Don’t rely on doctor Google for health information on the wild wild web

Self diagnosis on the internet. A good idea?By Rachael Dunlop, University of Technology, Sydney

If you typed “pins and needles” into Google, what kind of results would you expect to find? According to a recent study from Bupa Health, the search engine could diagnose you with anything from a completely reversible vitamin B12 deficiency, to sciatica, or worse, multiple sclerosis.

Entering “stomach cramps” into Google returns indigestion, appendicitis, or something as serious as heart disease or angina. Even a condition as benign as a rash comes up with dermatitis, psoriasis, eczema, or much more serious diseases such as meningitis.

No wonder there’s a dedicated term to describe patients who develop paranoia from googling their symptoms – cyberchondria.

The most recent statistics about Australians’ computer use shows around 80% of us now have access to the internet at home and the use of mobile devices is on the rise, thus nearly all of us can access the world-wide-web 24/7. Google is the search engine of choice for 93% of us, so when it comes to sourcing information about our health and medications, Dr Google seems an obvious place to go.

The Bupa study also revealed that: approximately a third (34%) of us would like to have the ability to text an image of our problem to receive a diagnosis; 45% would like to have access to our doctor by email; half of us self-diagnose; and 70% research our medications online. But while there is a plethora of information available online, it remains largely unregulated.

So how can you determine if the health information you find is accurate?

Well, mostly you can’t. In fact studies analysing the accuracy of Google results for the search term “vaccination” reveal 60% are actually against vaccination. (Interestingly searching “immunisation” is more likely to return accurate results since people opposed to vaccination do not believe that vaccination induces immunity).

All of this has created a difficult scenario for health care practitioners and patients alike. A patient could self-diagnose mild abdominal pain as constipation, for example, when they might have gallstones. Or on the flip side, another patient could incorrectly diagnose their headaches as meningitis.

Some doctors are justifiably worried that patients are diagnosing and treating themselves, using devices such as a gastric bypass surgery kit which was sold on Amazon. Or apps to scan moles and determine if they’re cancerous.

But while some doctors are frustrated by patients’ desire to research their conditions online, others are resigned to the fact it will happen, so are prepared to help guide patients to accurate information on the web.

If you self-diagnose, you’re not alone but you might save a lot of anxiety by seeing your doctor instead. MNicoleM

My top ten health websites

No website is completely free of errors or spurious or out-of-date information, so you will always need to exercise scepticism. A few rules of thumb include checking the date the information was updated, checking the “about us” section for the author’s/publisher’s qualifications and reputations. Also look for any evidence of peer review published data, as opposed to testimonials.

The Australian government offers accurate, consumer-driven information that’s generally kept up to date. Of note is its vaccination information which provides easy to read information for parents (the “Understanding Childhood Immunisation Booklet”, is just one example). The government’s National Prescribing Service and Health Insite provide consumer-driven health information, as do state government websites such as the Better Health Channel in Victoria.

The commercial My Doctor website will give you comprehensive local health and medical information from the MIMS medical reference tool.

Concise and accurate fact sheets on vaccination can be found at the National Centre for Immunisation Research and Surveillance (NCIRS) and facts sheets on other medical conditions are available from the Consumer Health Forum.

Other international sources include WebMD, The Mayo Clinic, NIH Health and the National Cancer Institute, which are all good places to find reliable and easy-to-understand medical information.

Government health websites are a reliable first stop for online health information. Ed Yourdon

There are also a number of crowd-sourced tools that indicate the quality of a site, based on user experience. Web of trust (WOT) is a browser plug-in which rates sites from green (good) to red (bad) depending on consumer reviews compiled from four categories: trustworthiness, reliability, child safety and privacy.

The HON (Health on the Net Foundation) Code is the oldest rating system and was founded in 1995 by the Economic and Social Council of The United Nations to encourage the dissemination of quality health information for patients, professionals and the general public.

If you come across information that makes you suspicious, you can always google it with the word “sceptic” or “debunk” and you’ll usually find several blog posts that offer a second opinion. A large community of scientists and health professionals lurk on the intertoobs and take great pleasure in applying their expertise to debunking suspicious and spurious medical claims. Science Based Medicine is one such multi-author blog, with contributions from pharmacists, cancer specialists, neurologists, infectious disease doctors and researchers.

The important thing to remember about researching health information online is to be sceptical, be critical, and never replace the trained eye and diagnosis of an experienced health professional with diagnosis by Dr Google. The internet can assist you, perhaps even calm your fears temporarily (or not, as case may be) but it will never replace the expertise of your doctor.

Finally, respect your doctor. Don’t be fooled into thinking you know more than them just because you’ve spent a few hours at Google University.

This list of websites is by no means exhaustive, so please feel free to add your favourites in the comments section below.

Rachael Dunlop receives funding from the Heart Research Institute and The Institute for Ethnomedicine, Wyoming. She has previously received funding from the NHMRC.

The Conversation

 

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Thumbnail Image courtesy of [Stuart Miles] / FreeDigitalPhotos.net

Have we got the science on why we’re getting fatter wrong?

By Lennert Veerman

An article published recently in the BMJ argues that we have been pursuing the wrong hypothesis on the causes of obesity. Along with substandard science, this wrongheadedness has apparently exacerbated the obesity crisis.

Author Gary Taubes asserts that obesity is probably not caused by a positive energy balance (more energy is consumed than spent). A promising rival hypothesis has been forgotten without having been properly investigated.

According to that hypothesis, obesity is a hormonal, regulatory disorder. Energy imbalance is only a consequence of that underlying hormonal factor. The problem is not that we’re eating too much, it’s what we’re eating. And the probable culprit is carbohydrates. But this is yet to be definitively proven.

Enter the Nutrition Science Initiative (NuSI), a US-based not-for-profit organisation co-founded by Taubes that will fund the rigorous experiments needed to “find out, once and for all, what we need to eat to be healthy”.

NuSI will also “re-introduce a culture of rigorous experimental science to the field of nutrition.” A condition for meaningful progress in this field is apparently “a refusal to accept substandard science as sufficient to establish reliable knowledge, let alone for public health guidelines.”

So, out with the research done to date, and away with current guidelines, right?

 

Who speaks and for whom?

Actually, not so fast. Let’s first examine who wants us to forget everything we know and postpone all action on obesity. Taubes is a journalist and author, not a scientist. And his organisation, NuSI, is financed by the “Giving Library”, which “offers philanthropists an innovative way to enhance their strategic charitable giving”. It also gives would-be donors a “forum for anonymous communication”.

The NuSI board of advisors “all share a passion and belief: to date nutrition science has been inadequate in drawing conclusions and making sound recommendations.” The board of directors are people with backgrounds in consultancies, corporate health care and private investment management.

Anonymous donors, claims of a scientific establishment suppressing ideas, claims that the science isn’t settled and no action should be taken, that more research by “independent, sceptical researchers” is needed, the involvement of big corporate actors in a field where research findings can have consequences for a multibillion-dollar industry – where have we seen all that before?

It smacks of denialism. But Taubes states that NuSI doesn’t accept support from the food industry, there are no food industry representatives on any NuSI board and taking aim at carbohydrates probably doesn’t make you friends in large sections of that industry. Perhaps this is just the way you raise funds for research in contemporary America.

But is it true that all the research in the field to date has uncritically accepted energy imbalance as the cause of obesity? And that no-one has yet looked at hormones as a cause of obesity? The short answer is no. While Taubes presents his ideas as revolutionary, they are actually fit quite comfortably in a long tradition of low-carb dieting. And it’s not true that such diets have never been scientifically tested.

To support his argument, Taubes cites a study that compared the Atkins diet to other diets, and found it achieved greater weight loss. That could mean carbohydrates are causing weight gain, but it could also result from the fact that carbs are the biggest part of our diets and restricting their consumption leads to overall reductions in caloric intake.

Whatever the case, it’s customary to do the research first and claim that you have found the cause of obesity (if indeed you have) second, rather than the other way around as Taubes seems to be doing. But again, this may be the way to raise funds for research in America.

 

Missing the bigger picture

Someone reading Taubes’ article might be forgiven for believing that the current thinking about solutions stops at the individual level and is all about diets and exercise. Not once does Taubes mention the “obesogenic environment”, which many obesity researchers consider to be the cause of the obesity epidemic.

Where many researchers focus on our changing living environment, Taubes puts the focus squarely on hormonal factors. But these probably haven’t changed while obesity rates soared. And he asks if we can all please wait for the results of this revolutionary research before taking any action.

That’s not helpful. We have a problem now, and contrary to Taubes’ claims, we do know something about its causes.

If Taubes believes increased consumption of carbohydrates is the cause of the obesity epidemic, he might have pointed to a trial that shows that replacing sugar-containing drinks with non-caloric drinks reduces weight gain and fat accumulation in children. Also, why not support calls for limits on advertising and availability of sugar-sweetened beverages, and for increased taxation to reduce consumption?

Taubes exaggerates the uncertainties in current nutrition science. There’s support for a causal role of carbohydrate-rich diets in the obesity epidemic but, as he notes, such diets also tend to be rich in calories. He is yet to conclusively prove it’s the carbs specifically that are to blame.

So rather than wait years for the results of NuSI-funded research, we should change our food supply to discourage excess sugar intake. A tax on sugar-sweetened beverages would be a good start, as would restrictions on advertising to children.

Lennert Veerman receives funding from NHMRC and ARC.

The Conversation

 

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Nutrient in red meat linked to heart disease

l-carnitine in red meat implicated in heart disease

By Fron Jackson-Webb, The Conversation

A nutrient found  in red meat may increase the risk of heart disease when it interacts with the bacteria in the human gut, according to a paper published this week in Nature Medicine.

The results point to the nutrient L-carnitine, rather than saturated fat and cholesterol, as the link between eating red meat and heart disease.

In a series of studies in humans and mice, the US researchers found that when L-carnitine is consumed, the bacteria in the human gut produces a compound called Trimethylamine-N-oxide, or TMAO.

TMAO slows the body’s ability to remove cholesterol from the walls of the arteries. The subsequent build up of cholesterol can clog arteries, leading to heart disease.

L-carnititine is also used in some dietary supplements.

In one of the studies, the researchers tested the blood of 77 participants, 26 of whom were vegetarian or vegan. They found that meat eaters who consumed L-carnitine produced higher levels of TMAO, suggesting a regular diet of meat encourages the growth of bacteria which turns L-carnitine into TMAO.

However, it is still unclear which species of gut bacteria contributed to TMAO formation.

In another study, the researchers reviewed the blood tests of 2,600 people having elective heart checks. They found that people with high levels of both L-carnitine and TMAO were prime targets for heart disease and stroke.

In yet another study, this time in animal models, the researchers found that mice who were fed L-carnitine were twice as likely to have have risky levels of arterial plaque.

But this only occurred when they had their usual gut bacteria: mice who were fed antibiotics to kill this bacteria experienced no such effect.

The researchers conclude that intestinal bacteria of meat eaters feed on L-carnitine to produce TMAO, which can clog arteries.

The findings raise the possibility that other dietary nutrients may also generate TMAO from gut microbiota and slow the removal of arterial plaque, the researchers say.

Professor John Funder, Executive Chairman of Obesity Australia and Senior Fellow at Prince Henry’s Institute said the findings were relevant to Australian meat eaters.

“Kangaroo meat – long considered very healthy, given its very low fat content – has more L-carnitine per gram than any other red meat; on the basis of the authors’ findings, it may not be such a healthy option after all,” Professor Funder said.

But he said more work needed to be done to confirm a causative link between L-carnitine and heart disease.

“As a scientist, one unanswered question is that of the particular microbes in the gut of meat eaters that are absent from that of vegans: do they require something in red meat for their ability to colonise the gut, and what are they like in species that are primarily carnivorous rather than omnivorous?”

Professor Gary Jennings, cardiologist and Director of the Baker IDI Heart and Diabetes Institute, said the study was impressive in the way it started with a novel hypothesis and used the latest scientific approaches to analyse the data.

“To date, any association with coronary heart disease was thought to be due to the saturated fat and cholesterol content of red meat. This possibility remains but the study adds another intriguing possibility to any link between red meat and coronary heart disease,” he said.

But the human component of the study was small, Professor Jennings said, and the findings should not prompt people to stop eating meat.

“The evidence is not sufficiently compelling to cause concern amongst the red meat industry,” he said, adding that eating a balanced diet remained the best recommendation for Australians.

“Red meat can be an important source of protein, iron and other nutrients in the diet,” he said.

With the help of the Australian Science Media Centre.

The Conversation

 

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The Dirty Dozen and the Green 15

appleThe humble apple heads up the 2012 “Dirty Dozen” list of foods which contain the most pesticide residue. The Environmental Working Group’s Shoppers Guide lists the 12 foods highest in pesticide residue and the green 15, those which hold the lowest pesticide residue. Keep in mind the EWG is US based, and farming methods differ from region to region even within countries, so all may not apply to the food we eat in Sydney.

See the EWG’s Shoppers Guide to Pesticides in Produce

What are chicken nuggets made of?

In less than two minutes, Jamie Oliver will turn you off chicken nuggets forever.

Next time your kids have a birthday party at a venue that provides chicken nuggets as “food”, just think back to this video. Really, they should be paying us to eat the stuff, rather than us paying more for the “party menu”.

Kids Stretching: Free Workshop

stretching thumbnailWhat’s the latest on stretching for kids? When should your kids stretch? When shouldn’t they? Does it really matter? Will stretching improve their performance, their posture, their disposition?

 

 

 

Hooked on Health and activeanatomy physiotherapy are presenting a FREE workshop for kids to learn all about the importance of stretching to improve their performance in running and other sporting activities, reduce their chance of injury, and improve their movement technique

Your child will learn how to perform the important stretches, how these stretches help in sporting activities, plus some basic anatomy to help them understand which part of the body is being stretched.

This is a practical workshop for kids. Parents are encouraged to join in if they wish.

Plus… we’ll give you the basics of  planning your child’s training.

We’ll also be briefly covering the basics of forming a training programme for your child leading up to important events such as Cross Country and Athletic Carnivals

Forestville Community Hall, next to Forestville RSL Club, Melwood Ave, Forestville
Fri, 12th April
6 – 7pm

Bookings are essential. Registration should be completed  by Monday April 8th

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About the Presenters

Merrin Martin

Owner of activeanatomy physiotherapy and health professional workshops, Merrin is an experienced physiotherapist, exercise scientist and qualified pilates instructor. Merrin is an APA, ESSA and Sports Physiotherapy member and is considered an expert in her role as a health educator, lecturer and developer of specific exercise programs. Merrin has extensive lecturing experience within the health industry and is regarded as an expert in her role as educator in specific exercise programs & managing injuries. Merrin’s premises are located in the Village Pilates Studio in Belrose.

 

Richard Sarkies

Co-founder of Hooked on Health, Richard has been running and coaching others in the sport he loves for over 30 years. He holds a Bachelor of Applied Science (Human Movement), has over seven years experience in lecturing in health and fitness at TAFE NSW and is a qualified personal trainer with a particular interest in children’s running. Richard conducts kids running training groups and cross country races across Sydney’s north shore and northern beaches area.