Can I trust WebMD?
WebMD is the most popular
source of health information in the US, and is likely to dominate your Google search results for almost any medical question you have. According to its
editorial policy,
WebMD promises to empower patients and health professionals with "objective, trustworthy, and accurate health information."
But is WebMD actually trustworthy?
While there have been some investigations into WebMD's potential
conflicts of interest, there's a remarkable dearth of independent
information on this question. The site generates revenue primarily
through advertising and sponsored content for pharmaceutical, biotech,
and medical device companies, as well as hospitals, health insurance
providers, and lifestyle and wellness brands.
The only high-quality study I could find that related to the question of WebMD's independence was published in
JAMA
in 2013. The researchers looked at which medical communication
companies targeting doctors received the most money from 14
pharmaceutical and device companies. They found WebMD, along with its
sister site
Medscape, were the top recipients of industry dollars:
They're not alone in that regard. Many health companies rely on
industry dollars as part of their business model. But those links raise
thorny ethical questions, said James Yeh, a physician-researcher based
at Brigham and Women's Hospital who has studied the influence of
industry funding on medical information.
"This puts [WebMD] in a
conflict of interest," he said. "Maybe they are trying to educate the
clinician or the public, but at the same time there’s the marketing
side: They are also trying to sell a drug."
The site's
editorial policy
says that it upholds the journalistic principles of honesty and
independence. When asked about how the site ensures independence, a
WebMD spokesperson said, "The strict editorial practices we have in
place ensure that the content we produce is unbiased, and the
production of such content done so independent of third party control
or influence." They also keep editorial staff separate from advertising
staff.
But over the years, others have questioned — and found
reason to critique — the site's relationship with drugmakers. In 2010,
Sen. Chuck Grassley sent a letter to the site after finding that a WebMD
quiz for depression, sponsored by pharmaceutical company Eli Lilly, was
rigged to suggest everybody who took the test was at risk for major
depression. Naturally, that would make them a potential candidate for
antidepressants, conveniently manufactured by Eli Lilly.
In my own perusals of the site, I was bombarded with a dizzying number of ads for pharmaceuticals, hospitals, and
sponsored content
brought to me by drug companies. On some pages, there were so many ads
that actual medical information was difficult to navigate. I also had to
click through multiple pages to read anything on a single topic,
forcing me to spend more time on the site and see more ads. All in all,
it was user unfriendly, and awash in advertising that might confuse
someone looking for a solution to a health problem.
Some parts of the site seem to be designed to turn users into patients. The site's popular
symptom checker,
which allows users to insert basic information about their age, sex,
and symptoms, is a hypochondriac's worst nightmare. A search for
bloating in the lower abdomen suggested one could have anything from
menstrual cramps to ovarian or colon cancers. A query on back pain spit
out this terrifying list of potential possibilities: gas pains,
shingles, ovarian cancer, acute kidney failure, and tick bites. No
context — just a list of scary diagnoses.
The pages on weight loss were a mixed bag. Information about
weight loss supplements suggested green coffee supplements might help.* Last time I checked, the
government had cracked down
on the maker of these pills for bogus peddling, and there's no good
evidence behind them. On the other hand, while the site dubiously claims
it has
"10 easy, painless ways to lose weight," the page actually included some reasonable, if obvious, tips: walk more, hydrate, share restaurant meals.
I also found problems with how the site conveys the effectiveness and
possible side effects of some prescription drugs. When I visited the
page on
weight loss pills,
an advertisement on meal replacement shakes popped up, as did an ad for
the drug Qsymia — which is among the six drugs featured in the article:
While the site's content is produced by a team of doctors and medical
writers, the article failed to mention any basic information about the
drug's effectiveness or how many people the drug was likely to help (the
number needed to treat, in medical parlance). And some of the
information was worryingly incomplete. For example, WebMD didn't note
the serious side effects associated with the drug Contrave — it can
cause severe, potentially fatal skin reactions and liver failure.
What independent doctors think of WebMD
But those were just my observations after spending a few hours on the
site. In the absence of better evidence, I decided to get the views of
independent doctors. To do this, I turned to physicians who write or
edit pages for
UpToDate, which is sort of the anti-WebMD. The subscription-based website,
used
mainly by doctors to access summaries of the latest medical
information, accepts no advertising money as part of its editorial
policy and pursuit of independence.
Overall, the doctors I spoke to said they didn't find anything
exceptionally egregious about WebMD. But they noted the lack of context
around some of the site's medical advice, as well as a smattering of
misinformation.
On WebMD's
treatments for depression, University of Pennsylvania psychiatrist
K. Ryan Connolly found "a few less-than-evidence-based medications listed (Risperdal, Zyprexa)."
These
anti-psychotics are not approved for major depressive disorder, he
said, and both failed to show significant benefits in a number of
clinical trials.
Vagus nerve stimulation,
a medical treatment that involves delivering electrical impulses to the
vagus nerve, was also listed — even though it's no longer considered
evidence-based and is almost never done, he said. Meanwhile, one
recently approved drug for depression, brexpiprazole, was left out.
Connolly's conclusion: WebMD's depression treatment information is
not totally unreliable but is sloppy and incomplete. "It looks mainly
like something someone dashed off in an hour," he said. And it could
easily give patients a skewed view of their treatment options.
University of Michigan's
Sandeep Vijan thought WebMD's
cholesterol treatments page
was "oversimplified" and "often phrased in an overly frightening way."
For example, WebMD suggests cholesterol is "precariously" high in 100
million Americans. "[Precariously] sounds terrifying, but they fail to
note that, while [having high cholesterol]
is not ideal, it's not the kind of thing that means you'll die tomorrow."
He also noticed inconsistencies in the evidence supporting the use of some
treatments
that the site recommends: Some were evidence-based (like statins),
while others (like fish oil/omega-3 supplements) have no clear evidence
of benefit. "It's somewhat superficial, and they don't really get into
evidence-based discussions or much about current treatment guidelines,"
Vijan said.
Again, Vijan noted a range in the quality of the site's information. Some of it
"may be fine for an initial introduction for patients," he said. "Hopefully doctors are using something a bit more scientific."
Within the group of doctors I surveyed, some spoke highly of the site. Of the page on
psoriasis treatments,
Robert Dellavalle, the chief of the dermatology service at Denver's VA
medical center, said he didn't spot any errors and thinks WedMD "is
doing a great job for a free online publication."
All in all, is WebMD trustworthy? It depends on which page you land
on and what you're looking for. The site may be an okay starting point
for information, like Wikipedia. But the information isn't always
reliable, and unlike Wikipedia, the site's business model relies on the
same industry it reports on.
If you want independent information about drugs, check out the
Informulary out of Dartmouth. (I've written about it
here.) For all medical questions,
UpToDate
is a great source. (It's mostly paywalled though patient information
summaries are free, and again, it has no advertising.) In contrast to
WebMD, the nonprofit
Mayo Clinic, the UK government's
NHS Choices, and the National Institutes of Health's
MedlinePlus all have patient-friendly information that's not overrun with advertising. Another nonprofit,
Cochrane,
is also a solid source with easy-to-understand, "plain language"
summaries of clinical evidence. I'd go to all these sites before WebMD,
but none is a substitute for seeing a doctor you trust.
PS: Free study idea for researchers — please follow up on my mini
survey and test the reliability of medical websites that millions of
patients rely on.
Update: On Thursday, WebMD published a statement
on their editorial integrity. They also updated their page on weight
loss supplements to reflect new information from Natural Medicine, a
source for evidence on complementary and alternative medicine. In
response to WebMD's statement, Vox has also updated parts of this story,
adding more context about WebMD's business model.
