American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, December 20, 2016

Bad information for a social disease

I rather doubt ignorance is genuine bliss. It's just a holding pattern; the proverbial calm that anticipates a storm. While the arc of the moral universe is long and bends toward justice, the arc of understanding is long and bends toward truth. It finds us all, eventually. The most ignorant are simply the last to get the memo. Ignorance is delay.

To be clear, ignorance is not a term of disparagement, not a character flaw. It's a state into which we are all born; babies are ignorant. Children are only nominally less so. Time conjoined to information is the remedy. The condition is preserved when information is inaccessible, through no necessary fault of those left uninformed.

Ignorance provides no active resistance against truth, for nature abhors a vacuum. Good information can readily populate the vacant spaces ignorance provides.

Ignorance is bad medicine, of course, relative to knowledge. To whatever extent knowledge reliably empowers—and, alas, it seems to do so quite imperfectly—ignorance does the opposite. Ignorance reliably disempowers, and is thus the common enemy to all who view the value in empowerment.

But bad as ignorance is, there is something far worse for the human condition, and the social diseases of every “-ism” and “-ophobia” to which the body politic is subject. Misinformation is much worse, a standout among the pernicious toxins to which we are vulnerable. Famously, it's hard to fill a vessel already full. Every vessel full of misinformation is actively resistant to the inconveniences of truth.

I graduated medical school in 1988, and have taken care of patients for most of the 28 years since. The Internet, in anything like its current incarnation, did not exist until 1990. Routine access for the masses of us came years later.

So it was that when I first started seeing patients, I encountered most often what every generation of my predecessors had encountered: relative ignorance. Our patients did not know nearly as much as we did about medicine.

This, of course, was no discredit to them or credit to us; it was a distinction four years of medical school were supposed to produce. It was a gap in knowledge that years of post-graduate medical training, five years in my case, were designed to widen. We doctors were supposed to acquire knowledge in matters medical our patients lacked, the very point of all that education. We were supposed to be the experts.

But the Internet has gone a long way toward killing expertise. For when information became universally accessible, so did misinformation. Increasingly, everyone knows everything- but much of it is wrong. Clinical care, outcomes, and the doctor-patient relationship, are all too often the worse for it.

Examples relevant to the broad expanse of clinical medicine, public health practice, and health promotion abound. In cyberspace, immunization is not one among the great advances in the history of public health, not the relief of immeasurable misery; but rather the cause of autism. This is not merely false, but robustly debunked, and yet the insidious meme of it refuses to die.

Internet conspiracy theories tell the gullible that the HIV epidemic was initiated intentionally by government, and that the CDC is complicit in genocide, fomenting anti-government passions. Every radical voice finds the echo chamber in which it reverberates to greatest effect, populating cyberspace with so many spider webs for unwitting flies. Excesses in one direction encourage the disgruntled to embrace “alternative” therapies proven not to work, while in the other staunch conventionalists make no effort to spare the baby in recurrent tirades about bathwater.

Applications of diet to health are an extreme case, subject to a bizarre balkanization owning much the same zealous hostility as religious wars. Every opinion, amplified by the like-minded in cyberspace, can masquerade as expert opinion, and impersonate truth.

Perhaps the greatest and most concerning illustration of all is the one that pertains to the one health that matters to us all, that of the planet. The filter-free broadcasting of misinformation about climate change and the fate of the planet propagates a volume of noise in which even the global consensus of experts is invited to drown.

The ramifications of rampant misinformation are ubiquitous.

The Arab Spring was made possible by the democratization of information. But it was followed not by summer, but rather by the tyrannies of winter in all of its reasons for discontent- aided and abetted by the democratization of misinformation, preferentially directed to divide and radicalize. The surprise of Brexit was borne along to England's now more isolated shores in just such currents. So, too, the restive flood waters soiling our own political house, now so flagrantly divided.

Ignorance has always been a malady of sorts, and universal access to information the obvious remedy. But universal access to misinformation is the quintessential case of a cure far worse than the disease. Only misinformation actively propagates the greatest plagues of human history, inspires the most heinous transgressions of our collective character.

The Internet is subject to few and uncertain laws, but was never immune to the law of unintended consequences. It proves to be an ideal purveyor of misinformation, whether born of willful demagoguery and propaganda, or the relative innocence of misdirected passions.

Either way, the Internet proves to be the dispensary for the worst of all medicines for the worst of all social diseases. The pharmacy is, irrevocably, open, and no prescriptions are required.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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