[Reblog] Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog

Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog.

Saying No to “Know Your Numbers” campaigns

Posted by Gary Schwitzer in Health care journalism, Risk communication

4 COMMENTS

“Know Your Numbers” campaigns can serve a useful purpose.

But they can also be guilty of non-evidence-based fear-mongering.  They can fuel obsessions with numbers that fully-informed people might just as soon not know anything about. There can be harm living our lives worrying about numbers, test results – making ourselves sick when we are, in fact, healthy.

Here’s a screenshot of just a tiny part of a Google search result of “Know Your Numbers” campaigns.  The list goes on and on and on.

The most recent that I saw was in the January 2014 edition of Prevention magazine.  It’s entitled, “Know Your Numbers: The 5 Health Stats You Should Know.”

While we acknowledge the prestige of the Cleveland Clinic and its chief wellness officer, we point out that there is a lot of debate in medical science circles about what is laid out in this Preventionmagazine piece. For example:

• The Eighth Joint National Committee (JNC 8) recently published evidence-based guidelines for managing high blood pressure in adults. They wrote:

“There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion”

So if 140/90 is where this group starts thinking about treatment, and if even the American Heart Association says normal is “less than 120/80,” what we have with an announcement that 115/75 is “ideal” is mission creep, medicalizing normal blood pressure, or disease-mongering. Where does this “ideal” come from?  It may only be a few points of difference, but with a few points, thousands of Americans suddenly become “less than ideal”…or, as we often call them, patients. One minute they’re healthy.  And then – voila – with a prestigious organization’s spokesman proclaiming a new “ideal” – they’re sick, abnormal, patients.

• Cholesterol.  Hmmm.  Let’s see what the Cleveland Clinic website says about LDL and HDL. The Clinic’s own website says the LDL goal value should be less than 130 for people who don’t have heart or blood vessel disease or high risk.  And since a Prevention magazine article reaches a broad audience, that’s the crowd we’re talking about. And the Clinic website says HDL goal value should be greater than 45.  So the Prevention magazine targets of LDL under 100 and HDL over 50 are again mission creep, medicalizing normal blood tests, or disease-mongering.  Please note:  we could (but won’t herein) write volumes about much broader questions about being obsessed over LDL or HDL numbers, which are surrogate markers that don’t tell people everything they need to know.

• This is the one that bugs me the most.  The article lists C-reactive protein as one of the “5 health stats you should know.”  What you should know is that the US Preventive Services Task Force does not share in that endorsement.  The USPSTF states that “the current evidence is insufficient to assess the balance of benefits and harms of using the (the test) to screen asymptomatic men and women with no history of coronary heart disease (CHD) to prevent CHD events.” Even a brief look at other guidelines by other groups shows that the promotion of this test as a “stat you should know” is not as simple and uncomplicated as the Prevention magazine article makes it out to be.

Please note that almost exactly 2 years ago we wrote, “Cleveland Clinic’s Top 5 Tests for 2012 clash with many guidelines.” C-reactive protein was on that list as well.

And you may be interested in some of my past articles about “Know Your Numbers” campaigns:

• TV station should stop promoting questionable screening tests at MN State Fair
• Star Tribune is wrong about experts recommending annual physicals

Comments

Laurence Alter posted on January 13, 2014 at 10:00 am

Dear Gary & Staff:

1. “Live by the numbers; die by the numbers”
2. “The facts speak for themselves”

Live by the first expression or idiom; die by the second one.

Fine physicians give subtlety and nuance behind “the numbers.”

Laurence Alter

Reply

Gary Schwitzer posted on January 13, 2014 at 12:06 pm

Laurence,

Thanks for your note, but for the umpteenth time, there is no staff.

There wasn’t even any staff when we had funding. So there certainly isn’t any staff in the unfunded era.

Whereas I once had help from as many as almost 40 different part-time contributors, they were not staff, just very limited part-time contributors.

It’s just me, flying solo these days.

Reply

Gwyneth Olwyn posted on January 14, 2014 at 10:50 pm

Dear Gary By Himself:

1. Live by the numbers, die anyway.
2. Unequivocally one death per person.

There is no subtlety or nuance to be had for fine physicians in an era of standard of care and fear of litigation from failing to screen aggressively for potential disease.

Therefore a person needs to know ahead of getting his or her numbers checked whether he or she is ready to inadvertently become a patient based on numbers and that the treatments to change those numbers may have little to no evidence to support them.

Reply

shaun nerbas posted on January 20, 2014 at 3:01 pm

It seems that the patient must look out for themselves, ask questions, and not just accept the standard script of medical people. I had an MI 4 years ago (stent placed in the LAD which was nearly 100% blocked ) , but in the 2.5 months before that I saw 4 different doctors who told me nothing was wrong. I had normal LDL and total cholesterol,but I did have low HDL, which I had recently raised up to a ” nearly normal ” value using niacin. I walked for 1.5 hours a day, but in that 2.5 month period before the MI, while walking, I started to get increasing shortness of breath, indigestion, and a pain in my upper back, between the shoulder blades. My doctor gave me Nexium . My doctor didn’t think it was my heart. He based that on having two relatives of his with heart disease, my normal ECG, and my normal cholesterol numbers. I saw other doctors, as my shortness of breath got worse, but again, they didn’t think it was my heart. Then one day I got the symptoms while eating lunch. I went to the local hospital,who after being in communication with a larger specialized hospital, sent me to that larger center, which put the stent in. I eventually learned that over 62% of MIs happen to people with ” normal cholesterol ” . How is it possible that the cholesterol numbers used by lay doctors are so useless for diagnosis ? Does heart disease have multiple causes or do we just not have a good understanding of how do diagnose and track it ? I almost never see this inadequacy discussed by the experts ! Subsequent to my MI I became a vegan to improve my diet to remove saturated fat, which along with a grandmother who had a heart problem, were, in my mind, the reasons for my heart disease. My cardiologist acted as if I was misguided with the vegan approach, which he felt was a path almost nobody could follow.. ….. just take the statins. Maybe Cardiology is a very lucrative occupation that keeps us coming back…..see you next time ! Sorry for being so cynical, but that’s how I feel.

Related articles

• How to Protect Your Heart
• Cholesterol levels linked to early signs of Alzheimer’s in brain
• Ldl Cholesterol: Think Beach Balls

[News article] Little-known aspect of Medicaid now causing people to avoid coverage

From the 23 January 2014 Washington Post article

Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house.

The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-
income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.

…

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

..

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

,,,,

 

Read the entire article here

Related articles

• State files emergency rule to shield new Medicaid enrollees from payback claims
• At Least 6.3 Million Americans Found Eligible For Medicaid Since October 1st
• With Utah on board, a majority of states now back Medicaid expansion
• Bill offers alternative to Medicaid expansion to help low-income people get health coverage

 

[Journal Article] Search engines cannot diagnose through symptom searching – only 14% accuracy

Ever enter your symptoms into a search engine (as Google) to find what was the cause? And bring the results to your health care provider?  Believe that search engines can correctly diagnose your symptoms?
A  medical researcher not only was thinking along these  lines. He also set up a system to see if search engines could diagnose symptoms accurately.

The results were published in a scientific paper.**

Here are some remarks from medical librarians at their discussion group.

• They don’t address the problem with these search engines of bias: Google,
  Bing, track what you’ve searched on, they aren’t ‘anonymous’ engines, thus
  biasing the results. A different computer, with different previous user
  will give different results with these search engines. Flawed article,
  in my opinion. Too bad, it is interesting.

• This article is very interesting. While it is about validating the instrument for analyzing the webpages, they found that only 14% of the website gave a correct diagnosis. Seventy percent came up with the diagnosis as part of a differential. It sort of scares me that many medical students and other healthcare students might use search engines to find differentials. One implication is that patients who bring in webpages may actually hold the appropriate differential in their internet printout. Physicians might consider that information. The article is NOT an open access journal. The abstract does not discuss the findings of accuracy since they were testing the scoring system.

My thoughts? Familydoctor.org (American Academy of Family Physicians) has great advice
Our symptom checker flowcharts allow you to easily track your symptoms and come to a possible diagnosis.
Remember,  be sure to consult with you doctor if you feel you have a serious medical problem.

As a medical librarian, we counsel people to use any information they find as a resource when consulting with their health care provider. Information on the internet may be outdated, flawed, and sometimes even wrong.
Also, the health care providers views you as a whole person, not just a narrow set of symptoms.  They use not only your symptoms, but other factors as health history, current and past treatments, and environmental factors to work toward a treatment plan.

Related Resources

   Online symptom checkers (Standford Health System)

**  Abstract from PubMed.
Full text of article not available online for free.
Might be available for free or low cost at a local public, medical, or academic libary.
Call ahead and ask for a reference librarian.
Many medical and academic libraries offer some help to the public.

Int J Med Inform. 2014 Feb;83(2):131-9. doi: 10.1016/j.ijmedinf.2013.11.002. Epub 2013 Nov 19.

The accuracy of Internet search engines to predict diagnoses from symptoms can be assessed with a validated scoring system.

Shenker BS.

Author information

• Rutgers Robert Wood Johnson Medical School and Rutgers Robert Wood Johnson Family Medicine Residency at CentraState, United States. Electronic address: bshenker@centrastate.com.

Abstract

PURPOSE:To validate a scoring system that evaluates the ability of Internet search engines to correctly predict diagnoses when symptoms are used as search terms.METHODS:We developed a five point scoring system to evaluate the diagnostic accuracy of Internet search engines. We identified twenty diagnoses common to a primary care setting to validate the scoring system. One investigator entered the symptoms for each diagnosis into three Internet search engines (Google, Bing, and Ask) and saved the first five webpages from each search. Other investigators reviewed the webpages and assigned a diagnostic accuracy score. They rescored a random sample of webpages two weeks later. To validate the five point scoring system, we calculated convergent validity and test-retest reliability using Kendall’s W and Spearman’s rho, respectively. We used the Kruskal-Wallis test to look for differences in accuracy scores for the three Internet search engines.RESULTS:A total of 600 webpages were reviewed. Kendall’s W for the raters was 0.71 (p<0.0001). Spearman’s rho for test-retest reliability was 0.72 (p<0.0001). There was no difference in scores based on Internet search engine. We found a significant difference in scores based on the webpage’s order on the Internet search engine webpage (p=0.007). Pairwise comparisons revealed higher scores in the first webpages vs. the fourth (corr p=0.009) and fifth (corr p=0.017). However, this significance was lost when creating composite scores.CONCLUSIONS:The five point scoring system to assess diagnostic accuracy of Internet search engines is a valid and reliable instrument. The scoring system may be used in future Internet research.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Press release[ Detecting Sickness By Smell

From the 1 January 2014 Association for Psychological Science press release

Humans are able to smell sickness in someone whose immune system is highly active within just a few hours of exposure to a toxin, according to new research published in Psychological Science, a journal of theAssociation for Psychological Science.

According to researcher Mats Olsson of Karolinska Institutet in Sweden, there is anecdotal and scientific evidence suggesting that diseases have particular smells. People with diabetes, for example, are sometimes reported to have breath that smells like rotten apples or acetone.

Being able to detect these smells would represent a critical adaptation that would allow us to avoid potentially dangerous illnesses. Olsson wondered whether such an adaptation might exist already at an early stage of the disease.

“There may be early, possibly generic, biomarkers for illness in the form of volatile substances coming from the body,” explains Olsson.

To test this hypothesis, Olsson and his team had eight healthy people visit the laboratory to be injected with either lipopolysaccharide (LPS) — a toxin known to ramp up an immune response — or a saline solution. The volunteers wore tight t-shirts to absorb sweat over the course of 4 hours.

Importantly, participants injected with LPS did produce a noticeable immune response, as evidenced by elevated body temperatures and increased levels of a group of immune system molecules known as cytokines.

A separate group of 40 participants were instructed to smell the sweat samples. Overall, they rated t-shirts from the LPS group as having a more intense and unpleasant smell than the other t-shirts; they also rated the LPS shirt as having an unhealthier smell.

The association between immune activation and smell was accounted for, at least in part, by the level of cytokines present in the LPS-exposed blood. That is, the greater a participant’s immune response, the more unpleasant their sweat smelled.

Interestingly, in a chemical assay the researchers found no difference in the overall amount of odorous compounds between the LPS and control group. This suggests that there must have been a detectable difference in the composition of those compounds instead.

While the precise chemical compounds have yet to be identified, the fact we give off some kind of aversive signal shortly after the immune system has been activated is an important finding, the researchers argue. It grants us a better understanding of the social cues of sickness, and might also open up doors for understanding how infectious diseases can be contained.