Dr Google

Last week, on a beautiful walk along the river here in Missoula, I had a good talk with another Mom.  We talked about life, kids, and Dr. Google.  My new friend conveyed her thoughts on how helpful Google has been, and how she has found many more answers on the internet than in her doctors office.  I’ve had hit and (many) miss experiences looking things up for Annika in the early months after she was born, so we talked about that a little as well.  While we were talking I thought to myself, I should really write a blog post about the potential dangers of Doctor Google.  Then I promptly forgot about it.

Until Friday.  On Friday I found an article on Twitter that piqued my interest, it was titled: “Natural Birth Control Using Herbs“.  Hmmm, I thought, as a naturopath I don’t know of any herbs that can be safely used to prevent pregnancy. (That’s the thing about natural medicine, it tends to promote fertility rather than prevent it.) Sure enough, the author listed a half dozen herbs to “promote sterility” or prevent implantation. The sterility promoting herbs included Stoneseed and Jack-in-the-pulpit roots, which are known to be toxic.  (Conventional medical sources recommend calling poison control center if ingested).  The implantation preventing herbs are what we usually call “abortifacients,” since they do, in fact, trigger spontaneous abortion.  All abortifacients carry risk of hemorrhage or incomplete abortion.  They are also teratogenic, and should the pregnancy fail to terminate they could result in significant birth defects.

I didn’t sleep Friday night.

I had dreams of women hemorrhaging.  Under the comments section of this page I saw several women ask if these (toxic!) herbs were safe to take while breastfeeding. Then I had nightmares of women breastfeeding, passing toxic herbs through their breastmilk to their tiny infants.  (Everything is more dramatic in the middle of the night.)

On Saturday I decided to start doing some research for this blog post.  Under the same blog I found advice to not take antibiotics for strep throat because strep throat will go away on its own “with or without treatment.”  (True, however, antibiotics are given to prevent the negative sequelae of rheumatic fever, rheumatic heart disease and post-streptococcal glomerulonephritis*). She also believes that she passed on strep immunity to her children because she didn’t take antibiotics.

Saturday night I had dreams of rheumatic fever.

After more digging on Sunday I found more blog posts by multiple authors.  One on why you should not immunize against tetanus and how, by exposure to dirt, you can create natural immunity**.  Another on why herd immunity doesn’t exist.  Another on herbs for birth control – this one promoting the use of Conium maculatum (poison hemlock) to reduce fertility.

I had a bad weekend.

This afternoon I checked back in on the herbal birth control post, and left the following comment (and a longer reply about the dangers of abortifacient herbs):

My number one priority as a physician is to protect the safety of my patients – but how can I shield people from the internet?  From Dr. Google? There is no accountability for what Dr. Google can prescribe.  There is no medical license to be revoked, no health department to oversee, no medical community to connect with.

Maybe I am over-reacting.  Ever since Annika was born I am hyper sensitive to anything that could cause harm, especially to mothers and children. Then again, maybe not – since a study found 25% of British women misdiagnosed themselves on the internet. Another study showed that Google searches may lead to a correct diagnosis a little more than half the time. (Actually – that’s not too bad!)

Then again, again, another study showed that Googling before heading into the physician’s office may actually improve patient-doctor relationships. This study showed that many patients who had previously Googled their condition thought that their visit to the doctor was more productive.

So what’s the take home message? Please, please, use Dr. Google carefully.  Always look at the credentials of the author, and watch for the “this is not medical advice” disclaimer. Ask your doctor (the one you see in person) before you jump on any health-kick bandwagon.  And if your doctor doesn’t have time to sit down and answer your questions – go find a new one.


Kim, et al. Rheumatic Fever. First Consult. Web. 2 March 2011 [http://www.mdconsult.com/das/pdxmd/body/377082501-3/1373734046?type=med&eid=9-u1.0-_1_mt_1014245]

Tetanus, Puerto Rico 2002. MMWR weekly. Web. 19 July 2002 [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5128a1.htm] 28 October 2012.

Prevots R, Sutter RW, Strebel PM, Cochi SL, Hadler S. Tetanus surveillance—United States, 1989–1990. In: CDC Surveillance Summaries (December 11). MMWR 1992;41(No. SS-8).

Verma R, Khanna P. Tetanus toxoid vaccine; elimination of neonatal tetanus in selected states of India.  Hum Vaccin Immunother.  2012 Oct 1;8(10).

Woldeamanuel YW. Tetanus in Ethiopia: unveiling the blight of an entirely vaccine-preventable disease.  Curr Neurol Neurosci Rep.  2012 Sep 21.

Tang H, Hwee Kwoon Ng J. Googling for a diagnosis – use of Google as a diagnostic aid: internet based study. BMJ 2006:333:1143.

Tibazarwa KB et al. Incidence of Rheumatic Fever in the world: a systematic review of population-based studies. Heart. 2008 Dec;94(12):1534-40.

* I have searched and searched for good data regarding the actual incidence of rheumatic fever, rheumatic heart disease and post-streptococcal glomerulonephritis.  Much of the data is old and lists the actual incidence of rheumatic fever at 0.3-3% in untreated persons.  Newer data suggests a rate of <10/100,000 persons in Western Europe and United States, with higher rates (>10/100,000) in Eastern Europe, the Middle East and Australasia.  This includes treated and untreated persons, however.  The medical community generally attributes declines in rheumatic fever to the use of antibiotics, but this has never been completely substantiated.  In this sense, the above-mentioned author is correct.  However, I still personally believe that cases of strep should be managed appropriately by a physician to carefully monitor for signs of rheumatic fever if the patient, given that knowledge, refuses antibiotics.  Though some herbal methods have shown antimicrobial activity against group A streptococcus, they have never been shown to reduce the incidence of rheumatic fever (i.e., no study has been done).

** On this, the research is pretty clear: vaccination campaigns in developing nations significantly decrease the incidence of tetanus.  Where there are vaccines the incidence is low, where there are not the incidence is high.  (Coincidence?) The blogger cites a few studies, but as far as I can tell these have not been replicated. Personally, I am happy to support families who decline vaccinations, even tetanus (though of all vaccines, this is the one most families tend to choose first, in my experience).  However, I think it is unwise to assume that natural immunity is likely.

Phew.  I’ve spent all day scouring Pubmed looking for journal articles for you, my loyal readers.  I need a break.

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14 Responses

  • Archer says:

    Some of those natural mommy blogs are so enraging, aren’t they?! Gosh darn it! Love your work here, Dr. Erika. This was a wonderful post that was well written and kept my attention. Good work!

  • Pragati says:

    LOVE this post Dr. Erica. Such an important lesson for every patient. I agree with Archer, well written and thought provoking. And thank you for responding to that blogger – those who read your comment will surely benefit. So many times I read things on the internet that are blatantly wrong but I don’t feel as though I don’t have credentials to leave a comment or be taken seriously. Hopefully that will change after graduation. I’m so glad you commented!

  • Right on Dr. Krumbeck! Nothing can replace an actual doctors visit!

    • Rheumatic Heart Disease / Rheumatic FeverWhat have been rheumatic heart mlediw as well as rheumatic fever?Rheumatic (roo-MAT’ik) heart mlediw is a condition in that a heart valves have been shop-worn by rheumatic fever.Rheumatic heat starts with a strep twist grip from streptococcal (STREP’to-KOK’al) infection.Rheumatic heat is an inflammatory disease. It can start many of a body’s junction tissues — generally those of a heart, joints, brain or skin. Anyone can get strident rheumatic fever, though it customarily occurs in young kids 5 to fifteen years old. The rheumatic heart mlediw that formula can final for life.What have been a symptoms of rheumatic heart disease?Symptoms change greatly. Often a repairs to heart valves isn’t rught away noticeable. A shop-worn heart valve possibly doesn’t entirely tighten or doesn’t entirely open.Eventually, shop-worn heart valves can means serious, even disabling, problems. These problems rely upon how bad a repairs is as well as that heart valve is affected. The many modernized condition is congestive heart failure. This is a heart mlediw in that a heart enlarges as well as can’t siphon out all a blood.How can we forestall rheumatic heart disease?The most appropriate invulnerability opposite rheumatic heart mlediw is to forestall rheumatic heat from ever occurring. By treating strep twist grip with penicillin or alternative antibiotics, doctors can customarily stop strident rheumatic heat from developing.People who’ve already had rheumatic heat have been some-more receptive to attacks as well as heart damage. That’s because they’re since successive monthly or every day antibiotic treatment, may be for life. If their heart has been shop-worn by rheumatic fever, they’re additionally since a opposite antibiotic when they bear dental or surgical procedures. This helps forestall bacterial endocarditis, a dangerous infection of a heart’s backing or valves.Related AHA publications:Heart as well as Stroke Facts

  • Very nice write-up. I definitely love this site. Continue the
    good work!

  • Savina says:

    Thank you for writing this blog. I find it informative and follow it regularly.

  • The good, the bad, and the ugly of Dr. Google. Great article Dr. Krumbeck.

  • llm1884 says:

    So where is the citation for the “toxic” herbs?

  • Jamie says:

    Thank you for this post; it provided plenty of food for thought.

    I must confess that I think the “Dr. Google” trend reflects a larger issue that I often feel the medical community as a whole is either blind to or choosing to ignore. Too often, the problem isn’t that doctors aren’t sitting down and answering questions, but that they’re answering questions without actually addressing the problem or meeting the underlying need.

    The post cited above is the perfect example. As noted, natural medicine focuses almost entirely on promoting fertility; if you need to NOT get pregnant, you’re offered barrier methods (insufficiently reliable alone) and NFP (which is useless if your cycle isn’t cooperatively regular – a common problem). Mainstream medicine will offer you IUDs and the Pill… and that’s it. When women who absolutely cannot afford to get pregnant are offered only these limited and entirely unsatisfactory options, no one should be surprised when they turn to “Dr. Google” and are willing to grasp at worrying straws to meet their needs themselves.

    I’m not placing blame; I don’t underestimate how hard it has to be to be a doctor – particularly when there isn’t always a great option for what people need, want, or feel is within their reach physically or financially. Certainly people do have to exercise great care in checking out information they find online. But until the medical and insurance worlds realign, reorganize, reorient, or otherwise adjust themselves to actually get patients what they need, I think online alternative information sources fill a critical gap. Better that people have the opportunity to find, research, and pursue a potentially risky option than that they be left with no options that they consider viable at all.

    • Jamie,

      I get it, I really do. This is actually the reason that I started this blog – I was so horrified by the information I found on other (well meaning!) mom-blogs. Some of the info is SO SO good, and some is so disastrously bad. It makes me frightened for my patients who have a hard time figuring out which is which.

      Honestly, it’s the way that the healthcare system is set up that is the problem. We reimburse physicians for big, expensive procedures, but pay doctors very (very!) little for having face-to-face conversations with their patients. A doctor gets paid roughly the same amount for a 5 minute visit as for a 30 minute visit – so why spend the time??

      And I totally agree with you. I wish we would have better options both for online info for patients AND for good patient-care in a doctor’s office.

  • Belle says:

    I’v been looking into herbal “birth controls” and stumbled onto this blog and I was hoping to talk to you about them more in depth if you would be able. I’m from Canada so a consultation doesn’t really work.

  • Julia says:

    I’m just wondering if you do recommend a safe contraceptive method besides condoms or other barrier methods. I would just like a backup alongside condoms to really protect against any unwanted pregnancies.

    • Hi Julia,

      Well I definitely do not recommend herbs for birth control. Sadly, it seems that naturopathic medicine is very good at improving fertility, but not so great at keeping people from getting pregnant. You can combine Natural Family Planning with condom use, which would improve its contraceptive effects considerably. Of course there are many other options, too (not necessarily naturopathic) like IUD’s, vasectomy, birth control pills, etc.

  • Terrence says:

    Hi Dr Erika. We enjoyed reading your blog.

    Just to add to comments regarding birth control, after my wife came off the pill we used lambskin condoms through to menopause. We found them safe and satisfying. A little more expensive than latex but a better product in our opinion.

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