Evidence vs. the Internet: A battle to the death

Evidence vs. the Internet: A battle to the death

Clients' online research is more about emotion than it is about facts.
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Apr 01, 2015

You know clients do it for their pets—and you have to deal with the effects in your exam room. But have you ever Googled your own symptoms? Two and a half hours later you’re convinced that you have a life-threatening condition, your doctor is your enemy because he’s just a shill for Big Pharma, and the only thing that can set you right is apple cider vinegar, the cure no one wants you to know about because then all the drug companies would go bust.

If enough people say it on an online message board, it must be true, right?

Oh, the Internet. So great for certain things health-related—you can find people with common interests, experiences and challenges, share tips and strategies and support. But it’s awful for other things—you have to sort out what’s true and helpful from what’s rumor, myth, craziness, wishful thinking or simply anecdotal and unproven.

Certain veterinary companies have been the target of much Internet noise in the last few years—notably, Purina with Beneful (see the article here for the latest) and Elanco with Trifexis. Both products have been blamed widely by consumers for the deaths of pets, but FDA investigations have yielded no evidence to that effect, at least not yet. That hasn’t quelled the hysteria on the part of Internet vocalizers, much to the chagrin of said veterinary companies.

Not long ago I heard a veterinary nutritionist—Tony Buffington, DVM, PhD, DACVN, of Ohio State, to be precise—talk about the especially emotional nature of the topic of nutrition among pet owners. When they come to you with their Internet message board findings and their raw food blogs written by “experts,” what they’re really asking you to understand is how much they care about their pet. And this can be difficult for scientifically minded clinicians who are trained to look at the evidence to engage with.

When faced with a client who is worked up by Internet chatter and looking to you (perhaps skeptically, since after all you’re just a shill for Big Pharma and Big Pet Food), Buffington’s advice is to acknowledge the emotion before you jump to the evidence. Validate the pet owner’s concern and affirm his or her commitment to seeking out the best solution for the pet (even if you think that “solution” is a combination of voodoo and bull feces). That warmth can knock down the walls of Internet-constructed resistance and open the door to a more rational, evidence-based discussion.

After all, those of us who Google our symptoms find in the end that a face-to-face discussion with an experienced, compassionate and wise clinician is of infinitely more value than exhausting hours spent online. Eventually the noise becomes overwhelming and we just need someone real: first to listen and then to make a plan. It’s no different with veterinary clients.

More information

thanks you Kristi; I am indebted to Bob Smith, MD at Michigan State for this approach. I highly recommend his book, Smith's Patient Centered Interviewing: An Evidence-Based Method, Third Edition for additional detail and evidence.

Cordially,
Tony Buffington