What To Watch Out For When Meds Are Discussed Online

The good news: The Internet reaches many patients who are otherwise isolated, and can draw them into helpful communities. Online patient forums are booming on the Web, helping millions connect.

The bad news: Those otherwise isolated patients are also the most vulnerable to biased information that may be propagated online by, say, companies hoping to sell more of their drugs.

That worries Dr. Harold J. Bursztajn, co-founder of the Program in Psychiatry and the Law at Harvard Medical School, an expert in clinician-patient decision making, and a researcher on the pharmaceutical industry's financial influence on psychiatry. He has served as an expert retained by the plaintiffs in Seroquel-related lawsuits. He has also served as an expert retained by the defense in other pharmaceutical liability lawsuits. He recently gave a talk at the University of Haifa Faculty of Law on the dangers of online marketing of psychiatric drugs, and kindly agreed to help convert it into this guest post combining warnings and tips for the general public.

Readers, have you seen any examples of biased information about prescription drugs in ads or the online patient communities where you hang out? Please share in the comments below.

What to watch out for:

Buried risks — In their official information about medications, some companies may bury the information about risks very far down on the first page, in small print, or a click or two away. For example: this advertisement for Seroquel SR that comes up when you Google depression.

The more the risks appear on your laptop screen or your smartphone on the same page as the benefits, the more likely you're being given the straight story.

Hidden industry ties — On some online forums, ranging from psychopharmacology listservs for clinicians to consumer groups, members give personal recommendations about drugs without mentioning their industry ties. It is best to trust recommendations from people who explicitly state that they have not had any industry ties rather than people who omit mentioning anything about such ties. In fact, it may be safer at times to trust people who explicitly say they do have industry ties rather than omit any mention of such ties.

Indirect ties —

A major shell-game problem is that of indirect industry ties. Clinicians and patients need to be wary of people who say they have no direct ties while being members of departments or organizations which are heavily funded by industry. Ideally, a forum would ask people to disclose both direct and indirect ties.

Marketing by proxy — Beware of Internet forum posters who hide industry ties by projecting themselves as disinterested patients or physicians. Feel free to ask a poster about financial ties. I was once struck by a poster whose data did not comport with my clinical experience, and a Google search turned up significant industry ties. Feel free to do such searches. Although industry ties by themselves do not necessarily mean a recommendation is biased, they do raise the question: Why the failure to disclose?

Biased selection of studies — Beware of recommendations based only on studies sponsored by drug manufacturers. Or that do not mention whether the results of studies not sponsored by industry differ from those of industry-sponsored studies.

What ‘adjunct’ means — Beware of recommendations that focus on FDA approval of a medication as an “adjunct” treatment without mentioning that this means that it’s not a first-line treatment for the condition in question.

FDA actions — When a medication is recommended, you may want to check whether its maker has been cited by the FDA for misleading marketing. On the other hand, the FDA is so overextended that the lack of such a letter of warning is no guarantee that the medication is as safe and effective as claimed. You may also want to check — using an engine like Google Legal — whether the drug manufacturer has any ongoing lawsuits related to the drug.

And the simplest of all: overconfidence and false necessity — Beware of recommendations made in an overconfident fashion. While prescribing medications in a confident fashion may induce a helpful placebo effect, medications prescribed in a blindly confident fashion, without reference to side effects or alternatives, can lead to helplessness and hopelessness when even mild side effects appear, as well as to overlooking potentially remediable side effects if they can be identified in time.

For example, if patients and physicians had been forewarned in a timely fashion of the association between atypical antipsychotics and the emergence of diabetes, careful monitoring of blood sugar and weight could have prevented at least some cases of serious diabetes-related complications. Similarly, beware of language that slips from medications being indicated to their being necessary. While there are some conditions for which a particular medication may be both indicated and necessary, there is a great deal of individual variation. Even individuals suffering from similar conditions may have a choice as to what combination of medications and therapy works well for them.

Postscript: Gary Schwitzer of the well-respected healthnewsreview.org shares here a "creepy" case of commercial interests invading a Facebook space.