January 26th, 2008 by Dr. Val Jones in Health Policy, Opinion
3 Comments »
I had a really great conversation with iHealthBeat reporter Kate Ackerman recently. She summarized our conversation
in an online article and I’ve copied some of it here. Please check out the full article for the entire interview.
Consumer Demand Fueling Online Health Care Market
by Kate Ackerman, iHealthBeat Associate Editor
As patients increasingly turn to the Internet for health care information and online tools to manage their health, many companies, both new and old, are stepping up to meet the consumer demand.
It is still too early to tell which companies will be successful and how the Internet-savvy health care consumer will transform the patient-physician relationship, but the trend has captured the interest of many health care insiders.
Val Jones, senior medical director of Revolution Health and author of a blog called “Dr. Val and the Voice of Reason,” spoke to iHealthBeat about the online health care market, physician concerns about patients relying on the Internet and the role of medical blogs.
…
A recent Harris Interactive survey found that the percentage of U.S. adults who looked for health care information online increased from 72% in 2005 to 84% in 2007. Why do you think more and more consumers are turning to the Internet for health information?
I think it’s partially because more and more consumers are turning to the Internet for information, period. Online information is incredibly convenient, served up lightning fast and has revolutionized how we research everything from buying toasters to finding a doctor. Of course, health is much more serious and complicated than purchasing products, so consumers should be very wary of the source of their health information.
Do you see a generational divide in the people using Revolution Health?
We primarily appeal to everyone between the ages of 20 and 60, though women conduct more health searches than men. The only age gaps are related to the medical subjects being researched. Clearly, not too many 20-somethings are reading about menopause, and not too many 50-year-olds are reading about college stress. Otherwise, all of our community tools and groups are fair game for people of any age. We have 60-year-olds blogging and enjoying discussion groups, and 20-year-olds posting forum questions too. It’s wonderful to see the generations interacting online and learning from one another.
New York orthopedist Scott Haig in November wrote an essay in Time Magazine complaining about patients who research their symptoms, illnesses and doctors online before seeking treatment. What are the downsides to patients searching for health care information online?
I think Dr. Haig’s essay has been somewhat misinterpreted because he was focusing on a specific patient with a serious disorder. My favorite quote from Dr. Haig’s article is that “the role of the expert is to know what to ignore.” I think the major downside for patients searching for health information online is that it can be difficult to figure out what’s contextually relevant to them. Aside from that, the next major downside is that there are snake-oil salesmen out there preying on the frustrations that we all have about our broken health care system and promising “miracle cures” and fueling mistrust in doctors.
What can be done to ease concerns from physicians, like Haig, about consumers relying on the Internet for health information?
Educated patients are a pleasure to work with, but misinformed patients require lots of extra help. The hours we spend every week dispelling urban legends and Internet-fueled medical myths is really mind-boggling. Physicians are naturally protective of their patients and don’t want them to be duped or misled.
From Google to Microsoft, companies are beginning to recognize an opportunity in the online health care market. Is there enough room for all of these companies? What will make successful ventures stand out from the rest of the pack?
There’s as much room as consumer demand will fuel. However, only the largest and most innovative companies will ultimately survive long term. While we’re all waiting for the government to create standards for health information and the creation of interoperability rules, successful companies will meet the needs of today’s consumer. Small but practical tools and innovations will keep the companies solvent while we work toward the holy grail of a common health information platform for all the stakeholders.
Medical blogs seem to have taken off in recent years. Who do you think the intended audience is?
Actually, while there are an estimated 70 million blogs out there, only a few hundred doctors are blogging. That’s a huge discrepancy, and I don’t think we’re even at the beginning of the wave of medical blogging that will inevitably occur as doctors enter the Web 2.0 world. The first pioneers of the medical blogosphere are writing mostly for their peers, though patients find their blogs very engaging and read them as well. Very few medical bloggers write specifically for consumers.
What are your predictions for the online health care market in 2008 and beyond?
With decreasing access and increasing patient loads, I think we’re going to see the consumer-driven health care movement take center stage. Patients are going to need to “do it themselves” a lot of the time (meaning manage their own health information, teach themselves about disease management and make financial plans to take care of their own needs if the government cannot afford to do so).
Another trend I have my eye on is the retainer medicine movement. As primary care physicians continue to be squeezed out of existence by decreasing Medicare reimbursements, they are beginning to join an “off-the-grid” group of providers who simply do not accept insurance.
As more PCPs create retainer practices, I think IT solutions will really take off. Online tools that simplify their practices and speed up their patient communication will be welcomed and encouraged.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 21st, 2008 by Dr. Val Jones in Uncategorized
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Health tips
Are you struggling with depression? Mira Kirshenbaum suggests that talk therapy may be more effective than medications.
Does your child have mono? Dr. Stacy Stryer explains that mono has very different symptoms depending on a child’s age.
Be careful of vitamins and supplements – some of them may negatively affect your other medications. Dr. Julie Silver offers a list of the most common supplements that interact with medications.
If you see flashing lights or floating objects in your visual fields, see an ophthalmologist right away. Dr. Jackie Griffiths explains why the symptoms of retinal detachment can be quite ominous.
Are you about to have surgery? Dr. Jim Herndon suggests some questions to ask your surgeon before and after the operation.
Don’t be shy about asking for help when you have cancer. Dr. Heinz-Josef Lenz highlights some great advice from the Colon Cancer Alliance.
Looking for ways to enhance your sex life? Mira Kirshenbaum has some creative suggestions.
Do you have diabetes? Exercise might be the most important “treatment” for type 2 diabetes. Dr. Jim Hill explains.
Did you know?
Fertility decreases by 5% for every 1 point increment in BMI over 29. That means that getting pregnant becomes more and more difficult as you gain weight! Dr. Mark Perloe explains.
Men can suffer from post-vasectomy pain. Dr. Joe Scherger describes this problem and what to do about it.
Could having children increase a man’s risk for prostate cancer? Dr. Mike Glode reviews the evidence.
Your brain needs sleep to recharge its neurotransmitters. Dr. Steve Poceta explains the exact reasons why sleep is so important for the health of the human brain.
Approximately 1 in 25 children will have at least one febrile seizure in their lifetime. Dr. Olajide Williams explains that a seizure that occurs during a time of fever does not mean a child has epilepsy.
Siestas and/or power naps could reduce your risk of heart disease. Dr. Joe Scherger highly recommends this regular form of stress reduction.
There are fat zip codes and skinny zip codes. Dr. Jim Hill explains why thinner people congregate in certain places. Think upper east side, Manhattan!
A recent study suggests that calcium supplements may put older women at higher risk for heart attacks. Dr. Jim Herndon explains why he’s skeptical of this potential link.
Medicare will not pay for in-hospital complications believed to be due to errors. Kelly Close wonders how they know for sure that an adverse outcome is related to an actual error or not.
Do you know someone who engages in repetitive, jerky movements? Dr. Olajide Williams is a neurologist who explains what “tics” are and what can be done about them.
Around the globe
China: How many autism experts are there in China? About 30 for 1.3 billion people. Robin Morris describes how bleak the prospects are for parents of children with autism.
United States: In an outrageous court ruling, a physician was held responsible for the death of a young boy who was run over by a patient (while driving his car) on blood pressure medicines. Dr. Cole Brown wonders how much of a patients’ actions can be blamed on his physician?
Africa: “River blindness” is caused by a parasitic invasion of the eye. These parasites can be killed with a medicine called ivermectin, but apparently the wily larvae have developed a genetic mutation that renders them resistant to the only known medicine that can kill them. Dr. Jackie Griffiths reminds us all how tenuous our antibiotic victory over microbes and parasites really is.
Personal perspectives
Some people use diet coke in their CPAP machines! Dr. Steve Poceta tells the story of how one of his patients preferred this type of humidified air. Not sure what that will do to your lungs…
Ever wonder how to weigh the pro’s and con’s of chemotherapy in a terminally ill patient? Dr. Mike Rabow describes how he advises patients about this difficult decision.
Dr. Rabow describes some tear jerking true stories from a hospice in Florida.
From the blogosphere at large: this week’s grand rounds is hosted by Alvaro Fernandez at SharpBrains.com. The theme is: briefing the next US president on healthcare. Some really important information in there folks, so go ahead and have a good read!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2008 by Dr. Val Jones in Uncategorized
5 Comments »
I’m so excited and honored to have been nominated – and now selected as a finalist – for the “Best New Medblog, 2007” award! Thank you MedGadget team! If you’d like to vote for me, please go to this page. The winners will be selected based purely on quantity of votes. The polls are open until midnight, January 20th.
I’ve also collected the best posts from 2007 below so you can get an overview of what my blog is like – where else can you join a weight loss group, read weekly round ups of the best posts from medical experts, stay in touch with breaking medical news, and have a generally cathartic experience with true health stories?
The Best “Feel Good” Posts
A Baby’s Life Is Saved – a young mother forces a doctor to reconsider his diagnosis, saving her baby’s life.
Do the Right Thing– a young intern fights to save the life of a patient that everyone else has written off.
The Wounds of Childhood– how I might have made a difference for a little girl who was marginalized.
Medicine: Face-to-Face– the story of how I treated a child for the same injury I had at her age: being mauled by a dog.
Informed Consent and the Animal Guessing Game– my reflection on the emotional side of consenting for a procedure.
Thanks to Surgeons– a heartfelt tribute to the surgeon who saved my life.
Fly the Ball– the life and times of a Pakistani doctor who builds a successful career in the US.
The Best Infuriating Posts
The Last Straw: My Road to a Revolution– the true story of a child with cerebral palsy who died because he was denied a wheelchair part by Medicare.
The Benefit of the Doubt– how my friend was labeled as a drug seeker and mistreated in the ER.
VIP Syndrome: A No-Win Situation – the story of how a young man with “connections” demanded and received inappropriate and expensive medical tests, leaving the doctors holding the bag.
The Case of a Predator in the Hospital– how one drug user managed to game the system, wreaking havoc on her fellow patients.
Don’t Believe Everything You Read in a Medical Chart– the story of how a misdiagnosis resulted in a patient being wrongly labeled as a drug seeker.
The Real Dangers of Pain Medicine – a woman who died of opiate induced constipation.
The Best Sad Posts
The Scream– how a cavalier end-of-life decision destroyed a family member.
The Size of Unhappiness– a reflection on America’s obsession with thinness.
Baking Cookies– that’s all I could do as a doctor in Manhattan on 9/11.
Unencumbered by Prognosis– my dear friend handles her diagnosis of stage 4 colon cancer with optimism and grace.
Alzheimer’s Dementia: A Life Lived In Reverse– the story of my grandmother’s dementia and her slow mental decline.
The Best Humorous Posts
Conversations at the Spa– the true story of my recent trip to a high end spa in California.
Kids Say the Darndest Things– these are some pretty good ones.
The Christmas Miracle– a “miraculous” icicle forms on a Christmas tree and pandemonium ensues.
Medical Haiku– some irreverent poems I created a few years ago.
Is that Your Real Skin?– the silly conversations that arise when you’re really pale.
Dudes– a quick look at how men perceive a new hairstyle.
The “Perfect” Wedding– the story of how my hair was transformed into an alien head on my wedding day.
The Best Healthcare Policy Posts
Why I Worry about a Government Sponsored Single Payer System – previous experience with government rulings make me distrustful of population based healthcare savings initiatives.
Pay for Performance: More Red Tape without Improved Quality of Care – the title pretty much sums this post up.
Are Physician Salaries Too High? – compare them to health insurance and corporate executive salaries.
Concierge Medicine for the Masses?– my physician is part of an “off the grid” movement in healthcare.
Rationing Healthcare and the Emperor’s New Clothes – I take a look at some of the funding allocation decisions being made by the government.
End of Life Care: Healthcare’s Big Ticket Item– I explore some of the high costs of end-of-life care and the ethical dilemmas that rationing it creates.
Posts That Make You Go…Hmmm
My First Day as a Doctor– it was a baptism by fire.
The Great Unveiling– who are we deep down inside?
Night Float in the Hospice– what it feels like to care for the dying.
Dying with Dignity– I refused to practice intubation on a deceased patient as his family members waited for news in the next room.
Face Transplants: Ethical Dilemmas– should they be covered by health insurance?
The Man Who Couldn’t Speak– a strange diagnostic dilemma solved by a doting mom.
The Best High Brow Posts
Cancer: Do We Really Understand It?– a wonderful post by guest blogger Avrum Bluming, questioning if we really do know as much as we think we do about this formidable foe.
Hormone Replacement Therapy: A Critical Review– another wonderful post by Dr. Bluming.
Good Science Makes Bad Television– a series on research methodology and why the public should care about it.
The Power of Magical Thinking– describes how to recognize snake oil salesmen.
What You’ll Learn in Pre-Med Classes– a rant about how irrelevant some of the course work is that is required for admission to medical school.
What the Heck is a Rehab Doc?– the history of my medical specialty: PM&R.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 15th, 2007 by Dr. Val Jones in Health Policy, Opinion
5 Comments »
More healthcare dollars are spent on end-of-life measures than perhaps any other single expense. About 25% of Medicare’s 2.8 trillion dollar budget is spent on care for people in the final year of life. That works out to be about $2500/person/year that we spend on government funded end-of-life care. Medicare spending overall is closer to $10k/person/year in this country… and given that the average household pays $6K in taxes/year… you can see that we’re in a real pickle when it comes to healthcare spending (and that’s just for Medicare).
In a recent blog post, PandaBearMD suggests that it’s time to “put granny down.” This gallows humor speaks to what the medical community has been been discussing in more academic terms. Here are some interesting sound bites (click on links for full references):
Terminally ill patients should be treated outside of acute care facilities. …Acute care hospitals are, by definition, set up for handling acute conditions – trauma, childbirth, orthopedics, heart attacks, etc. Terminal illnesses are not acute conditions, and therefore should be treated in a facility or setting that is chronic-care oriented.
The technological advances that medicine has witnessed in the last few decades are no more apparent than in the ICU. Yet when used inappropriately, this technology may not save lives nor improve the quality of a life, but rather transform death into a prolonged, miserable, and undignified process.
Hospice care can reduce the cost of end-of-life care by 30% or more (though this is debated).
“We don’t operate in a closed health care system, where there is a fixed number of dollars for health care, and thus the need to choose how to allocate those dollars,” said Dr. Weissman. “Our health care system is open-ended, which is why the cost of health care goes up every year. So we’re not making a tradeoff of spending more on the elderly and thus not using those resources on children’s care.
While it is fairly obvious that we deliver a lot of unnecessary, costly, and heroic medical care at the end of life, determining how to ration this care is fraught with moral and ethical dilemmas.
What sort of population-based rules should we institute to govern access to acute care services at the highest level? Would limiting care to people based on age or comorbidities sit well with Americans? Imagine that you’re 65 – just entering retirement and expecting to enjoy another 20 years of life – and you’re disqualified from top tier medical treatments because of your age. Who has the right to judge your worthiness of top medical technology?
I know of an elderly woman who accidentally took too many diuretics over the period of two weeks. She became delirious and was admitted to a hospital where the doctors assumed she had end stage Alzheimer’s disease and sent her home with hospice care. Another doctor later discovered the error, rehydrated her and she returned to her usual state of health. It was a close call for that “granny.”
My parents are in their late 70’s and in excellent health, enjoying book writing and traveling. I asked them to read PandaBear’s analysis of end-of-life care in the United States – and how billions of dollars are spent on heroic measures for the frail elderly.
My mother said tersely, “I hope I die in Europe.”
My father replied, “Whether you’re old or young, it’s nice to be alive.”
But I can’t help but think of that patient who was sent home with hospice care for delirium caused by severe dehydration. Will we turn our backs on the elderly and not carefully consider their differential diagnoses simply because of their age? As long time tax payers, are they not the most deserving of access to top technologies if so desired?
This is one tough dilemma – and the best I can advise is that we each create living wills, and save our own money for that rainy day when we need critical care, but are ineligible based on some future population-based rule to save money on futile care. In that case, the wealthy would always maintain access to the best care available.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 18th, 2007 by Dr. Val Jones in Health Policy, Opinion
5 Comments »
A recent blog post at Terra Sigillata really disturbed me. The author describes how, in the face of increasing healthcare costs, Medicare now declines coverage of life saving medicines for lymphoma patients. This is one example of rationing healthcare that will become ever more common (as it is in other leading industrialized nations) as we move towards further cuts in government programs and funding. In Canada, expensive chemotherapies are not commonly covered by the national health plan, and in Britain, age is a determinant for transplant eligibility.
But what troubles me about the apparent capriciousness of denying coverage to certain types of cancer patients over others, is that government programs are – at the same time – allocating millions of dollars to researching implausible alternative medicine treatments while denying coverage of proven therapies to patients who will likely die without them.
Take homeopathy, for example. The National Center for Complementary and Alternative Medicine lists homeopathy as an eligible area of research, and boasts several ongoing studies in the area of stroke, dementia, fibromyalgia, and prostate cancer. And yet, there is no plausible mechanism of action to support its potential use as anything more than a placebo. Homeopathy operates on the assumption that water has memory, and that once it has been exposed to certain substances, such as arsenic, it obtains curative properties for illnesses that bear resemblance to poisoning from those very substances (though the water itself may no longer contain a single molecule of the substance).
Research into scientifically implausible theories should not be funded by our tax dollars at the expense of offering life saving treatments to cancer patients. It is time for scientists to stand up and point out that the Emperor has no clothes when it comes to homeopathy and other similarly flawed alternative medical treatments.
As we move towards rationing limited healthcare resources, we have a moral obligation to prioritize the money correctly. “Open-mindedness” is no excuse for poor stewardship.
Dr. Wallace Sampson sums this up in a provocative recent editorial. Here is an excerpt:
We now see accumulation of useless information in journals and information data bases — hundreds of clinical trials (RCTs) on implausible methods, such as homeopathy, unrefined plant products, prayer, and acupuncture. Initial plausibility retreats before two 20th-century development ideologies of relativism — a principle that all facts and opinions have equal or similar value, and postmodernism — that regards facts as social constructions.
Once thought to be too esoteric for relevance to medicine, these twin ideologies now mold the thinking of policy makers and granting agency officials. Ancient and traditional cultural practices are not diminished for lack of plausibility, but are investigated by RCTs because they are there.
Plausibility depends on prior reliable observations, physical and chemical laws, pharmacological principles, and advocates’ economic and legal misadventures. The National Center for Complementary and Alternative Medicine spends $100 million/year on implausible research and training grants. In performing RCTs on implausible proposals, clinical research has taken a wrong turn and departed from rationality.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
