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Online Buyers Beware: A Warning for Physicians and Patients
The American Journal of Medicine (2006) 119, 623
COMMENTARY
Online Buyers Beware: A Warning for Physicians and Patients Recently, I was reading Friends, Lovers, Chocolate, the latest offering from one of my favorite authors, Alexander McCall Smith.1 In this novel, a character who has undergone a heart transplant experiences recurrent frightening visions of a threatening face. This character and the heroine, amateur detective Isabel Dalhousie, discuss the possibility that the phenomenon results from something that they call “cellular memory.” Since I was unsure about what cellular memory entailed, I began an Internet search, exploring the term “transplantation: cellular memory” on both Google and PubMed. These two searches turned up remarkably different results! The PubMed search culled the literature for articles pertaining to the ability of immune-competent cells to remember antigens. Typical offerings included such articles as “Age dependent incidence, time course, and consequences of thymic renewal in adults”2 and “CD28 costimulation independence of target organ versus circulating memory antigen-specific CD4⫹ T cells.”3 In contrast, the Google search produced something more akin to what McCall Smith was referring to in his novel. Among the results was a skeptical article referring to cellular memory as a speculative notion that human somatic, nonneural cells contain information about personality traits, as well as memories of specific events that occur during a lifetime. Supposedly, these recollections could be retained by the cells even after they are transferred into another person during organ transplantation. In this version of cellular memory, someone with a transplanted heart could receive also the persona, memories, and visions that once belonged to the heart’s former owner. This rather unique and revolutionary attitude was described in a variety of the Google records. As might be expected, the Skeptic’s Dictionary (www. skepdic.com) took a very dim view of this notion, concluding that if such cellular memory transfers were possible, then an individual might grow a beak after eating too much chicken! A number of cardiac transplant surgeons and cardiologists also scoffed at this notion of cellular memory, attributing their patients’ seeming familiarity with incidents and emotions from a stranger’s life to other factors, such as drug effects or postoperative delirium. At the same time, a number of New-Age websites embraced this version of cellular memory, describing occasions 0002-9343/$ -see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2006.06.015
on which alleged memories were the result of messages transported into a transplant recipient’s body along with the DNA contained in heart muscle cells. Some sites went so far as to claim that even memories of events from “past lives” were transplanted along with the heart (www.healpastlives.com/ future/rule/rucelmem.htm). Needless to say, I was not convinced by the New-Age entries. What I find most extraordinary about my two searches was the tremendous disparities in material that popped up on my computer screen despite using the same query. As physicians, we have all had patients bring in printed Internet material concerning their own illnesses. Often, these excerpts contain exaggerated therapeutic or diagnostic claims that are completely at odds with current concepts of disease pathophysiology and therapeutics. Repeatedly I have had to explain to these patients the unreliability of their Internet sources, thereby consuming valuable time that could have been spent discussing valid concerns. As a result of my recent Internet searches, I now inform all of my patients that much of the health information available on the Internet is unscreened, unconfirmed, and therefore, undependable. I recommend that if they do wish to find out more information about their disease that they employ reliable websites, such as those sponsored by informed and intellectuallyobjective groups—for example, the American Heart Association, the Mayo and Cleveland Clinics, WebMD, and various university websites. Truly, the ancient Roman warning, “caveat emptor”—let the buyer beware—must be applied to Internet sources of so-called medical knowledge, just as it should be with the purchases of goods or services. Joseph S. Alpert, MD Robert S. and Irene P. Flinn Professor of Medicine Special Assistant to the Dean University of Arizona College of Medicine Tucson
References 1. McCall Smith, Richard. Friends, Lovers, Chocolate. New York: Pantheon Books, Random House, Inc.; 2005. 2. Hakim FT, Memon SA, Cepeda R, et al. Age-dependent incidence, time course, and consequences of thymic renewal in adults. J Clin Invest. 2005;115:930-939. 3. Fontenot AP, Gharavi L, Bennett SR, Canavera SJ, Newman LS, Kotzin BL. CD28 costimulation independence of target organ versus circulating memory antigen-specific CD4⫹ T cells. J Clin Invest. 2003;112:776-784.
COMMENTARY
Online Buyers Beware: A Warning for Physicians and Patients Recently, I was reading Friends, Lovers, Chocolate, the latest offering from one of my favorite authors, Alexander McCall Smith.1 In this novel, a character who has undergone a heart transplant experiences recurrent frightening visions of a threatening face. This character and the heroine, amateur detective Isabel Dalhousie, discuss the possibility that the phenomenon results from something that they call “cellular memory.” Since I was unsure about what cellular memory entailed, I began an Internet search, exploring the term “transplantation: cellular memory” on both Google and PubMed. These two searches turned up remarkably different results! The PubMed search culled the literature for articles pertaining to the ability of immune-competent cells to remember antigens. Typical offerings included such articles as “Age dependent incidence, time course, and consequences of thymic renewal in adults”2 and “CD28 costimulation independence of target organ versus circulating memory antigen-specific CD4⫹ T cells.”3 In contrast, the Google search produced something more akin to what McCall Smith was referring to in his novel. Among the results was a skeptical article referring to cellular memory as a speculative notion that human somatic, nonneural cells contain information about personality traits, as well as memories of specific events that occur during a lifetime. Supposedly, these recollections could be retained by the cells even after they are transferred into another person during organ transplantation. In this version of cellular memory, someone with a transplanted heart could receive also the persona, memories, and visions that once belonged to the heart’s former owner. This rather unique and revolutionary attitude was described in a variety of the Google records. As might be expected, the Skeptic’s Dictionary (www. skepdic.com) took a very dim view of this notion, concluding that if such cellular memory transfers were possible, then an individual might grow a beak after eating too much chicken! A number of cardiac transplant surgeons and cardiologists also scoffed at this notion of cellular memory, attributing their patients’ seeming familiarity with incidents and emotions from a stranger’s life to other factors, such as drug effects or postoperative delirium. At the same time, a number of New-Age websites embraced this version of cellular memory, describing occasions 0002-9343/$ -see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2006.06.015
on which alleged memories were the result of messages transported into a transplant recipient’s body along with the DNA contained in heart muscle cells. Some sites went so far as to claim that even memories of events from “past lives” were transplanted along with the heart (www.healpastlives.com/ future/rule/rucelmem.htm). Needless to say, I was not convinced by the New-Age entries. What I find most extraordinary about my two searches was the tremendous disparities in material that popped up on my computer screen despite using the same query. As physicians, we have all had patients bring in printed Internet material concerning their own illnesses. Often, these excerpts contain exaggerated therapeutic or diagnostic claims that are completely at odds with current concepts of disease pathophysiology and therapeutics. Repeatedly I have had to explain to these patients the unreliability of their Internet sources, thereby consuming valuable time that could have been spent discussing valid concerns. As a result of my recent Internet searches, I now inform all of my patients that much of the health information available on the Internet is unscreened, unconfirmed, and therefore, undependable. I recommend that if they do wish to find out more information about their disease that they employ reliable websites, such as those sponsored by informed and intellectuallyobjective groups—for example, the American Heart Association, the Mayo and Cleveland Clinics, WebMD, and various university websites. Truly, the ancient Roman warning, “caveat emptor”—let the buyer beware—must be applied to Internet sources of so-called medical knowledge, just as it should be with the purchases of goods or services. Joseph S. Alpert, MD Robert S. and Irene P. Flinn Professor of Medicine Special Assistant to the Dean University of Arizona College of Medicine Tucson
References 1. McCall Smith, Richard. Friends, Lovers, Chocolate. New York: Pantheon Books, Random House, Inc.; 2005. 2. Hakim FT, Memon SA, Cepeda R, et al. Age-dependent incidence, time course, and consequences of thymic renewal in adults. J Clin Invest. 2005;115:930-939. 3. Fontenot AP, Gharavi L, Bennett SR, Canavera SJ, Newman LS, Kotzin BL. CD28 costimulation independence of target organ versus circulating memory antigen-specific CD4⫹ T cells. J Clin Invest. 2003;112:776-784.