spinofflive
Dr Google is useful, up to a point. (Photos supplied, additional design by Tina Tiller)
Dr Google is useful, up to a point. (Photos supplied, additional design by Tina Tiller)

InternetJanuary 15, 2024

Can you trust Dr Google to diagnose your skin condition?

Dr Google is useful, up to a point. (Photos supplied, additional design by Tina Tiller)
Dr Google is useful, up to a point. (Photos supplied, additional design by Tina Tiller)

Tools like Google Lens and DermAssist have some real benefits, but can also confuse and misinform. Are they worth using?

A few weeks ago I caught my son scratching furiously at his leg and was horrified to find a large cluster of raised red bumps on his inner thigh. So I did what every human with a smartphone would do: turned to Dr Google. 

But rather than typing a description of the offending rash into the search bar, I used the camera to snap a picture for image recognition technology Google Lens. The app immediately offered up a range of photos and links to click for further information. The top result, and the one that visually matched the problem area, was some yuck-sounding skin condition called molluscum contagiosum, which the suggested reading material informed me is a relatively harmless poxvirus similar to warts. It’s very common in children, apparently, and would supposedly resolve itself without the need for intervention.

My son has an annoying fear of medical professionals after being held down for a blood test as a toddler, so avoiding the drama of an unnecessary doctors’ visit seemed compelling. But could I trust what Google had to say? 

Dr Google is always unsettling.

I asked my newly-retired GP father (whom I affectionately call “Dr Dad”) for a second opinion, and was surprised when, after a quick look and feel of the rash, he confirmed the internet’s diagnosis and prognosis. A late-adopter of new technology and someone who is a little suspicious of the way AI is silently creeping into many facets of modern life, I began to wonder if, in this instance, the tech behemoth did have something useful to offer. 

Google Lens (available for both Android and iOS) came out in 2017, and allows users to search what they see with their camera rather than relying on words to describe what they are looking for. If you see someone wearing a top you like or don’t know if a plant in your garden is a weed, simply take a photo and the app will offer you suggestions on where to buy and whether or not to remove. 

Google was already seeing billions of skin-related searches each year, so they expanded their reach to include dermatology in 2023, encouraging people to upload their skin woes for their image recognition technology to identify. And this is just the beginning. GoogleHealth is currently testing a tool called DermAssist that the company claims recognises hundreds of skin, hair and nail conditions (including more than 80% of the conditions seen in clinics) with better accuracy than primary care physicians and nurse practitioners. 

Skin conditions are the number one presentation to GPs in New Zealand and family doctors can usually treat the majority of minor cases. But with minimal dermatological training and a myriad of possible conditions of varying severity, they do often refer their patients on for specialist care. There are only 75 dermatologists in the country, and wait times in the public system currently sit at around six months. 

Dr AJ Seine was happy to give Google Lens a trial run. (Photo: supplied)

The tool we are carrying around in our back pockets could be seen as a way of improving access and helping a system under strain, but before we let robots come for the doctors’ jobs, it is worth exploring whether AI can replace the knowledge and skill of qualified skin specialists who have completed 13+ years of study.

One of these highly trained doctors is Dr AJ Seine, a consultant dermatologist in the Bay of Plenty who sees hundreds of patients every year with a range of skin conditions from ringworm to rosacea, shingles to skin cancer. Dr Seine typically spends 20-30 minutes with each new patient, taking a detailed history that includes a timeline and description of symptoms, pre-existing conditions and what medication they are on, before doing a thorough physical examination. 

He sometimes uses a UV light or dermatoscope to help him see what may not be visible to the naked eye, but points out that visual representation of a skin condition is only one part of the diagnostic process. “Sight alone cannot encompass all the nuances required for accurate diagnosis and treatment,” he says. 

‘If you value The Spinoff and the perspectives we share, support our work by donating today.’
Anna Rawhiti-Connell
— Senior writer

Dr Seine always feels for texture and thickness to understand what is going on underneath the skin, and will often take biopsies to help with diagnosis. Once he has reached a satisfactory conclusion, he will talk his patient through their options and come up with a personalised treatment plan.

It all sounds far more complicated than scanning a patch of skin with a smartphone, and I was curious how Google Lens performed, so Dr Seine was happy to give the technology a test drive on three different patients (admittedly not the largest sample size, but interesting nonetheless). 

First up was a fair-skinned adult with psoriasis, a rash that, despite being fairly common, Google Lens could not find a visual match for.

The second test subject presented with dry skin, an itchy rash on his back and a history of eczema as a child. Dr Seine did a spot diagnosis of eczema (that he would expect any GP to correctly identify), but Google Lens offered up three possible options: eczema, psoriasis or post inflammatory hyperpigmentation. All are very different conditions that are potentially treated in different ways. He worries that being unable to offer up conclusive identification may lead a patient down the wrong path of trying incorrect, over-the-counter medication that could actually have a detrimental effect on the skin. 

Self-diagnosis is not recommended.

He did, however, see some value in the fact that Google narrowed it down from hundreds of potential skin conditions to only three, for the user to go and research more thoroughly. Dr Seine himself uses the search engine as a starting point for rare presentations, but he knows to only rely on peer-reviewed journal articles and clinical trials that support evidence-based medicine. 

If everyday people are going to use Google, he urges them to make sure they are using reliable sources like DermnetNZ – run by local dermatologists who ensure the information is accurate, unbiased and up to date – and to avoid reading what the general public have to say, which can be alarmist when taken out of context. “People will often post about the worst case scenario,” he says, “because that is what has most affected them or will get the most interest.”

Dr Seine’s third patient was a Māori man with a large scar on the back of his head that he diagnosed as acne keloidalis nuchae, an inflammatory condition around the hair follicle on the scalp. But Google suggested the autoimmune condition alopecia areata that causes patchy loss of hair instead. 

Dr Seine wonders if the patient’s ethnicity may have had something to do with this misdiagnosis, and explains that conditions with inflammation that are easily visible on Caucasian skin are often less discernible on darker skin tones, which can lead to delayed diagnoses, even by experienced specialists.

Google Lens can be less accurate on darker skin tones. (Photo: supplied)

One of his major concerns with the use of AI in dermatology in New Zealand is that the algorithms can have built-in biases and a lack of data powering them. “What has gone into these deep learning systems that reflect our diverse population, and does it have sufficient quantity to be able to reliably diagnose?” he says. “I don’t know how they can have enough photos of Māori skin … I know that my colleagues and I sometimes struggle with skin of colour, so I worry about an online tool doing the same thing.”

But Dr Seine’s biggest concern is the potentially devastating consequence of incorrect identification around moles and skin cancers. We (with Australia) have the highest rates of skin cancers in the world – so common, in fact, that he diagnoses between five and 20 every day – and what is worrisome is that fair-skinned New Zealanders have a lot of sun damage that can make them harder to detect. “My concern with AI is about its ability to diagnose skin cancer, and not falsely reassure someone that their mole is fine”. 

Around 300 Kiwis die of melanoma every year, so the stakes are high. When a patient presents with a questionable mole, unless he can categorically say it is completely harmless, he will take a biopsy. “If in doubt,” Seine says, “we need to know.”

Google Lens does come with a disclaimer that says use of the tool doesn’t replace a medical diagnosis, but there is a risk that patients with low health literacy, particularly those struggling to pay for healthcare or desperate for answers, might take the guidance as an accurate diagnosis and avoid a visit to the doctor. 

Seine points out that visual representation of a skin condition is only one part of the diagnostic process. (Photo: supplied)

While he has never had a patient report using Google Lens specifically, Dr Seine says that the use of the search engine is common. Many of his patients look sheepish when admitting they have Googled their symptoms, but he is happy they are actively involved in their care and always open to hearing what they have discovered before investigating himself. “Google is part of everyday life and I need to accept it to have a proper therapeutic relationship with my patients,” he tells me.

But people should always approach information obtained online with a healthy dose of scepticism, he adds, stressing that it should never replace professional medical advice. This is particularly important for anyone whose rash is rapidly changing, coming out in blisters or is making them feel unwell. “You don’t need to be sitting there on Google looking at what it might be,” he warns about those cases. “You need to get yourself seen.”

Back to my son’s leg. I followed the advice given to me by Google and Dad to not treat the molluscum, and am pleased to report that the angry red rash has started to calm down – as have I. Photos I found online of the unsightly bumps infecting mouths and eyes sent me into a spin, with my overactive imagination picturing my son’s beautiful face forever scarred by the dreaded pox. While the reputable DermNet NZ website did advise that it is contagious, it didn’t say that spreading to the face is very uncommon – I had to learn that nugget of wisdom from Dr Dad instead. 

So, it seems that in my short dalliance with Dr Google (dermatologist), the machine managed to inform but failed to reassure. For that, I needed the human touch. 

Keep going!
Image: Archi Banal
Image: Archi Banal

InternetJanuary 11, 2024

Why it’s so hard to quit Facebook Messenger

Image: Archi Banal
Image: Archi Banal

Summer reissue: The messaging app is ubiquitous even among people who go out of their way not to use Facebook. But with Meta signalling that Messenger may be folded back into Facebook proper, where will everyone go? Shanti Mathias explores in the final instalment of a series about how we use Facebook today

First published on July 26, 2023.

When I was 14 I had to have a Facebook account. I needed it to post pictures I’d taken on my digital camera, of the school dance and a camel I saw. I needed it to see which other people my friends were friends with. I needed it so I could spend an afternoon leaning over my sister’s shoulder by the family computer in the living room, convincing her to tell her crush that he was “skux”. I liked the weird power trip in responding to friend requests: delineating who counted as a friend and was therefore worthy of things like the artsy photo of my eyes with the colours enhanced on picmonkey.com which had taken me an entire afternoon. When I started a blog, I would post links to the things I wrote on Facebook, convinced that my friends would want to read them. Sometimes they did. 

All of this dates me, of course; the way that Facebook enmeshed with my life as a teenager, the time I spent thinking about it was not because I was particularly internet-obsessed or popular. Instead, regular use of Facebook seemed normal; it was what everyone around me was doing. 

I’ve spent the past two months trying to figure out what Facebook means now; all those semi-active accounts as the parent company has pivoted to the metaverse, then to AI. From the headlines in business publications, Facebook might seem to be forgotten. Certainly my younger siblings and cousins aren’t coming home from school to log into the shared computer to see what is happening on Facebook. They’re scrolling Instagram, maybe; absorbed by YouTube and TikTok, certainly. Meanwhile, Facebook itself plods on. It’s still there. It still has millions of users, around three million in this country. 

And the reason those users haven’t all fled to new platforms is that despite the privacy controversies, despite the company’s wholesale determination to eliminate news from its business, despite the misinformation, despite Cambridge Analytica, despite the newsfeed increasingly stuffed with ads, Facebook is still useful. For some people, there’s the thrill of a good deal snapped up on Facebook Marketplace. For others, there’s the fact that it’s still one of the easiest ways to invite real people to your event. For others, there’s the camaraderie of Facebook groups – people who you don’t need to know in real life to share interests or hobbies. 

four different phones with colourful overlpping text bubbles
Facebook Messenger: where all your friends are (Image: We Are/Getty)

And then there’s Messenger. I tell myself I could give Facebook up – I could abandon the newsfeed, the cringe photos of my teenage self, the abundant deals of Marketplace, the weird groups I’ve discovered focused on map projections and the slim possibility of being invited to events – but then I think of Messenger. After a few years of living room Facebook sessions, I finally got a smartphone. I never downloaded the Facebook app on it, but I immediately got Messenger, which was separated from Facebook in 2014. Those days might be ending. In March, Meta said that there were plans underway to integrate Facebook and Messenger again. “We’ll build more ways to integrate messaging features in Facebook over the coming year,” head of Meta NZ, Spencer Bailey, confirmed to The Spinoff. 

A brief history of Facebook Messenger

When I first downloaded Messenger, I wasn’t thinking about the history of the product as a way to make people more dependent on the Facebook platform. But Facebook’s executives – there has been a separate role for “head of Messenger” since at least 2015 – were. While Facebook has had messaging as part of its product since 2008, Messenger was created to “reduce the friction of messaging,” said Mark Zuckerberg in a Verge interview at the time. It did so by making it impossible to read Facebook messages on mobile without the app. Quickly growing to billions of users, the Messenger app was largely considered a great success as its parent company (then called Facebook, now called Meta) wanted messaging to become an all-encompassing platform

Some of that ambition has become obvious in the years since. Messenger has billions of users, yes. It also has a “stories” function, Marketplace connectivity, community group chats with members of Facebook groups you’re in, the ability to message businesses, photo filters, emoji reactions and much more. While WhatsApp, also owned by Meta, offers most of the same functionality, WhatsApp is largely an app that relies on you knowing people’s phone numbers. In a similar way, Instagram messaging may require you to know someone’s handle, since not everyone lists their name on their profile. But with Messenger, all you need to know is their name. It’s monetised, too: there are advertisements nestled among your messages to your friends. 

a romanian woman wearing a tan jacket with long brown hair
Loredana Crisan, head of Messenger at Meta (Image: Meta)

There’s so much functionality that Facebook had a “Messenger Lite” app for several years – all Messenger and none of the mess – for people who had phones with less processing power and smaller data plans. There’s also a Messenger Kids app with parental controls. 

The difficulty of disconnecting

“Facebook has a powerful role in constructing intimacy,” says Alex Beattie, a researcher at Victoria University of Wellington who has researched what disconnecting means in a digital world. Ten years ago, Beattie deleted his Facebook account, but he downloaded an archive of all his data first, including some of the first messages he had exchanged with his partner. “That valuable information disincentivises you from disconnecting,” he explains. As you scroll through Facebook messages, for instance, you’re able to see the people who you contact regularly at the top, along with the most recent message you sent them, a reminder of who you are most close to. 

The personal connections with people you know well over messaging apps are a big part of the appeal of social platforms more broadly, Beattie says. In a recent study about how a nationally representative sample of people feel about the internet, he found that younger people felt that they should “stay online for their friends,” even when they didn’t want to post on social media themselves. Most people spend most of their time messaging online with people they know in real life; the digital messages are just an extension of the connection. 

illustration of some family members sitting in front of a big phone screen filled with the rest of their family
Family group chats, containing both gossip and logisitics, often take place on Messenger. (Image: Getty Images)

“I use Messenger every day; I would say it’s my primary form of communication with other people,” says Hassaan Mirza, a professional who works in Auckland. He estimates that at least 65% of his communication takes place on Facebook Messenger, which he has had since 2016 when he was a high school student. For many of the people he messages on Facebook, he doesn’t have another way to contact them – an email, a phone number, or a street address. “It makes me feel like it’s so easy for us to accept the potential infiltration of technology into our lives if it’s convenient,” he says. The immediacy of connection, the ability to send photos and videos and make calls and the long history of data already on the platform makes it hard to leave. 

Like Mirza, I open Messenger all the time. There are close friends whose number I still don’t have because when we met, we messaged on Facebook, and haven’t stopped since. I feel a sick churn of discomfort when I think of the thousands, maybe millions, of words I’ve exchanged with my boyfriend on Messenger, years of links and sweet goodnight texts and complaints about flatmates. All on someone else’s platform; all for some corporation to make money from – from all the people I talk to and love. 

“Not having Facebook [now] is like not having a phonebook [40 years ago],” Beattie says. Being able to look people up if you know their names, and checking on a picture that they’ve posted to verify it, is extremely useful (especially if, say, you’re a journalist). For people with a long history of Facebook messages, the photos and videos and links are a useful archive, one threaded with emotion and memory – and that makes it all the more difficult to quit, he says. All that data about your interests and relationships is valuable to Facebook, he says. “But it’s also valuable to you.” 

the facebook logo on a black background
An image of the platform this article is about, to keep you on topic (Getty Images)

Beattie points out that if it is the appeal of social connections that convince people to make and keep their accounts, the expectation of connection is not experienced equally. Younger people, accustomed to being constantly digitally available find disconnection particularly difficult, Beattie’s research has found. “There’s that fear of missing out,” he says. Women, too, are often expected to maintain connections with family to an extent that men are not, making it harder to leave Messenger, even if you don’t want to use Facebook for other purposes. 

It’s not just me and Mirza using Facebook Messenger – we’re there because our friends are there. In a statement to The Spinoff, Meta said that over 140 billion messages are sent across their apps (including WhatsApp and Instagram Messenger) every day. 

The promise of instant communication

“Messenger is very easy to use, it’s so amazing,” says Paddy Baldwin, a grandmother who lives in a retirement village in Auckland. Baldwin’s grandson is currently travelling overseas, and she’s been amazed at how quickly she’s been able to get messages through, with him even sending a voice message for her husband’s birthday. “It feels absolutely wonderful to get to hear from him,” she says. “I don’t know what his phone number is while he’s away but I can hear from him on Messenger.” 

She compares the experience to communicating with her son when he lived in London 25 years ago. “One time, I hadn’t heard from [my son] for three weeks, he could have been anywhere,” she says. With Facebook Messenger, her grandson in Taiwan is only a tap away. 

a hand overing over a phone cartoon with questionmarks
Facebook Messenger is also where scams can happen (Image: Tina Tiller)

Baldwin only has a Facebook account to use Messenger. She never opens the newsfeed, because she doesn’t like that her interactions with people on the main Facebook app are visible to all and sundry. When I call her, she’s particularly perturbed about social media, having received a message from someone with the name of an old friend a day earlier. “I said hello and got a weird reply back, and she didn’t remember me, I started to wonder if she was becoming forgetful,” she recounts. “Then she sent me a link for me to get some money and I told her I didn’t need any money.” After a while, Baldwin figuered out it was a scam – luckily before she’d entered any of her personal details. “It was scary,” she says. “And it came through Facebook, it made me feel like it’s hard to trust.” 

Scams on Messenger are so ubiquitous that the company itself has a help page dedicated to common scams, advising that users not click suspicious links or respond to connections saying they are in an emergency – even if the platform is so widely used that it may be the first port of call for people really wanting to get in touch with someone after an emergency. Of course, all widely used communication networks, including landlines and the postal system, have had the same issue; it’s just that the betrayal of trust seems particularly insidious, as Baldwin found, when it’s coming from a person you think you know. 

Despite his near-daily use of Messenger, Mirza thinks that he would like to eventually quit the app, especially if using it required having to log into Facebook proper. “I believe that face-to-face comms are the best,” he says. “I don’t think the immediacy of [Messenger] is always good for me.”

In the meantime, two of the most obvious alternatives to Messenger are also owned by Meta: WhatsApp and Instagram. “Once you’ve experienced sending photos and videos instantly, it enriches your conversation and there’s a sense of loss when you can’t any more,” Beattie says. Text messaging is also nearly instantaneous, but more inconvenient for sending pictures and videos and, as mentioned, requires that you already know someone’s number when you contact them. There’s a place for independent encrypted services like Signal (whose CEO is currently doing a big media push), but only large corporations have achieved the scale needed for a messaging service. iMessage is an alternative, too, but only if every single one of your friends and connections are locked into Apple products, ostracising any Android users for the green bubble effect. “These giants are dominating – people don’t want to join a place that no-one else is using,” Beattie says. 

I’m struck particularly by what Mirza says, that the convenience of Messenger is the reason it has persisted, even for those who haven’t browsed an album of digital camera photos on the Facebook newsfeed  or been “poked” by their friends for years. I imagine the ways that Facebook is useful to me and conclude that it isn’t very. I tell myself that I’d have the gumption to quit, abandon the people who weren’t important enough for me to know how else to contact them. I’d download an archive of all my data for my grandchildren to cherish, just like I love rediscovering letters my mother wrote when she was in her early twenties. Then I’d move on – probably, if I’m being honest, to WhatsApp. You can get away from Facebook, but you can’t escape Meta.

‘Hutt Valley, Kāpiti, down to the south coast. Our Wellington coverage is powered by members.’
Joel MacManus
— Wellington editor
But wait there's more!