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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The 8 bits of good news about integration buried in the Casey Review

It's not all Trojan Horses.

The government-commissioned Casey Review on integration tackles serious subjects, from honour crimes to discrimination and hate crime.

It outlines how deprivation, discrimination, segregated schools and unenlightened traditions can drag certain British-Pakistani and Bangladeshi communities into isolation. 

It shines a light on nepotistic local politics, which only entrench religious and gender segregation. It also charts the hurdles faced by ethnic minorities from school, to university and the workplace. There is no doubt it makes uncomfortable reading. 

But at a time when the negative consequences of immigration are dominating headlines, it’s easy to miss some of the more optimistic trends the Casey Report uncovered:

1. You can always have more friends

For all the talk of segregation, 82 per cent of us socialise at least once a month with people from a different ethnic and religious background, according to the Citizenship Survey 2010-11.

More than half of first generation migrants had friends of a different ethnicity. As for their children, nearly three quarters were friends with people from other ethnic backgrounds. Younger people with higher levels of education and better wages are most likely to have close inter-ethnic friendships. 

Brits from Black African and Mixed ethnic backgrounds are the most sociable it seems, as they are most likely to have friends from outside their neighbourhood. White British and Irish ethnic groups, on the other hand, are least likely to have ethnically-mixed social networks. 

Moving away from home seemed to be a key factor in diversifying your friendship group –18 to 34s were the most ethnically integrated age group. 

2. Integrated schools help

The Casey Review tells the story of how schools can distort a community’s view of the world, such as the mostly Asian high school where pupils thought 90 per cent of Brits were Asian (the actual figure is 7 per cent), and the Trojan Horse affair, where hardline Muslims were accused of dominating the curriculum of a state school (the exact facts have never come to light). 

But on the other hand, schools that are integrated, can change a whole community’s perspective. A study in Oldham found that when two schools were merged to create a more balanced pupil population between White Brits and British Asians, the level of anxiety both groups felt diminished. 

3. And kids are doing better at school

The Casey Report notes: “In recent years there has been a general improvement in educational attainment in schools, with a narrowing in the gap between White pupils and pupils from Pakistani, Bangladeshi and African/Caribbean/Black ethnic backgrounds.”

A number of ethnic minority groups, including pupils of Chinese, Indian, Irish and Bangladeshi ethnicity, outperformed White British pupils (but not White Gypsy and Roma pupils, who had the lowest attainment levels of all). 

4. Most people feel part of a community

Despite the talk of a divided society, in 2015-16, 89 per cent of people thought their community was cohesive, according to the Community Life Survey, and agreed their local area is a place where people from different backgrounds get on well together. This feeling of cohesiveness is actually higher than in 2003, at the height of New Labour multiculturalism, when the figure stood at 80 per cent. 

5. Muslims are sticklers for the law

Much of the Casey Report dealt with the divisions between British Muslims and other communities, on matters of culture, religious extremism and equality. It also looked at the Islamophobia and discrimination Muslims face in the UK. 

However, while the cultural and ideological clashes may be real, a ComRes/BBC poll in 2015 found that 95 per cent of British Muslims felt loyal to Britain and 93 per cent believed Muslims in Britain should always obey British laws. 

6. Employment prospects are improving

The Casey Review rightly notes the discrimination faced by jobseekers, such as study which found CVs with white-sounding names had a better rate of reply. Brits from Black, Pakistani or Bangladeshi backgrounds are more likely to be unemployed than Whites. 

However, the employment gap between ethnic minorities and White Brits has narrowed over the last decade, from 15.6 per cent in 2004 to 12.8 per cent in 2015. 

In October 2015, public and private sector employers responsible for employing 1.8m people signed a pledge to operate recruitment on a “name blind” basis. 

7. Pretty much everyone understand this

According to the 2011 census, 91.6 per cent of adults in England and Wales had English as their main language. And 98.2 per cent of them could speak English. 

Since 2008-2009, most non-European migrants coming to the UK have to meet English requirements as part of the immigration process. 

8. Oh, and there’s a British Muslim Mayor ready to tackle integration head on

The Casey Review criticised British Asian community leaders in northern towns for preventing proper discussion of equality and in some cases preventing women from launching rival bids for a council seat.

But it also quoted Sadiq Khan, the Mayor of London, and a British Muslim. Khan criticised religious families that force children to adopt a certain lifestyle, and he concluded:

"There is no other city in the world where I would want to raise my daughters than London.

"They have rights, they have protection, the right to wear what they like, think what they like, to meet who they like, to study what they like, more than they would in any other country.”

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.