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Get A Second Opinion After Seeing Dr Google

I wasn’t too surprised reading the other day that health-related matters take up 2% of all queries on internet search engines. In fact, I thought the figure would be higher, judging from day-to-day conversations with patients.

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Reading too many Health web-sites may lead to one imagining having various dire diseases, resulting in cyberchondria.

The big question of course is: how reliable are the facts dished out on the Internet? Obviously, its important that these websites are reliable and churn out accurate information. Even so, healthcare information is complicated by a few other factors not related to the reliability of these websites, as explained later.

How do you identify reliable websites? First of all, as a yardstick, websites sponsored by the governments, not-for-profit health or medical organizations, and university medical centers are the most reliable resources on the Internet.  Sites supported by for-profit drug companies, for instance, who may be trying to sell you their products, are usually not your best option. Also note that medical info changes rapidly with time and a look at the dateline of the article is important. Here are a few such sites:

Medlineplus.gov - sponsored by the National Institutes of Health and managed by the U.S. National Library of Medicine, MedlinePlus provides information on more than 900 diseases and conditions in their “Health Topics” section, and links to other trusted resources.

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WebMD  provides a wealth of health information and tools for managing your health from an award-winning website, which is continuously reviewed for accuracy and timeliness.

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MayoClinic.com – owned by the Mayo Foundation for Medical Education and Research, this site is produced by more than 3,300 physicians, scientists and researchers from Mayo Clinic, and provides in-depth, easy-to-understand information on hundreds of diseases and conditions, drugs and supplements, tests and procedures.

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Sometimes,even with reliable trustworthy information, its rather difficult for the untrained public to give due weightage  to the complex info that is being bombarded onto them.  For instance, when reading the side-effects of a particular medication, it is difficult to appreciate that not all the listed side-effects will invariably occur when one consumes the drug.

This is why its better to consult a doctor to obtain clarification. It takes years of medical training to adequately decipher fully what’s found on  web health-sites and to fully appreciate its implications.

In fact, the over-reliance of info on the internet has given rise to a new condition called cyberchondria (aka internet self-diagnosis) – this refers to the practice of leaping to dire conclusions while researching health matters online. If that severe headache haunting you in the morning led you to the Web search-engine and a search on ‘headaches’  led to ‘brain tumours’ or ‘meningitis’,  people tend to look at the first few results in the search-engine which forms the basis for them to probe further till they are convinced  that they have a brain tumour. The likely diagnosis is probably cyberchondria than anything else!   The phenomenon has become so pervasive that Microsoft did its own study on the causes of cyberchondria way back in 2008.

Vitamin Makers Won’t Want You to Know This

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What with more than 54,000 dietary supplements on the market, sold under 1,000 different brands, vitamin pills and dietary supplements are big business nowadays. But there are some things that consumers need to know..

The Food and Drug Administration (FDA) defines a supplement broadly, as an ingestible product containing a “dietary ingredient,” which may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars and metabolites.That practically means anything from plain old Vitamin C to exotic stuff like L-carnitine.

Faced with so many choices, consumers are hard-pressed to know what are safe products. In some countries like Malaysia, the Drug Control Authority issues licences to those that have met safety standards, including supplements. However, as in the US, the FDA does not need to sanction any of dietary supplements known before 1994. Manufacturers producing supplements after that date need only notify the FDA and produce documents showing the ingredient is “reasonably expected to be safe” — according to the manufacturer’s own assessment.So supplement makers need not undergo the stringent tests expected of prescription drugs.

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More Is Not Always Better – taking more than the daily requirements may be harmful

 

More does not mean better -  Often, people think that if they take more than the recommended dose, they’ll reap even more benefits. This isn’t necessarily so, especially in the case of fat-soluble vitamins like Vits A,D and E.  Taking more than the daily recommended dosages can lead to serious side-effects. Vitamin A poisoning can cause liver failure and permanent brain damage, for instance, and I have seen this in my personal practice.

‘Natural ingredient’ does not mean ‘safe’- I can name a lot of natural ingredients used in supplements that are by no means safe. Case in point – arsenic, mercury. A popular Chinese herb,  Ephedra (ma huang) marketed for weight-loss and athletic performance, has in fact caused high blood pressure and death in users.ephedra

What you see is not what you get- just because the label says 2 grams of extract does not mean you’re getting just that. The words ‘blend’ and ‘formula’ are used in marketing products which may not contain exactly the claimed amount. This is especially true in expensive ingredients like chondroitin. When reading labels, focus on the ingredient you want, and make sure it’s listed alone as an ingredient , not followed by the word “blend” or “formula.”

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Read the labels carefully!

Health benefits may be debatable- because supplements do not have to undergo the rigours of a scientific study, some claims cannot be proven and are subject to anecdotal and ‘word of mouth’ evidence. Products that  “curbs appetite to help with weight loss” may be no more than unsafe ‘amphetamine-type’ appetite suppressants with high-fibre additives.

Pills are not a substitute for a balanced diet.- In fact, with a balanced diet, supplements are often unnecessary, except if one is recovering from an illness or have special needs. All the supplements one takes is not going to supply the calories and proteins the body needs for its daily tasks.

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So-called herbal formulas actually may contain prescription drugs, like this one which has a Viagra-like substance added.

Some ‘effective’ supplements may contain prescription drugs- supplement makers have been known to add in proven drugs to make their products effective. A classic example are supplements to enhance male sexual performance that have been found to contain sildenafil citrate, an active component of Viagra. See my posting  on “Viagra Coffee – Keeps You Up All Night”.  Tip: don’t buy from an Internet company you’ve never heard of, or one that  only has a P.O. box.

Let your Doctor know- ..what you’re taking, especially when you are scheduled for surgery. Quite a few of supplements like Evening Primrose Oil (EPO) and Gingko interfere with the clotting mechanisms of the blood in conjunction with surgery and can cause excessive bleeding. Its surprising how very few makers insert this warning message on their labels. I have written in an earlier posting here on the list of supplements which can interfere with surgery.

This Slimming Pill Kills

The death of a medical student who took a banned slimming pill, dinitrophenol, commonly called DNP, raises the point that most, if not all, slimming pills that are currently available, are a major hazard to health. In fact, to date, the US FDA has only approved two new weight-loss pills (in 2012) after the previous approval of Xenical in 1999. Such are the difficulties faced by pharmas in securing approval for a safe and efficient medicine to lose weight.

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Sarah Houston – succumbed to the slimming pill DNP.

23 year old Sarah Houston, a medical student at Leeds University,England, died after taking DNP in an attempt to lose weight in September last year. DNP had already been linked to 62 deaths around the world in a study published last year in The Journal of Medical Toxicity.

DNP is illegal for human consumption but is still available commercially to make make dyes,other organic chemicals, wood preservatives and herbicides. It was originally used as a diet pill in the 1930s but the presence of severe side-effects such as an undue rise in body temperature (hyperthermia) which can be fatal has resulted in its ban since.

A shocking fact which emerged following this tragedy is that DNP is still being sold online as a diet pill. In Sarah’s case. she had bought them via the internet from a trader in Spain. My advice: scrutinise the ingredients of any nonprescription diet pill carefully and avoid disreputable sources.

 

 

Say No to HRT

At one time, hormone replacement therapy (HRT) was routinely prescribed to any woman reaching menopause and asking for it, in an effort to prevent fractures,osteoporosis, dementia and other chronic diseases.

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Hot flushes are a common symptom on reaching menopause, not always needing treatment

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That was fine but recent developments have advocated the reverse – only women with severe symptoms of menopause like flushing,headaches and excessive sweating are given a short course to relieve the symptoms. Otherwise, HRTs are now not advised at all.

What is the evidence for the change in stance? The US funded Women’s Health Initiative, known as WHI, was halted in 2002 when initial results showed women taking a combination of estrogen and progestin had a higher risk of breast cancer, heart disease and stroke than women who received a placebo( or ‘dud’ pill). This marked a drastic shift in opinion, so that now, these combination pills are no longer advocated. Indeed, even oestrogen-only pills are now  taboo.

You can find more facts about HRT here:

http://www.nhlbi.nih.gov/health/women/index.htm

For alternatives to hormone therapy, see here:  http://www.nhlbi.nih.gov/health/women/pht_facts.pdf

So What Is the Mediterranean Diet?

The fact that the Mediterranean Diet has led to lower rates of heart disease, stroke and cancer has been known for decades; and the latest study highlighted over the media recently (see here) is on the back of several similar studies done over the years. I had written about one such study in an earlier blog posting in 2008 (see here).

Mediterranean food pyramid

So how many more studies do we need before the guidelines on healthy eating habits are changed by governments from the low-fat high carbohydrate that is so widely advocated? Even in those countries where a greater awareness of what constitutes healthy eating exists, the end-product may not be what the consumer paid for – olive oil is adulterated and/or filtered, garlic is taken as a pill than a freshly-crushed clove and even red wine is not aged and commercially processed so that it is lacking in polyphenols.

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There are many grades of olive oil – extra virgin being the best

The Mediterranean Diet – low in saturated fat and high in fiber and monounsaturated fat –  includes vegetables, whole grains, fish, legumes, fruit, and moderate red wine, if so inclined. The main cooking fat is olive oil – pure unfiltered virgin olive oil is preferable, although the quality varies quite a bit commercially.

It is interesting to note that this oil has been around since time immemorial and its benefits  mentioned by most of the world’s major religions, whether its the Muslim Hadith (“Consume olive oil and anoint it upon your bodies since it is of the blessed tree”), the Catholic church (“Oil of the Sick”) or the Jewish Talmud which states that frequent consumption of olive oil is good for one’s memory.

But behind the benefits of this diet, a more stark message is revealed: that the typical ‘Western Diet’ is  the antithesis, with processing, additives and chemical substitutes causing many of the lifestyle diseases it is supposed to prevent.

 

Flying On The Wings of Stress

As the Olympic athletes fly home by the tens of thousands, I could’nt help wondering what kind of stress they were subjected to.. Anyway, the official seven leading causes of stress, according to a University of Washington study are finances, work, family, personal concerns, personal health & safety, relationships and death. I’m going to take it they left out flying.. because they forgot to ask anyone who’s taken a trip by air. Many will agree that taking a flight is one of the major causes of stress in modern everyday living.

The amount of stress involved in flying starts way before the actual flight, right on the ground itself. First and foremost, the long trip to the airport itself is fraught with stresses, from lack of timely taxis to traffic jams to  making sure the kids are ready on time. Even if you decide to take to take to the road yourself, there’s the outrageous airport parking charges and the distance they are located from the terminal..

Having reached the terminal, there’s the queues, the far-from-easy electronic check-in terminals and the extra charges, ranging from that for overweight baggage to really unexpected surprises – Ryan Air insists you print your own boarding cards and if you misplace yours, they’ll print it for you..for a fee, 40 British pounds to be precise.

Then there’s the security screening..more stresses if you have shoes with bootlaces or laptops. By the way, the liquids ban mean you need clear plastic bags which are now sold at 1 pound each at some UK airports. Departure delays..these are a way of life nowadays with airlines cutting back on flights due to bad times.

Flight stress

Despite Attempts to Improve Economy Class, some Stressors Cannot be Eliminated

Once in the air, your problems are about to begin. If you turn left on entering the aircraft, well and good; but if you turn right, be prepared for cramped seating conditions (noticed the shrinking leg-room, especially on low-cost carriers?). If you can stomach the low-quality food, this may not stay down too long if the plane hits into turbulence – this has been cited as the top cause of stress while flying.

Once settled down, your mind may be jarred by a seemingly endless stream of in-flight announcements, in multiple languages, informing that you are 35,000 ft in flight stress2the air (who really cares?). Add to this, the snoring passengers and crying babies and the soon-to-be-allowed mobile phone-calls and one can see why there’s so much stress.

Don’t forget polluted cabin air..a recent report in the London Telegraph confirms that the smell of jet-fuel in some cabins is far from imaginary.

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TCP,from jet-fuel present in cabin air, causes drowsiness,nausea and headaches

Lost-luggage

33 million pieces of luggage were misplaced in 2008

Once landed at your destination and after surviving the long queues at Immigration, you might have to face the heart-sinking sensation of lost luggage (God forbid!) and the monumental paperwork that comes with it. And you thought London Oxford Airport would be at least near London.. be prepared for a 60-mile journey to the city!

And..long after reaching your final destination, there’s still the perennial fight with jet-lag! Numerous antidotes have been promulgated – but that’s another story..

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Football – When the Violence Is At Home

Balotelli reacts after an apparent foul in the Italy vs Spain match at Euro 2012

With the Euro 2012 soccer finals in progress, its quite understandable when episodes of violence, real or simulated, occur on the field, or even nearby( as the riots after the Russia-Poland game showed). But when this extends into the home, then its a cause of public concern.

Research by BBC News has found there was a surge in domestic violence reports to police during the 2010 World Cup.Police in England noted that reports of domestic violence increased by some 29% during games when England played in the recent 2010 World Cup.  The police expect a similar increase in domestic violence during the current Euro finals and have placed themselves on alert, apart from publicising awareness in the media and working together with related agencies like Domestic Violence UK.

Chris Hancox, from White Ribbon UK, which campaigns against violence to women, said: “If someone’s football team loses, that’s no reason to take it out on anyone, particularly the person they’re supposed to love.”  But the reality is quite the opposite:  arguments about the amount of television watched, alcohol intake, jealousy due to people spending more time with friends and an increase in money spent could lead to an increase in tensions.

Many would agree that alcohol by itself does not cause domestic violence, but could be the catalyst, especially when there is disinhibition after excessive alcohol and deeper emotions begin to surface.

So what does the Football Association (FA) has to say about it? It said it could not comment on what was not a footballing matter. Is that really a fair statement?

Gonorrhoea..And Then There Was One.

There was a time not too long ago when  doctors could cure a patient with gonorrhoea (aka the clap) with their eyes shut. But then this was the pre-HIV days when this disease stood centre-stage among sexually-transmitted diseases.

The Gonorrhoea bug has become drug-resistant and developed into a superbug nowadays

With the attention diverted to HIV and AIDS, the disease was practically unheard of in the media. What really happened was that Neisseria gonorrhoeae (aka gonococcus), the bacteria causing this disease,  continued to proliferate quietly without the bells and whistles, not making the headlines because it was so easily treated with the wide array of modern antibiotics that were readily available. Up to now, that is.

In the 60s this may be true, but not nowadays when the effective drugs are down to one

 

The World Health Organization(WHO)  warned yesterday of a spreading resistance to drugs used to treat the sexually transmitted disease gonorrhoea.

Millions of people with the condition may be at risk of running out of treatment options unless urgent action is taken, the United Nations agency said.

Up till now, the germ had developed resistance to many antibiotics which had been used over time; so much so, the current mainstay is the use of cephalosporin group of antibiotics, in particular ceftriaxone.  But , there now emerges reports that even this antibiotic has proven useless. Left untreated, gonorrhoea causes infertility in men and women and may add considerable healthcare costs if left untreated.

WHO has called for greater vigilance on the correct use of antibiotics and more research into alternative treatments for so-called gonococcal infections, which is quite understandable, as research for new antibiotics have taken a back-seat in recent years. Meanwhile, for individuals, the best way of not contracting the disease is of course having a regular partner or abstinence, failing which condom usage has proven effective.

 

The Best and Worst Doctors of 2011,part 2

Took me some time to compile this list, so here goes:

The Best Doctors

1.Drs Beutler, Hoffman and Steinman

These three were the winners of the 2011 Nobel Prize in Medicine and the impact of their research will be felt for many years to come.

In essence, they discovered receptor proteins in the body that can spot bacteria and other microorganisms and then activate the body’s innate immunity to defend itself. These dendritic cells activate the T cells which then produce antibodies which attack the invading germs.

Their studies determine  how clinicians prevent and treat infection, inflammatory diseases, and cancer in the future. Strangely enough, one of them, Dr Steinman (right,above pic) himself died of cancer of the pancreas before he won the award. This disease was one of the potential beneficiaries of his research.

2. Dr Valentin Fuster

This Spanish cardiologist, who is the Head of Mount Sinai Heart Centre in New York, is the only person to be awarded the top research awards from all the four main cardiovascular organisations.

He is best known for his profound contribution towards the understanding and prevention of atherothrombosis and was the first to have highlighted the role of platelets in acute coronary syndromes. In other words, how heart attacks happen-see below.

Dr Mark Kris

Lung cancer specialist at one of the top cancer centres in the world, Memorial Sloan-Kettering in Houston,Texas, he was recognised for his  dedication and compassion in his professional work and volunteer efforts by being awarded the inaugural ASCO Humanitarian Award .

He has built homes for families in Hyde Park, New York,  gone to Costa Rica to build a basketball court and a church and made several trips to assist with earthquake relief in Haiti; and helped with relief efforts in Biloxi, Mississippi  after it was hit byHurricane Katrina.

Of course, to the unsung heroes out there,those who have toiled without bells and whistles, well done for being a credit to your profession!

 

The Best and Worst Doctors of 2011,part 1

Couldn’t help recalling that last year, quite a number of physicians made the headlines..so here’s my list of the Dr Jekylls and Dr Hydes of 2011.

The Worst Doctors

1. Conrad Murray,MD

Physician to the King of Pop.. in November he was sentenced to 4 years in jail for his conviction on a charge of involuntary manslaughter in the pop star’s death. There wasn’t much substance in his defence once he admitted to using propafol injected intravenously into Michael Jackson’s veins so as to enable him to sleep at home. What was worse was that this drug is normally used in a hospital setting with the patient hooked on close monitors; using it otherwise (at home) constitutes negligence and inappropriate use.

2. Gerald J Klein, MD

Gerald who? Well, he was one of 14 Florida doctors indicted in August 2011 for illegally distributing opioid analgesics such as oxycodone and sedatives like Xanax. Drug addicts and dealers would queue in their clinics to sell or receive drugs illegally under the pretext of valid medical reasons. Opioid analgesics were dispensed and prescribed on an assembly line basis,  paid for with cash and credit cards. Clinic employees hauled their money to the bank in large garbage bags. This way, each doctor netted USD 1 million yearly. “Drug dealers in white coats”, said the FBI.Read more here.

Dr Gerald Klein..described as a drug dealer in a white coat

3. John R McLean,MD and others

The Maryland cardiologist was convicted on 6 charges of healthcare fraud relating to insurance claims that he had filed for doing unnecessary coronary angiograms and angioplasties (invasive test and treatment of blocked heart arteries), as well as for ordering unnecessary tests and making false entries in patient medical records. In November, Dr. McLean was sentenced to 8 years in jail.

The buck does not stop here in Maryland – already two other cases are being heard (see here and here) of similar cases where cardiologists have done unnecessary procedures on otherwise well patients, in return for unethical financial rewards.

In the next blog entry, I will name the best doctors of 2011.

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