Friday, January 25, 2008

Searching the Internet on your own can Cause Serious Problems

The US Center for Medicine in the Public Interest (CMPI) recently released a report documenting that patients who search the internet on their own, looking for answers to health questions can make medical decisions that are potentially dangerous to their health. They note in their report that some patients have replaced their trusted physician with "google" or other search engines, but note that the medical information they find there always appears to be authoritative and accurate, but often isn't. They note examples of lawyers posing as medical experts, plaintiff firms searching for people willing to testify in lawsuits, and many groups or individuals selling alternative medical products of various sorts.

The authors further note that 65% of the first three pages of search results came from sites that were biased or contained unverified information. Nearly half of the first three pages of search results belonged to lawyers and attorney referral services seeking plaintiffs for class action law suits. Finally, they noted that no official regulatory pages or professional medical organizations appeared in the inventory of results.They note that persons who use the internet to obtain health information will find little that is reliable upon which they can depend and, worse, can get confusing, contradictory or dangerous advice or suggestions.

We have frequently noted on this site that we believe that the best model (other than working directly with your own personal physician) is to have a trusted physician who can either refer internet based information to you that relates to your particular issue, or send a site that you have found to a physician to review and verify its validity.At eDoc, the physicians almost always search the net and attach one or more relevant web sites to expand or illustrate our answers and comments. This provides patients with the best of both worlds: direct interaction with a trusted physician AND reliable, verified information from the vast resources of the internet.

Have you had frustrating experiences conducting your own searches? If so, I'd like to hear from you!

Wednesday, January 23, 2008

How to be Helpful to a Greiving Friend

Grieving has no season. Several folks have brought up the issue of how, now that the traditional Holiday Season is passed, they feel a surge of grief related to a recent loss. I wanted to share some tips modified from information on PsychCentral, on this important topic.

Often, I find that close friends who want to help just don’t know what to say or do. Indeed, sometimes we can say things that unintentionally make matters worse. Even if you are trying to help yourself through a difficult loss, I hope this helps. But, please don’t try to go through your grief alone; there are people who care and people helping you can really make a difference.
You can locate the entire PsychCentral article at <>

Here are some Practical Tips to Consider

Take action and do something specific that you think can help the grieving person. The well-intentioned offer, “Call if you need anything” usually is not enough.
Encourage healthy expression of thoughts and feelings.
“Do you feel like talking?”
“I don’t know what to say, but I care, and I am here.”
“I can listen, and that might help you.”
“Please don’t worry if you cry in front of me.”
If your friend uses email, keep close contact through short emails (this is not to replace other tips, but needs to be part of the overall action plan).
Help create new traditions and memories.
Help put regrets into perspective; no life is perfect.
Help your friend look to their faith community for extra support.
Urge discussing their grief with a behavioral health professional or even their primary care physician, if you feel this is more than you feel comfortable handling.
Plan for difficult times/dates well-ahead of time (anniversaries, birthdays, holidays, mealtimes). The key here is to not be caught off guard with a surge of anniversary or nostalgic grief. Getting through the year of “firsts” can be particularly troublesome for many.
Help clean out the loved one’s things.
Encourage your friend to take care of their physical and behavioral health, and be a good role-model in the process.
Be patient and be prepared for a roller-coaster of emotion. Grief is a process that takes time.
Remain doing what a good friend would do: Put your good intentions into consistent, helpful, supportive and caring actions.

All comments welcome on this important topic

Saturday, January 19, 2008

Antidepressants May Not be as Effective as we Think

A report recently published in the New England Journal of Medicine concluded that drug companies may have misrepresented the effectiveness of antidepressant medications by publishing those trials which showed better results and witholding other trials that were not as positive.

In the published reports, the drugs were about 60% more effective than placebo, but when the results of the unpublished reports were included, they were only slightly more effective than placebo in treating depression.

Over the past few years, it seems to me that patients and physicians alike have increasingly tended to rely on antidepressant medication to treat patients with depressed mood. It has even been suggested by some that we have been guilty of "medicalizing" sadness and treating relatively normal down times in life as a clinical illness, depression. But, clearly, depression is a common and serious malady in the practice of every primary care physician and we must always strive to maintain an effective approach to helping patients with this problem.

So, then, how do we take this recent finding and incorporate it into our practice? I think that antidepressants should be used, in most cases, as adjunctive, rather than primary treatment of depression. The medication clearly reduces anxiety, improves sleep, and in many cases, does elevate mood. But, we should all be cautious, especially in light of this insightful finding, about over-reliance on drug treatment. Use of psychotherapy and other forms of counselling, exercise, attention to sleep and nutrition, and addressing alcohol or other substance abuse issues are all examples of important aspects of treatment beyond just putting the patient on antidepressant medication.

If you have depression, are taking an antidepressant, but are not improving, you should strongly consider a return trip to your doctor to request a fresh approach!

Your comments are welcome...

Wednesday, January 16, 2008

Zetia, Premarin, and the safety of medicines

Part of our Federal tax money goes to support the Food and Drug Administration (FDA), charged with overseeing the safety of medicines sold in America. The pharmaceutical companies are quick to describe how very expensive it is to take a proposed new medicine through the FDA approval process. So, why is the effectiveness and even safety of Zetia, (ezetimibe; a component of Vytorin) a cholesterol reducing medicine, being questioned now quite some time after its FDA approval.

Everyone would like their risks of heart attacks and strokes to be reduced. This is the ultimate goal of preventing and treating cardiovascular diseases, the number 1 cause of deaths in the US. Heart attacks and strokes are thought to be caused by cholesterol plaque being deposited in the walls of blood vessels thus narrowing them or by clots lodging in the blood vessels of the heart and brain.

The ideal means of experimenting with a proposed medicine for reducing the risks of heart attacks and strokes would be to treat some people with the medicine and not treat others. Then, wait to see which group gets more and which group gets fewer heart attacks and strokes. And, ideally, everyone in both groups would have the same diet, stresses, living conditions, etc. Well, reality is far from the ideal and people tend to live for a long time so either the groups on the medicine and on a placebo need to be huge or the groups need to be followed for decades in order to get statistically valid results to answer the question - does the medicine prevent heart attacks and strokes.

We have thought that blood cholesterol levels served as indicators of what was going on in the blood vessel walls but this has not been shown to be the case for people on Zetia or for women taking Premarin (an estrogen hormone supplement). When the expensive studies were done, there was not a close correlation between the cholesterol levels and the diameter of the blood vessels (for Zetia) or the numbers of heart attacks and strokes (Premarin). We are just more complicated than was thought and these two surprises to medicine may end up having a great influence on how medical research is done and medicines approved in the future.

Sunday, January 13, 2008

Are We "Overparenting" our Children?

Recently, I was driving down a rural Arkansas road and got "stuck" behind a school bus. That gave me an opportunity to observe the children that got off the bus. In one instance, there was this cute little redheaded kid that couldn't have been more than 5 years old, who got off the bus (at a busy road). His back pack weighed almost as much as he did. He proceeded to run happily down his rather long driveway to his farm house as his little dog made its way to meet him halfway. As small and young as he was, there were no parents or siblings there to meet him, escort him home, make sure he was safe, etc. But he looked fine, and very self assured for such a small fry.

For the next four or five stops, it was the same: The kids got off, happy, were not met by anyone, and proceeded towards their house to get started on the afternoon's activities. Where were their parents? Weren't they all being neglected? In my community of West Little Rock, these kids would all be met at the bus by at least one parent and, in most cases, would be whisked off to dance or music lessons, then on to a fast food restaurant or other venues, always closely supervised, accompanied by lots of questions, etc.

On the other hand, as I thought more about it, these kids were learning, at an early age, how to be more independent, how to solve problems and how to entertain themselves without the need for their parents to be in tow. In West Little Rock, parents tend to "helicopter" their kids and the result is often a child who goes off to college underprepared for independence, problem solving and good decision making.

Surely there is a balance in parental attention v. allowing the child to be away from a parent to learn the skills of becoming an independent person. But how does one achieve it? How do you know how much parenting is enough without smothering your kid with your attention? To what extent, I thought, have we parents crossed this line and have begun "overparenting" our kids. By washing, cooking, buying, transporting, thinking and, sometimes, even talking for them, we are likely robbing them of opportunities they need to experience.

What are your thoughts on this important issue?

Tuesday, January 8, 2008

Four Ways to Prolong Life

Greetings! I have been recovering from knee surgery for the last several weeks, so I haven't posted for a while. But, I'm happy to say that I'm doing well, and planning to return to work in a week.

How would you like to live an average of 14 years longer? A study reported today by Kay-Tee Khaw and colleagues at the University of Cambridge in the UK suggested that 4 behaviors would prolong life by an average of 14 years. These were:

1. Drinking only moderately (this is usually defined as no more than 2 alcoholic beverages per day)
2. Quitting smoking (or not starting if you don't)
3. Exercise (usually defined as 30 or minutes of aerobic exercise on 5 days of the week)
4. Eating five servings of fruits and vegetables per day.

The authors questioned 20,000 people between 1993 and 1999, assigning them one point for each of the above healthy behaviors. After controlling for age and other factors, they found that persons with a score of "0" were four times more likely to die.

The researchers tracked deaths among the participants until 2006 and found that a person with a health score of 0 had the same risk of dying as someone with a health score of 4 who was 14 years older, thus the presumption that the healthy habits were likely to proling life.

I have long advocated keeping simple goals such as these four behaviours for maintaining health. Therefore, I'm delighted to see quantifiable evidence of benefits. Since I haven't seen the original study or analyzed the data, I can't be certain that the study doesn't have some statistical flaws, but I am willing to accept that there is life-extending benefit to these behaviors and recommend them as the basis for good health.
In this season of resolutions, why not adopt these four simple, but profound, lifestyle changes and make a choice to lead a healthier and longer life!

Monday, January 7, 2008

Walk Further with a Pedometer

My wife and I recently installed a photovoltaic system at our house so that we can generate electricity from the sun. If we produce more than we use (which we do), we can sell it back to the power company. By producing an excess of electricity, I thought that we may become less careful about energy use, but the opposite reaction has occurred. We have actually become more conserving of electricity. Apparently, a similar mentality occurs when people use pedometers to keep up with the amount of walking they do on a daily basis.
The Journal of the American Medical Association recently summarized the results of 26 studies involving 2767 healthy adults that evaluated the association of pedometer use with physical activity and health outcomes. This review found that by simply wearing a pedometer, participants were motivated to increase the number of steps that they took each day. Overall, pedometer users increased their physical activity by an astonishing 26.9% over their baseline. But better yet, these same subjects also significantly decreased their body mass index as well as their systolic blood pressures.

The health benefits from use of a pedometer were clear in this study population. For those who require some extra motivation, this may be an easy way to increase their amount of daily exercise. The authors of this study weren’t sure if the level of physical activity and improved physical parameter would persist, but I can tell you that after 6 months of our photovoltaic system being on-line, we are still enjoying watching our electric meter “run backwards”.

Thursday, January 3, 2008

Successful Dieting for Weight Loss

Losing weight is probably the most common New Year's resolution. Losing weight and keeping it off is hard work. If you are reading this, you may be among the many who are working at it.

My local San Diego Union Tribune had a very nice article in the Jan. 1, 08 issue called "Dieting Detours" by R.J. Ignelzi. I'd like to give you some of the highlights I thought were great practical suggestions. The bold topics are his, the comments are mine. A dieting detour is something which knocks you off course in your quest for weight loss.

Eating in a Restaurant: People who eat out, eat more than at home. Restaurants sell large portions to please you (they think) and keep you coming back. Don't eat it all! You may have grown up like I did with the "always clean your plate" culture. Only eat what you need to satisfy your hunger and send the rest back! You will feel good about that. Tell them what you want: You do not have to get the food like they want, make it the way you want. Hold the butter and put the salad dressing on the side are good starters, and save many calories and fat intake. Beware of buffets: This is where you eat multiple plates just because you can. Have a plan and make sure you only eat the meal you really need.

Family Gatherings: Be sure what you bring is healthy. Be conscious to only eat what you need. If you cannot help but eat more, burn some of that before and after the event through exercise. Burn what you eat is a great rule for maintaining weight.

Vacations: On vacation you will usually eat out more, so the first category above is important. Avoid alcohol in larger amounts. Alcohol is very high in calories and makes you store as fat much of what you eat. Stay active: Plan exercise into your daily routine, much like at home. My wife hates cruises because of all the food and the weight gain. I love them, and jog the deck and use the fitness center every day. I get off the ship stronger with no weight gain.

I hope these ideas will help you with successful weight loss for 2008.
Healthy New Year!