when just over 50 million American adults had gone online to look for health information: #11, February 17, 1999. By 2005, that number had risen to 117 million. In the 2010 poll, the number of cyberchondriacs had jumped to 175 million from 154 million the previous year: “ ‘Cyberchondriacs' on the Rise?,”
theharris​poll.​com
, August 4, 2010. See also J. Stone and M. Sharp (2003), “Internet Resources for Psychiatry and Neuropsychiatry,”
Journal of Neurology, Neurosurgery and Psychiatry
74(1): 10–12.

a groundbreaking study
: R. W. White and E. Horvitz (2009), “Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search,”
ACM Transactions on Information Systems
27(4), Article 23.

“health anxiety”
: G. J. G. Asmundson, S. Taylor, S. Sevgur, and B. J. Cox (2001), “Health Anxiety: Classification and Clinical Features,” in G. J. G. Asmundson, S. Taylor, and B. J. Cox (eds.) (2001),
Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions
(Chichester, U.K.: John Wiley & Sons), 4–5.

The desire for information that will help us thrive is a natural, primal urge
: J. Panksepp (2003), “An Archaeology of Mind: The Ancestral Sources of Human Feelings,”
Soundings: An Interdisciplinary Journal
86(1/2): 41–69.

a number of sweeping changes
: American Psychiatric Association (2013),
Diagnostic and Statistical Manual of Mental Disorders
, 5th ed. (Arlington, VA: American Psychiatric Association), 812–13.

anxiety and concern
: C. F. Belling (2006), “Hypochondriac Hermeneutics: Medicine and the Anxiety of Interpretation,”
Literature and Medicine
25(2): 376–401.

Hypochondria is found in 4 to 9 percent
: The prevalence of somatic symptom disorder is not known. The DSM-5 estimates the figure to be around 5–7 percent of the adult population, while it puts prevalence of illness anxiety disorder between 1.3 and 10 percent (pp. 312, 316). Although there is no comprehensive international study, some research has been conducted in individual countries, for example, Australia, which is at 5.7 percent (M. Sunderland, J. M. Newby, and G. Andrews [2013], “Health Anxiety in Australia: Prevalence, Comorbidity, Disability, and Service Use,”
The British Journal of Psychiatry
202(1): 56–61, and Germany, at around 6 percent (G. Bleichhardt and W. Hiller [2007], “Hypochondriasis and Health Anxiety in the German Population,”
British Journal of Health Psychology
12[4]: 511–23).

a wide range of emotional difficulties
: T. A. Widiger and P. T. J. Costa
(1994), “Personality and Personality Disorders,”
Journal of Abnormal Psychology
103(1): 78–91.

average length of a consultation
: E. Sillence, P. Briggs, P. Harris, and L. Fishwick (2006), “Changes in Online Health Usage over the Last 5 Years,” in
CHI '06 Extended Abstracts on Human Factors in Computing Systems
(New York: ACM Press), 1331–36.

suffering from “Munchausen syndrome”
: R. Asher (1951), “Munchausen's Syndrome,”
Lancet
1(6650): 339–41.

“Munchausen syndrome by proxy”
: R. Meadow (1977), “Munchausen Syndrome by Proxy: The Hinterland of Child Abuse,”
Lancet
2(8033): 343–45.

proliferation of various conditions
: L. J. Lasher and M. S. Sheridan (2013),
Munchausen by Proxy: Identification, Intervention, and Case Management
(New York: Routledge).

also known as “hospital addicts”
: D. O. Day and R. L. Moseley (2010), “Munchausen by Proxy Syndrome,”
Journal of Forensic Psychology Practice
10(1): 13–36.

develops the condition after hospitalization for a true illness
: L. Criddle (2010), “Monsters in the Closet: Munchausen Syndrome by Proxy,”
Critical Care Nurse
30(6): 46–55.

evolution of the original condition
: J. Kleeman, “Sick Note: Faking Illness Online,”
The Guardian
, February 26, 2011.

he found exactly what he was looking for online
: A. Moses, “Alarm Sounded over Dr Google's Diagnosis,”
The Sydney Morning Herald
, February 10, 2011.

more dependent on online searches
: Y. Amichai-Hamburger (2007), “Personality, Individual Differences and Internet Use,” in A. M. Joinson, K. Y. A. McKenna, T. Postmes, and U-D. Reips (eds.),
The Oxford Handbook of Internet Psychology
(Oxford: Oxford University Press), 187–204.

In 2013, more than 1,600
: D. Fine Maron, “Pill of Goods: International Counterfeit Drug Ring Hit in Massive Sting,”
Scientific​American.​com
, July 3, 2013.

missing common cancers
: G. Kolata (2005), “Rapid Rise and Fall for Body-Scanning Clinics,”
The New York Times
, January 23, 2005.

“You don't know what's inside until you look”
: W. James, “Know Thy Inner Self: A 3-D Scan Spots Cancer and Other Health Risks Before It's Too Late,”
body​scanintl.​com
.

He was celebrated on
The Oprah Winfrey Show
: M. Ballon, “Full-Body Scan Pioneer Is on the Outside Looking In,”
Los Angeles Times
, August 19, 2001.

evolving pathology was found in
every case
: P. Bowes, “US Doctors Offer Full Body Scan,”
news.​bbc.​co.​uk
, January 2, 2001.

“It's a daily event”
: R. Davis, “The Inside Story,”
USA Today
, August 25, 2000.

“Yes, there's an increased risk”
: P. Eastman (2005), “Whole-Body Scanning for Patients with No Symptoms: What Are the Pros and Cons?,”
Oncology Times UK
2(3): 20–21.

third most common cause of death
: B. Starfield (2000), “Is US Health Really the Best in the World?,”
The Journal of the American Medical
Association 284(4): 483–85.

deaths…a result of medical error in hospitals
: L. T. Kohn, J. M. Corrigan, and M. S. Donaldson (eds.) (2000),
To Err Is Human: Building a Safer Health System
(Washington, DC: National Academy Press);
nap.​edu
.

180,000 patient deaths annually
: D. R. Levinson (2010),
Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries
(Office of Inspector General, U.S. Department of Health and Human Services).

stunning jump in deaths
: J. T. James (2013), “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,”
Journal of Patient Safety
9(3): 122–28. The report used a weighted average of four studies carried out between 2008 and 2011 to reach the lower limit of 210,000; the higher figure of 440,000 was arrived at by estimating errors and omissions in medical records and diagnostic procedures (p. 127). Now see M. A. Makary and M. Daniel (2016), “Medical Error—the third leading cause of death in the US,”
British Medical Journal
353.

when as many as 60 percent of Americans search for health information
: S. Fox and M. Duggan, “Health Online 2013,”
Pew​Internet.​org
, January 15, 2013.

The Google motto “Don't be evil”
: Google's Code of Conduct is prefaced with: “Don't be evil. We believe strongly that in the long term, we will be better served—as shareholders and in all other ways—by a company that does good things for the world even if we forgo some short term gains,” Securities and Exchange Commission registration statement,
sec.​gov/​Archives
.

“First, do no harm”
: This phrase does not actually occur in the classical Hippocratic Oath. The closest phrase is: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.” But modern versions of the oath often have something more general. The Latin phrase is attributed to the seventeenth-century English physician Thomas Sydenham, in a book by surgeon and mythologist Thomas Inman from 1860 called
Foundation for a New Theory and Practice of Medicine
(London: John Churchill). On page 244 it states: “We crouch under the cloak of Sydenham, and say, that our motto is none other than a translation of his Latin aphorism respecting a physician's duties, viz:—‘
Primum est ut non nocere.
' ”

This finds agreement in Japan
: In the past the decision was left up to the patient's family, who were usually reluctant to disclose the truth, but in the 1980s the introduction of hospice care and new, aggressive treatments resulted in a government recommendation that the terminally ill patient be given both a diagnosis and an estimate of life expectancy. The National Cancer Center issued “Guidelines for Telling the Truth to Cancer Patients” (H. Okamura et al. [1998],
Japanese Journal of Clinical Oncology
28[1]: 1–4). Included were instructions that may seem basic—such as “On no account should the diagnosis be communicated via the telephone, or in passing in a corridor, or in a public place”—but that reveal how unaccustomed Japanese physicians had been to approaching such a task (Y. Uchitomi and S. Yamawaki [1997], “Truth-telling Practice in Cancer Care in Japan,”
Annals of the New York Academy of Sciences
809: 290–99).