Can the masses provide more than the specialist?

Crowd-sourcing is defined by Meriam-Webster as ‘the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people and especially from the online community rather than from traditional employees or suppliers.’ Applied to Health, this can therefore mean many things. For the intent of this blog however, I am going to use a custom made definition: the practice of obtaining medical knowledge from a broad range of people, across the internet. This therefore does not include crowd-sourcing the development of tools (e.g. Medable) or the use of resources (e.g. UberHealth), or anything beyond medical knowledge and diagnosis. Basically, I’m focusing on Health Forums.

So, let’s start with a little experiment on the more common form of Health Forums. I will hypothesize that I have a headache that is worse than usual, and have blurred vision as well. When I search for ‘Health forum’ in Google, the first result is patient.info/forum. I search for ‘Headache blurred vision’ and click on the first result. They are not tailored to the blurred vision, but the page is full of posts about headaches. ‘561 recent posts’ to be exact. As well as many of these having multiple replies, there are many that still have no replies. No credentials of the contributors are displayed so the validity of the diagnosis is uncertain.

While these forums receive a lot of criticism for giving information that may not be accurate, they can be useful in certain circumstances. Very common issues can be well explained on such forums, and if you can be bothered to trawl through many posts, you may gain a broad view of potential issues. Whilst these forums give you an idea about what could be wrong and how to physically fix it, they will also have an impact on the mental status of people using them to gather information. This can go either way, by having a calming effect if many other people have had similar symptoms, or by causing concern if people mention serious or untreatable conditions.

People often turn to these sorts of forums while waiting for physical appointments, as the information is available instantly. However crowd-sourcing medical information can also be used for long term conditions where correct diagnoses have not been reached by individual doctors. Crowdmed.com was founded in 2012, and provides a regulated crowd-sourcing service for medical information on complicated illnesses that have not been correctly diagnosed. The system works by ‘Medical detectives’ signing up to the site and registering their credentials. According to the website, 69% of their detectives work in or study medicine. Cases are submitted by patients, who are encouraged to submit as much information as possible, including test results. The ‘medical detectives’ then get to work to solve the case. However there are two key things that make this crowd-sourcing much more interesting than traditional forums: detectives are incentivized, and they are ranked. Patients pay to use the service, and the money (apart form a cut taken by the website owners) is rewarded to the detectives that come up with the most accurate diagnoses, as determined by the patient. This incentive is coupled with a score, whereby new users have less influence on the topic. If they perform well their score is increased, so that the best detectives end up having the most influence, and also receive the highest reward.

According to Crowdmed.com, over 60% of their clients claim the site helped them come to the correct diagnosis, and over 50% say that their Crowdmed.com diagnosis was later confirmed by a physician. What makes this service impressive is that these are cases that have not been solved by physicians or specialists at the time of uploading.

Crowdmed.com is just one example of an alternative system that can be used to crowd-source medical knowledge, and it definitely has many pros compared to traditional methods. Yet it also has its flaws, for example the information can be inaccurate, it costs money, and patients end up with a list of possible diagnoses. It seems however that to a certain extent, crowd-sourcing medical knowledge can be more effective, or faster, that relying on individual specialists. So far I am unaware of any other systems for crowd-sourcing medical knowledge, but if you know of any please let me know, as I am sure there are many more out there!

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Is Gaming Healthy?

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Despite being a relatively frequently flyer, I am slightly nervous at taking to the air. My most recent distraction during a rather bumpy flight was listening to ‘The Cathedral’, an episode of the ‘Wired’ podcast recommended to me by a friend. I soon forgot about the flight and was completely engrossed by the Green family and the development of the video game ‘That Dragon, Cancer’. It brought me to tears (much to the confusion of those sat next to me) and got me thinking about the potential impacts of videogames on health.

A note of caution when reading this blog – Like the majority of my generation I have occasionally taken a swing at tennis on the Wii and have dabbled in ‘Pokémon’, however I do not think anyone would call me a video game player.

The stereotype of an avid video-gamer is a nerd. Take for example characters in ‘The Big Bang Theory’ or ‘Spaced’. However this stereotype, while seemingly big enough to catch media attention, does not hold true in all cases. The popular videogame ‘World of Warcraft’ involves online quests where players are required to interact and collaborate with other players, and the way the players form these relationships will impact their success in the game. In addition, unlike a school classroom with a limited number of people, failure to make friends the first time does not stop you trying again with other people. Developing social interactions online requires similar skills to those that occur in real life, and as we have all been taught since birth: Practice makes perfect.

Increasing social skills in the population is obviously beneficial for population health, both for those who suffer from specific issues such as anxiety and as we all know having no friends can be lonely and therefore have a detrimental impact on our mental health.

Videogames can also be specifically designed to tackle such diseases, an example of which being SPARX. This is available for free in New Zealand and is designed to combat mild to moderate depression, stress or anxiety. A study by Dr. Theresa Fleming concluded that the video game had more positive effects on kids aged 12 to 19 than traditional therapy, with 43.7% achieving remission from anxiety in the SPARX group, compared to 26.4% traditionally. Not only this, but reducing the need for traditional therapy will greatly reduce the demand on Health care workers, allowing them to concentrate on more severe cases of the disease. Given the current strains that mental health puts on the NHS, the benefits of creating and implementing such games in the UK could have enormous impacts on the finances and reach of our health system. Definitely worth further research!

The positive mental effects of videogames have also been noted in other diseases, such as Alzheimer’s, or Dyslexia by increasing the attention span (Franceschini et al. Cell Symposium 2013). It has also been shown to reduce the effects of ageing (Anguera et al. Nature 2013). The research into the impact of videogames on specific mental disease is vast, and I will therefore not delve too deeply into this realm. It suffices to say that positive impacts have been seen in these areas.

It is not only mental health, but also physical health that can be impacted by videogames. Although there is much talk of the negative impacts in this realm (sedentary lifestyle and a reduction in exercise (Youth Sport Trust)), there are examples where the positive effects outweigh those. One such case is in patients recovering from stroke. The games require motions that develop strength in the hand. As above, this can reduce pressure on traditional therapeutic measures such as physiotherapy, as well as being more enjoyable and motivational for the patient. With the development of ‘Kinect’, a motion-sensing input device, any visible muscle could potentially be trained in this way.

The enjoyment videogames bring has additional positive impacts as well, for example the games trigger the release of many chemicals in the brain, such as endorphins. Jeffery Gold has shown that playing videogames can result in a reduction of pain, both in children and adults. They can therefore be used as a pain killer in some circumstances. Obviously this is not applicable to all situations as the game will require your attention and cannot be taken surreptitiously in meetings like traditional painkillers. However, in some circumstances they could act as an alternative or supplement to pharmaceutical pain killers.

Before I finish by discussing the trigger of this blog, ‘That dragon, Cancer’, I want to briefly discuss the impact of videogames on Intelligence and its relation to health. Many of us who would not normally associate ourselves with videogames, have briefly or more religiously taken part in brain training games such as ‘Luminosity’. These definitely have an impact on our ability to perform these games, and may also impact our intelligence in other situations. How increased intelligence relates to health I do not want to discuss, as I feel that it could be construed in the wrong way. However in more specific examples it has very clear impacts on our populations’ health. Rosser et al. (2007) showed that keyhole surgery was performed with 37% fewer errors and 27% faster by heavy video game using medical students than those who did not play regularly. This educational aspect of the games can be used throughout the health sector as well as beyond, increasing the skill of our professionals and hence having a huge impact on population health.

Now on to ‘The Dragon Cancer’, the game that initially sparked my interest in this blog theme. The game has affected the health of both the developers and the players. It was created by a distraught couple during their sons fight through a fatal brain cancer. As the player you are the parents, and the game was developed to give the player understanding of what parents in such a situation go through. The development of the game was important from a health point of the developers (parents), as it was through the process of making the game that they mourned. Players on the other hand gain an understanding of what people affected by cancer go through. The game received positive reviews in this respect, for example Lucy O’Brian from IGN stated that the game was “imperfect, but unforgettable”. Teaching people empathy and understanding will benefit those around you, not just the gamer!

Therefore, contrary to popular opinion, there are many video games that can be healthy not just for the individual, but beneficial to society as a whole.

 

Note: I do not have access to the academic journal articles, so my information from the journals comes from other articles that cite them.