Once upon a time, in my academic career, I worried that inaccurate mass media depictions of, say, diabetics would cause people to make bad care choices. If you’re thinking of Julia Roberts in Steel Magnolias right now, trust me: Julia Roberts in Dolly Parton’s hair salon is the tippy-tip of the iceberg. Now I worry more about YouTube, the modern-day Library of Alexandria of instructional videos.

In the past year or so I have watched YouTube videos, off the top of my head, to learn to: change a blinker bulb in my car, fix my thermostat, learn to run specific reports within Quickbooks, refresh my memory on how to do certain math problems for helping with my daughter’s homework, and shut off the “move to wake” feature in my iPhone. And dozens more.

But I’ve also used YouTube in the past to remind myself how to reduce my son’s dislocated elbow (my son’s orthopedic history gets more complex by the year). There’s an old saying in medicine: “see one, do one, teach one.” I needed to “see one” again before I subjected my son to it. The procedure was successful, for what it’s worth. (Being a doctor’s kid is weird. I digress.) Are you scheduled to have your thyroid gland removed? YouTube can show you the procedure. Are you a new type 1 diabetic who wants to practice carbohydrate counting for insulin dosing? Boom. Starting chemotherapy and interested in using cooling therapy to reduce hair loss? Look no further. Recently we talked about the reliability of physician rating sites (spoiler: potentially useful, but with major caveats). How do YouTube videos stack up for general medical information? For the purposes of this post, I’m mostly ignoring obvious conspiracy-mongering about COVID vaccinations, cholesterol medications, and whatnot. Like pornography, I trust that you’ll know those when you see them.

To get an answer on the accuracy and utility of YouTube videos for medical inquiry, I looked not to YouTube, but to PubMed, the search engine of the National Library of Medicine. Here’s what I found:

YouTube contains so much information that investigators tend to categorize it by learner, generally either medical trainees or the general public. Videos for medical trainees seem to be relatively generously reviewed by researchers. Using our example of thyroid surgery from above, one study found that most YouTube thyroid surgery videos were posted by surgeons operating in academic institutions, which they took to mean the intentions of the videos were purely educational and not promotional. But the researchers also noted that surgeons who had no history of traditional academic publications–i.e., not necessarily the most respected people in the field–posted the majority of surgeon-sourced videos. This led the authors to conclude that “Trainees and educators alike should critically analyze the quality of video content,” which is the academic equivalent of throwing shade. A systematic review of studies of YouTube videos aimed at medical learners backed this up, concluding that “While videos authored by academic physicians were of higher quality on average, their quality still varied significantly,” and “Video characteristics and engagement metrics were found to be unreliable surrogate measures of video quality.” That is, a video’s slick production and millions of views did not mean it was accurate.

Videos aimed at the general public tend to be more harshly judged. One study by two emergency room doctors investigating the quality of videos pertaining to the management of low blood sugars went so far as to say that “health videos should only be uploaded by physicians,” a statement hilarious in both its confidence and its wrongness. Surely someone without a medical degree somewhere, at some point, has been filmed saying something accurate and helpful. But, in general, the quality of public-facing YouTube videos does appear to suffer in comparison to professional learner-directed videos. A systematic review from 2015, admittedly ancient history in internet years, concluded that “YouTube contains misleading information, primarily anecdotal, that contradicts the reference standards and the probability of a lay user finding such content is relatively high.” But, on the bright side, they also found that “videos from government organizations and professional associations contained trustworthy and high-quality information.” We at KBGH, who have produced and posted videos of our own, hope that we fall into that category.

Let’s bottom-line what we can take from this research. First, beware of any video that makes claims that seem extraordinary. Someone who says that removing a food from your diet is as powerful as taking cholesterol medications for preventing heart attacks, for example, better have good evidence to back that statement up. Second, pay attention to the source. Videos from academic centers, government agencies, and professional associations appear to be the most reliable. But they’re also, I suspect, the most conservative. Few such organizations are willing to put themselves out on a limb compared to their peers. Finally, beware of using the number of views or shares as a marker of the reliability of a video’s contents. As we’ve discussed before in this very blog, the internet is set up to make sure the most radical statements get the most eyeballs.

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.