Online Medical Advice Can Be a Prescription for Fear

Online Medical Advice Can Be a Prescription for Fear

From the Resource Shelf news item of February 7, 2011 17:04

Online Medical Advice Can Be a Prescription for Fear

If you’re looking for the name of a new pill to “ask your doctor about,” as the ads say, the Mayo Clinic Health Information site is not the place for you. If you’re shopping for a newly branded disorder that might account for your general feeling of unease, Mayo is not for you either. But if you want workaday, can-do health information in a nonprofit environment, plug your symptoms into Mayo’s Symptom Checker. What you’ll get is: No hysteria. No drug peddling. Good medicine. Good ideas.

This is very, very rare on the medical Web, which is dominated by an enormous and powerful site whose name — oh, what the hay, it’s WebMD — has become a panicky byword among laysurfers for “hypochondria time suck.” In more whistle-blowing quarters, WebMD is synonymous with Big Pharma Shilling. A February 2010 investigation into WebMD’s relationship with drug maker Eli Lilly by Senator Chuck Grassley of Iowa confirmed the suspicions of longtime WebMD users. With the site’s (admitted) connections to pharmaceutical and other companies, WebMD has become permeated with pseudomedicine and subtle misinformation.

Because of the way WebMD frames health information commercially, using the meretricious voice of a pharmaceutical rep, I now recommend that anyone except advertising executives whose job entails monitoring product placement actually block WebMD. It’s not only a waste of time, but it’s also a disorder in and of itself — one that preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.

Source:  New York Times

Shirl’s note:  You can’t go wrong with MedlinePlus, from the National Library of Medicine. Every site linked there has been vetted by a reliable professional.

Editor Flahiff’s note: You also cannot go wrong with these resources (via a Consumer Health Library Guide

Dietary Supplements Labels Database

Information about ingredients in more than three thousand selected brands of dietary supplements. It enables users to determine what ingredients are in specific brands and to compare ingredients in different brands. Information is also provided on the health benefits claimed by manufacturers. These claims by manufacturers have not been evaluated by the Food and Drug Administration. Check out the Help section for tips on how to browse and search this site.

Drug Digest

This noncommercial consumer health and drug information site provides information about drugs and treatment options to be discussed with your primary health care provider or a pharmacist.  Information about over 1,500 drugs as well as common herbs and supplements. The check interactions tab (potential interactions between drugs)  and conditions/treatments area provide easy-to-read overviews. Information provided by Drawing pharmacy experts, licensed doctors of pharmacy, and physicians. From ExpressScripts.

Drugs and Supplements (sponsored by the Mayo Clinic)

Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals. 

Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.

Drug Information Portal

A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed ***(summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, some whole articles may not be for free on the Internet).

For information on how to obtain medical and scientific articles for free or at low cost, click here
***As of July 2011
The National Library of Medicine Drugs and Lactation Database (LactMed)
has added complementary and alternative medicine (CAM) products. CAM
products generally consist of dietary supplements derived from botanicals
(herbals), “nutraceuticals” (natural and synthetic nonherbals, such as
coenzyme Q10), and related products.
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Sentries in the garden shed

Sentries in the garden shed – Plants that can detect environmental contaminants, explosives

This is Dr. June Medford in her lab at Colorado State University.

From the February 15, 2011 Eureka news alert

Someday, that potted palm in your living room might go from green to white, alerting you to a variety of nasty contaminants in the air, perhaps even explosives.

The stuff of science fiction you say? Not so, says a Colorado State University biologist whose research is funded in part by Homeland Security’s Science and Technology Directorate (DHS S&T), as well as by the Defense Advanced Research Projects Agency (DARPA), the Office of Naval Research (ONR), and others.

Dr. June Medford and her team in the Department of Biology at Colorado State have shown that plants can serve as highly specific sentries for environmental pollutants and explosives. She’s enabled a computer-designed detection trait to work in plants. How? By rewiring the plant’s natural signaling process so that a detection of the bad stuff results in the loss of green color.

Based on research so far, Medford says the detection abilities of some plants (tobacco is an example) are similar to, or even better, than those of a dog’s snout, long the hallmark of a good detector. Best of all, the training time is nothing compared to that of a dog…..

 

This graphic shows de-greening in plants over a 48-hour period.

 

Health care spending: Study shows high imaging costs for defensive purposes

Health care spending: Study shows high imaging costs for defensive purposes
Costs and frequency of defensive medicine in Pennsylvania

From the February 16, 2011 Eureka news alert

Nearly 35 percent of all the imaging costs ordered for 2,068 orthopaedic patient encounters in Pennsylvania were ordered for defensive purposes, according to a new study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

For many years now, some physicians have ordered specific diagnostic procedures that are of little or no benefit to a patient, largely to protect themselves from a lawsuit. Until now, however, efforts to actually measure defensive medicine practices have been limited primarily to surveys sent to physicians. Such surveys would simply ask whether or not that individual actually practiced defensive medicine.

“This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time — prospectively done,” says John Flynn, MD.

Flynn, who is Associate Chief of Orthopaedic Surgery at Children’s Hospital of Philadelphia, says that many lawsuits hinge on the plaintiff’s lawyer’s claim that the doctor should have ordered extra diagnostic testing. “And such a claim may be the driving force of so much of the defensive test ordering.”

According to Flynn, 72 orthopaedic surgeons, who are members of the Pennsylvania Orthopaedic Society, voluntarily participated in this study, which included some 2,068 patient encounters throughout the state of Pennsylvania. Most patients in this study were adults. The study found that 19 percent of the imaging tests ordered were for defensive purposes. Defensive imaging was responsible for $113,369 of $325,309 (34.8 percent) of total imaging charges for this patient cohort, based on Medicare dollars. The overall cost of these tests was 35 percent of all imaging ordered because the most common test was an MRI, an imaging test which costs more than a regular X-ray.

One piece of this problem to remember, Flynn says, is that the legal environment that drives physicians to order additional tests has an effect on patients too, in a way that involves more than costs. “Patients are sometimes put through tests that maybe otherwise would not be ordered.”

The finding from this research that surprised Flynn the most was that surgeons were more likely to practice defensively if they had been in practice for more than 15 years.

“This was counterintuitive,” he says. “I thought that young doctors would come out of medical school immediately after training, be less confident because they weren’t experienced, and order more defensive tests. Then, as they become more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests.”

“In fact, the opposite was true. We found that — in Pennsylvania at least — a surgeon’s defensive nature gets worse over time. In this legal environment, orthopaedic surgeons order more imaging tests of a defensive nature, because over time they become more concerned that someone is going to second guess or sue them.”

Flynn says that medical liability awards typically are given because of the severity of a bad outcome, and not necessarily because of negligence. In fact, a May 2006 study published in the New England Journal of Medicine (Studdert DM) showed that 37 percent of claims did not involve medical errors, and in 3 percent of claims, no injury occurred at all.

Flynn pointed to various studies that show that defensive medicine, in general, is quite prevalent. One such study in the June 2005 Journal of the American Medical Association (Studdert DM) reported that almost 93 percent of 824 physicians in Pennsylvania responding to a survey practiced defensive medicine.

“Ideally, as a next step, we would hope to try to get a broader national picture using this prospective practice audit methodology, so we could get a better sense of the true costs of defensive imaging in orthopaedics,” says Flynn.

“Ultimately, if you had doctors from multiple specialties — from OB/Gyn to Neurosurgery to Emergency Medicine — do this type of practice audit, you could accurately quantify how much of our nation’s healthcare resources are wasted on defensive medicine.”

 

 

 

 

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

From the Rand Corporation summary

n both industrialized and transitioning countries, population aging and better survivability have led to a rapid increase of the prevalence of chronic disease and disability. As a result, there is growing concern about the financial sustainability of health care systems, which is compounded by capacity constraints and workforce shortages. Advanced home health care solutions promise to mitigate these pressures by shifting care from costly institutional settings to patients’ homes and allowing patients to self-manage their conditions. A global study of the needs, priorities, and expectations of key stakeholders regarding home health care in six countries (China, France, Germany, Singapore, the United Kingdom, and the United States) revealed that, despite their potential, such technologies face a number of barriers to adoption. Restrictive coverage and existing incentives for in-person home care create obstacles, as does limited patient readiness because of insufficient health literacy. Concerns about audience-appropriate product design and support and limited data on effectiveness and efficiency also impede uptake. Realizing the promise of telecare requires a concerted stakeholder effort, including creation of a conducive policy environment, design of convincing products, and development and dissemination of persuasive evidence.

PubMed MeSH database changes

The PubMed** interface is being changed section by section.
The MeSH section has been revised. 
Here is a message from the GMRLIST (an email list for the National Network of Libraries of
Medicine-Greater Midwest Region (NN/LM-GMR) members)

Hi Folks,Many of you have noticed the change in the MeSH database interface.
http://www.ncbi.nlm.nih.gov/mesh
NCBI is working to update the entire website – section by section.FYI:The Technical Bulletin article
on this change is at:http://www.nlm.nih.gov/pubs/techbull/jf11/jf11_pm_mesh_db.htmlThe updated brochures “Searching PubMed with MeSH are at:
PDF: http://nnlm.gov/training/resources/meshtri.pdf
Word: http://nnlm.gov/training/resources/meshtri.doc

If you have comments or questions about the new interface, feel free to contact NLM directly –
they welcome your feedback.http://apps.nlm.nih.gov/mainweb/siebel/nlm/index.cfm/

Here is a related posting from MEDLIB-L (a medical librarian listserv)

Here’s what I recvd. from NNLM: There have been some changes to MeSH.
–>Type your search term in the MeSH box.
–>Then click the box(es) on the left to select your term(s).
 –>Then click on the far right: Add to Search Builder Here are some helpful resources
(you have to click CTRL + Click for the URLs to work).

PubMed’s MeSH Database**
Searching with the MeSH Database
<http://www.nlm.nih.gov/bsd/viewlet/mesh/searching/mesh1.html> (3 min., February 2011)
* Combining MeSH Terms Using the MeSH Database
<http://www.nlm.nih.gov/bsd/viewlet/mesh/combining/mesh2.html> (3 min., February 2011)
* Applying Subheadings and Other Features of the MeSH Database
<http://www.nlm.nih.gov/bsd/viewlet/mesh/subheadings/mesh3.html> (3 min., February 2011)
You can also see the MeSH Database section in the tutorial:
http://www.nlm.nih.gov/bsd/disted/pubmedtutorial/020_

**Pubmed is the largest database of biomedical journal articles (some are free full text) in the world.
It is most often best searched using medical subject headings (MeSH).

The above two hyperlinks (PubMed and MeSH) including Help pages and tutorials.
Please do not hesitate to contact a public librarian, academic librarian, or medical librarian for assistance
in searching PubMed or locating medical articles.
In the case of academic or medical settings, call ahead to see what services the library has for the general
public.You just might be pleasantly surprised!

(You may also email me at jmflahiff@yahoo.com…I am willing to give free assistance which would
include about an hour of my time)

Visualizing the Visual Data Explosion

Visualizing the Visual Data Explosion

This video about medical scans includes streaming video examples in these areas: forensics (virtual autopsies), cardiac surgery, physical examinations, and “cat” scans.

Other TED Ideas Worth Spreading health/medical related videos include

• The linguistic genius of babies
• Your health depends on where you live
• Bonnie Basser on how bacteria talk
• Dean Ornish says your genes are not your fate

From a Dr Shock MD PhD blog item

Today medical scans produce thousands of images and terabytes of data for a single patient in mere seconds, but how do doctors parse this information and determine what’s useful? At TEDxGöteborg, scientific visualization expert Anders Ynnerman shows us sophisticated new tools — like virtual autopsies — for analyzing this myriad data, and a glimpse at some sci-fi-sounding medical technologies in development. This talk contains some graphic medical imagery (Editor’s note- This “disclaimer” is correct)

 

Related item from the Library of Contress

New LC Science Tracer Bullet: Forensic Sciences

Forensic science is the use of science to solve criminal cases. It can include the use of many disciplines, such as anthropology, biology, botany, chemistry, computer science, engineering, entomology, genetics, medicine, and toxicology.

This guide highlights the diversity of the scientific professions and disciplines used in investigations and provides sources on the general practice of criminalistics. Also included is information on ballistics, firearm examination, and scientific examination of documents.

Physicians on Twitter

Physicians on Twitter

From the Dr. Shock MD PhD Blog

In the latest issue of the JAMA the results of a survey is published. The authors did a search on physicians using twitter. They extracted the public profile pages of the physicians using twitter with 500 or more followers between May 1 and May 31, 2010. They analyzed the tweets of these professionals.

Of the 5156 tweets analyzed, 49% (2543) were health or medical related, 21% (1082) were personal communications, 14% (703) were retweets, and 58% (2965) contained links. Seventy-three tweets (1%) recommended a medical product or proprietary service, 634 (12%) were self-promotional, and 31 (1%) were related to medical education.

But what is somewhat worrying were their findings of potential patient privacy violations andconflicts of interest. Thirty-eight tweets (0.7%) represented potential patient privacy violations, of the 27 users responsible for these privacy violations 25 were identifiable by full name on the profile, by photo or link to their personal website. Twelve tweets were about a product they were selling on their Web site or repeatedly promoting specific health products, 10 were statements about treatments not supported by the official guidelines.

Using social media by physicians does broadcast useful medical information, unprofessional content in tweets by physicians is rare.
Chretien KC, Azar J, & Kind T (2011). Physicians on twitter. JAMA : the journal of the American Medical Association, 305 (6), 566-8 PMID: 21304081 ***

*** The abstract of this article may be found here.

For suggestions on how to get the full text of this article (letter to the editor) for free or at low cost, click here