You may have noticed that Dilbert, the cubicle-dwelling office worker that I
created in 1989, doesn't have a mouth. At first, I didn't see any
significance to this. But now I wonder whether the way I drew him forecast
my future.
A few years after I launched Dilbert, I contracted a neurological movement
disorder that caused involuntary muscle spasms in my drawing hand, and only
my drawing hand. I'd look at my fingers and tell them to do one thing, and
they'd do jagged things instead. It was focal dystonia, more commonly known
as severe writer's cramp, brought on by overuse of the hand. My doctors
managed to provide a diagnosis quite quickly but couldn't provide a cure,
apart from changing my job, which was unthinkable.
At first I sidestepped the problem by drawing with my left hand. Meanwhile, I
continually practised touching pen to paper with my right hand, pulling back
just before the spasms started. I did this for months, gradually building up
the time I could last before a spasm until one day, somewhat suddenly, I got
back full function in my hand.
About ten years later I overused my drawing hand again and the problem
returned. As a quick fix I found I could draw directly to a special computer
monitor using a stylus, which changed the way I drew just enough to avoid
triggering spasms. The spasms stopped, and since 2003 Dilbert has been drawn
on the computer (in about half the time it used to take). Then in spring
2005 I lost my voice. It started with my usual seasonal asthma and allergy,
and developed into what I thought was laryngitis. The best I could manage
was a hoarse whisper, but it went on for months. My doctors suspected
bronchitis and then acid reflux, and then an ENT specialist said he could
find no growths and that everything was structurally OK. The doctors were
checking for the conditions that were the most likely culprits. But they
were baffled.
I was beginning to despair. I can't tell you how lonely having no voice makes
you feel. It's like being a ghost in the room because you can't participate
in anything socially. Then, about six months after I'd first lost my voice,
I woke up wondering if my speech problem might be related in some way to my
hand problem. So I typed “voice dystonia” into Google and up popped a link
to a video of a person speaking in a damaged voice that I immediately
recognised as the same as mine. The search had taken me straight to a page
that identified the condition as something called spasmodic dysphonia, which
is, as it happens, a vocal form of dystonia. It's where the vocal cords
clench, making you unable to speak.
I told my wife and doctor that I thought I'd found what I had, and they were
sceptical. But I found my way to a specialist in that condition, who
confirmed that I had it. Unfortunately, I still couldn't find a cure. The
specialist tried the standard treatment, Botox shots to the vocal cords,
which forcibly relaxes them. This was unpleasant and had limited success. I
also spent a week with a voice expert, trying a voice training technique
that had cured some. It helped, but I was far from fixed.
My cure came via the internet. About a year ago I started using Google alerts
to tell me whenever someone mentioned Dilbert, me, or anything about
spasmodic dysphonia on the internet. Then, six months ago I got an alert
with a link to an obscure medical publication with a report about an even
more obscure surgical procedure for fixing spasmodic dysphonia, developed in
Japan. I took that information to my doctor, who thought it wouldn't be
right for me but referred me to an expert at Stanford University who might
know more, who, in turn, recommended a different type of surgery being
conducted by an expert surgeon at UCLA. This surgery had a good track
record, especially recently.
The operation wasn't pleasant. It involved opening up the neck, cutting the
nerves linking the brain to the vocal cords and splicing in nerves from
another area of my neck. But I was desperate and I went ahead.
Within four months my voice was back to normal, and it remains good. I never
would have found that path without Google alerts. It makes me wonder how far
the Dr Google trend can go and what impact that can have on society's
medical costs. I have used the internet dozens of times to diagnose various
minor medical problems: if you have a mole or a bite or some toe fungus, you
can compare it with internet pictures, and ask what type it is, and whether
it's dangerous. I particularly use WebMD, which allows you to check your
symptoms.
It makes sense that we should use the internet more to diagnose our problems
and to find treatments because a doctor has only so much time in a day, and
there's no way one doctor can be an expert in everything. Doctors are always
going to be much better at spotting and treating things they see every week
than those they'll see three times in their career.
Obviously there are plenty of examples when seeing a doctor is better than
using your own flawed judgment plus the internet. But aren't there just as
many or more cases where using the internet gives you a better result?
We're not talking about emergency room or trauma situations where a doctor is
obviously the best solution. I'm talking about all the trips to see the
doctor when you essentially say: “Something hurts. What is my problem? Do
you have a pill for that?” If the problem is uncommon, as with my spasmodic
dysphonia, maybe Google or WebMD can do a better (faster, cheaper) job than
a doctor, especially if you can call up videos of people with identical
symptoms. Are you any worse than your doctor at looking at high-definition
pictures of a skin problem and comparing it to your own skin problem?
Common problems, too, may become as easy to diagnose yourself as by going to
the doctor. I'm imagining someday that you can buy a home kit that takes a
picture down your ear or throat and puts it on your computer for easy
comparison to stock medical pictures. If WebMD asks the same questions
online that your doctor will ask in person, an intelligent person is going
to get an answer there rather than visit a doctor. The doctor won't be so
pushed for time as a result, and the patient won't have to wait so long to
get an answer - and timing in health matters a lot.
The hard part is weeding out the con artists and drug companies when you do
your search, but you have to compare the costs and benefits. In the US, huge
numbers of people don't have healthcare. Sure, sometimes the information on
the internet will be wrong, but that can still be better than no medical
help at all. I don't think it will be too long until Google is your new
doctor.
Scott Adams's new book Dilbert 2.0 (Andrew McNeel, £50) is available for £45,
free p&p. Phone 0845 2712134; timesonline.co.uk/booksfirst.
www.dilbert.com
Should you use the internet to get health advice?
5 pros
1. Your GP is a generalist, not an expert. The internet provides a vast array
of specialised expertise and Googling can tap you in to that.
2. It also helps you to access patients' expertise,allowing you to compare
symptoms/experiences. Each article provides clues and search words to
explore, allowing you to burrow deep.
3. A study in the British Medical Journal found that self-diagnosis via the
internet can be reasonably accurate; 15 out of 26 people studied came up
with the correct diagnosis.4. Googling makes sense because only you know how
you feel. Good doctors recognise that you can help them, especially in
finding treatments for conditions they may know little about.
5. The growing sophistication of internet tools (alerts, advanced searches)
and internet users' increasingly sharp bullshit detectors, means that
trawling for health information is not the minefield it once was. Soon we'll
be able to sort search results even more rigorously, and tailor them to our
own health record.
5 cons
1. Diagnosis is tricky. Comparing your rash with an online photograph is
likely to lead you up the wrong track because appearance provides only 10
per cent of the information needed to provide a diagnosis. No two people
suffer the same condition in the same way.
2. Doctors take into account your appearance, history, state of mind, words,
etc, in making a diagnosis. No computerised symptom checker (such as those
provided in www.WebMD.com or NHS Choices, www.nhs.uk)
will equal a complex professional assessment.
3. Many websites have an interest in misleading you. Some masquerade as
patient information or self-diagnosis sites, when, in fact, they are
marketing drugs, supplements or treatments.
4. The internet feeds itself. Myths get repeated over and over again, simply
because one website copies information from another.
5. The British Medical Association has warned that consumers should not seek
online advice from doctors, because if something goes wrong they have little
protection or follow-up.
5 tips
1. Don't take anything you find on the internet at face value; check against
other sources before believing anything.
2. Look for reliable sources of information. The most obvious are charities or
health organisations you've heard of. Look for clues about whether the
information is from a cranky source: blogs, discussion boards and websites
with names such as “toothpastekills. com” are less likely to be coolly
scientific than websites from educational bodies ending in ac.uk or
government bodies ending in gov.uk. But the latter are less likely to yield
anything new.
3. Consult your doctor before acting on anything you find on the internet.
4. Don't underestimate the value of talking to people. The internet is a good
starting point, but doctors and charity helplines will help you to put what
you've found in context. If your doctor refuses to talk, it may be time to
find another doctor.
5. Know your technology. If you use advanced search features, you're more
likely to find the information you need.
SIMON CROMPTON
