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 23rd, 2008 by Dr. Val Jones in Humor
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Ok, I admit it. I’m just stealing content from themommyblog.net. But this quote was too charming to miss.
My friend Mindy keeps a list of her kids’ comments on her blog and at Pear Soup (a kiddie quote aggregator). This one struck a funny bone today:
Daphne and I were talking about how much we love each other and she said:
“I love you more than 1000 centuries, more than anybody or anything like a bunny or something bigger than the whole world including China.”
Now that’s a lot of love.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 5th, 2008 by Dr. Val Jones in Uncategorized
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Welcome to 2008’s first edition of Revolution Rounds, my biweekly round up of the best Revolution Health expert blog posts. Not surprisingly, there’s a decidedly New Year’s theme in this collection of posts. If you’re looking to stick to a New Year’s resolution, be sure to check out the Revolution Health groups section of the site. Whether you’d like to lose weight, quit smoking, or improve your relationships – there’s a group of like minded souls out there resolving to do the same!
Health tips
Dr.
Stacy has 20 New Year’s resolutions for kids. She has even organized them
by age group for you.
New
Year’s resolutions are more likely to succeed if you follow this advice. Mira Kirshenbaum has some great tips for adults.
Would
you like to lose weight effortlessly? Sandra
Foschi suggests that good sleep habits can contribute to
weight loss.
Reading
the right blog could save your life. Dr. HJ Lenz describes how one woman
learned about certain treatment options from his colorectal cancer blog, and it
changed her life.
Would
you like to stop snoring? Dr. Steve Poceta
has some excellent tips.
The best treatment for autism may not be a drug, but human caring.
Robin Morris discusses the findings of some recent research.
Do
you struggle with jet lag? Dr. Vivian Dickerson has some suggestions for
reducing your symptoms.
Pedometers
can encourage increased exercise. Dr. Jim Herndon suggests that a pedometer
might be an excellent addition to your weight loss resolution!
In
case you need another good reason to quit smoking: Dr. Mark Perloe reminds
us that smoking a pack a day can increase the risk of erectile dysfunction by
40%.
Think
you know how to insert eye drops? Think again. Dr. Jackie Griffiths has
some special advice for those of you who need eye drops regularly.
Did you know?
San
Francisco’s mayor has proposed a soda tax. Dr. Jim Hill explains that this
money is unlikely to put a dent in the obesity epidemic.
In
some cultures childhood epilepsy is treated by burning the feet with hot coals.
Dr. Jide Williams describes this horrific practice in rural Africa.
Snowblower
injuries are still quite common even though manufacturers have been working for
over 30 years to make the machines safer. Dr. Jim Herndon explains.
It
is possible to create embryos for the purpose of treating certain diseases, not
strictly for procreation. Dr. Mark Perloe discusses some of the ethical
dilemmas associated with stem cells.
Fitness
is more important than fatness. Dr. Vivian Dickerson explains.
Excess
weight in childhood is linked to adult heart disease. Dr. Jim Hill suggests
that fitness and weight control should begin early to promote good health in
adulthood.
Many
physicians need to work on their empathy. Dr. Mike Rabow explains that
younger physicians may be more empathic than older ones.
Your
emotional state can dramatically affect your physical health. Dr. Joe Scherger discusses this mind-body connection.
Demanding
parents may cause their childrens’ teachers to burn out. Dr. Stacy Stryer
describes this unfortunate phenomenon.
Skim
milk consumption may be linked to prostate cancer. Dr. Julie Silver raises
the question of whether or not skim and low fat milk are over-rated in their
health benefits.
You
don’t need both eyes to have good depth perception. Dr. Jackie Griffiths,
Revolution Health’s ophthalmologist, explains.
Newer
isn’t automatically better. Dr. Mike Glode bemoans the fact that we have
the tendency to rush after the latest medical technology without stopping to
analyze the cost benefit ratio.
Personal Stories
One
woman had an unpleasant surprise on her 40th birthday: a massive
stroke with left hemi-neglect! Dr. Olajide Williams describes the event
with poetic language.
Laughter
is the best medicine. Dr. Stacy Stryer describes how she puts this axiom
into practice in her family.
Dr.
Julie Silver was prompted by her daughter to become one of Charlie’s angels.
You’ll have to read the post to get the reference.
Vitamin
hawkers exaggerate their product’s benefits without recourse. Dr. Mike
Glode describes one interesting example of this phenomenon.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 3rd, 2008 by Dr. Val Jones in News
4 Comments »
A colleague of mine asked me what I thought about the recent New York Times article correlating household clutter with weight gain. It’s an interesting connection, so I thought I’d blog about it.
I think that clutter is probably a reflection of person’s emotional state, personality type, and upbringing. Some people seem to be more orderly by nature, others don’t focus on neatness as much. Some of us were trained to make our bed every morning, a few had a parent or nanny to do that. And still others have been “whipped into shape” by their spouse. Overall I think most of us prefer some degree of order over chaos, and given the choice would like to keep a fairly orderly home.
Now, what’s interesting to me is the emotional component in all this. We each have a certain level of baseline neatness, and we stray from that when we feel anxious, depressed, or exhausted. Think about what your house looks like now – is it at your natural baseline of orderliness? If not, are you more anxious, depressed, or tired than usual? I bet there’s a connection.
Many people gain weight when they’re anxious, depressed, or sleep deprived. So in a way, household messiness can be a marker for emotional distress. And it’s the emotional distress that fuels the weight problems. When a person is ready to lose weight, they’re probably motivated because they’ve managed to rise above their emotional concerns to achieve their goal.
So my point is this: take a look at your home to get a sense for how you’re doing emotionally. Are you anxious or depressed about something? Are you having relationship problems? Are you having difficulty sleeping?
Revolution Health has expert-led groups available to help you understand your emotions and how they influence your behavior. I think you will really benefit from getting into a discussion group and sharing your stories with others like you.
Here are some examples of groups that you can join right now (click to join):
Relationship Help – Mira Kirshenbaum, Counselor
Sleep Better – Steve Poceta, MD, Neurologist
Take Charge of Your Life – Ned Hallowell, MD, Psychiatrist
Lose Weight – Val Jones, MD, Rehabilitation Medicine
A Fit Family– Stacy Stryer, MD, Pediatrician
De-stress – Brad Jacobs, MD, Internal Medicine
Quit Smoking – Joe Scherger, MD, Family Medicine
Walk Your Way Thin – Jim Hill, PhD, Psychology
Maintain Your Weight – Chris Newport, Personal Trainer
Eat Right– Sandra Foschi, Nutritionist and Physical Therapist
Why not join a group? They may really help you to look and feel your very best this New Year. Not too many websites will offer this for free as Revolution Health does.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 19th, 2007 by Dr. Val Jones in Book Reviews
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Have you ever been surprised and confused by what seem to be conflicting results from scientific research? Have you ever secretly wondered if the medical profession is comprised of neurotic individuals who change their mind more frequently than you change your clothes? Well, I can understand why you’d feel that way because the public is constantly barraged with mixed health messages. But why is this happening?
The answer is complex, and I’d like to take a closer look at a few of the reasons in a series of blog posts. First, the human body is so incredibly complicated that we are constantly learning new things about it – how medicines, foods, and the environment impact it from the chemical to cellular to organ system level. There will always be new information, some of which may contradict previous thinking, and some that furthers it or ads a new facet to what we have already learned. Because human behavior is also so intricate, it’s far more difficult to prove a clear cause and effect relationship with certain treatments and interventions, due to the power of the human mind to perceive benefit when there is none (placebo effect).
Second, the media, by its very nature, seeks to present data with less ambiguity than is warranted. R. Barker Bausell, PhD, explains this tendency:
1. Superficiality is easier to present than depth.
2. The media cannot deal with ambiguity, subtlety, and diversity (which always characterizes scientific endeavors involving new areas of investigation or human behavior in general)
3. The bizarre always gets more attention than the usual.
I really don’t blame the media – they’re under intense pressure to find interesting sound bites to keep peoples’ attention. It’s not their job to present a careful and detailed analysis of the health news that they report. So it’s no wonder that a research paper suggesting that a certain herb may influence cancer cell protein expression in a Petri dish becomes: herb is new cure for cancer! Of course, many media outlets are more responsible in their reporting than that, but you get the picture.
And thirdly, the scientific method (if not carefully followed in rigorous, randomized, placebo-controlled trials) is a set up for false positive tests. What does that mean? It means that the default for your average research study (before it even begins) is that there will be a positive association between intervention and outcome. So I could do a trial on, say, the potential therapeutic use of candy bars for the treatment of eczema, and it’s likely (if I’m not a careful scientist) that the outcome will show a positive correlation between the two.
There are many reasons for false positive results (e.g. wrongly ascribing effectiveness to a given therapy) in scientific research. “Experimental artifacts” as they’re called, are very common and must be accounted for in a study’s design. For fun let’s think about how the following factors stack the deck in favor of positive research findings (regardless of the treatment being analyzed):
1. Natural History: most medical conditions have fluctuating symptoms and many improve on their own over time. Therefore, for many conditions, one would expect improvement during the course of study, regardless of treatment.
2. Regression to the Mean: people are more likely to join a research study when their illness/problem is at its worst during its natural history. Therefore, it is more likely that the symptoms will improve during the study than if they joined at times when symptoms were not as troublesome. Therefore, in any given study – there is a tendency for participants in particular to improve after joining.
3. The Hawthorne Effect: people behave differently and experience treatment differently when they’re being studied. So for example, if people know they’re being observed regarding their work productivity, they’re likely to work harder during the research study. The enhanced results therefore, do not reflect typical behavior.
4. Limitations of Memory: studies have shown that people ascribe greater improvement of symptoms in retrospect. Research that relies on patient recall is in danger of increased false positive rates.
5. Experimenter Bias: it is difficult for researchers to treat all study subjects in an identical manner if they know which patient is receiving an experimental treatment versus a placebo. Their gestures and the way that they question the subjects may set up expectations of benefit. Also, scientists are eager to demonstrate positive results for publication purposes.
6. Experimental Attrition: people generally join research studies because they expect that they may benefit from the treatment they receive. If they suspect that they are in the placebo group, they are more likely to drop out of the study. This can influence the study results so that the sicker patients who are not finding benefit with the placebo drop out, leaving the milder cases to try to tease out their response to the intervention.
7. The Placebo Effect: I saved the most important artifact for last. The natural tendency for study subjects is to perceive that a treatment is effective. Previous research has shown that about 33% of study subjects will report that the placebo has a positive therapeutic effect of some sort.
So my dear readers – if the media wants to get your attention with exaggerated representations of research findings, and the research findings themselves are stacked in favor of reporting an effect that isn’t real… then how on earth are we to know what to make of health news? Luckily, R. Barker Bausell has explained all of this really well in his book and I will attempt to summarize the following principles in the next few posts:
1. The importance of credible scientific evidence
2. The importance of plausible scientific evidence
3. The importance of reproducible scientific evidenceThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
