What would a “good” WebMD look like? | Hacker News Reader

What would a “good” WebMD look like?

blog.tjcx.me

305 pointstomjcleveland312 comments

A better question might be: Why is the private sector responsible for providing accurate health information? As this article shows, the incentives for people running medical websites and the people reading them are not aligned. I'd say the UK NHS website and symptoms/medications pages hit the nail on the head - https://www.nhs.uk/conditions/. It has no advertising and provides short, easily readable and actionable information on the majority of conditions and the correct way to use and take many different sorts of medication.

And crucially - if the information present is not sufficient, clear and obvious UI elements that direct the next best steps to get the help you need, whether that be ringing the non emergency helpline or immediately going to A&E. (It's been commented on before, but the new UK government sites are very consistently structured and open source their design systems https://service-manual.nhs.uk/design-system)

That's a nice page, and I'll definitely bookmark that one. But I don't see most of the public using something like that over WebMD.

WebMD is complete trash (I even block it in my Kagi search preferences), but it succeeds over sites like the NHS one because of blog SEO. WebMD is really a glorified blog with posts about every condition you might get paranoid over. I don't know how precisely they achieve this, but they're doing something right in an SEO sense if The Google continues to put them near the top of results after all these years.

Meanwhile, there are also sites like Merck Manuals, which is both a terrific resource and privately run, but I don't recall ever seeing it coming up for a search query like "what is that bump on the side of my neck."

https://www.merckmanuals.com/

The resources are out there. Whether The Google thinks the average person should read them is a different story. I don't believe The Google is going to ever filter out WebMD, so there must be a middle ground where sites like the ones you and I mentioned find a way to make themselves more WebMD-like without sacrificing their more academically-minded content they already have.

So there's a private option that's terrible (WebMD) and a private option that's terrific (Merck Manuals). And it's the terrible one that ranks well at Google.

Sounds like a Google problem and apparently only a Google problem.

It's a bit of a conundrum; on the one side, the NHS and (in a different area) MDN are better, more authoritative, etc sources, so Google should promote those. On the other, this would mean that Google can no longer cite neutrality or hide behind "the algorithm", as has been their legal defense against a ton of lawsuits where the suers said one websites should go higher or lower in the rankings.

If it's a human curating content or an algorithm doing so, I don't see how that helps Google on a lawsuit. Unless they blame sentience.

The best algorithms adapt to feedback. Surely Google's own algorithm can accept Google's feedback to adjust for flaws in it.

What lawsuit? There is no legal basis for a lawsuit. As a private corporation, Google is free to rank search results however they like regardless of whether that's done by humans or algorithms.

You'd think so but Google has essentially a monopoly depending how you look at it and some countries have stricter rules than others.

So what? You haven't cited a successful lawsuit against Google on that issue, or even a plausible legal theory. Have you discussed this with an actual attorney?

I wasn't the one mentioning lawsuits. Check OP's message I was replying to. You seem confused.

Google already does this. Searching for "YMYL" (Your Money or Your Life) should produce useful results:

> For pages about clear YMYL topics, we have very high Page Quality rating standards because low quality pages could potentially negatively impact a person’s health, financial stability, or safety, or the welfare or well-being of society.

https://static.googleusercontent.com/media/guidelines.raterh...

Google chooses to rank "authoritative" sites based on its own notion of authoritativity (which they don't share, but they decide).

They implement it as agnostic tuning as much as possible, avoiding single human chery picking sites. They use panels of humans (mturk style) for quality ratings.

Could you imagine the outrage if Google said "The government is always the best source about everything?"

What even would be the point? Use the government search engine for that use case.

> Sounds like a Google problem and apparently only a Google problem.

I want something like webrings to become A Thing again. A user curated search engine. And the users doing the curated need to be vetted. I don't know if this is even possible, but I get tired of having to come to HN to get a human recommendation that is miles better than the algorithmic crap from the current search engines.

> And the users doing the curated need to be vetted.

It comes back to the age-old question: Who vets the vetters?

Unsolvable since it's a network of fallible humans we attempt to topologically score.

You can make decent attempts, such as academic peer review. Even this system perpetuates its own problems (beta amyloid) and has perverse incentives (publish or perish, falsified results), though.

Semantic web had some good ideas about this. Networks of signed FOAF data attached to articles and posts. You could form a side graph of trust information that you could revoke at any time.

You do. I imagine people or groups curating lists of pages or sites - they decide what to put on their lists, but you decide to include them in your personal search engine or not. Or you could fork their list and edit as you see fit.

Web of trust, not web rings.

Post your bookmarks, share to your friends, encourage your friends to do the same. Import those bookmarks into a search engine site fliter extension.

T100 sites and the like seemed to be the peak of discovering interesting and relevant content to me.

There is the "awesome list" phenomena:

Search "medical information awesome list"

https://github.com/NeovaHealth/awesome-health

https://github.com/lalaithan/awesome-health

https://github.com/jeromecc/awesome-health

Fork and make your own!

That's where I continue to want to see what results in a search engine would look like that heavily punishes presence of advertisements in a result. All the SEO spam pages are ad-driven, so cutting out anything following that incentive should result in removal of all pages that follow that terrible SEO spam pattern that ruins search results.

Punishment/vengeance is a popular idea around here, but you have to also remember that a search engine is supposed to bring you the most relevant results.

Filtering out, say, Stack Overflow or Reddit because it has ads doesn't help you when it answers your question and is perhaps the only thing on the internet that truly does.

People seem to think there's this ad-less replica of the internet, sitting right behind our ad-riddled internet, where everything they want exists for free, it's just hidden. In reality, the websites making money are the ones providing the vast majority of things people are looking for.

Use https://search.marginalia.nu if you want to severely punish ads.

Maybe instead of heavily punishing websites with ads, a search engine could instead punish heavily ad-driven websites. A lot of the SEO-exploiting blog mills are filled to the brim with ads where the goal is to get you to visit to view as many ads as possible, not provide good content that's funded by ads.

Some sort of ratio algorithm would be nice.

Does this site (in general, not just this page) have more than 5 advertisements per page? Between 2 and 4?

Does this site attempt to load 12 trackers? "Only" 4 trackers? Just 1?

Does an AI text analysis of the first few paragraphs match on this nonsense?:

> Fixing your gadget is important. Many people find that their gadget sometimes breaks. Gadget helps us do action easier, and improves our lives. We all hate it when our Gadget doesn't work the way we expect it to. It can be frustrating. Read below for tips on how to fix your gadget. (Followed by 3 more paragraphs of filler before getting to regurgitated gems like "reboot it".

I'm sure we have the AI tech now to semantically see this bullshit and downrank it. Right? (Ok, maybe I overestimate how easy this would be. Forgive me, I'm just ranting here)

Do you mean the advertising company that runs a search engine should punish pages in the results that... show their ads? Or just when it's a "lot" of their ads? Or should they only do that if the pages are showing ads from their competitors?

I mean when it's a lot of ads. It could perhaps be an ad to content ratio? It seems SEO spam contains more ads than content most of the time.

I’m honestly surprised that Google thinks that a page with N ads deserves N times the CPM. The more ads, the less attention each ad can grab, no? I wonder whether just treating ads as zero sum (regardless of ad provider) — such that a page with 5 ads, 2 of which are Google ads, gets a payout of 2/5 the CPM of a page with one Google ad and no other ads — would basically drive all these SEO mills out of business. While also not really impacting honest ad-sponsored sites (like Reddit), that only tend to run one ad per page.

Or maybe the search engine shouldn't care about ads at all, and just figure out what is good content and what is bad content, and what actually answers queries well.

When I said "punish", I meant that the ranking algorithm should do that. It's not about vengeance, it's about filtering out SEO spam. The problem with filtering out SEO spam by detecting it as such is that it's by definition an arms race. That's why I propose to instead of looking for the symptom (SEO spam) pull it out at the wrong incentive structure that's causing it (ads).

Imagine a world where the biggest search engine made its money from advertising. In that kind of a world, wouldn’t the search engine primarily be incentivized to show you the results pages with the most advertising, regardless of the quality of the content?

No, because people would stop using the crappy search engine.

That's how the world was before Google.

And that differs from today because.... why?

Anyone who wants attention is motivated to do SEO. Should engines downrank every site that has good SEO? That is, downrank every site that ranks highly?

They already look at things like clickthroughand dwell time and bounce back. If enough people dislike Example.com enough to avoid clicking on it or come back to search after visiting it, the engine learns that it is a bad result.

Maybe the problem is that most people like what you don't like.

No, they key is to differentiate SEO'd pages with useful content from SEO'd pages with useless content.

This is a game as old as search engines. In 2005, it meant filtering out sites that were just lists of keywords, not coherent sentences and paragraphs. It meant for giving extra points to articles with structure, such as header tags and paragraphs, as opposed to just blobs of text. It meant using PageRank to organically discover which pages real people thought were useful.

It's a much subtler and more difficult problem in 2022, but there are also better tools to do it (big NLG models). It just seems that Google lost interest in quality control at some point.

And I would guess they lost interest in quality control because of Chrome's market penetration. Chrome is a browser monopoly at this point, and with Google being the default search engine on Chrome, they no longer have to give quality results to maintain their search user base. On top of that, they control such a large share of the ad market that any SEO spam website is more likely than not to be using AdSense. Which means they have a financial incentive to deliver page views to SEO spam sites, which tend to have higher ad/content ratios.

This seems like a good fit for a ! solution like duckduckgo. !gov !universities These may already exist.

That stuff definitely helps. That's also why do many now just search Reddit. However, wouldn't it be nice if the search engine could be smart enough to figure that out itself?

The problem is that people clicking+dwelling on something is not highly correlated with it serving their needs.

See: clickbait YouTube videos that show you something you really want to see in the thumbnail, then spend 10 minutes doing something else before showing it, and when you see it it’s a tiny aside with no more context than what you got in the thumbnail. If it’s even in the video at all.

Those videos have both high clickthrough (thus “click bait”) and also high dwell time (from people waiting for the thing they wanted to see to show up.) They do also have high bounceback, but only from people who recognize what’s going on. “A new sucker’s born every minute”, and those suckers will click the video and watch it, because they don’t yet know the principle that this specific kind of enticing thumbnail+title format implies that they won’t find what they want here.

These metrics all measure, effectively, “wanting” rather than “having.” It’s like measuring food by how addictive it is, rather than by how satisfied it makes you. You’ll end up optimizing toward cheetos — literally flavoured air — rather than toward anything that fills your stomach. People might enjoy cheetos while they’re eating them, but if they’re genuinely hungry, cheetos won’t solve their problem — they’ll still be hungry afterward.

"that heavily punishes presence of advertisements in a result." while that is pleasing to read at face value, it has two fundamental problems:

1. it's orthogonal to relevance of content (semi-solvable algorithmically I suspect) 2. it's antithetical to Google's core business model (a lot tougher nut to crack)

> it's orthogonal to relevance of content

I disagree. The way content is presented matters. Splitting an article into 4-6 pages and filling those pages with ads makes me not want to read that content. I'd much rather go somewhere that has the same text in a single page and only a few ads.

What about playing 2-3 unskippable video ads before watching the actual content? Thus, Google should degrade YouTube search results as well!

The ideal search engine would show me the ad-free page first given otherwise identical quality. Of course Google will never do anything like that. That's why I'm hoping for an alternative search engine to do so.

> 1. it's orthogonal to relevance of content

The entire point of my comment was that it's not orthogonal. The ads are what fuels the click bait and SEO-driven articles. Nobody for example would ever pay a subscription to a website that is just waffle filler. While stackoerflow has ads, it's much better in that regard to the SEO spam pages.

Aren't you contradicting yourself there? Stack Overflow is ad-supported, but is good. But you want search engines to penalize sites that have ads?

I hate ads, but I don't think we should be focusing on them here. Some sites that have ads have garbage content, and some sites that have ads have useful content. Just... find the useful content, and return it in search results. I know "just" is doing an awful lot of heavy lifting there, but I don't think "has/does not have ads" is as important a signal to a search engine's algorithm as you think it is.

This is so simple its easy to overlook the fact that its also ingenious

Teclis implements a fun approximation of this. It runs uBlock Origin on results and penalizes according to the number of items blocked.

No, as I suspect the ad revenues are just fine the way they are now. Google isn’t altruistic. They want ad rates.

Google can make or break any online business they want to. It is what it is... We let them get there... That being said, I haven't even tried to use Bing, and it's pretty much impossible to convince me that Microsoft Edge is worth a second look after all the years of MSIE, and how Windows has been slowly devolving over time.

If worst comes to worst, just add "reddit" to your search term, and then all you have to do is determine whether he answers you find look like they came from a human, a spammer, or a corporation.

Edge is chromium based now so......

I disagree. There is lots of useful information around the internet that is hard to find. A lot of content simply doesn't have the keywords it needs to be discovered.

For example, somebody could search for "best rewards credit card for married couple with normal lifestyle" and find some listicle full of referral links that's a few years old. But the best advice might be in a Reddit or Twitter discussion titled "what's a good card for my P2 with no AF, low MSR, and at least 2CPP" whose replies are terse comments like "CSP?" or "BofA Custom; select CNP transactions as the 3% category and order everything online. they give high CL if you want to AU instead". There's enough jargon and levels of understanding that Google can't find the best advice, only good keyword matches.

I recently had a similar issue when I searched for something well-phrased and generic ("how to stop wood joints from squeaking"). The results were lackluster, but after a few attempts, I found the most helpful results were actually under a specific application ("how to stop a bed frame from squeaking").

So what's my point? It's not Google's fault. They are trying their best of optimize text search, with some fancy word associations and other stuff to help. But it's going to take a lot of effort to make an efficient, scalable, general-purpose AI that can achieve near-human understanding of text and then find the most relevant articles related to that. This "super-Google" would have to comprehend every post and comment on the internet, contextualize the knowledge ("a squeaky bed is caused by squeaky wood joints or fasteners, so this advice is useful for any kind of squeaking wood furniture"), and quickly generate results for every query.

It's not WebMD's fault they have ad revenue that lets them hire writers to SEO their articles with the best keywords. Nor is it Merck's fault that they are using specific language that doesn't cover all the phrases that a person could search. Nor is it Google's for making a search engine without human comprehension. It's just a technological gap that can't be bridged in the present day.

I'd make the claim (without any real data), that the NHS has _such_ institutional power in the UK that it goes a long way to transcend any SEO shortfall it may have.

It does. Google treats gov.uk and nhs.uk sites as authoritative sources and ranks accordingly. We typically pay no consideration to SEO on non-campaign sites.

It doesn't stop ads from sneaking in above the results though. There's a whole industry of shady companies 'hijacking' and charging extra for free/cheap government services.

What does "non-campaign" mean in this context?

The sites that sit on gov.uk are usually either:

* transactional services - those that let a person do a task, like applying for a driving licence or registering a trademark

* information services - a collection of guidance on a subject, like maximum working hours or data protection responsibilities

There are some that don't really fall into either category and are there to advertise something. They aim to be informational and inspirational. Some examples:

* https://helpforhouseholds.campaign.gov.uk/

* https://www.apprenticeships.gov.uk/

* https://national-security.campaign.gov.uk/

* https://skillsforlife.campaign.gov.uk/

The reason SEO is more important on these is that there's often competition. For example, if I search for 'teach in uk' the Get Into Teaching campaign site will be competing with lots of teacher training colleges and companies, job sites, etc.

Why don't you use SEO on your non-campaign transactional and info sites?

Those are the ones that need protection from fee scammers. It seems you've got it exactly backwards.

SEO is what the scammers use. When Google prioritises an authoritative page, that’s making SEO less important.

This. The major risk isn't losing to SEO, it's that the shady operators pay for ads that appear above search results.

Lots of people don't realise they're ads and not the official service.

Google didn't really do much to combat it until the law was changed a year or two ago.

No, that's "black hat SEO".

Google has a support article with SEO advice:

https://support.google.com/webmasters/answer/7451184?hl=en/

The NHS definitely does rank highly in the UK. Not sure if it ranks above web md, but they’re usually both in the top 5 results if they have a relevant page.

It pretty much always ranks above WebMD in the UK. WebMD has a very low rank for me. Mayo Clinic is the site that I normally see tussling for the top spot with the NHS. Some examples randomly plucked from my brain:

1. Vitiligo: NHS: 1, Mayo Clinic: 2, WebMD: 7

2. Bronchiolitis: NHS 1, Mayo Clinic 2, WebMD: 9 (on the second page!)

3. Appendicitis: NHS 1, Mayo Clinic 2, WebMD: 3

4. Myopia: Mayo Clinic 1, WebMD 2, NHS: 3

5. Gastroenteritis: NHS Inform (never seen this before?) 1, WebMD: 2, Mayo Clinic 3, NHS: 4

6. Hodgkin's disease: Mayo Clinic 1, NHS: 2, WebMD: 5

> Whether The Google

Indeed. You mention it being SEO but I see the NHS website has a nice site hierarchy and even has schema.org data.

SEO in one sense is to 'help search engines understand a page', maybe the crossing point is where it outranks and appears too much. A site/page ranking well in Google says as much about Google as the site/page.

> The Google continues to put them near the top of results after all these years.

WebMD: the Pinterest of Health.

i wish pintrest could be scrubbed from the internet

> I don't know how precisely they achieve this, but they're doing something right in an SEO sense if The Google continues to put them near the top of results after all these years.

One hand washes the other. WebMD is chock full of google and other ads.

I wonder if UK users see the NHS site further up the rankings?

I'd be curious to know if people are putting in 'NHS' as a search term as well.

One anecdote from a UK internet user. I just tried googling

long covid

and the top result was NHS. Not sure if it is for other nationalities but they're definitely getting good ranking in the UK

edit: I also tried flu and meningitis and NHS is top for both of those queries too.

Yes, I'm in the UK and will often include "NHS" in the search terms when reading up on health issues or advice.

I consistently see NHS results at or near the top for most symptom searches.

I don't know if that's geography specific.

I just tried it for "swollen ankles" and the NHS came top, followed by webmd.

I think this is giving way too much credit to Google. WebMD has existed in some form since 1996 and first went live as WebMD in 1999. They've been the web's most popular health information publisher from the beginning. This was before Google became the web's dominant search engine.

If Google has an issue here, it's that it tries to rank things based on a more or less mathematical look at its actual popularity at the time of indexing. It isn't aiming to promote sites based on quality in order to make them popular. If a site is where other sites are pointing and people are visiting, then Google is going to rank them highly (modulo whatever the hell other secret sauce goes into the algorithm - i.e. punishing slow load times), even if the information content is bad. WebMD was very much already the web's most popular source of health information well before they hit the top of any Google search.

This isn't even a problem specific to the web, let alone Google. Medical textbooks were available at the time Chicken Soup for the Soul was a best seller. Consumers quite often prefer shittier information to better.

Google's problem is that it ranks pages, not sites. It will much prefer a crappy site with a crappy page that is highly specific to your search query, instead of showing you a good site related to the idea you are looking for.

It puts far too much faith in its language parser, which doesn't comprehend.

Sites definitely matter. All indications are that domains have a ranking as well as individual pages

I disagree with the WebMD hate. It’s not the best site out there, but it isn’t delivering misinformation or otherwise problematic data.

That type of site is difficult in general. People seeking medical advice via online means are always going to struggle.

I still have a super old merck manual I keep just in case of emergencies. Makes me wonder if I should be purchasing one that is up to date.....

Not to mention pretty much every health condition you look up will list that you have cancer or some mental illness.

I’m honestly blown away by the Merck Manuals! How can this resource be so comprehensive and clear yet seemingly never come up in topical searches?

It seems like the most comparable medical version to Cornell’s Legal Information Institute. https://www.law.cornell.edu/

Here in the UK the NHS website has excellent SEO. I land there all the time

I want to thank you for posting this. I was not aware of the Merck Manuals, and have often struggled to identify useful information on WebMD or Mayo Clinic sites.

Today my wife had a specific medical concern that we wanted supplementary information about, and because of your link we had incredibly helpful and credible insight that helped us and provided a deeper understanding of what her physician was saying.

I also prefer information from the NHS even though I live in the US. Here medical information online is all about making money from ads and who knows what else they sell. There is actually little money to make from providing relevant information, unlike a national heath care system (which despite its terrible current state politically in the UK, where it seems they want to move to the US model) has an incentive to provide good information.

The US government also provides healthcare info at cdc.gov, nih.gov, health.gov, or USA.gov/health.

I don't know about the NHS, but we can't trust the information vended by the CDC -- they have proven willfully incompetent over the past two years. I will give just one example: they initially told us masks were ineffective against COVID, which they knew at the time was inaccurate. They said it because they didn't want a run on PPE required by medical workers. Result: there was a shortage anyway and they damaged their reputation irreparably. Great job everyone.

If one negative example decreases an entity’s credit, would positive examples increase an entity’s credit?

What about the proportion of positive to negative examples? How does that impact an entity’s credit?

Mistakes to correct statements, yes. Those balance out. The opposite of being right is being wrong, the proportion of these two is their score.

Lies though, where we find out they knowingly said something they knew was wrong when they said it, don't balance out. The opposite of lying to someone to manipulate them is respecting them enough to let them make their own choices. They need to acknowledge that and start purely providing facts again - even at the cost of some political narratives, before they'll regain trust.

The intent of the lying also matters.

Corruption is bad, lying with good intentions is context dependent bad, mistakes are OK. But if one is going to throw out the baby with the bath water at every instance of corruption/lying/mistake, you are not going to be left with much other than chaos.

Humans are fallible creatures, we have to work and improve with what we have.

The exceptionalism of the USA is the fact that most of its organization are open to criticism and repair. The FDA/CDC/USDA/DoT/EPA/etc and many other non governmental orgs are far from perfect, but they are pretty awesome compared to the alternatives around the world.

Sure, the organization is mostly fine. But the people who lied are not, and are not redeemable.

Mistakes are fine, policy lies are absolutely unacceptable and should be punishable by public whippings and jail.

Interesting! But the first link you gave is just a list of conditions, which requires that I already know what my problem is. Is there a page that goes from symptoms to likely causes and what to do, like WebMD?

You can search at the top for symptoms: https://imgur.com/a/y5RUk5x

I'd say if I were to suggest improvements the symptom search could definitely be better and more prominently placed. In the UK I personally (and I'd imagine most people) get to the NHS website directly from Google, which is better at finding more relevant pages.

That doesn’t really help. It just vomits a list of articles that mention coughs. The “killer” (rescuer?) feature of WebMD is being able to start from a symptom and narrow down through clarifying questions. You implied the NHS does this better, when it doesn’t attempt that feature at all.

I’m not sure this is the prime “UX done well for symptoms->cause” example you cited it as. Though I agree UK government sites follow much better UX patterns!

Is that NHS page what people go to webMD for?

I feel like that's something else entirely.

It's my first time seeing it, but it seems like yes.

I have a relatively new mole that I thought looked a bit funny, so I awhile ago now I looked up what malignant ones look like, thankfully it doesn't seem to be.

This page is definitely clearer and more concise than what I found at the time: https://www.nhs.uk/conditions/moles/

One issue with the NHS is that I get the impression the information they publish that strongly respects their goals and desires perhaps to the detriment of patients sometimes.

I’ve certainly noticed in the past big differences in advice. The NHS will downplay and not suggest investigations whereas another (non UK) site does the opposite.

The NHS advice surely is carefully crafted not to cause unnecessary (from their point of view) GP visits, tests etc.

NHS is focused on the appropriate allocation of resources to the problem. It strikes an excellent balance of doing the right work when necessary and based on probabilities. If you have evidence that the process recommended by the nhs is failing patients in statistically significant numbers I would agree with you on them not doing enough tests but frankly, I think NHS would perform very well if it was adequately resourced (it’s currently starved of necessary funding).

The NHS follows a strict set of guidelines for the identification and treatment of illnesses. They do not act like medical businesses such as hospitals whose goal is to do as much testing as they can justify to get more money from insurers.

That's nice, but when I'm sick, I want to get well, and I might be willing to pay for it with my money, time, or labor.

I don't want to die just because it's more cost efficient for the government to save two others.

That's not the argument being made.

If you're not sick you should not be subjected to too much testing, because the risk is that you are diagnosed with a thing that will not harm you. And once you're diagnosed with it the tendency is to treat you for it. Treatment is not a neutral option, it carries risk.

Over-testing, over-diagnosis, and over-treatment all contribute to patient harm.

The argument was that the NHS does the exact correct amount of testing, diagnosis and treatment. That’s patently false.

The NHS regularly fails me, my friends, my family by refusing to do diagnostics while clearly sick. My GP refused to test me for Lyme disease even though I had lots of classic symptoms and had been in close contact with a deer (because he believed they’re not an issue in the area.)

I feel we’ve strayed quite far from my original point but that’s to be expected in any religious discussion.

I wouldn't necessarily assume that not suggesting investigations is detrimental to patient health. There is a continuing big debate in the UK medical profession about how over-investigation and over-medication/medicalising people can be a real problem in terms of patient health.

If you are seeing a disparity between UK and US in terms of advice about when something needs to be investigated, it could be that the US site is over-promoting investigations.

Keep in mind that the NHS puts a lot of work into prevention, into staying healthy without medication - it will quite often advise life-style changes, rather than popping pills - and that's for patient benefit.

I was careful to say non-UK. (I’m also not American fwiw)

I agree with many of your points.

Apologies for the US assumption.

The point is that they aren't neutral. They have a bias toward what they think is best, and they don't overcome it by acknowledging and advertising alternative views.

Agreed. I think you would be naive to not think the NHS information factors treatment cost/managing demand into their answers as well.

> One issue with the NHS is that I get the impression the information they publish that strongly respects their goals and desires perhaps to the detriment of patients sometimes.

Do you have data that supports the NHS withholding or advising against necessary care that results in worse patient outcomes?

More utilization is not inherently better, and even in the systems like the NHS, everyone is incented heavily to keep patients healthy and out of the hospital system. The idea that they want you to be sicker rather than provide relatively cheap preventive care is, generally, absolute nonsense.

I think the issue isn't data, its the "packaging". Going through the NHS website, it's useful if you already know what you have. I'll use myself as an example because I had an ingrown hair on my neck a few weeks back, went on google and I didn't search for "Ingrown Hair" because at that stage, I didn't know that it was an ingrown hair. I searched for "bumps on your neck" which led me to conclude that it was an ingrown hair (followed by a doc telling me the same thing).

One idea I've had for a long time is the US Gov't (and all major governments) should have a large data gathering/distribution operation. This data would be things like medical research, and other data that would be in "the public interest" (basically all the data we have now, just in one place), everything from meeting notes, congressional bills, etc.

With a wealth of data from a single source, companies like WebMD could stop focusing on how to get the data, and shift their focus to how to "package" the data. A list of conditions with symptoms is nice, but lets repackage that into a "medical graph" that lets you explore related conditions through symptoms. Companies could then compete on the "packaging". You could go to FreeMD and get the same data as you could on WebMD, but WebMD has a much better search engine for X thing so they are worth the $4.99/month cost.

It would be expensive, and probably be a decade long multi billion dollar operation. But imagine the revolution in government services if there was a single source of truth for data.

There are arguments against this, mainly do you want a government to have that much power. But I think it could be done with some strict limits and checks. Data in this API would only be public government data, so IRS data and other private information is not on there.

NHS already offers a (fairly rudimentary, last I checked) diagnostic tool in the form of NHS 111, which as well as being a phone number that people in the UK can call to talk to someone, is also a website (https://111.nhs.uk/) where you can give your symptom(s) and get a suggestion if possible causes.

It may not yet be good enough in all cases, I'm not sure, but is that what you're asking for? I'm not quite sure as you dived into things like data licensing without being clear on your actual hoped end result.

(Of course, the 111 site is designed as part of the wider NHS system, so when in doubt it's more likely to give advice to speak to a GP / call to speak to a nurse / visit a hospital, than to say "not sure, here are all the conditions it could be". But as it gets better I expect it to be able to do both.)

Not to mention that the main NHS site also lets you search for symptoms in the main search bar, so you don't need to know the condition to use it to search for possible conditions. edit: as better pointed out by jjar here https://news.ycombinator.com/item?id=32650958

This is the model for weather in the US. Do you like weather.com and all the derivatives?

Is weather.com the root, or is it noaa.gov?

NOAA.gov is. They are the official source of the data, and the only organization that puts out weather alerts/warnings, etc.

I assume edmundsauto meant weather.gov instead of .com, otherwise their comment does not make sense to me.

weather.com is a private company owned by IBM.

https://en.wikipedia.org/wiki/The_Weather_Company

It is the misaligned incentives that come from advertising. Click-bait and outrage drive views and ad revenue. Look at the "news" segment these days.

To extend this a bit, the ultimate solution is a quasi-government nonprofit organization along the lines of ICANN (or maybe part of ICANN) that operates a crawler and a database of crawled sites, plus an API for that data.

This would not be a search engine per se but a neutral backend that anybody could build a search engine on top of. Want to build a search engine and sell ads? Fine. Want to build a search engine specializing in health information subsidized by the drug companies? Fine. Want to build one as a neutral nonprofit and charge subscriptions? Fine. The same backend database works for them all. Even Google could build a frontend on top of it.

Yes it would be expensive. The government would have to pay for all the backend infrastructure (whether the government buys it or rents it from Amazon, Google, Microsoft, etc.), and Cloudflare and robots.txt would have to allow "icanncrawler" to access sites without friction. But it would finally allow the creation of neutral search engines not beholden to advertisers. It's a piece of infrastructure the modern Internet sorely needs.

The closest I've found to the NHS sites are published by Mayo Clinic in the US... https://www.mayoclinic.org/diseases-conditions

Still not perfect, but I've found it more useful than WebMD.

If the “government” becomes the only source of truth, that source of truth is necessarily political. The oft-mentioned NHS — do they not have an incentive to lower health care expenditures? Would providing medical information to the public that prescribes a suggested course of action incentivize the course of action that is least expensive to the government but not necessarily the best treatment? Is there any potential for a conflict of interest there? Of course there is. If some condition is best treated with an expensive procedure, would the NHS be incentivized to recommend a cheaper, but less effective approach? Of course they would. The NHS routinely denies or delays life-changing surgeries over cost despite such denials not being in the best interests of the patient. (Try getting an NHS knee replacement.) There are treatments NHS won’t recommend because a person is too old. Not because they can’t handle the procedure but because the expense isn’t worth the amount of lifespan remaining in the patient.

Medical information provided by governments is often centered around what’s best for “populations” and not necessarily the individual. Covid is a prime example: masking kids was bad for the kids but allegedly “good” for the population. Damaging to the individual for the alleged benefit of the so-called greater good. Despite all the kid masking “science” turning out to be garbage. Covid vax for kids is another example: the government right now in the US promotes vaccinating even toddlers despite their individual risk of serious illness being statistically zero.

HIV is also something that the government really got it wrong in the 1980s. https://www.aier.org/article/fauci-was-duplicitous-on-the-ai...

Covid information is another example: the government was wrong on multiple occasions throughout the pandemic. Yet when “official sources” are the only approved source of information, the public gets mislead. The marketplace of ideas is a real idea and it should be embraced. We need more private sector competition for information, not less.

If WebMD is bad, the solution isn’t government, it’s a competitor.

> If WebMD is bad, the solution isn’t government, it’s a competitor.

And how to decide who to trust? Still unsolved. The general public loves being lied to, as long as they like who is lying to them (same political party, religion, or just making impossible promises).

Of course the NHS has an incentive to lower costs, it's in their interest for doctors to prescribe the most cost effective treatment as patients rarely stop coming back as a result of ineffective treatment. Does this mean that objectively good preventative treatment (like physio) and quality of life elective surgery get pushed to the back of the triage queue, and that individual needs are occasionally failed? Absolutely, and in these cases where the NHS falls short there's always the option of going private, which just highlights that healthcare is always political.

In a purely private healthcare system (which doesn't exist in the developed world) the politics are firstly whether you can pay and secondly how much you can pay. No point offering free dieting and lifestyle advice when risky weight loss surgery (which has a notoriously low success rate) offers instant success, got a bad back or knee? Try out this risk free* (*not actually risk free) surgery! It wasn't that long ago in the US that getting cancer without health insurance was a death sentence, and that again is a political choice, one that the US government reneged on.

Check out the National Library of Medicine’s MedlinePlus resource for an equivalent to the NHS’s consumer-oriented health info portal: https://medlineplus.gov/

It’s a fabulous and under-utilized resource!

I also highly recommend the NHS website.

The information there a couple of years ago helped me losing a lot of weight and adapt a healthier overall lifestyle.

The information is dry, concise and easy to understand for a layperson. I cannot judge how well it is aligned with recent science, but I trust the site much more than most others, because their incentives after all is public health (I'm sure some politics play a role as well), not selling you books and courses with unrealistic expectations.

>>Why is the private sector responsible for providing accurate health information? As this article shows, the incentives for people running medical websites <in the private sector> and the people reading them are not aligned.>>

I don't know that the cause of this particular misalignment is "private sector". But no doubt the current implementations by the private sector exhibit this misalignment.

>>I'd say the UK NHS website <which is public sector> and symptoms/medications pages hit the nail on the head>>

I assume this implies that the NHS website does not exhibit the previously noted misalignment. Why is that? Obviously this site's sole funding is not from advertising. I assume it's from taxes collected by the government. So what is incentivizing those that build this site and maintain its content to make it so good?

I'm wondering why my question got downvoted. I've had this happen before when asking questions. Could it be a matter of a couple of readers not assuming benign intent? As in, someone thinks I'm not actually asking a question but making a statement and they don't agree with the statement. Either way it's interesting.

Perhaps the more likely to be read as benign version would be this: We all agree site A is bad because it's misaligned (which I think all agree is due to being driven by ads). Then we propose that site B is good - but there's no indication about WHY site B is good. We know why site A is bad, but why is site B good. And more specifically since we're describing the value in terms of alignment, what alignment is there in site B that drives the goodness?

Just another aspect of neoliberalism. An undue faith in markets.

It's a common conflict for info publishers, the only solution is really to get rid of advertising. WebMD relies too much on industry advertisers and on companies selling pharmaceuticals and it corrupts their ability to objectively provide health advice. Advertisers pressure publishers for prime placement, and for editorial influence when they have weight to them, and it corrupts the tone of what a site can publish by nature.

The same is happening with many doctors that need to pay their overhead, many offices turn into "pill mills" because that is what keeps the lights on. We're at a very weird time in history, where people are more profitable as unhealthy individuals, so certain actors in health care peddle fear, confusion, and paranoia to sell medications as well as the valid issues and panaceas to them, and even minor and completely minute afflictions normally have commercials running non-stop on TV. WebMD is a tiny blip when you consider that people type their affliction into Google first.

Perhaps for them, and as the online ad economy melts itself down, contracting with the government to provide official information on a non-ad funded site with a far less cluttered UI might be a better long-term profit model.

> We're at a very weird time in history, where people are more profitable as unhealthy individuals

The thing is that to wider economy and society at large, people are vastly more profitable if they are healthy. This is one of the top reasons why countries spend so much on healthcare: healthy citizens are productive citizens.

The entire problem is one of externalized costs and misaligned incentives.

What would be better if basic stuff like this was part of our public education system. We need the equivalent of "shop" class but for basic medical needs. Wilderness First Aid would be a good start

A fairly straightforward answer is that the government's goals are not necessarily aligned with your own. You, presumably, care very much about your own personal health. You also care about other people's health, but you really, really care about your own health, and probably don't want to die earlier than you need to.

The government, on the other hand, doesn't generally care about individuals, and is working on a statistical level. A good government wants the population overall to be in good health, and has a budget within which it must operate. It may make more sense for the government to ignore your rare disease if detection/treatment is expensive, and that money can be better used to save, say, 10 people with a more common disease.

Now, if the government was just providing health information, and individuals were on the hook for payment, this disconnect wouldn't really exist. But if the government is also providing the healthcare services "for free" to individuals, then there is an incentive to downplay testing for rare or expensive to treat diseases due to the cost/benefit ratio.

The terse version of this is to say that the government would prefer you die cheaply rather than live at great expense.

The government is pulling the lever on the train track thats saves 5 but kills another 1.

That's not really what's happening at all. It's often cheaper to get an early diagnosis or catch a condition before it progresses too far.

The government doesn't actually hide information about diagnosing or treating diseases, even rare or expensive ones. They do, however, take into account the relative risk of false positives and resulting unnecessary treatments, which often outweigh any benefit of proactive testing for rare diseases.

It's counterintuitive, but if you have a 99% accurate test for something that means you're going to end up with 1 in 100 people getting false positives and undergoing potentially expensive (out of pocket) or dangerous diagnostics and treatments. When considering rare conditions that might only occur in 1 out of 100,000 patients each year, a 99% accurate test results in 1000 unnecessary false positives just to catch the 1 true positive. At scale, this can produce a lot of problems that can actually make life worse on average for the population rather than better.

I agree that there are valid statistical reasons to limit testing, but governments ration care and allow for long wait times when they are responsible for paying the costs. Faster testing and treatment is generally believed to be one of the best things you can do to improve patient outcomes, and government healthcare systems are notoriously bad at this (even worse than private healthcare).

Long wait times don't reduce the rate of false-positives, and false diagnoses. Long wait times deter people from seeking treatment, thus reducing costs.

Is that supposed to be an advertisement for private healthcare? With insurances companies deciding based on profit margins? I'd say the government incentives are a lot more aligned to have their population healthy and productive, than the insurance company looking at how much you paid for your premium and how much the treatment is.

Pointing out a conflict of interest is not an advertisement for anything. It is what it is. You could also have publicly funded, 100% government provided healthcare which provided some base level of care but allowed individuals to pay for specific treatments if they wanted them and they weren't a part of the base level of care.

Most public healthcare systems provide excellent treatments for the majority of the population. And, if you have some rare condition that can only be treated with some state-of-the-art cure that is only provided by some hospital out of the country, and you have several hundred thousand $$$ in your bank account, nobody will stop you from paying the treatment from your pocket.

It's best to know and understand each party's interests. Insurance companies want to keep you alive and paying premiums. Hospitals (government, for-profit, and non-profit) want you to receive a lot of treatment. The government treasury wants to keep you alive as long as your future tax payments exceed their healthcare and other expenditures. Government health departments have an extremely complicated set of incentives, dependent on exactly how they're organized.

> the government's goals are not necessarily aligned with your own.

as opposed to the private sector?

> But if the government is also providing the healthcare services "for free" to individuals, then there is an incentive to downplay testing for rare or expensive to treat diseases due to the cost/benefit ratio.

Which is what current private insurers often do. The government's incentives aren't just to cut costs and run more efficiently. It mostly cares about staying 'the government' and having people live long enough to pay taxes. I want to hear the same argument when you're talking about the government's incentives to be more cost effective when it comes to funding the armed forces.

I think the gist of it is that as an individual, in theory, you have leverage over the government via your votes or representatives. You have none of that when dealing with the private sector. So in this case, if I'm bothered by what the government publicizes about diseases and such, I have several tools at my disposal to deal with it (FOIA requests to track down who's responsible, town halls, writing to the representatives, lobby, voting etc..). If a private company does it, what am I going to do? Write a bad review?

The private sector will generally be happy to give you a service if you come with cash in hand. Which is why in the UK I can go get a brain MRI at a private clinic if I had a dream that I was developing MS, whereas I can't do that with the NHS.

You are talking about "The Government" as if it is some uncontrollable force of nature. Here in reality, we are actually self-governing.

Obviously it's messy, complicated, and not as simple as just "deciding what to do and doing it".

But it is fair to say that pretty much every rational person agrees that we should take care of each other including anyone with a rare condition.

> Here in reality, we are actually self-governing.

Given there is more to we than just me, "The Government" would refer to mostly other people and specifically other people with a particular proclivity toward involving themselves in the lives of others, to what effect is in the eye of the beholder.

> A good government wants the population overall to be in good health, and has a budget within which it must operate. It may make more sense for the government to ignore your rare disease if detection/treatment is expensive, and that money can be better used to save, say, 10 people with a more common disease.

That happens on the research funding side (e.g. it makes more sense to spend research money on cancer or heart disease than on an obscure disorder that only 10 people have).

However, it's not true that the government will provide misinformation or otherwise get in the way of diagnosing your rare disease to save money.

There are a lot of studies about the cost/benefit tradeoff of early diagnosis and preventative screenings. The goal isn't to reduce healthcare expenditure, it's to reduce problems and deaths from unnecessary procedures and treatments. We learned a lot from previous eras of over-treatment and over-testing that led to a lot of unnecessary treatments due to false positives. The risks of over-treating can actually outweigh any benefit of excessive testing, for example.

This is counterintuitive to individuals who want to order huge numbers of tests all the time just in case something might be wrong. The problem is that a lot of diseases may have occurrence rates on the order of 1 in 10,000 or 100,000 per person-year, while the tests may only be 98% to 99% accurate. This 1 to 2 in 100 will be misdiagnosed as false positives and potentially put on expensive medications or treatments that have negative health consequences. It's a very real problem that isn't obvious from the individual level but becomes very obvious at the population level when you start looking at the details.

But no, the government isn't actually hiding information about diseases or misleading people in an attempt to reduce costs. With many conditions it's actually much more expensive to be diagnosed later in the disease than it is to be diagnosed earlier when many conditions are more receptive to treatment.

In the US, the CDC has been really bad at providing health information, and the FDA has been really bad at providing food safety info. They also don’t have incentive alignment (incentives are mostly to grow the bureaucracy and serve careers).

I’d expect private enterprise to eventually converge on better info… eventually consumers will choose services that provide the best info amidst competition.

NHS Conditions was what I came here to post. You'll notice your GP glances at precisely those pages when they're talking to you too.

The phenomenon they describe for health information is, IMHO, absolutely rife across many different domains. Try looking up information about gardening, plant management, home improvement, etc - you'll find the same thing. Search results dominated by sites that have mastered the art of producing SEO-optimised "content" that is not authoritative, full of waffle, and not especially helpful.

For whatever reason, the business model of "draw a huge amount of traffic" outcompetes the business model of "provide a really good source of information".

It's interesting to ponder why in very specific domains, that's not the case: for instance, StackOverflow dominates in programming queries, and provides very useful content.

Someone much smarter than me should write a really good blog post about this.

Because StackOverflow successfully (for some value of success) transitioned the forum model to the modern web.

We had these "really good sources of information" - we had forums dedicated to almost any topic you could want to know about, and people educated in the area would frequent them.

They've almost all died out - some remain as a mostly static reference (which is incredibly useful!), others continue to plod along. A few subreddits pop up now and then, but it's not really the same thing (subreddits are even more prone to "flooding" from outside "contributors" who end up turning it into a meme-reddit).

If a company is tangentially related to a topic, you can do worse than dedicating a few full-time employees to a forum on that topic. We're posting on one right now!

Meanwhile search results are absolutely infested with sites that scrape and rehost StackOverflow content, and somehow manage to get better search engine rankings than StackOverflow itself on many queries.

> They've almost all died out

I'm a member of a few active old-school forums. The reason they didn't grow like StackOverflow did is because you really need to spend a lot of time reading through garbage (small talk, etc) to get to the good stuff.

The answer to the question (as posed in the title), might be 3 pages away. With StackOverflow, the answer is almost always immediately under the question since it's been voted into that position.

Tragedy of the Commons. We all could use easily accessible, accurate and unbiased medical information, but most people can't or won't pay a website to procure and publish such content, especially when they don't really know if they can trust the site! It's rather circular.

If only there were some association of all people, some kind of organization that included all members of the public, which could collect a nominal fee for common goods and services and then provide them freely after the fact. Some sort of union that governs what goods and services are provided...

The existence and success of Wikipedia (and other similar sites) easily counters this notion of needing consumer propensity to pay for a knowledge repository. Sure, reliability and accuracy of the information may be put into question, but that would have been a concern either way even if it were a paid service.

People are not encouraged to make personal health decisions by Wikipedia.

We all know the people that collect the nominal fee have the best interest in delivering a quality product - a serious responsibility to do so even - and not solely making their section of the entity larger and more powerful year over year.

What is a bureaucrat if not a highly skilled creator who completes their mission ahead of time and under-budget?

This, but unironically. A number of countries (and a number of federal and state orgs in the US) have competent sources of record for the public good. Why we don't have it for medicine is beyond me.

Governments would need to run big very expensive ad campaigns to change peoples behaviour from “googling” to entering a government website url. The browsers now make searching so much easier than typing an URL.

I believe you don't have this problem with stackoverflow because it's user generated content. Answers provided by people doing it out of passion are usually better. That's why you'll often find the best answers on Reddit.

As to why there is no successful medical overflow.com: Software developers are inherently more web-affine and likely to help there. On top of that it's a great way for developers to show their knowledge in a way they can show to prospective employers. The medical field is a lot more old-school sand I cannot imagine a doctor showing their online help history to a potential employer.

I wonder if a bounty or information-bridge would work?

Make there an incentive for medical knowledge to dump on there, or have people who are incentivized to go get that data and deliver it.

The difference is that software developers have a freedom of speech online. There is no legal liability or professional consequences for a junior coder accidentally giving out wrong-headed or misleading programming advice. So coders post freely, and the good posts eventually float to the top.

In licensed and regulated fields - law, medicine, finance - the situation is quite different. Posting a bad answer might result in you getting sued by an angry reader or investigated by your field's regulatory body.

Another somewhat successful area: Very specific task based home maintenance instructional videos on youtube.

I'm not sure why but if I look up specific tasks I do find what seem like capable handy man / plumbers or similar folks with good quality advice.

Medical stuff.... oh gawd almost no chance of good advice there. But maybe that's because the range of "hey we don't know" or "it's complicated" that you're going to get from honest folks when it comes to the medical world, and most folks gravitate towards solid answers that hucksters love to give.

Hucksters might find it hard to monetize "how to cut down a small tree", while "cold remedies" are prime grounds for them.

Yeah handymen want to impress you so locals hire them. Mail order shops want to scam you into making one bad purchase.

> Try looking up information about gardening, plant management, home improvement

I found a particularly egregious offender the other day.. the #2 result for "best cordless screwdriver" is one of those content farms that made a "Best of 2022" article. Their top recommendation in 2022 is an old NiCad one that was discontinued in 2015!

This seems like a side effect of centralized power in general. You see it at amazon too which is full of either subpar goods or counterfeit products[1]. It becomes a game of manipulating these companies into showing your product/good/service, and only part of winning that game is producing a quality product

[1] https://davidgaughran.com/amazon-has-a-fake-book-problem/

I have noticed this on YouTube as well, I would assume something similar is happening on other video sites.

Sometimes there is a video on a trending topic among the first few Google search results, and when you go over to YouTube and have a look it turns out to be a montage of stock and/or stolen photos, with a synthesized voice reading a narration that was obviously churned out by a content mill somewhere very low-wage, if not generated by "AI."

It baffles me that Google ranks these things highly, it's not like they don't have an eye on YouTube activity.

In the end I have no better explanation than institutional rot: so much money is flowing in, and engineering incentives are so perverse, any problem that doesn't directly irritate the cash cow is not gonna get fixed.

I've started using YaCy and Searxng for searches. It was terrible at first but I set my YaCy engine off indexing high quality sites that I find useful for the subjects I'm interested in.

It's refreshing in some ways - the content I get is definitely "outside of my promoted echo chamber". However, you really need to use use query syntax to get decent results, something I'd gotten out of the habit of doing with Google (actually, I'm convinced Google ignored it half the time even if you tried).

This is very common for electronic gadgets that haven't come out yet. Since there are no real reviews, but enough search interest, people will make awful slideshow-based videos that just repeat the specs and use OEM's own teaser footage.

I looked up a “how to change guide spark plugs” for a vehicle.

First hit was SEO garbage that started off “Before we explain the steps, let’s first examine what the proper stoichiometric ratio is!”

… I closed that site while grinding my teeth.

The internet kinda sucks now.

I think it's because professionals and expert users know what good content looks like, which feeds back into the algorithm. The average gardener using the web (not books or other local knowledge) for advice doesn't.

Google says "democracy on the web works" which means that what wins is what looks good to the average person among the population who uses that search term.

A partial salve would be a search engine that only returns results from websites where the people writing cannot make money from their content.

It's quite interesting to ponder the implications of this.

When you put it that way, it's so glaringly obvious that Doubleclick (wearing their Google skin; keeping the name when they merged was the smartest thing the devil ever did) is the precise and irreconcilable opposite.

Extremely relevant Slate Star Codex/Astral Codex Ten piece: https://astralcodexten.substack.com/p/webmd-and-the-tragedy-...

Wow that article does a much better job explaining the problem than the submission does.

A better WebMD already exists, and it’s called UpToDate. It’s target audience is doctors, but you can pay ~$20 for a week as a consumer (you can pay less per week for longer also). It’s a great resource, and has a summary of the most recent consensus view on common medical topics. It doesn’t expand pages out with fluff or talk down to you, though it won’t have too much info about assumed medical fundamentals. You can pull the citations and look up the references.

Reading it makes your appreciate why WebMD exists. Not everyone wants to read highly technical medical jargon and read medical papers. But the HN audience probably has a lot of folks that are down to do that, and I strongly recommend UpToDate for those that do. I use almost every time I have a substantial new issue that requires a physician visit.

I can give a nice example of how some of UpToDate’s information is compiled, and why its so high quality.

I built a new diagnostic test that replaced and upgraded upon one that had previously been discontinued. After building it a clinician who is a top expert on that specific diagnostic reached out since he was responsible for the relevant up to date page. We had a knowledgeable discussion and they gained a full understanding of the diagnostic I had built. After that they wrote up a new and high quality UpToDate piece describing the new diagnostic and its clinical usefulness. Overall it felt like a very effective process, and one that happened pretty early on in the life cycle of the new product.

Sure this article is spammy self-promotion, but their prototype is exciting. I’d use it. It’s frustrating to go to a drugstore and see medicines for a cough, let’s say, each with a different active ingredient, and be unable to find concrete information comparing the effectiveness of each ingredient.

And wow, the WebMD article they mentioned on essential oils was terrible. It really lowers my opinion of WebMD. At this point I get more helpful information about medicines from Reddit.

Isn't that what the pharmacist is for? Pharmacies sell some dumb stuff, but if you actually ask for advice from the person with a license they'd like to keep, you should get some straight talk I'd think.

I'd say over 50% of the time at my pharmacy, this would involve waiting in line for 20 min and talking to a harried, overworked pharmacist who may or may not be up on the latest research... not a great UX.

As an experiment, I will try that next time I’m buying an OTC remedy. It sounds like we share an opinion: Given that drugstores unironically place homeopathic nostrums and essential oils right next to actual medicines, I treat them as hostile environments out to scam unwary consumers rather than honest sources of information. But, as I said, I will give that a fair test.

the pharmacist at a chain store has zero control of what's out there on the shelf. Just talk to them and see what they say. I suspect they'll give you an active ingredient suggestion first and then a handful of options of stuff they have on the shelf with that active ingredient.

I just read the essential oils article and it doesn’t seem that bad? They recommend lavender for sleep, aromatherapy for stress reduction and tea tree oils for foot fungus. It’s not great, but as far as trying to be objective goes, it’s not like they’re arguing it cures cancer. They could, as I think is covered more generally provide more data, but while I don’t think we should swallow “alternative therapies” whole hog, I don’t think we should be biased against them just because they sound woo-ey. The evidence should speak for itself. what was your specific beef with the essential oils article(as compared to other WebMD articles)

Also interesting he contrasted it with Aspirin, because ironically, I don’t think pain killers have all that much power when studied against placebo.(heart benefits notwithstanding)

For example: https://pubmed.ncbi.nlm.nih.gov/19673707/

They actually do dance around a claim regarding cancer:

> Many essential oils have antioxidant properties. Antioxidants help prevent damage to cells caused by free radicals. This damage can lead to serious diseases such as cancer.

For comparison, Wikipedia:

> Aromatherapy may be useful to induce relaxation, but there is not sufficient evidence that essential oils can effectively treat any condition.

Is the wikipedia article actually more accurate though?

https://www.healthline.com/health/tea-tree-oil-for-nail-fung...

"Results of a 1994 studyTrusted Source found pure tea tree oil was equally as effective as the antifungal clotrimazole (Desenex) in treating fungal toenail infections. Clotrimazole is available both over the counter (OTC) and by prescription."

Reading through the wikipedia article it seems they're conflating all use of essential oils and specifically the use of essential oils in aromatherapy treatment, which is what the linked article is about.

Also fair point on the cancer line but:

https://www.cancer.gov/about-cancer/causes-prevention/risk/d...

"In laboratory and animal studies, the presence of increased levels of exogenous antioxidants has been shown to prevent the types of free radical damage that have been associated with cancer development" -- which seems close to what they were saying. A bit overstated for something published to the public, but technically accurate.

Overall it seems like the dismissal is a bias of the idea of essential oils, not necessarily a comprehensive review of the literature.

Honestly I'm WAY out of my lane here. I have no medical training and can't even call myself an interested amateur. So me trying to argue via random snippets of internet text would just waste everyone's time! :-)

The only thing I can really say is, there's a lot of medical-related material out there that seems vague and hopeful, that I don't think is doing much good for anyone but its creators. I'm with you - let's see what the research says and what the studies show, while keeping the placebo effect in mind. If crabgrass cures cancer, I'm down for some grazing.

What exactly is wrong with the WebMD article? There wasn't really anything inaccurate there... Is it just about tone?

Examine.com is the closest analogue to what this site is trying to do, and as far as I know, it works. It takes a while, but if people develop trust in a product or website they value that deeply, and are even willing to throw money at it. I don't even consider trying to google a supplement; I'll just go to examine and look at the body of evidence, recommended dosages, etc. I've paid for Examine and I would pay for this.

Here's my point of feedback / wishlist item / thing I think is missing from the world. Examine is focused on supplements, which I don't actually care that much about. If my question is "How do I lower my fasting blood glucose", I don't want a list of what supplements help with that, I want a list of everything that helps with that. If daily cardio is 100X as effective as green tea catechins then IDGAF about green tea. Examine broadened a bit, but it's still very supplement focused, which can give the false impression that some supplement is the best way to approach some condition.

Going by the long covid example, it sounds like this glacierMD takes the broader focus of "here's all the things", which I absolutely love. And there could be a lot of value in that alone. But what I really feel is missing from the world is a comprehensive, salutogenic look at health. Yes I want to know what the best treatments are for long covid. But what I also really want to know is what is the rank ordered list of things I can do to develop and maintain a strong immune system. Or how do I lower my resting heart rate. What even is the optimal fasting blood glucose for that matter? Any searching you do will just tell you "above 100 mg/dL is prediabetic, 99 and below you're perfectly healthy".

Anyway, I love the demo. The author is correct that it is missing from the world. And I 100% think people would pay for it once it grows enough. I do just hope that it isn't purely build around a pathogenic way of thinking, like just about everything else in the medical world seems to be.

Thanks for sharing examine.com, looks interesting!

> Here's my point of feedback / wishlist item / thing I think is missing from the world. Examine is focused on supplement

That's exactly what we're doing!

We released version 2 of Examine less than two weeks ago. Here's a page on how to use: https://examine.com/how-to-use/

It's still early, but the entire goal is to break down research on conditions and goals, and where they connect, relate them to interventions.

Any questions, happy to answer them.

Hey that's awesome to hear! I saw the redesign but haven't really poked around much yet. If that's the direction examine is pivoting though I am very, very excited for it. Will definitely be checking it out.

An interesting example: a few months ago I dropped something on my toenail and it turned black.

Wading through WebMD etc (which is where google was sending me) was not helpful, especially in between the popups and autoplay videos

I finally restricted my search to wikipedia and quickly found out that it's called 'subungual hematoma' and "usually self-resolving", which is what I needed to know.

Recently I tried this query on GPT-3 and it worked well too:

Prompt: Something fell on my nail and it turned black

GPT: Possible causes for a black nail include: trauma to the nail, a melanoma, or a subungual hematoma (a collection of blood under the nail). If the black nail is accompanied by pain, swelling, or redness, seek medical attention. If the black nail is not painful and has no other symptoms, it is likely a subungual hematoma and will eventually grow out with the nail.

>especially in between the popups and autoplay videos

I hop ur toes get gooder.

There is an excellent version of WebMD called UpToDate.

The primary audience is physicians / clinicians, and they make money by selling subscriptions. So not a consumer health product, but an example of what the gold standard in this space looks like.

Example link: https://www.uptodate.com/contents/approach-to-chronic-cough-...

> Why can't I see the percent of people who experience a particular side effect?

Is that a US thing? Because I’m looking at the small-print paper thingie that came (has to come) with a moderately dramatic prescription drug, and it has:

“Side effects:

very frequent ( ≥ 10%): ...

frequent ( ≥ 1% and < 10%): ...

infrequent ( ≥ 0.1% and < 1%): ...

rare ( ≥ 0.01% and < 0.1%): ...

very rare ( < 0.01%): ...

The following side effects were observed after this drug was released to market. The incidence rate is considered to be unknown, as it cannot be estimated from the available data.

...”

(This seems especially weird because I expect most of the data to have come from FDA submissions.)

This information is absolutely available, just not on WebMD!

Look up "[drug] FDA prescribing guide", you should be able to find it, though search engines recently appear to have gotten a bit worse at it.

If only there was a profession where knowledge, experience and continuous development are used to provide advice and care for individuals who may not have specialised in that same area of expertise. </s>

I assume medical websites are somehow kept vague in order to steer us to pay these highly regulated professionals a fee for a visit.

I’d say its more likely that they are vague because of regulations and liability.

IE you cant/shouldn’t give blanket medical advice and if you do you may be liable if someone has a bad outcome from the advice.

That's my point!

Regulations have been set up so you have to pay an AMA member to get any information that might be labeled "medical advice".

There is tons of medical advice. Wikipedia, cdc, health.gov, mayoclinic, webmd, Reddit forums, hacker news, etc.

You can even get fake diagnosis and fake healthcare from chiropractors who are allowed to advertise themselves as doctors, and fake medicine from naturopaths or whatever who are also allowed to call themselves doctor.

I am using fake to mean unsupported by evidence in the form of sufficiently blind trials and whatever else is needed to qualify as scientifically sound (not the same as FDA approved).

That chiropractors have good lobbyists that managed to carve out a lucrative regulatory niche doesn't really disprove my theory.

Are chiropractors part of the AMA? Or any of the other sources of medical advice I listed?

Pretty weak “regulation” when you can get a “doctor” to prescribe you herbs and spices for your illnesses. Not to mention the tech startups that hand out amphetamine prescriptions written after an online telegealth visit by remote physician assistants and nurse practitioners (see Cerebral and Done).

There might be some regulation to get paid by Medicare and Medicaid services, and some requirements by insurance companies, but that seems entirely reasonable. There is little regulation on who is allowed to give medical advice.

They have already been experimenting with expert knowledge systems in hospitals for decades. I am not sure what the result of that is but I rarely ever hear of them anymore.

ref: https://en.wikipedia.org/wiki/Expert_system

I’d assume that they are kept vague so that users keep browsing the website and never quite get an answer. WebMD doesn’t benefit if you actually make it to a doctor to look at that sketchy mole.

I suppose there are lots of possibilities, but regardless of steering, fees and visits, a non-expert is unlikely to be able to self-diagnose, read a bit of text, and come up with a treatment plan.

The problem isn't information availability, it's experience and interpretation which is not something you can do on an individual basis 'on the side', hence the expertise requirement. If the subject matter at hand was as simple to deal with as "see X, apply Y, get result Z", then that would be great. But as this is not an exact science, such a method does not truly exist, and therefore cannot be made effective in a listicle on a website or other medium.

  So to summarize: a good version of WebMD would have:
    * structured, quantitative information
    * real-time updates
    * summaries of supporting evidence
  
  So why hasn't anyone done this yet?

They have: https://www.clinicalkey.com/ However, it's for professionals, and it's not free. Only a professional has the knowledge, experience and context to use the information properly. For patients there are separate products/resources that clinicians can use to give patients more information about their case. But the patient can't just diagnose themselves. And certainly the effort of curating the dataset and developing the toolkit to power it isn't free.

Goes without saying, but "Don't google your symptoms." has been an unwritten law of the Internet since Google first became the dominant search engine. WebMD and its knockoffs have been hot garbage for quite some time now.

There's a standup bit, I don't remember who the comic is, where he says, "my elbow was kinda sore after I was playing a bunch of tennis. I looked it up on the internet and oh no! It turns out I have elbow cancer!"

im not sure i see the punchline? theres a group of connective tissue cancers called sarcomas that are often found near knees and elbows.

The joke is that anything medical you search for online you'll end up having your greatest fears validated, rather than get helpful and balanced insight.

Or rather, all online diagnoses are cancer.

yeah they all pander to hypochondriacs and people who suffer from anxiety. Oh and they all absolutely prey on new parents. Never ever resort to the internet as a new parent, just call your pediatrician. As a father of two, i can't stress the previous sentence enough.

Disclaimer, I am the founder of Wyndly (YCW21) -- we fix allergies for life through telehealth and personalized immunotherapy.

WebMD, Healthline, and Verywell Health all monetize off of views. They're exceptional SEO operators, and they know how to game Google. The trick is to find people who aren't monetizing off of just views.

Actually helpful information is coming from services that don't monetize off of views, or where the content is written for more than just SEO. For example, Anja Health is educating people about a novel idea (https://www.tiktok.com/@kathrynanja). At Wyndly, we build trust with our content by having my co-founder answer common questions (https://www.instagram.com/wyndlyhealth/).

These are experts sharing their niche. In fact, we source the questions we answer from our support inbox. So, not only are we putting useful information our into the world, we're creating resources for our support team. It's a win-win.

Side note: yes, we do play the SEO game somewhat. At the end of the day, if we have a successful video, it'd be foolish not to resource it for Google and for people: https://www.wyndly.com/blogs/learn/what-kind-of-doctor-for-a...

I worked for a company that tried to do exactly what this article is proposing, I was responsible for parsing the data from publications into exactly this sort of table.

The primary reason is that it is very hard to come up with a schema that even 5% of papers would adhere to. The vast majority of this knowledge is phrased as natural language.

There are databases that track compounds and the publications related to them, but those papers again are natural language and cannot be readily converted to tabular data. Our first basic approach involved POS tagging and then trying to associate proper nouns with numeric values. Again the issue became how do you interpret a sentence like "may lead to sudden death" as a symptom? Something like "may lead to symptom X in Y% of respondents" is a nightmare to consistently parse without heavy ML running over huge datasets of just text.

In the end we wound up having to shut down concluding that until papers are released with not only arbitrary XML tables/results we were not equipped to handle the task. And even worse, what if our models didn't interpret things correctly and a consumer got {symptom:"sudden death", chance:0%} and insisted on that compound for their indication only to later realize the paper stated "in lab setting 0% of animals didn't experience sudden death after being administered X after diabetes diagnosis". Paying a hundred students to work around the clock couldn't get the volume processed accurately for months, let alone getting a second army of validators to confirm each entry.

In the end the only functional parts that worked algorithmicly are exactly those featured in the GlacierMD demo. What trials are running related to this indication, what compounds are being tested for the indication and what other indications are related.

That's the easy part, it's effectively a word association game, TF-IDF did this job admirably, scoring proper nouns by their uniqueness and then associating them with one another and searching for publications with similar words as the requested indication. Effectively a medical word cloud for each indication and compound. Parsing them into symptoms is the first nightmare, the second is numeric values associated with those symptoms and paper results.

There is a very good reason the demo only has one indication and a handful of symptoms, it's being done manually and then at best showing publications related to the words encountered.

It's not a matter of cost, although the author is all but doomed if they want to cover more than a few indications, it's a matter of not forcing publicly funded health publications to use an electronically parseable Format despite the simplicity of them being able to parse their paper by definition.

See the standards XKCD, the issue is getting many different academics and departments to agree on a set of schema to include alongside their publications. PubMed at least tries with their XML dumps but even those are inconsistent at best and non-syntactically interpretable at worst. The Japanese compound tracker is great to learn about a specific compound and their indications but stops there.

Just make it a condition of funding and they'll probably get on board with machine-readable standards. But the first thing the feds will have to do is fund and do a big competition to define those standards.

WebMD is "awful" because a list of every medical condition with every possible treatment and every possible symptom is totally useless to normal people. When people visit WebMD what they really want is actual, personal medical advice.

The solution isn't throwing technology at it to do "automated evidence synthesis," it's making it easier and more affordable for people to talk to get a consultation with an actual medical professional.

I always figured it was due to liability. WebMD wants the monetizable traffic but not the liability of ya know, providing health care. So they profit off of the user's duress and just recommend they see a health care professional anyhow.

Of all the places Google could send people, WebMD isn't the worst.

Amazon reviews, for example, have lots of terrible medical advice in them. Go to an apricot kernel page and look at the product reviews. I just did and the first review says:

> I have cancer, have not treated it yet but I've started with these. Easy to use, clean fresh product

A few reviews down:

> THE BITTER THE BETTER! And they really are! People need to be more educated about the benefits of the BITTER apricot kernels! THEY MUST BE BITTER in order to kill and prevent the cancerous cells in your body! All you need is 2 kernels a day!

That bitterness is cyanide, right?

I don't have to imagine - Healthline.

it's clearly an SEO game that's cropped up recently, but it's executed in a sustainable way. The articles I stumble on are actually helpful.

For example, there was a recent HN article on research supporting the practice of grounding. So I googled it, and found a Healthline article: https://www.healthline.com/health/grounding#benefits

It clearly explained what it was, why it may have benefits, what a few experts say, risks, etc.

There are ads but barely (for now) - on a recent article on mobile, it's one small banner, and then one in-line ad that doesn't even look like one. It's not a barely-readable dumpster fire like WedMD.

Of course, all roads lead to Rome, so at some point Healthline may look like a dumpster fire as well, so enjoy it while we can!

Someone already mentioned the NHS website, but also the Mayo Clinic's is great [2]. We have a great one run by the Swedish state too [3]. I think the article is wrong that "we accept" them though, they've just SEO spammed themselves over anything that actually is useful. It's not like we vote on search results (yet.) NHS, Mayo Clinic or others that must exist would be top if these assholes didn't scam their way in.

1. https://www.nhs.uk/conditions/

2. https://www.mayoclinic.org/diseases-conditions

3. https://www.1177.se

WebMD is for the general public (GP) and useless on anything you need in depth - helpful for broad inquiry. UpToDate which practitioners use is amazing but too much information for the general public.

It's part of what I mentioned in another comment which is that the internet is to general and vague in its information (and generally low-mid quality) while private information is, sometimes, of higher quality. It leads people who want to learn more about things in a bind where they are limited by the accessibility to good quality information.

Also you don't want the GP to have access to uptodate because they would self diagnose in so many of the wrong ways and wouldn't understand everything.

Looks like UpToDate is $60 a month, or you can subscribe for a week for $20.

They have patient/caregiver subscriptions. I'm not sure if it's the same set of articles that doctors get access to. The ones I use are definitely not written for the layperson, though they do have a whole series of articles written for laypersons "The Basics" and "More Than The Basics" which are designed to be handed out by doctors.

Those prices are for the patient subscription. $20 for temporary access doesn’t seem too bad for medical information if you need it, but most people aren’t going to pay it without trying it out first. Particularly when free info is available.

https://store.uptodate.com/ccrz__ProductDetails?viewState=De...

GP is quite a confusing initialism to use here as GP often means "general practitioner", which is like a family doctor/primary care physician in much of the anglosphere outside of the US.

Ugh, and "family doctor" drives me nuts, I'm not a family, there's just one of me, I just want a general practitioner.

Medscape is what WebMD should be. It targets health professionals but it's a great resource for independent learners.

There are great summaries for every disease and treatment written by doctors and researchers. Summary includes epidemiology, symptoms, causes, prognosis, possible treatments, novel treatments, differential diagnoses, etc.

Given that there are bad professionals in every area, it's a great resource to evaluate if your doctor's diagnosis and suggestions make sense.

Unlike your local doctors, good online resources don't have financial incentive to recommend unnecessary drugs or surgeries where the risks outweigh the benefits.

Medscape is owned by WebMD fyi.

Doctors generally use a service like UpToDate, which I understand is pretty good.

Issues with providing the same quality of service to consumers include:

* Doctors are willing to pay a lot (ex: UpToDate is ~$500/y) and you might not be able to keep such high fees for doctors if you also offered a great consumer-focused option.

* Consumers have a wide range of experience levels, where it's going to be hard to make a page that satisfies both people who know very little and have minimal medical background and others who are looking seriously into their condition.

* Liability is very different when you're writing directly for consumers.

It’s a different service because it’s generally quite technical, and also it has a fairly large editorial team constantly reviewing and updating the content. The ‘simple English’ UpToDate is Wikipedia or the NHS website

Compare WebMD to examine.com

The difference? You pay for examine.com.

The outcome? The highest quality site for information on supplements, vitamins, etc available on the Internet.

WebMD just needs to be good enough for Google.

> The outcome? The highest quality site for information on supplements, vitamins, etc available on the Internet.

This just sounds like snake oil advertising but with the privilege of paying to see it.

There are in fact a lot of supplements that are effective. Magnesium for heart issues, Calcium for bone density, creatine for weight lifting.

There are also a lot of supplements that do nothing. The "snake oil".

Examine exists so that you can use studies to determine which is which.

Snake oil per se is an analogue of fish oil, effective. It's use as a pejorative term dates to false advertising of petroleum as actual snake oil in the 19th century. The biggest problem was it wasn't well processed at the time, and was not really edible like petroleum derivatives can now be made to be.

And I generally don't take it at face value, I accept it as a glitch in English.

> The difference? You pay for examine.com.

Shouldn’t it be "You can pay"? Because I get all the information I need on Examine for free (and checking their paid offering, they seem to have changed from "professionals" to "laypeople" as their target audience, with everything being a guide and behind a clearer interface).

Plot twist (spoiler alert?) - in the last section the author reveals he's got prototype WebMD replacement!

I've been involved in an attempt to do this at a smaller scale, for a specific discipline: https://maxfacts.uk/ – which aims to be a complete resource for patients and professionals in the oral and maxillofacial field. Like WebMD, but up-to-date, properly researched, and very thorough.

The linked article here talks about having structured, quantitive information, but I think this might be an engineer's view on medicine. The reality on the ground is much messier. We tried to give people enough information on medical practice, explanations on the biological/chemical mechanisms, and other resources to make their own informed choices about their treatment and care. For example, trying to explain the mechanics of taste, and texture for eating food so that people can understand what kind of adaptations they can make to improve their quality of life. I think we probably fall short of that goal sometimes because our material is overly technical or scientific but it's a work-in-progress.

A good WebMD would be probability based.

Rather than list all the possibilities, it would calculate in real-time the probability of each diagnosis and show how that probability changes as you add/remove symptoms or possibly even test results.

Even doctors would benefit from this as Bayesian inference is hard and even healthcare professionals generally put too much weight on a single positive test result.

The article does smell a bit like "tech can fix everything" when the problem with WebMD and others is not that they are full of ads or SEO optimisation.

The simple truth is that medical care is more complex than just "headache = paracetomol". Some drugs don't work on some people, others might be more effective but more expensive. Some are not compatible with e.g. pregnancy or other drugs you might be taken.

As for symptom identification, many of us have seen "House MD" and should know that pain + swelling could be any of about 1000 conditions. This is why we still need Doctors.

Sure, us "clever" types might be able to self-diagnose 90% of the time but we need the doctor who can see the pale skin, the yellow eyes, who asks about recent changes in lifestyle or health, things that we could easily miss.

Now if you could encapsulate all of that on WebMD....

I see a lot of people talking about WebMD but not much about the prototype the author made to fix it: https://www.glaciermd.com/

I really love the website, it’s simple, fast, and very useable from a mobile context!

> researchers published eight million new health citations—a 47% increase in all published health knowledge. So why hasn't any of this innovation made online health information even slightly better?

Because the vast majority of this research does not change the current "standard of care" for most health issues that anyone is likely to experience.

Trying to be your own doctor by reading websites is stupid. Doctors go to school for 8 years and many do years more eductation and practial training in a specialty. You are not going to outsmart them by spending 10 minutes reading an article on a website.

If you are sick, see a doctor. If you are not sick, get an annual checkup if it makes you worry less. This isn't so complicated.

Your last paragraph alludes to the gap in MDs, their strength is is in identifying and treating acute conditions that require surface level knowledge of everything.

You will absolutely “outsmart”(ie consistently get better advice) if you are able to find a community of people living with your condition. You will get incredibly in depth reviews of medications, long term results of interventions, management strategies, incredibly updated research analysis.

Anyone who says just to go the doctor if you’re sick has never experienced the hellscape that is chronic conditions.

The line between “we know exactly what is wrong with you and have 6 different treatment options” and getting diagnosed with “something-is-wrong-itis” is paper thin.

No one is more obsessed with their disease then someone suffering from it 24/7.

Fair point, but a long-term involvement with a "community of people living with X" is far different from reading WebMD's article on X.

Just don't expect miracles. Many chronic diseases are poorly understood and don't have effective treatments. Wishful thinking from a support group doesn't change that, and all the website researc in the world won't change that either.

My mom had ALS, we went to local support groups, and it was an utter waste of time, other than having other people to commiserate with.

the best site would be a single page that says "talk to your doctor" vertically and horizontally aligned in a large font.

If you want to read about how not using a certain brand of band-aids means your child is destined to become a serial killer then research medical information online. For medical information the Internet is the last place i go.

Not when a large percentage of Americans can’t afford a visit to their doctor, that disclaimer is only going to be ignored and users will look elsewhere.

Yeah there's a highly restrictive quota, your affording medicine comes at other Americans's expense. Cornered market.

Now if you were to travel to South America or in particular to Cuba that would not restrict health care access to other Americans. On the contrary. They basically all speak English in Chile, accent yeah just deal with it, better than a 50-minute wait for a 6-minute appointment meant to last 20 minutes.

This problem is pretty solved in the Netherlands. https://www.thuisarts.nl is set up by the Dutch federation of General Practitioners and provides good, non-sensationalist information that is guaranteed to be vetted by the likes of the very doctor you'd normally visit (or by the people who train them, I presume - pretty sure if you look up a GP handbook you'll find almost the same text as on that site, only with more detail and with more complicated language).

As other comments hint but don't directly say: the incentives for WebMD are the same as any other website: revenue through ad sales. WebMD is owned by Internet Brands, which is owned by private equity, so of course it's not just revenue, but profit. Any website needs a source of money, just to pay to keep the lights on, much less develop and maintain the content. As long as ad-driven revenue is the incentive, the result will always be perversely steered towards attention-getting content.

Most medical research is junk science that doesn't replicate so any site relying on those studies is probably going to be useless anyway. That could be why the satisfaction is so low.

I'd go further than this and ask why pretty much everything is awful.

This issue comes up a lot when people talk about Google "stealing" content or favoring their own properties. I think there's some merit to this argument and it's worth monitoring but the other side is that Google ends up embedding things in search results because the sites for those things are both trivial and awful.

Example: go Google "mortgage calculator". You will get exactly what you want embedded at the top. Put in the principal, loan length and interest rate and it'll tell you waht the payment is.

Now go click on any of the links on the first page. You will get hammered by ads. You will get pages that split their calculators over multiple pages to get more ad impressions. The whole experience is just plain awful.

So it's no surprise to me that Google just embedded their own for what is really a trivial function. As a user I much prefer that and would hate to see any government action forbid such a thing.

So, WebMD. WebMD is an example of all the bad incentives that make those mortgage calculators terrible. It's all about maximizing ad impressions.

Now I absolutely hate Google AMP but I also understand the motivation for it (even if I vehemently disagree with the solution). So many sites are just plain awful and slow.

Exceptions to the "slow and awful" principle are rare but exist. Stack Overflow is a prime example.

I don't see what the big problem is. WebMD, drugs.com, etc are generally fine for me when I want some quick basic info. Some of the stuff they're complaining about WebMD not having, like percentage of different side effects, are available on other sites like drugs.com. If I want in-depth info, I'll visit PubMed. Sites like NIH, CDC, and FDA can be helpful, but generally not any better than WebMD in regards to format, content, searchability, or precompiled rankings/lists.

To take the example of Aspirin and Essential Oils, NHS has no ads and has information on Aspirin https://www.nhs.uk/medicines/aspirin-for-pain-relief/ , but doesn't have information on Essential Oils. It probably doesn't list supporting evidence because most people don't want to read it and wouldn't understand it.

I don't get the WebMD hate. It's leagues ahead of Healthline.

WebMD is full of doctors. The gov and AMA should be sanctioning doctors for abuse of license if the content is bad.

The atrocious UX isn't helping. Paginated articles, popups, autoplay ads within the well of content... these tactics put you in a bad neighborhood with bot-farm-type sites, no matter how many doctors are involved in the actual content creation.

If you don't use an ad blocker it's your own fault. Paginated articles are not a hill to die on.

I don't really get it either. My biggest complaint is that they tell you to go see the doctor for everything and 9/10 of the time the doctor will tell you to go home and take ibuprofen and see what happens.

I think it's generally possible to tell, based on what's provided on WebMD, what symptoms would cause a doctor to recommend an immediate trip to the ER or surgery or pharmaceuticals. It's required learning more than I would otherwise know about how my organs function, but I also don't think I know like... an exceptional amount about the human body.

Has no one here heard of the Merck Manual?

https://www.merckmanuals.com/professional

Why do scientific studies have such poor user experience?

Partly because they're written to pass peer review, not to inform practitioners or the public.

I want to know one main thing before I read your study - Why should I believe your study? That is: what is the sample size, did you pre-register methods, who funded the study, what type of study is it, etc.

Studies are written for paper publications, but that hasn't been the main distribution method for years.

> Why do scientific studies have such poor user experience?

> Partly because they're written to pass peer review, not to inform practitioners or the public.

Neither you nor the public nor practicioners should be reading "scientific studies". Please remember that the actual value of any one scientific study is practically _zero_. They are only useful to big companies and/or national scientific bodies which actually may have the resources to even try to reproduce them.

This is a very pertinent point, and i speak from experience when I say that if less laymen (and women) tried to read scientific papers on their conditions, real or imagined, the job of a doctor would be easier

If I need information I look for the publications linked from the NIH website.

I think the problems with health information are that the vast majority of the population isn’t sophisticated enough to understand the physiological and biochemical specifics, and that generic info is pretty much worthless.

People should listen to their doctors (who specifically advise against running to google for every symptom)

Doctors can be wrong (they have been for me multiple times) and I feel a certain sense of responsibility for learning about and understanding what is going on in my body. Now, if I had a panel of doctors at the ready to answer my questions and explain things to me in the detail I want, that would be great. But that seems unrealistic. So we do need something to bridge the gap between the fallible doctor we very occasionally get to talk to and our otherwise deep ignorance of our own health and bodies.

>satisfaction with online health information is incredibly low, around 38%

I wonder what satisfaction with offline health information is

Article sums it up as: there hasn't been a better WebMD because the costs of making one have been too high, but new advances promise to draw those costs down, so the author is founding.

Costs might be a factor. But revenue is a bigger one. WebMD and Healthline have flourished because advertisers have an incentive to underwrite them. Symptom checkers for health professionals do well, too—hospitals and medical malpractice insurers have an incentive to pay for provider-focused tools. A comment brings up the UK NHS site—sure, it makes sense that a national health system would have a strong incentive to help people self diagnose.

Do end users have a similarly strong incentive to maintain a subscription to a service like this month after month? Selling direct-to-consumer subscriptions at scale is hard. I wish you the best, but it's tough business.

I wish I could have had a 35% to 40% satisfaction rate with the various actual medical professionals I've dealt with in-person over the years.

I'd say that fewer than one in five such encounters has left me feeling like I got good advice, and a favourable outcome. Even just a 25% satisfaction rate would be a notable improvement for me.

WebMD and hypotheticals like this blog reminds me of a quote from Hamlet:

“There is nothing either good or bad, but thinking makes it so”

I do not think you can make a good nor bad version of WebMD. But what it does today is makes you think about things that you're better off not thinking about.

Health is subjective to start with. It is more qualitative than it is quantitative at the individual level. The exact problem of WebMD is that it uses the latter to help inform the former.

I have got way more answers from old books than I can find online. Especially those on back pain, chronic illness, and even regular headaches. Much of this information is not new and even goes back to the idea that "thinking makes it so".

The real question in my head is whether WebMD does more harm than it does good or vice versa. It's pointless to think about because it is what it is.

In the U.S., MedlinePlus [0] seems to be the best repository for vetted medical information. It's government-backed and links to the relevant organizations where appropriate.

[0]: https://medlineplus.gov

A lot like wikipedia.

Which begs the question: why is wikipedia the best source of medical information online?

Doctors, research hospitals, and the like should be required to maintain best of breed public health information.

Public universities are funded to the level of A TRILLION DOLLARS A YEAR.

Think about that.

A much better WebMD would like like Wikipedia.

Hint: it’s Wikipedia.

It's annoying that google has been forcefully pushing down wikipedia at least for medically related things. I don't want to have to go to the second page to get an article that isn't scared to use a word longer than 6 letters.

If I want information on medically related things, Wikipedia is my go-to. I skip Google (actually, DuckDuckGo) altogether and just start my search on the Wikipedia home page.

I would say that WebMD is better than Wikipedia. Anyone can edit Wikipedia, and in practice this means content often comes from idiosyncratic people with axes to grind. Wikipedia pages vary immensely in correctness, completeness, objectivity, clarity, and usefulness. WebMD, in contrast, is pretty consistent in all those ways; its flaws (wordiness, lack of reference to detailed research, catering to the customer) are of minor consequence to the typical person searching for medical information (we at HN are not the typical person). The best Wikipedia articles are better than the best WebMD ones, but the worst Wikipedia articles are worse, and in medicine it's the floor you care more about.

Merck Manuals, also known as MSD Manuals, can be accessed here: https://www.msdmanuals.com/

This is a fact-based, peer-reviewed, classic manual of Western medicine.

Also, Merck manual consumer version is free to access online. It should be a first stop for medical information.

I gave up on WebMD and its ilk years ago. You get better information by just searching for med literature on google scholar, and you can read anything with sci-hub. Or ask a doctor friend to download a subject page from UpToDate.

Answer: append "mayo" to medical searches

https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

In 10 years, they have never failed me.

tangential resources for nutritional/dietary supplements:

Consumer focus: https://examine.com/ Professional focus: https://naturalmedicines.therapeuticresearch.com/

Both sites maintain nice monographs that curate evidence and provide easy to interpret effectiveness scores.

Natural Medicines database goes even further and maintains a database for commercial products.

I find both incredibly useful for evaluating ingredients and their structure/function effects

Two words: Revenue optimization

Everything free on the web is optimized to maximize the delivery of advertisements and referrals at the expense of everything else. And Google no longer rewards credible sources vs ad-laden garbage.

> And every SEO expert knows that long articles rank higher than short ones, so now "treating covid headache" takes you to a thousand-word article when really I just want short summaries of the top three treatments.

John Mueller from Google has been saying the opposite for years: https://www.reddit.com/r/bigseo/comments/clg1hn/how_to_find_...

> brief feelings similar to electric shock

To be fair, that's a side effect of stopping the medication suddenly. They ought to have worded that better. Happens when I forget to order more of my own preferred SSRI. As far as electric shocks go, it's definitely on the milder end of the spectrum (I suspect most of the commentariat here have some experience with such things) -- more unusual than painful. Sometimes we call them "brain zaps", which would probably sound even worse on WebMD.

The author alludes to subscription services, and I think this is bearing out to some extent. Twitter accounts like https://twitter.com/grimhood are passionate generalist SMEs who take money from Patreon and deliver deep dives into various health topics. We're in the early days, but this guy is basically a subscription preventive health doctor knocking out topics one by one.

The health sector will probably be the last to get disrupted mainly because it is tightly controlled and regulated.

Regulation probably isn't a bad thing in itself but if it isn't used to enforce the status quo, keep control and set prices.

I have this idea that health data should be open sourced, I have no problems with my continuous blood pressure, sugar levels and pulse rate (etc) being used in machine learning to identify clusters that might be useful. Just a thought for now.

I work in Finance in the US, and I think our industry has a good model to build on. The SEC requires a decent amount of information for all sorts of investments and financial entities to publish at various times - everything from IPOs to management changes.

I'm not sure if the FDA/CDC/NIH/etc has anything like this, but they should probably start requiring it and/or providing it.

I think this would go a long way to solving this problem.

I'm an interventional radiology resident near the end of my training. I think Google needs to index the clinician-facing side of UpToDate. It can't right now because it's paywalled.

For those unfamiliar with UpToDate, it is considered the #1 online reference for evidence-based medicine. What they do is write articles that summarize research articles from each domain. They have much more content than this, but it's the expert-summaries that make it a "killer app" for clinicians. We simply don't have time to read all the latest research.

Also, UpToDate is the #1 most expensive subscription that most academic universities pay for (e.g. in terms of journal subscriptions).

Wikipedia exists despite all the barriers to doing so, yet remains generally an accurate and useful source of information that Google ranks highly. A version that's more tailored to health advice doesn't seem so hard to imagine... yet a quick Google brings up no evidence that anyone's tried to create one yet. Why is that?

Like https://www.thennt.com which friends of mine started and tried to monetize – but there's no obvious revenue source for unbiased evidence-based diagnosis and treatment recommendations. Or none that's obvious to investors.

A massive improvement would be listing probabilities of various symptoms. Typically you go to WebMD/similar, look something up, and it includes every possible symptom. This creates low signal to noise and makes it difficult to diagnose and understand risks.

To summarize: a good version of WebMD would have: * structured, quantitative information * real-time updates * summaries of supporting evidence

I'm obviously very biased, but that is exactly what we're building with www.Examine.com

Basically just a big banner page that reads "Yep, you probably have cancer."

And AIDS

Back when I was a kid, my mom had a 1,000 page book that is more or less what this article is asking for. I wonder what ever happened to that book. (Are there newer editions, for example?)

Sounds like the Merck Manual. (see other comments for links)

Unpopular opinion(?): online medical information should be inaccessible to the common person. It should be journal papers full of jargon, behind paywalls, and otherwise restricted. Laymen can't handle medical information. They use it to self-diagnose, or worse, diagnose others. They use it to question doctors because the doctor's advice doesn't match their Google-fu. Ridiculous sites like WebMD make it worse. WebMD will tell you that you have cancer no matter what you search. I sympathize with those in the health care system who are too busy, and those who are waiting for care. But giving the public a bunch of misinformation with which to shoot their feet seems like the wrong approach. (Anecdotal: I live with a Google warrior who distrusts all doctors because they think their understanding of medicine is superior.)

As a doctor I have a brief moment of sympathy with this idea - I've seen far too many patients badly mislead by "Dr Google" - but ultimately I think it is important to provide clear, helpful, and well-targeted health information online for the layperson.

Of course there's no incentive for WebMD to do this, they just want clicks on ads. But in Australia our governments publish a fair bit of helpful health information online, and I do often print some of it out for my patients when they go home. Sometimes it's not enough in itself, but it's great for a "you've got X, here's some info about it" situation.

UpToDate is the medical-grade, actually helpful, for professionals only, quite expensive "Wikipedia for Medicine", I use it every day, among a few other resources. But it's not something you can just open up and use - it's very much designed to be used by people with the right background knowledge - you need to know how to find what you want, and you need to know how to use what you find.

Just watch what happens on every HN article which is about anything possibly medical. One day you have one conclusion, the next day you have the completely opposite conclusion, and the only thing that's common is that the comment section of _both articles_ is filled with people who will readily claim "this worked for me".

One that doesn’t say cancer in the same list as other possibilities every time you try to find out why there is a small issue. It’s a UX/UI issue they can solve

A functional healthcare system irl would be a good start

The first question would be; DO YOU HAVE A F**ING fever? If so treat that first, then call your doctor if that fails, then and only then do you call 911.

Do you have an asterisk missing?

Real world metrics on causes. Totals of cases, known vs unknown cases and a percentage associated to each possible cause based on those variables?

>So to summarize: a good version of WebMD would have

> - structured, quantitative information

> - real-time updates

> - summaries of supporting evidence

>So why hasn't anyone done this yet?

>The short answer: cost.

Money

It's always money

Better WebMd already exists. https://www.cochrane.org/

Something I'd like is a diagnosis tool that worked similar to the software dispatchers use to obtain information from the caller

It would look like an open access UpToDate.

I think it would need to ask more questions. Interrogate the question asker more, like a doctor would

maybe a new wikipedia, where not any tom, dick or harry gets to write/edit articles, but one who is acknowledged as a subject matter expert?

To start with, in each topic, there is a broad expert, and then he creates additional topics, and names experts in this, and so on....

Stopped paying attention at "a 47% increase in all published health knowledge."

Not hardly. Maybe a X% decrease (if Science is advancing), but the amount of garbage, not knowledge, is overwhelming. (Maybe biased memory, but I think every PubMed article that has come up here has been ripped to shreds)

Uptodate.

This is 100% the correct answer - it’s literally what actual doctors use, even while you’re sitting in their office with them as they diagnose you. It’s subscription only though.

Five year survival rates listed for local surgeons across the procedures they perform. Sortable by number of procedures performed, death rates on the table, survival rates.

I don't care how "kind" the physician is, if they listened to my concerns.

I want to know their effectiveness.

How useful would that information be? Seems like a good way to "punish" surgeons that take more difficult cases.

Maybe the patients were crap.

How does the article and comment section not have one mention of liability?

No one gives clear medical descriptions without 10 miles of caveats that water the information down completely. This is because no one wants to be sued for bad medical advice.

it would be run by a publicly-funded consortium of doctors, social scientists, and public health experts with no mandate to earn a profit, for one.

'seo' appears only twice in this but deserves way more blame imo

The life cycle of an article now seems to be 1) legit author in legit place, possibly paywalled, 2) worse copies elsewhere, with or without sources

(I can't say how prevalent this pattern is, but you've seen it too, and if google has any nlp chops at all they are able to measure it in their index)

even bad content doesn't come out of nowhere. an indexing platform that tried to tease out the 'copy of a copy' structure of the web would have a much easier time filtering out the blurry copies.

not saying this is google's job, but they are the architects of the incentive structure here, and are in the best position to fix it if they wanted to

What are they talking about. I'm perfectly happy with WebMD. Well written and accessible articles. Often the first hit in a google search, and rightly so.

Could the OP possibly be projecting a bit here?

Keep it up! Love where you are heading with this!

graph database backend for textmining/associations

I like Healthline

I, and my advisor's lab[1] work in this area. I'm going to focus on the technical aspects of evidence synthesis, as opposed to the business aspects.

There's a difference between symptoms, diagnosis, treatment options, evidence for those, and the audiences for whom these are written. WebMD and friends target a broader market, scientific studies target...scientists and doctors.

I think the hard parts of building a better WebMD (along the article's lines) are:

  - screening articles for relevance. This is more than mere search or finding potentially relevant articles, but also making a decision to include them
  - extracting _structured_ information from the articles. Frequently we talk about Populations/Problems, Interventions, Comparators (interventions), and (medical) Outcomes, collectively PICOs. Extraction of each component is easy. Assembling them is surprisingly hard. Finding equivalencies between them within documents is surprisingly hard. Finding facets or different parts of a treatment (how do you handle combined treatments for a single study? how about when some studies use them and some don't?)
  - establishing equivalencies for your evidence synthesis between documents is even harder: do you care about dosage? combination with other treatments? what happens when a slightly different formulation of a treatment gets used, or a treatment is administered poorly? I don't know of anyone within scholarly document processing community working on analysis of medical methods (possibly ignorance on my part!).

It would be nice if trial preregistration had all these details, but not all trials are preregistered, nor all outcomes published, the aim of the trial can shift, and there's a large pile of literature where this information isn't available.

I think real time updates are the smallest problem among these: solving extraction (including the big structured objects) mostly solves this; the statistics of a meta-analysis are not complicated. To be clear, this is still an issue. I have a figure[2] highlighting the lag.

Presenting the evidence in a digestible, meaningful way, seems like a hard HCI problem to do right, and easy to do poorly. Merely giving PICOs (structured!) and findings is easy and a bad UX for the non-technical, a narrative summary is interesting to provide and hard to do well, and a subgroup analysis can suffer problems from differing group sizes and effectiveness findings (tailoring is tricky).

There are several organizations[3] working on these sorts of problems.

[1] https://www.byronwallace.com/

[2] https://www.semanticscholar.org/paper/MS%CB%862%3A-Multi-Doc...

[3] https://community.cochrane.org/organizational-info/people/st...

not owned by big pharma

I have a story for all of you on this topic, strap yourselves in.

We had the solve for this issue, and we had it back in 2013.

I remember interviewing for a brand new startup as the first employee, the idea was that you had an app/website and got the doctor to add what they told you into this app. I remember sitting there and saying during the interview, something like "That adds stress onto the doctors who are already stressed, you should be giving relief to them, perhaps what we need is something better than google/WebMD so people might not need to come in IF they find their anwser".

So that was what we decided to do, to make a App/Website to give anwsers better than Google/WebMD, verified by doctors on our board.

We called it Your.MD.

It was a symptom checker, it took search queries like google, and ran NLP against that, then asked follow up questions based off the query... It worked really really well.

Then our Chairman punched our first CEO, the CEO left, and we got a second CEO in, he got a couple board seats, and the writing was on the wall.

He brought in some guy from Talking Tom... remember that talking cat app? The new CEO and this guy decided to change the working symptom checker and turn it into a chatbot.... we protested about as much as we could as founding members.. but it fell on deaf ears..

We were forced to destroy something that worked perfectly for the abomination that became what Your.MD was...

The CEO fired us all... well he tried, but labor laws are amazing here in Norway, so I got a nice exit.

The CEO installed himself as the "Founder" on everything including the Wikipedia page.. I think the company has some new name now.. dunno don't care.

But yeah.. We had the solve for this, the problem was always that people google things, and google isn't great (read terrible) at this problem, and WebMD suuuucks because .. well this article says it better than I could.

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