Tuesday, February 17, 2015

Dear Mayo, Did you approve this ad?

On February 10, Google announced that it would enhance its search results on medical conditions:

We worked with a team of medical doctors (led by our own Dr. Kapil Parakh, M.D., MPH, Ph.D.) to carefully compile, curate, and review this information. All of the gathered facts represent real-life clinical knowledge from these doctors and high-quality medical sources across the web, and the information has been checked by medical doctors at Google and the Mayo Clinic for accuracy.

So what happens when we search for Prostate Cancer? We get the following list of procedures:

What heads up the list?  Robotic surgery.

Observers want to know:  Does this nonalphabetic list represent Mayo Clinic's view of the most likely, highest priority, or most recommended approach to this disease?

And why is watchful waiting, aka "monitoring of symptoms for change or improvement," which is so often recommended nowadays further down the page under "other treatments," as opposed to being placed above procedures?  Is that Mayo's view, too?

I doubt it.  So how did the list get organized, and who at Mayo approved it?


akhan13 said...

Wow, the potential for this either disorganized or deliberately misleading and incomplete list (enzalutamide etc. missing) to misinform patients is stunning.

Henry said...

You’re right, Paul, but “watchful waiting” has been upgraded not only in name (i.e., active surveillance) but also in terms of proactive practices, even as urology treatment records on a collective scale continue to show a massive degree of patient overtreatment.

Typical of the newly recommended actions include diet (like cooked tomato sauce), exercise of an intensity to promote fitness, drugs tailored to the individual and vitamins like vitamin D3 (which becomes a hormone at the cellular level). Gleason grade six lesions, moreover, seem to display none of the characteristics of other grades of prostate cancer nor is there unequivocal evidence that this grade metastasizes.

The “Prescription” and “Also Common Procedures” parts read like laundry lists that hardly anyone is likely to pay close attention to. Robotic surgery leads the way likely because the hospital needs to recoup the cost of a multi-million investment that has shown no efficacy over other forms of prostate surgery.

Notice, too, the notable absence of Cures, as if Mayo could have been talking about diabetes treatment (versus diabetes reversal, the non-drug approach that community medical groups have begun to undertake from sea to shining seas.

e-Patient Dave said...

Something is very wrong here, and after 15 minutes of digging, so far it smells to me like Google is playing fast and loose with the Mayo name. It almost seems willful to me, because Google is VERY conscious (at an expert level) of the power of what people see first.

The Google doctor whose name is touted in the press release is an innovator/startup guy with a Twitter account that has never tweeted, though a Merck buddy @JABrilliant congratulated him in November for being seen on Shark Tank.

The wording "checked by Mayo" is fishy - as you say, it doesn't stipulate what that means, and as I say, Google is fully aware of the power of what meets a reader's eyes first.

But by far the most concerning is that when you look at Mayo's own prostate treatments page, right there at the top the first thing it says, in enlarged boldface, is:

"Immediate treatment may not be necessary"

"For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance."

So the real question is, who's IGNORING Mayo's actual recommendations and posting something different over Mayo's name?

This seems to me to be an excellent example of why all "curation for sale" efforts require absolute transparency. BIG problem here.

e-Patient Dave said...

Here's Mayo's actual prostate treatments page http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/treatment/con-20029597

Anonymous said...

Surprising that it got past Google's risk management lawyers. If things are as fishy as suspected, there may be a cease & desist in the works at Mayo. Mayo's risk management attorneys are probably all over this. I see the value of Google doing the quick answers for simple topics but not for medical stuff. Seems like they are better continuing what they've been doing and finding the best 3rd party sites as they've been focused on medical for as long as Google has been in existence.

Medical Quack said...

I did a search with Google and surprisingly enough, the Prostate Cancer Foundation ended up at the very bottom of the list too? I know folks over there and might make them aware of this fact as well:) They do not jump in and recommend robotic surgery as such...still seems it's all about the money:)

Medical Quack said...

This is a good point as consumers are really getting garbage today out there on the web, and not to say this is garbage here but it seems like who pays calls the shots.

I have been all over Healthgrades to get their garbage off the web too and they pay to come up at the top on Google. It's so bad and a few yeas ago the AMA interviewed me about it and nothing has changed. Consumers indeed are getting "table scraps" and nobody seems to care as garbage data gets the same price as good data. See this hospital that was closed about 3 years ago, still has a 5 star rating and has doctors on staff. This was the place that put fake screws in patient spines. You think they might update this after 2 years being a California state senator was in on this too and had to resign due to bribes? This is just one, lots more like it on Heatlhgrades and again they come up in the top Goolge search spot. You'll love this one Paul:)


I guess you could say this is yet one more reason to license data sellers, so we know who they are and what their angles are. This is really getting bad and both quants and the anonymous folks even agree with me via some recent tweets. What are we getting, honesty or what is paid for content...a real good question indeed...


I have been watching the amount of either flawed or "out of context" data really grow the last couple of years and yes something needs to be done here and 3 years ago I started the "license" campaign so we know who they are.

LeeAase said...

Here's my response post with an explanation and my take on the process:


Paul Levy said...

Perhaps the context for Lee's response would be made more clear if Mayo and/or Google disclosed the natural of the financial arrangement between them, if there is one.

What does he mean when he says that "These Knowledge panels aren't ads," in that they clearly promote the Mayo name (and none other) when you see a search result. If it looks like an ad, smells like an ad, and feels like an ad, it's an ad.

In addition, prominent placement of the Mayo name gives the reader the impression that Mayo has endorsed the material therein, not just for inclusion, but--as in the case of the robotic surgery--for emphasis.

It seems like Mayo wants to have it both ways. "It's ours but its not ours." "We helped, but we're not responsible, even though our name's on it." This attitude seems to me to be quite at variance with the high regard with which many of us hold Mayo Clinic.

Thanks for clarifying the four classes of disease prevalence. Those classes were not immediately obvious to readers. Note that I came upon the MS item because of a comment from an MS-knowledgable person.