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Who is the source of that information about health on the internet?

119_1916January 19, 2010

Surveys show that most of us go to the internet to search for health information and we do it fairly often. I was reminded of that as I had one of my infrequent flair-ups of pseudogout.  It has been years since I’ve had the pain and swelling in my knees and this time it affected my fingers, my wrists, and even my back. And it didn’t go away after a few days. So I went online. And I found lots of information. 

How we search for health information on the internet and what we do with the information once we have it is likely to predict whether the information is going to help or harm us. We can conclude that we are not at risk based on the information and be wrong. We can conclude that we are at risk based on the information and also be wrong. So a good place to start thinking about health information found on the internet is to consider the source of the information.

First, consider the motivation of the source. In the broadest sense, .com sites are commercial, while .org sites identify organizations, and .gov sites come from the government. We usually start with a search engine such as Google to seek answers to our questions. When I did, Google health came up as the first link to information. With so many people searching for health information, I guess it isn’t too surprising that the owners of a search engine like Google might want to get in on the act…  

Second, consider the expertise associated with a site. Just ‘who’ is the author of the content you are reading and applying to your health? Is it a doctor or a nurse or a physical therapist? Is the doctor speaking on behalf of research or based on experience as a doctor? Is the information just presented, so the source is just the internet with no way of knowing if there is medical research to support the claims, particular researchers presenting the claims, or doctors supporting the research conclusions. I followed the Google health link and I searched for information about the expertise. I found some information at the bottom of a loooooooong page of information. But I couldn’t trace it back to any research. So I couldn’t find out much about where all the conclusions were coming from. Health communication researchers find this to be the case time and again. Not just on the internet. In newspapers, magazines, and broadcast news reports, the expert source on which information is being based is too seldom mentioned.

Third, what part of the information is the author of the content emphasizing, and what part is not being discussed? Is the author providing information for an organization that wants them to present a particular point of view? So, they might be describing the benefits of getting care at the organization whose site they represent but not tell you that it cost more than your insurance is likely to pay. Or, they might be telling the benefits related to one type of treatment for the drug company who has paid for the site you are reading, and they likely believe in those benefits, but there may be no discussion of the risks for the treatment. So, consider not only what content is included in the information but what content might be missing as well.

Doing so should help to make the information we find useful and help us to frame additional searches for more information to fill in the missing content…

Why don’t we ask doctors to clarify information when we don’t understand it?

January 15, 2010

I’ve done it. Have you? Walked out of the doctor’s office scratching your head, telling your waiting family member or friend, or running to the nearest computer to get online…and figure out what the doctor was talking about. Why don’t we just ask?

First, it is a bit embarrassing if the doctor says something and doesn’t ask us if we have any questions. It seems like we should know what is going on. So, we don’t ask because we feel embarrassed that we don’t understand. These days, I try to ask myself, “Do I literally want to ‘die’ from embarrassment?” If I don’t understand and I don’t ask a question, what are the chances I could…fail to follow advice, fail to understand my diagnosis, and well—harm my health… 

Second, we have to admit to ourselves that we don’t quite understand what’s going on. Cholesterol called good cholesterol and bad cholesterol…what does that mean? Isn’t it all bad?  If I at least ask the doctor to spell it or write it out, I  find that most of the time, I get more information and I get it reinforced in writing.

…two ways to help myself out when I don’t understand……

Why should you talk about family history and health?

roxannebuggyJanuary 12, 2010

The woman on the horse is a relative that I share a first name with…tho, of course, I never knew her. I wonder what else we might share. Hair color, height, health?

 The U.S. Surgeon General advises us to ‘know our family health history.’ The problem is, what to know and how to know it. Since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day [http://www.hhs.gov/familyhistory/] as part of an initiative to get us talking. While we do need to find a time to talk with our family about our health histories, few things seem more doomed to failure than pushing families to talk about poor health at a gathering aimed at celebrating.

First, older adults in our families have many interesting things to tell us about that go on in their lives besides poor health. Many have good health and no reason to focus on poor health. Many want to avoid the stereotype linked to old folks talking about their health and nothing else…even when they do have poor health.

Second, younger adults who need to know about their family health history need to know details that are unlikely to be discussed in such public settings, or if they are discussed, unlikely to be remembered.

Third, it is not particularly helpful to know that there is diabetes or heart disease or cancer in your family if you don’t also know who had the condition, at what age they had the condition, what treatment they used to address the condition, and with what success. Or, knowing what family members have died from should be accompanied by information about the age at time of death.

In this  era when we have more awareness of how genes affect health and our reponses to medications and other therapies, we may want to know whether our family members have had any genetic tests. If they have, what ones led to positive results indicating the presence of a particular form of a gene? 

Talking about family health history is important but can be difficult if we don’t make time and don’t know what to talk about….

Direct-to-consumer advertising..

January 7, 2010

Only the U.S. and New Zealand have policies that allow advertisers to sell prescription drugs, durable medical goods, and even medical tests by appealing to consumers to be informed and ask their doctors to ‘prescribe’ specific drugs and therapies. On the one hand, these ads provide an opportunity for consumers to learn about different treatments. They also may reduce the sense that particular symptoms or conditions are unusual or embarrassing. For example, depression has long been a stigmatized condition. DTCA have undoubtedly played a large part in making us feel like the prevalence of depression is much greater than we might otherwise think. That might make us more willing to tell our doctor about our symptoms and seek help with them. On the other hand, DTCA have been faulted for providing a lot of content about the benefits of particular prescription drugs or treatments and providing very little information about possible harms.

If we find ourselves learning something new about health from DTCA, we should look for the content to give us a balanced review. Companies want to make profits. They won’t make profit by harming us, but they may make profit by persuading us that our life will be better if only we take a pill…

Feeling susceptible…

January 5, 2010

When talking about health, one of the most important things to say if we really want someone to listen is, “You are at risk. This is about you. This isn’t about your neighbor, your child, your boss… You are susceptible.”

If I don’t think I am actually personally at risk because I don’t have a family history, then what makes me susceptible? If I don’t think I am because I do all the right things like eat healthy and exercise, then what makes me susceptible? If I don’t think I am because I just never get sick and never get injured and never forget to take my vitamins or never neglect to wash my hands, then what makes me susceptible?

Our age can make us more susceptible. Some health conditions happen more often to children and some happen more often to people in their 50s or their 70s or older. We saw this discussed with the H1N1 virus and the need for younger people to be vaccinated because they were more likely to be affected. But what are each of us more susceptible to because of our age?

How much “chemo” is too much or too little?

122_0568January 3, 2010

It doesn’t surprise us to think about needing different dosages of medications…pain relievers, aspirin, and so on. But how often have you heard anyone talk about the dosage for chemotherapy?

My good friend will begin chemotherapy for her colon cancer in a couple of weeks. She was reading a bit online about some of the research related to the treatment. She read that obesity may make it difficult to determine the right dosage for someone’s chemotherapy to be enough to work. Not that she is fat. Quite the opposite. She is a petite woman of average weight. So she wonders if perhaps she needs a lower dose of chemo to work but to avoid some of the toxicity that a so called average dose would have for her. She will ask her oncologist about it.

Another example of important work being done in cancer research studies to help patients get the most out of their treatment. It would be awful to go through chemo and have it not work because you were overweight and didn’t get a high enough dosage…

Another example, too, of how the ‘normal’ dosage is not a one size fits all prescription. A good lesson to keep in mind when we talk about health…our size and the dosage we need.

Why does Dr. Oz talk about “gas”?

imgp0014January 1, 2010

A couple of days ago, I was listening to the Dr. Oz show, and he talked with the audience about ‘gas.’ He described how much gas or flatulence is ‘normal’ and showed the audience a balloon filled with the amount of gas that any one of us on average has in a given day. Dr. Oz described some of the foods linked to forming flatulence. He did a great job of filling some of the void in our understanding about this topic.

But there is more to it than that as anyone who watched could tell from the giggles and embarrassed expressions on audience members’ faces. While we  many now understand both that having gas is part of  the human experience and that some foods cause more gas than others, we may be struggling with the fact that our doctor told us to start eating a diet that is higher in fiber and doing so has — you guessed it — caused us to have more gas than is normal for us and some discomfort or gas pains as well.

So now the problem is that we are not sure how to tell our doctor about the discomfort. It is after all embarrassing. So do we just give up trying to eat a diet that is higher in fiber? I hope not. A higher fiber diet has a lot of health benefits. So try increasing the fiber in your diet with a little less gusto… perhaps add 1-2 servings of fiber a day rather than 7, and keep track of how that makes you feel. Still a problem? Realize that your doctor may have advice to help with the gas, and no way of knowing you are having discomfort if you don’t disclose the experience. Tell your doctor what you have been eating and what you have experienced and that the gas is not normal for you and is causing discomfort. Normal is, after all, best judged by each one of us when it comes to our own health.

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