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.

Photo: Getty Images
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I'm far from convinced by Cameron's plans for Syria

The Prime Minister has a plan for when the bombs drop. But what about after?

In the House of Commons today, the Prime Minister set out a powerful case for Britain to join air strikes against Isil in Syria.  Isil, he argued, poses a direct threat to Britain and its people, and Britain should not be in the business of “outsourcing our security to our allies”. And while he conceded that further airstrikes alone would not be sufficient to beat Isil, he made the case for an “Isil first” strategy – attacking Isil now, while continuing to do what we can diplomatically to help secure a lasting settlement for Syria in which Assad (eventually) plays no part.

I agreed with much of David Cameron’s analysis. And no-one should doubt either the murderous barbarism of Isil in the region, or the barbarism they foment and inspire in others across the world.  But at the end of his lengthy Q&A session with MPs, I remained unconvinced that UK involvement in airstrikes in Syria was the right option. Because the case for action has to be a case for action that has a chance of succeeding.  And David Cameron’s case contained neither a plan for winning the war, nor a plan for winning the peace.

The Prime Minister, along with military experts and analysts across the world, concedes that air strikes alone will not defeat Isil, and that (as in Iraq) ground forces are essential if we want to rid Syria of Isil. But what is the plan to assemble these ground forces so necessary for a successful mission?  David Cameron’s answer today was more a hope than a plan. He referred to “70,000 Syrian opposition fighters - principally the Free Syrian Army (FSA) – with whom we can co-ordinate attacks on Isil”.

But it is an illusion to think that these fighters can provide the ground forces needed to complement aerial bombardment of Isil.  Many commentators have begun to doubt whether the FSA continues to exist as a coherent operational entity over the past few months. Coralling the myriad rebel groups into a disciplined force capable of fighting and occupying Isil territory is a heroic ambition, not a plan. And previous efforts to mobilize the rebels against Isil have been utter failures. Last month the Americans abandoned a $500m programme to train and turn 5,400 rebel fighters into a disciplined force to fight Isil. They succeeded in training just 60 fighters. And there have been incidents of American-trained fighters giving some of their US-provided equipment to the Nusra Front, an affiliate of Al Qaeda.

Why has it proven so hard to co-opt rebel forces in the fight against Isil? Because most of the various rebel groups are fighting a war against Assad, not against Isil.  Syria’s civil war is gruesome and complex, but it is fundamentally a Civil War between Assad’s forces and a variety of opponents of Assad’s regime. It would be a mistake for Britain to base a case for military action against Isil on the hope that thousands of disparate rebel forces can be persuaded to change their enemy – especially when the evidence so far is that they won’t.

This is a plan for military action that, at present, looks highly unlikely to succeed.  But what of the plan for peace? David Cameron today argued for the separation of the immediate task at hand - to strike against Isil in Syria – from the longer-term ambition of achieving a settlement in Syria and removing Assad.  But for Isil to be beaten, the two cannot be separated. Because it is only by making progress in developing a credible and internationally-backed plan for a post-Assad Syria that we will persuade Syrian Sunnis that fighting Isil will not end up helping Assad win the Civil War.  If we want not only to rely on rebel Sunnis to provide ground troops against Isil, but also provide stable governance in Isil-occupied areas when the bombing stops, progress on a settlement to Syria’s Civil War is more not less urgent.  Without it, the reluctance of Syrian Sunnis to think that our fight is their fight will undermine the chances of military efforts to beat Isil and bring basic order to the regions they control. 

This points us towards doubling down on the progress that has already been made in Vienna: working with the USA, France, Syria’s neighbours and the Gulf states, as well as Russia and Iran. We need not just a combined approach to ending the conflict, but the prospect of a post-war Syria that offers a place for those whose cooperation we seek to defeat Isil. No doubt this will strike some as insufficient in the face of the horrors perpetrated by Isil. But I fear that if we want not just to take action against Isil but to defeat them and prevent their return, it offers a better chance of succeeding than David Cameron’s proposal today. 

Stewart Wood is a former Shadow Cabinet minister and adviser to Ed Miliband. He tweets as @StewartWood.