Who can you trust on online health forums?

The perils of "Münchausen by internet".

For all the benefits that search engines and online support groups have brought to patients – especially in an era of shrinking health budgets and stretched front-line services – the collision of health care and social media has highlighted a number of thorny issues. The internet is notoriously patchy as a source of health advice, for a start, with nervous users often vulnerable to "cyberchondria", the kind of hysteria that can transform an innocent mole into a malignant tumour or a minor rash into a life-threatening bout of meningitis.

Among the more pernicious phenomena that put today's online patients at risk is a pattern of behaviour known as "Münchausen by internet" (MBI), an online variant of Münchausen syndrome. Where old-fashioned, non-digital Münchausen sufferers feign illnesses in hospitals and GP's offices, MBI involves posting faked stories on internet support forums in an attempt to elicit sympathy and support from other users.

MBI, a term coined by the US psychiatrist Marc Feldman but still unrecognised by the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), has gained widespread media attention through a series of high-profile cases, one of the most recent being that of a teenage girl who, it was revealed last November, adopted the fictitious persona of a mother caring for her cancer-stricken daughter, stringing along the Macmillan cancer support forum for more than two years before the deception finally unravelled.

MBI falls into the hazy nether-region between the wider culture of online trolling and a genuine psychiatric condition. Whether a user lying on health forums is motivated by simple malice or deeper psychiatric issues, the fact remains that it's a lot easier to mislead a supportive online community than a doctor and the consequences are more serious. Whereas doctors are equipped to deal with hypochondriacs and fakers, people who post on forums are often patients themselves and considerably more vulnerable to abuses of trust.

What's more, the vast, faceless mass of anonymous online communities makes it incredibly difficult to pick out the fakers from their genuine counterparts. Barring the use of plagiarism software to spot suspicious patterns or bolstering privacy settings, which seems to defeat the purpose of public forums, the best defence is a sharp-eyed community, with specialists also calling for formal recognition of MBI as a pattern of behaviour and a more proactive social media stance from health-care authorities. Unfortunately, the internet seems to be throwing up issues such as MBI faster than anyone is equipped to address them. In the meantime, the best advice for health forum users will remain depressingly basic: tread carefully and carry a big grain of salt.

The article can be read in full here. Chris Lo is a senior technology writer for the NRI Digital network.

Web of deceit: internet users can be vulnerable to "cyberchondria". Photograph: Daniel Berehulak/Getty Images

 

Chris Lo is a senior technology writer for the NRI Digital network.

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Benn vs McDonnell: how Brexit has exposed the fight over Labour's party machine

In the wake of Brexit, should Labour MPs listen more closely to voters, or their own party members?

Two Labour MPs on primetime TV. Two prominent politicians ruling themselves out of a Labour leadership contest. But that was as far as the similarity went.

Hilary Benn was speaking hours after he resigned - or was sacked - from the Shadow Cabinet. He described Jeremy Corbyn as a "good and decent man" but not a leader.

Framing his overnight removal as a matter of conscience, Benn told the BBC's Andrew Marr: "I no longer have confidence in him [Corbyn] and I think the right thing to do would be for him to take that decision."

In Benn's view, diehard leftie pin ups do not go down well in the real world, or on the ballot papers of middle England. 

But while Benn may be drawing on a New Labour truism, this in turn rests on the assumption that voters matter more than the party members when it comes to winning elections.

That assumption was contested moments later by Shadow Chancellor John McDonnell.

Dismissive of the personal appeal of Shadow Cabinet ministers - "we can replace them" - McDonnell's message was that Labour under Corbyn had rejuvenated its electoral machine.

Pointing to success in by-elections and the London mayoral election, McDonnell warned would-be rebels: "Who is sovereign in our party? The people who are soverign are the party members. 

"I'm saying respect the party members. And in that way we can hold together and win the next election."

Indeed, nearly a year on from Corbyn's surprise election to the Labour leadership, it is worth remembering he captured nearly 60% of the 400,000 votes cast. Momentum, the grassroots organisation formed in the wake of his success, now has more than 50 branches around the country.

Come the next election, it will be these grassroots members who will knock on doors, hand out leaflets and perhaps even threaten to deselect MPs.

The question for wavering Labour MPs will be whether what they trust more - their own connection with voters, or this potentially unbiddable party machine.