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I had no idea how to format this outline on the blog! :( Sorry for how jumbled it is!


Outline: Dangers of Internet-based Health Searches
I. Introduction:
A. When, how it started
1. rise of new media and the “internet age”
-“The World Wide Web was developed in 1989 by English computer scientist Timothy Berners-Lee for the European Organization for Nuclear Research (CERN).” (Ament, Phil)
-“According to the Pew Research Center (2001), approximately 104 million American adults have access to the Internet.” (Eastin, Matthew S)
B. Along with advancements came consequences.
1. Increased availability of various forms of media (soundbites, videos, visuals), but also increased circulation of pornography
2. Expansion of communications, but also opened new avenues for the exchange of information between criminals that aren’t as noticeable or easily tracked
3. Much like these, the beginnings of online health information provided significant benefits, but has also proven to account for many overlooked consequences.
C. New demand for health information on the internet—stats
1. High cost and low availability of professional health care information
-“One of the primary uses of the Internet by consumers is to obtain information about health and health care.” (Bundorf, M) This is driven by the high cost and overall low availability of health care.
2. Seven percent of health seekers, or about 8 million American adults, searched for information on at least one health topic on a typical day in August 2006. This places health searches at about the same level of popularity on a typical day as paying bills online, reading blogs, or using the internet to look up a phone number or address. (Fox, Susannah)
3.
D. The use of internet-based medical information and services has attributed to a rise in the misinformation of consumers, altered the patient-physician relationship, and negatively impacted clinical business due to its ease of accessibility and common lack of credibility.
I. Misinformation of Consumers
A. Greatest problems with online health information—inaccuracy
1. Disparity between clinical and online information
-“Research indicates that medical professionals do not author an extensive amount of health information available on the Internet. This creates a possibility for false information, thereby potentially leading ill people away from proper care.” (Eastin, Matthew S)
-“the Internet's free and unregulated flow of information and information providers creates many possible hazards to those who seek and trust online information. In many instances those accessing information are unaware of: (1) who authored the material, (2) when the information was last updated, and (3)whether the information is accurate.” (Eastin, Matthew S)
-In 2006, about 113 million American adults used the Internet to find health information (Pew Internet & American Life Project, 2006). More than any other source, the Internet provides instant access to tremendous amounts of health-related information that may affect "personal perceptions of health and illness, patients’ compliance to treatment protocols and ultimately, overall health" (Taha, Jessica, and Joseph Sharit)
-“There is an increasing concern, for instance, that some health information disseminated via the internet is “inaccurate, erroneous, misleading, or fraudulent and actually poses a threat to public health in general” (Weaver, James B)
-Three-quarters of health seekers do not consistently check the source and date of the health information they find online. Just 15% of health seekers say they “always” check the source and date of the health information they find online, while another 10% say they do so “most of the time.” Fully three-quarters of health seekers say they check the source and date “only sometimes,” “hardly ever,” or “never,” which translates to about 85 million Americans gathering health advice online without consistently examining the quality indicators of the information they find. (Fox, Susannah)


B. Conflicting Sources à find specific examples
C. Leads to:
1. Mistreatment of illness or ailment
2. Wasted money on products or medicines that won’t help, and sometimes will make consumer’s problem worse
3. Hesitancy to accept a physician’s diagnosis and method of treatment.
-“emerging evidence that a significant proportion of internet health information consumers are self-diagnosing health conditions, seeking information about alternative treatments or medicine, and engaging healthcare strategies inconsistent with medical recommendations.” (Weaver, James B)

II. Patient/Physician Relationship
A. Misinformation leads to greater gap between patient and health professionals
1. Mistrust
-“Methods: An observational study was carried out of office visits by 732 patients of 45 physicians (16 family physicians, 18 general internists and 11 cardiologists), within two managed care settings. Participants were consecutive, English-speaking patients, age 18 and older who had a significant health concern. Visit questionnaires were completed by 68% of patients known to be eligible. Post-visit measures included services requested (information, examination, prescription, test or referral); services provided; and requested or needed services not provided during the visit. Measures at 2-week follow-up included patient satisfaction, intended adherence to advice, interval contacts with the health system and symptom improvement.
-Results: After adjustment for patient and physician characteristics, patient trust in the physician was not associated with the likelihood that a service was requested or provided during the visit, with the exception that prescription of a new medication was more frequent among patients with higher trust. In contrast, patients with low trust prior to the visit consistently were more likely to report that a needed or requested service was not provided (P < 0.001 for all services).
-Requests for services (and their fulfilment or lack of fulfilment) occur in the context of the doctor–patient relationship and, in turn, play an important role in defining the quality of the relationship. From the patient’s view, whether or not they receive the services they request or feel they need often defines the success of the visit.” (Thom, DH)
-low trust might prompt patients to make requests because they do not trust the doctor to provide what they need, while patients with high levels of trust might feel more comfortable asking for what they want. (Thom, DH)
2. Failure to Comply with Treatment (12,
-Patients with a low level of trust were less satisfied with their care (Thom, DH)
3. Disadvantages the patientà easier to take advantage of (4)
a. Of the consumers surveyed:
25% say they felt overwhelmed by the amount of information they found online.
22% say they felt frustrated by a lack of information or an inability to find what they were looking for online.
18% say they felt confused by the information they found online.
10% say they felt frightened by the serious or graphic nature of the information they found online. (Fox, Susannah)
b. This confusion, frustration, and fear can increase a patients ignorance of their own condition, heightening the doctor’s ability to take advantage of just how much they don’t know. This may lead to spending large amounts of money on harmless but unnecessary treatments or multiple, unneeded doctor’s visits because questions weren’t asked or answered the first time around.
B. Because patients mistrust professional help...
1. -“Consumers may forego contacts with physicians in response to the availability of information from alternative sources depending on the caule they place on these alternative sources. (Bundorf, M)
2. Because there is a significant asymmetry in the knowledge-base of patients and physicians, patients often look for information “…to evaluate the quality of either the information or the services they receiver from a physician…” (Bundorf, M) The problem with this is that the online sources they consult often contain flawed instruction, which creates distrust between patient and health professional.
C.
III. Negative Impacts to Clinical Business
A. Because information is provided without charge on the internet, those who seek it most (those with low income and poor health) (9), who also happen to be those who provide clinical businesses with the most income, will go to the internet rather than a professional source.
1. -“the challenges users face in acquiring and using information are a defining feature of health care markets.”
2. -“…the distribution of free health information increased demand for self-care resources and reduced the demand for information from health professionals.”
3. - “…the availability of health information on the Internet may have major implications for consumer behavior and market efficiency.”
4. -“…consistent with the underlying economic theory of demand for information, those who potentially benefit the most from health information and those who face higher costs of obtaining information from other sources are more likely to turn to the Internet as a source of health information.”
5. - “…traditionally physicians and health care professionals have been the primary source for consumers. Physicians have superior information about the production of health due to both their extensive training and their experience in treating patients. Because health production is highly customized based on the characteristics of individual patients, both sources of information create a gap between physicians and patients in their ability to obtain, understand, and make recommendations based on heath information. This asymmetry in information between physicians and consumers creates a market for health information from physicians.” (Bundorf, M)à online health information takes this market away! They can no longer market the skills and information they have obtained because of its costless availability online.
B. The Former two arguments contribute to this loss of business
1. Misinformation – more likely to drive patients away from clinical visits because the information they find from online sources differs from what they hear from a health professional (4)
-consumers fall into a false sense of security, thinking that they don’t need clinical advice and that the Internet can give them everything they need.
2. Patient/Physician Relationships
-mistrust of physicians will discourage doctor’s visits
-also discourage adherence to a doctor’s counsel, which means that a patient will be less likely to pay the health provider for the prescribed treatment (4)
IV. Conclusion
A. The use of online medical information needs to be heavily discouraged and perhaps even prohibited.
1. Internet-based health information may have its uses, and is not always detrimental to the consumer, but its negative consequences are too great
2. Misdiagnosis due to misinformation
3. Takes away business from the professionals, who ironically have the most valuable knowledge