The Internet has become the go-to place for all manner of personal inquiries, including medical research: A recent survey found that 6 in 10 adults have gone online in the past year to diagnosis health issues. But how accurate is the information we find?
On KevinMD.com, family physician Kenneth Lin warns than many health websites contain “flawed, inaccurate, or biased” information. Sometimes, the group running the site may have a hidden agenda, such as a drug company that promotes awareness of a previously unrecognized to spur consumer demand for its new product – a practice known as “disease mongering". Or an organization may willfully disregard scientific evidence to promote certain health beliefs.
For his patients who need trustworthy health information, Lin recommends several websites that have received a high quality rating from independent medical associations, such as Healthfinder.gov and FamilyDoctor.org. The latter site offers a variety of handouts about preventive test basics or newly diagnosed health conditions, including one that advises patients to ask themselves three questions about every health-related website they visit:
While Lin warns patients not to use online information to self-diagnose or treat a medical problem, he does believe that visitng a high-quality health website can help them make better-informed choices – so long as its in conjunction with a doctor’s care.
The U.S. Food and Drug Administration has approved a new drug to treat advanced lung cancer, HealthDay News reports. Gilotrif (afatinib) will be available to patients with a specific subtype of non-small cell lung cancer (NSCLC).
The agency approved the drug to treat tumors that carry key deletions on the epidermal growth factor receptor (EGFR) gene, long a target for lung cancer therapeutics. Mutations in the EGFR gene – thought to occur in about 10% of NSCLCs – are targeted by Gilotrif.
“This drug represents a new important alternative to standard chemotherapy in the 10-15% of lung cancer patients who have EGFR mutations,” said Dr. Jorge Gomez, medical director of the thoracic oncology program at Mount Sinai Medical Center in New York City.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, added that new drugs such as Gilotrif “complement standard chemotherapy [and] give hope of increased survival even in late stage lung cancer.”
Along with common side effects such as itching, bladder inflammation, low blood potassium levels, fever, and eye inflammation, serious side effects associated with Gilotrif include diarrhea that can result in kidney failure and severe dehydration, severe rash, lung inflammation and liver toxicity, the FDA said.
An increase in the amount of time Americans spend exercising hasn’t slowed the rise in obesity, the Los Angeles Times reports.
Data published in the online journal Population Health Metrics revealed that while individuals in two-thirds of the nation’s counties have stepped up their physical activity in the past decade, national obesity rates have also climbed. On the positive side, some recent evidence suggests the rates may be leveling off.
“There has been a lot of progress on physical activity,” said Christopher Murray, lead author of the research. “But we probably also need to do more. There are still more calories coming in … than calories going out in physical activity.”
Indeed, bad diet choices are the single leading cause of America’s poor health compared to other countries, said Robert Lustig, a neuroendocrinologist and clinical professor at UCSF School of Medicine. While physical activity is a critical component of well-being, “[t]here is not one study anywhere in the world that shows that exercise [alone] causes weight loss.”
Lustig noted that poor diet also reduces the will to exercise, and advised that people reduce their insulin levels by drinking less alcohol and eating less sugar, trans fats and corn-fed beef and chicken.
Despite last year’s recommendation by the U.S. Preventive Services Task Force that older men shouldn’t get a prostate cancer screening, most still plan to do so, HealthDay News reports.
A survey of over 1,000 men aged 40 to 74 with no history of prostate cancer found that only 13% of respondents plan to follow the USPSTF recommendation and not get tested, compared to 54% who said they’d ignore it and 33% who were undecided. Blacks, wealthier men, those who’d had a recent PSA test, and those who were at least somewhat worried about prostate cancer were more likely to plan to get a test.
Overall, the survey shows that “we need to do a better job of presenting both the benefits and harms of screening to all patients,” said Linda Squiers, lead author of a report on the survey. “We also should explain the science behind the recommendation in plain language so everyone can understand it.”
The USPSTF website states that “current methods of PSA screening and treatment of screen-detected cancer are not the answer", and critics of the test believe it can lead to unnecessary and harmful treatment. Nevertheless, many physicians say the test serves a useful purpose.
MedBen follows American Cancer Society screening guidelines, which recommend that men at age 50 who are at average risk of the disease and are expected to live at least 10 more years consult with their primary care physician about getting tested.
While MedBen recommends that health plan members see their family doctor regularly, it’s also a good idea to rely on your pharmacist for guidance, as a new study of hypertension treatment demonstrates.
According to HealthDay News, researchers found that 72% of individuals who self-monitored their blood pressure with home kits for six months and partnered with a pharmacist for medication guidance kept their high blood pressure under control, compared to 45% whose care was limited to scheduled physician checkups. And six months following the study, 72% of the home monitoring group still controlled their high blood pressure compared to 57% of the usual care group.
“The reason that only about half of people with [high] blood pressure have it under control is that usual care isn’t working. We combined two interventions that we thought would be very powerful together – home monitoring and pharmacist managements – and this is one system that we’ve shown works very well for blood pressure control,” said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.
This is not to suggest, however, that the family doctor doesn’t play an important role in helping to control high blood pressure, in addition to managing a patient’s care in general. But it does show how taking on greater responsibility for one’s health, and taking advantage of every available resource, can make a positive difference.
An extensive new study of U.S. health trends from 1990 to 2010 revealed some positive developments, according to the Health Hub:
Still, not all the news was good. The study, conducted by the Cleveland Clinic, found that while the U.S. is spending more, our health is only gradually improving compared to other countries. Additionally, the gap between life expectancy and the expected number of healthy years that an American loses to disability increased from 9.4 to 10.1 years.
The study also determined that disease and long-term disability account for nearly half of the U.S. health burden. The researchers suggested that by stressing education and preventive medicine to limit chronic conditions, our country could reduce that number.
MedBen Worksite Wellness adheres to that philosophy. By promoting prevention of chronic diseases through physician office testing that uses the plan member’s primary care provider, we eliminate the logistical headaches and potential redundancy of on-site screenings. And our program uses customized education and counseling to help high-risk plan members reduce their odds of developing diseases in the first place.
For additional information about worksite wellness, contact MedBen Vice President of Sales and Marketing Brian Fargus at firstname.lastname@example.org.
So many studies have lauded the benefits of aspirin, it’s easy to conclude that a daily dose doesn’t hurt and may even help. But such thinking is unwise, the Cleveland Clinic’s Health Hub reports.
While it’s true many doctors prescribe aspirin therapy for patients with heart disease, self-prescribing to stay heart healthy carries serious risks, says Steven Nissen, MD, Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic – and some, such as gastrointestinal bleeding or hemorrhagic stroke, can be potentially fatal.
“Only those individuals who are at high risk for a heart attack benefit from taking aspirin as a preventive measure,” says Dr. Nissen. “Before taking a daily dose, you need to have a dialog with your physician about the benefits and risks of aspirin therapy.”
Dr. Nissen acknowledges that for patients who have had a heart attack, bypass surgery or a history of coronary artery disease, the benefits of daily aspirin outweigh the risks. But for others, only people with a cluster of risk factors – say, having diabetes, being a smoker, having high cholesterol and high blood pressure – should consider a daily aspirin, and even then only under a doctor’s counsel.
Right on the heels of a recent study that found smoking and surgery don’t mix comes a analysis that suggests heavy drinking also hinders recovery.
Reuters Health reports that a review of 55 past studies concluded that people who have more that a couple of alcholic drinks every day tend to have more complications after surgery than teetotalers or light drinkers. Infections and slow wound healing were the most common complications associated with heavy drinking.
Patients who drank heavily leading up to surgery were also more than twice as likely to die in the month after their procedures than abstainers, according to lead author Marie Eliasen of the National Institute of Public Health at the University of Southern Denmark in Copenhagen.
While the analysis confirms that “alcohol and surgery are a bad combination,” it’s not clear what effect stopping drinking before surgery would have on complications, Bolette Pedersen of the Clinical Health Promotion Center of Bispebjerg told Reuters by email. Pedersen was not involved in the review.
A recent New York Times article highlights America’s growing use of narcotic painkillers in the past decade. Once prescribed primarily for short-term discomforts, OxyContin and other popular opiods now provide relief from such chronic conditions as back injuries, headaches and arthritis – though questions have arisen about the long-term effectiveness of such drugs.
The growing reliance on painkillers has led to an increase in usage beyond what is required for treatment. In addition to the risk of addiction, side effects can include psychological dependence, reduced drive, extreme lethargy and sleep apnea.
Deaths from opoid overdoses have also risen in the past decade, especially among females. According to the Centers for Disease Control and Prevention, prescription pain pills were involved in 6,631 overdose deaths, intentional and unintentional, among women in 2010, a 415% increase from the 1,287 such deaths in 1999.
In spite of the known risks, narcotic painkillers are now the most widely prescribed class of medications in the United States. But depending on a patient’s overall health, many ailments for which opoids provide temporary comfort may realize more lasting relief through physical therapy.
(Thanks to John Goodman’s Health Policy Blog for the link.)
Sometimes, the words “patient” and “consumer” are used interchangeably. And while it may seem unbecoming to describe a person getting a checkup with the same term used for buyers of Big Macs, there are times the word is entirely appropriate, writes Roys Laux:
“[A]s healthcare coverage changes in America, as patients become more responsible for paying out of pocket upfront, you can bet they’ll be looking at the decisions through a consumer lens.
“It’s time for all of us to change our thinking.
“Consumers need to think about what matters most to them so they can effectively value a provider or treatment when they embark on their next hiring decision. A convenient appointment time and waiting room with amenities may be valuable to one, while another places greater value on the volume of procedures the HCP performs each week and yet another values physician bedside manner and staff responsiveness most. With greater visibility into patient experience before one hires a provider, consumers can determine just what service they’re willing to pay for and how much.
“Caregivers need to be open to and encourage patient feedback. Many physicians don’t like to think of new patient acquisition as a ‘hiring experience.’ But that’s exactly what it is. Consumers are paying for a service – a very personal, very important service. Providers should provide great customer service, great clinical quality and visibility about price every step of the way.”
The Obama administration has released a final rule regarding female contraceptive coverage under health care plans offered by religious groups, MedPage Today reports. The rule – a provision of the Afforable Care Act – takes effect January 1.
The rule is similar to those proposed by Health and Human Services last year. While churches themsevles are exempt from covering birth control, hospitals, schools, and other organizations with religious affiliations are not.
What has changed is the definition of “religious employer", to better facilitate churches that may hire or serve individuals outside their denomination. The final rule eliminates requirements that a religious employer:
As for other faith-based groups, an insurance company must provide no-cost contraceptive coverage if notified by the group of its religious objection. In compensation, HHS will reduce the fees that insurers must pay to participate in the ACA’s federally-run health insurance exchanges.
Self-funded groups need to make arrangements to provide coverage through a separate health plan, and their third-party administrator must notify enrollees of coverage availability.
Potential evidence that one type of chronic condition raises the risk of other illnesses: People with heart failure are more likely to be diagnosed with cancer, a new study suggests.
Reuters Health reports that the study matched newly diagnosed heart failure patients (average age: 73 years old) with those of the same age that did not have the condition. Eight years later, after accounting for certain disease risks such as people’s weight and whether they smoked, the researchers calculated that heart failure patients were 68% more likely to be diagnosed with cancer than their heart failure-free pairs.
The research team, led by Dr. Sudhir Kushwaha of the Mayo Clinic, noted that the finding doesn’t prove that heart failure causes cancer, and that more research and study is required. But the association makes sense because heart disease, caused by a lack of blood and oxygen, could create problems in many organs.
Kushwaha’s group added that there may be other explanations for the link, such as heart drugs that could increase cancer risks, stress and inflammation from heart failure itself, or a lack of oxygen.
Micheal Edmond, a professor of internal medicine VCU Medical Center, offers his professional perspective on the problem of “presenteeism", or coming to work while under the weather:
“While most humans inherently know that it’s not a good idea to come to work with fever or diarrhea, many either can’t or won’t stay home and risk infecting co-workers, customers, or patients.
“One major reason for presenteeism is lack of sick time, a particular problem for food service workers and other low wage earners. But the healthcare industry has its problems too, as many hospitals provide workers with paid time off (PTO) as opposed to sick leave. PTO is time that can be used for vacation, personal days or sick time. While this has some advantages, it also presents problems. For example, time off for illness reduces vacation time, so a sick worker may have to choose between working with the flu or going to Disney World. A worker that has used all of his PTO, may also feel compelled to work while ill.
“New York City took a step in the right direction when it mandated five days of sick leave with pay for employees who work in companies with 20 or more workers. Smaller businesses will be forced to allow workers to have sick leave without pay with no threat of job loss.”
An aging and more chronically ill population, plus the lure of more lucrative specialty practives, has created a shortage of primary care physicians in the U.S. – and the forthcoming addition of millions of newly insured individuals promises to make a tough situation even more difficult, the Associated Press reports.
While about a quarter million primary care physicians work in America now, that’s not nearly enough to meet current needs. Nearly 20% of Americans already live in a region with a inadequate number of family doctors – and the Association of American Medical Colleges projects the shortage will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade. Poorer inner cities and rural areas will be especially hard hit.
The Affordable Care Act is expected to add another 30 million potential patients looking for general care.
In an attempt to ensure that more Americans have access to primary care, various political solutions have been proposed. Some state legislators have introduced bills to expand the scope of practice of dentists, dental therapists, optometrists, psychologists, nurse practitioners and others. Others have suggested expanding student loan reimbursements. Neither idea has been favorably received.
Dr. Andrew Morris-Singer, president and co-founder of the non-profit group Primary Care Progress, warns, “If you don’t have a primary care provider, you should find one soon.”
A new study suggests that cigarettes and surgery don’t mix – and simply quitting a couple months before a medical procedure won’t help, Reuters Health reports.
Based on a post-surgery review of current smokers, former smokers who had quit at least a year earlier and people who had never smoked, the study found that smoking increases the risk of serious health complications after major surgery, such as heart attack, developing blood clots and pneumonia. The chance of death is also higher.
Study leader Dr. Faek Jamali noted that, while his research concluded that current smokers were more likely to die than nonsmokers post-surgery, former smokers had the same risk of death as those who had never smoked. However, former smokers did have a 28% greater risk of heart attack than never-smokers – still much better than the 77% greater risk among current smokers.
“We knew that smoking increased risk, but it was difficult to distinguish between risk caused by smoking-related problems like heart and lung disease and the risk of smoking itself,” Dr. David Warner of the Mayo Clinic told Reuters. “Knowing that smoking itself is a risk is important because it suggests that quitting can reduce risk.”
If your hospital of choice has a good track record for treating heart attack, pneumonia and congestive heart patients, chances are it also performs well for patients with other conditions – and these three mortality measures may be enough to identify high- and low-performing hospitals for patients and policymakers, Modern Healthcare reports.
An analysis of performance across more than 2,300 hospitals compared Medicare mortality rates for pneumonia and the two heart conditions for high- and low-performing hospitals with those for 19 medical and surgical conditions, such as stroke, renal failure, coronary artery bypass grafting and colon resection. It found the composite medical and surgical mortality rates was 3.6% lower, after adjusting for risk, among hospitals in the top performance quartile on the trio of Medicare mortality rates when compared with the worst-performing hospitals.
The correlation suggests there may be factors at work across an entire hospital – not just one department, such as cardiology– that improve quality outcomes, said study co-author Dr. Ashish Jha, a professor of health policy and management at Harvard University. “Leadership and culture probably matter a lot.”
Modern Healthcare noted that the ability to judge hospitals based on a limited set of factors would be a boon for patients, who would not have to wade through dozens of mortality statistics to find a suitable facility.
Monitoring early stage prostate cancer is more effective and economical than performing surgery and radiation from the start, a new study finds.
“Most of the men who are diagnosed in this country these days have low-risk prostate cancer,” said study leader Dr. Julia Hayes to Reuters Health. “There’s a huge group of men out there who are probably treated unnecessarily.”
Conducted by the Dana-Farber Cancer Institute, the study of slow-growing, early-stage prostate cancer tracked the health of men ages 65-75, taking into account tests costs, missed work, treatment side effects, quality of life and their chance of dying from prostate cancer.
The risk of men dying from prostate cancer was 4.8% for those who were monitored with active surveillance, through PSA blood tests, rectal exams and ultrasounds at regular intervals. The risk was 6.0% for those men under “watchful waiting” – less intensive treatment, fewer tests, and greater reliance on symptoms for the provider to decide whether treatment is necessary. In contrast, men who went directly for treatment had an 8.9% risk of death.
UPDATE (7/3/13): Reuters Health has also reported on a separate study which concluded that the “wait-and-see” treatment approach may not work as well with low-risk black men as it does with white men.
“It’s known that outcomes for African Americans with prostate cancer are less good,” said Dr. Edward Schaeffer, the study’s senior author from Johns Hopkins Hospital in Baltimore. “This study’s number one highlight is that because of that observation, we don’t think you should just recommend active surveillance.”
With childhood obesity more than tripling in American adolescents over the past 30 years, the need for parents to step in and take action has never been greater. But a new study suggests that rather than dwelling on their kid’s extra pounds, mom and dad should promote better health habits, HealthDay News reports.
Childhood obesity is the number one health concern among parents in the United States today. “Because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents,” said former Surgeon General Richard Carmona.
There is a right way and a wrong way to discuss healthy eating with children and teens, said Dr. Jerica Berge, who led the study. She advised that parents need to have a conversation with their children about healthy food choices. Instead of emphasizing weight, encourage children to eat more fruits and vegetables.
The study found that adolescents pressured to lose weight were actually more likely to have a problem with dieting and other eating behaviors. But parents who discussed healthy eating were less likely to have teens who exhibited unhealthy eating behaviors, such as anorexia, binge eating or bulimia.
David Katz, MD, Director of Yale University’s Prevention Research Center, says that the American Medical Association made a mistake in recognizing obesity as a disease:
“The notion that obesity is a disease will inevitably invite a reliance on pharmacotherapy and surgery to fix what is best addressed through improvements in the use of our feet and forks, and in our Farm Bill.
“Why is the medicalization of obesity concerning? Cost is an obvious factor. If obesity is a disease, some 80 percent of adults in the U.S. have it or its precursor: overweight. Legions of kids have it as well. Do we all need pharmacotherapy, and if so, for life? We might be inclined to say no, but wouldn’t we then be leaving a ‘disease’ untreated? Is that even ethical?
“On the other hand, if we are thinking lifelong pharmacotherapy for all, is that really the solution to such problems as food deserts? We know that poverty and limited access to high quality food are associated with increased obesity rates. So do we skip right past concerns about access to produce and just make sure everyone has access to a pharmacy? Instead of helping people on SNAP find and afford broccoli, do we just pay for their [weight loss drug] Belviq and bariatric surgery?
“If so, this, presumably, requires that everyone also have access to someone qualified to write a prescription or wield a scalpel in the first place, and insurance coverage to pay for it. We can’t expect people who can’t afford broccoli to buy their own Belviq, clearly.”
With over half of American adults relying on smartphones for everything from mapping trips to buying groceries, it should come as no surprise that many want to use their devices to make health care simpler.
HealthDay News reports that many Americans are already using phone applications to record and organize personal health information – and that’s just the tip of the iceberg. Many companies are designing apps along with specific types of equipment that will enable the user to can help diagnose everything from ear infections and eye diseases to irregular heartbeats and malaria.
And once the smartphone has gathered the information? A recent poll compiled by Harris Interactive/HealthDay reports that more than one-third of respondents said they are “very” or “extremely” interested in using their phone or tablet to ask their medical provider questions, make exam appointments and retrieve test results.
Of course, for such an app to be effective would require your provider to have the proper systems in place, noted Titus Schleyer, who heads the Center for Biomedical Informatics at the Regenstrief Institute. “This poll shows us that the public is interested in using these apps. But the health-care system has to make it easier for them to do it,” he said.