Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (2)

Where Is The Worst Health Information On The Internet? The Huffington Post

Going to the Huffington Post for medical information is perhaps comparable to going to Vito Corleone for advice on income tax compliance.  Another prominent blogger refers to is as “that hive of scum and quackery,” a lovely and accurate epithet for a media outlet which provides refuge and cover for anti-vaccationists, homeopaths and practictioners of reiki and other such pseudoscientific twaddle. I avoid the HuffPo like the plague.  But, like a moth to the flame, sometimes I can’t help myself, and when a facebook friend (and former blogger) pointed to this contrarian article, my interest was piqued and I had to check it out.

Is High Blood Pressure Overtreated? Dr. Dennis Gottfried, Associate professor, University of Connecticut Medical School

First of all, I don’t know Dr Gottfried, and I don’t want to cast aspersions on him professionally. He might be a faith healer and snake-handler, or he might be a prominent researcher and expert in the field. I have no idea, and other than his questionable judgement in being affiliated with the HuffPo, I don’t want to make any judgement on him as a physician or a scientist.

The media and communications, part, however, is pretty aggravating. As a general-interest publication, the HuffPo is trafficked primarily by people who are, in the medical context, patients. Which means that when they consume medical news they tend to personalize it — “How does this article relate to me?” It’s also true, perhaps unfortunately, that for most news articles, many people read only the headline and the lede and maybe the final paragraph.

So the take-home message of this article most health consumers will get is this: “Diagnosing and treating hypertension is clearly sound preventative medicine; but, as with so many areas of health care, too much of a good thing is often not good!” and this: “What these studies do show is that lowering blood pressure excessively with medications can be dangerous. The national belief that more and newer in health care always represents improvement is not only expensive, but dangerous. In medicine, too much of a good thing can be bad.Which are absolutely awful messages to send to the general public! It’s a public health imperative to educate people of the importance of identifying and controlling high blood pressure, and this article sends a confusing and conflicting message to patients that maybe it’s actually a bad thing to control their blood pressure!

Now it’s true that the article pays lip service to the importance of controlling blood pressure for most people. But that’s a nuance too easily lost, especially when it’s in direct opposition to the central thesis of the article — that too much treatment of blood pressure is bad. It’s also true that the author does a nice academic-style review of some recent studies which do, in fact, support this central thesis. But there is a major qualifier which is actually pretty difficult to extract from this article: the applicability of the thesis is solely to a very small selected population of people who already have been identified as vasculopaths. That’s a huge caveat, and one which absolutely needs to be clearly and prominently identified in the key parts of this article, especially since it is directed at the general public.

There is a huge difference in the way a physician and a patient read this sort of thing.  A health care provider will (hopefully) evaluate the argument and the data and consider which of the many patients he or she cares for it might be applicable to. The population in discussion is reasonably well identified in this article, and I think most doctors would be able to internalize and use this information clinically. But for general audiences, this is terrible, since most people/patients who read this (who are problby more likely to have HTN than the average reader) may not pick up on the narrow applicability of this study and draw the wrong conclusion as it relates to their own health, that taking their meds or controlling their pressure is maybe not as important as their doctor said, and maybe even harmful. This is all the more possible since the discussion of the research is pretty dense and academic. (I had to read it a couple of times to make sure I had a grip on it, and I am accustomed to reading medical literature.) People have a hard time making sense of conflicting and changing medical science, and this article, written as if for a professional audience but presented in a general publication, only exacerbates that public health challenge. As an editorial in Circulation, I’d have little argument with this piece. As an article in the “Personal Health” section of a mass-market website, it does a grave public disservice.

Take home message: know your audience and make sure your message is geared to be clear and accessible to them.

*This blog post was originally published at Movin' Meat*

You may also like these posts

Read comments »

2 Responses to “Where Is The Worst Health Information On The Internet? The Huffington Post”

  1. Health Blog says:

    Over treatment for anything may not a be a good idea, especially hypertension as the patient may become hypotensive and have problems of low blood pressure. The answer is optimal treatment/management.

  2. eMingko Blog says:

    i’m agree with this opini “too much of a good thing is often not good”

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »