Looking for quantitative proof that people prefer dark intimations of doom over well-meaning public service announcements? Researchers at the University of Toronto analyzed 153 YouTube videos that addressed the topic of health risks associated with vaccinations. Guess what? The videos that portrayed vaccinations negatively were viewed more often and rated more highly.
Even more distressingly, in a "Research Letter" published in the Dec. 5 issue of the Journal of the American Medical Association, the authors reported that the anti-vaccination videos were also more likely to be filled with "unsubstantiated" assertions that contradicted the "reference standard" employed by the researchers for assessing that ever-so-slippery subject: "truth." The standard is the 2006 Canadian Immunization Guide. Among the claims the authors considered unsubstantiated are the assertion that there are links between thimerosal and autism, or that HPV immunization may increase high-risk sexual behavior.
The conclusions are presented with restrained rhetoric but it's clear that the results of their analysis disappointed the researchers. What ever happened to the theory that good information drives out the bad?
Approximately half of the videos posted were not explicitly supportive of immunization, and information in negative videos often contradicted the reference standard.The video ratings and view counts suggest the presence of a community of YouTube users critical of immunization. Clinicians therefore need to be aware of Internet video-sharing sites and should be prepared to respond to patients who obtain their health information from these sources.
Of course, if you don't accept the Canadian Immunization Guide as the arbiter of truth, you are unlikely to be alarmed by the high rankings and popularity of YouTube videos railing about the evils of vaccination. How the World Works is going to refrain from tiptoeing into that postmodern morass. But before we join in the mass wringing of hands and gnashing of teeth by the medical community, it might be worth considering that YouTube might be the beginning of the journey toward enlightenment, and not the end.
I went to YouTube and searched for the keywords thimerosal, autism and vaccinations. The first hit was Part 1 of a series delivered by a Dr. Rashid Buttar, a sober-enough sounding man who calmly explains his reasons for believing that thimerosal is a deadly toxin. I then did about 15 minutes of Googling to get some context on Dr. Buttar.
On Nov. 20 the North Carolina Medical Board formally accused Buttar of unprofessional conduct. Among the charges: providing "unproven and wholly ineffective therapies," and charging exorbitant fees. A copy of the complaint can be found here. An article in the Charlotte Observer covering the controversy is here. Further Googling indicates that the autism community on the Web, such as it is, is split between those who regard Buttar as a hero fighting against an entrenched bureaucracy out to get him, and those who think he's a snake-oil-selling quack.
My own opinion, judging from the contents of the North Carolina Medical Board's complaint, is that Dr. Buttar is not a man I personally would go to for medical advice. But I could be wrong; maybe he has been, as he claims, unfairly targeted by a "rabid dog" medical board. But there's a larger point here. The University of Toronto researchers are alarmed at the popularity of what they regard as inaccurate medical information. But taken in total, our ability as consumers of information to gain context for and judge the accuracy of the information presented to us has taken a qualitative leap forward since the mainstream debut of the Internet.
If 15 years ago, Dr. Buttar had come to Berkeley, Calif., and given a speech outlining his views on thimerosal, it would have required a not insubstantial amount of legwork to get a sense of where he stood on the quack/healer spectrum. A day or two of reporting might have been required just to discover that he was embroiled in a fight for his medical license in North Carolina, much less top obtain a copy of the actual text of the formal complaint.
My guess is that information seekers who go to YouTube looking for information about autism and vaccinations will not stop there -- they'll use the same tools to do additional homework. And yeah, clinicians need to be aware of this, because like it or not, they are going to be dealing with patients who have been reading up. Some of them may be misinformed. Others may be better informed.