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February 28, 2008

Tips for savvy medical Web surfing

by Kelly G. Dencker

Below is a helpful piece from CNN on tips for finding credible health information on the Web. The one tip missing here, and in similar other stories like this, is to round out research by going to pharmaceutical company Web sites.

In this era of the new "e-patient" there is an increasing need and opportunity for pharma companies - who employ some of the world's top health experts and field cutting-edge research in their respective product areas - to do more as experts in this space.

Some companies are doing this better than others, but the emergence of the empowered and Web savvy patient should prompt companies, at a minimum, to look closely at their Web site content to determine if they are providing patient/consumer education that measures up to their vast expertise.

Tips for savvy medical Web surfing

By Elizabeth Cohen
CNN

Empowered Patient, a regular feature from CNN Medical News correspondent Elizabeth Cohen, helps put you in the driver's seat when it comes to health care.

ATLANTA, Georgia (CNN) -- When Mary Ryan's 4-year-old nephew, Nick, landed in the hospital with a serious infection, her brother called her in a panic. Ryan isn't a doctor. She's not a nurse. She's a librarian.

Finding accurate, reliable medical information on the Web can be a daunting task.

Nick had cat scratch fever, and for weeks it was impervious to antibiotics. Desperate, the doctor in Nick's small town wanted to use a more powerful antibiotic that might save him -- but also might make Nick deaf.

Ryan's brother hoped she could find something -- anything -- that would save his son without disabling him. Ryan asked one of her colleagues, a research specialist at the Texas Medical Center Library in Houston, to search the medical literature. She came up with an article about an antibiotic that worked against cat scratch fever but wasn't toxic.

"We sent the doctor the whole article, and when he read it, he said, 'This is great. I hadn't thought of that,' " said Ryan, the president-elect of the Medical Library Association. Nick took the antibiotic and recovered without complications.

So if you're trying to find medical information for yourself or someone you love, and you're not lucky enough to have access to a professional research librarian, what do you do?

"The Empowered Patient" assumes you already know the basics of good Internet searching: .gov and .edu sites are to be trusted, as are sites for major health centers (think MayoClinic.com) and health organizations (such as the American Cancer Society's cancer.org).

"But there's so much more you can do. You can take this to a whole new level," says Jan Guthrie, director of The Health Resource, a for-pay medical research service.

So for the Internet searcher hungry for more, here are some tips for being a sophisticated surfer:

1. Use search engines that screen out the garbage for you

There's a lot of junk on the Internet. "It's the wild, wild West out there," says Alan Spielman, CEO of URAC, a company that certifies health Web sites. "You really have to be alert as you go through these sites."

To get rid of the junk, use a search engine that looks only at reputable sites that have been vetted by health professionals. Dirline, run by the National Library of Medicine, is one such engine, as are medlineplus.gov and Imedix.com. Healthfinder.gov searches for information on government health Web sites.

2. Find smart bloggers with your disease

Some bloggers do an excellent job of linking to resources specific to your disease. That goes for advocacy groups, too.

3. Invest 30 minutes in the pubmed.gov tutorial

Pubmed.gov searches the medical literature, but it isn't completely intuitive. It's worth the time to learn how to use it by doing the tutorial.

Nervous you won't understand the technical jargon in medical articles? Don't be, says Guthrie. She advises reading the very beginning of a study and the very end. "The conclusion will tell you whether the treatment they studied was effective, moderately effective, or not at all effective."

In addition, the Medical Library Association, has brochures called Deciphering Medspeak to help translate some of the more common medical jargon.

Tara Parker-Pope, a health columnist for the New York Times, found it useful to specifically search for review articles on pubmed when she was looking for treatments for her mother's esophageal cancer. Review articles give an overview of the latest research on a particular subject. "Review articles are an excellent way to get a lay of the land and to get the big picture on a topic," Parker-Pope says.

To find review articles on pubmed, go to the "limits" tab and then under "type of article", check "review."

4. Click on information about annual meetings

For example, let's say you just got a breast cancer diagnosis. You could go to asco.org, the site for the American Society of Clinical Oncology, and look at information on new breast cancer treatments discussed at last year's meeting.

This is the way to get cutting-edge information, Guthrie says. "Information on new treatments is presented at conferences six to 12 months before it's published in a medical journal."

Guthrie says she managed to find out about a new treatment for tendonitis this way. "It wasn't even in the medical journals yet. We found one doctor in New York who was doing it. If I had tendonitis, it might've been worth traveling to him," she says.

5. When in doubt about a Web site, click on "about us"

Sometimes it's clear who runs a Web site. Often it's not. Clicking on "about us" should explain it. Knowing who's behind the information you're reading (especially if they're trying to sell you something) helps you evaluate whether the information is biased. If you can't figure out who runs the site, don't use it.

And here perhaps are two of the most valuable pieces of advice: Use Internet resources in combination. "An advocacy group or a review article by itself is pretty useless," Parker-Pope says. "No one of these works by itself."

The second piece of advice: Don't expect the Internet to cure your disease. "I wanted to find the needle in the haystack to cure my mother," Parker-Pope says. "But information doesn't cure cancer. It just leads you to the best doctor and the best options."

Parker-Pope never found the needle in the haystack. Her mother, Karen Parker, died nine months after her diagnosis. But because of what they found out on the Internet, Parker-Pope and her family had confidence she received the best possible care. "And feeling confident in your care is no small thing," she says.

Elizabeth Cohen is correspondent with CNN Medical News. Senior producers Jennifer Pifer and Karen Denice contributed to this report.

Posted by kelly_dencker at 08:44 AM
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February 27, 2008

Wading Through The Insurance Morass? You'll Need More than a College Degree

by Stephanie Koze

A New York Times article, “Health Coverage Often Stops at the Campus Gate,” conveys that on many college campuses, ‘a family’s insurance plan is effectively worthless.’

Why is that you might ask? According to the article, most campus health centers have traditionally been funded through tuition, general fees or specific health fees, providing all students with the same access. In many cases, the campus health centers do not accept standard insurance.

So, what should parents do? Pay for two plans – the university’s and the family’s standard insurance plan – or, take a risk and pick one option over the other? The answer remains unclear. By the time you wade through the various points of view, however, you might have enough information to prepare a Master’s thesis.

Posted by stephanie_koze at 08:40 AM
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February 22, 2008

Not the real FDA – a Grahamatization

by Peter Pitts

Interesting omnibus piece from by Warren Ross of Medical Marketing & Media on the various slings and arrows being tossed at the worlds premier medical regulatory agency.

Here’s the first paragraph:

The FDA seems to be under fire from all sides these days, with everyone from drug industry pooh bahs to would-be watchdogs nipping at its heels. The agency, some charge, is going slow on approvals due to a risk-averse culture deepened through the experience of Vioxx and other product safety crises. Resignations are up, morale is down and the put-upon bureaucrats are laying low, the story goes. Others complain that reviewers are subject to political and corporate pressure through PDUFA and a nefarious web of relationships.

And here’s a link to the complete article.

Here’s what I had to say about the David Grahmatization of the whistleblower culture:

Pitts also takes a dim view of people who go outside the agency to complain. A professional, he maintains, should not “weep and whine and try to get decisions made that are based on politics rather than on science.” Whistleblowers, he acknowledges, at least deserve “grudging respect” for letting it be known who they are, “but what is truly damaging are the silent leakers” who try to force political pressure on FDA decisions. “The motive may be either to get drugs approved or not approved—it cuts both ways.”

As Jimmy Durante said, “I’m surrounded by assassins.”

Posted by peterpitts at 08:07 AM
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February 21, 2008

Dr. Bureaucracy vs.The Sustainable Individual

by Peter Pitts

No, not a new horror movie, a new op-ed from today's edition of The Detroit News:

Bureaucrats threaten personalized medical breakthroughs

American health care has come to a fork in the road.

On the one hand, science is opening up exciting possibilities. The booming field of "personalized" medicine recognizes that every one of us is unique -- not just in some sort of philosophical sense, but in the ways we get sick and the ways we get better.

Personalized medicine can size up our gene sequences to find out what ailments we're likely to get, and even prescribe preventative treatment.

Cancer doctors can now look for "biomarkers" on proteins to detect disease early and determine which treatments are most likely to work.

And this same science can help our doctors understand what medicines are wrong for us, avoiding unnecessary pain, suffering - and expense.

Unfortunately, just as these groundbreaking therapies are coming within reach of consumers, politicians and bureaucrats are threatening to make them off limits. As science makes ever-more-targeted treatment possible, politics could drag us right back to a one-size-fits-all system."

Here's the rest of the story.

And to further entice you, here's the concluding paragraph:

We hear a lot about sustainability these days. We want our ecosystem and our economy to be hale and hearty over the long term. But we also need a health care system that creates sustainable individuals. A market-driven system can do that, by bringing all the latest treatments to the public and letting competition drive down prices. Bureaucracies, by contrast, are mainly in the business of sustaining themselves. A move to government health care will take us down the wrong path.

Posted by peterpitts at 08:59 AM
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February 19, 2008

Importation a "done deal? Don't bet on it.

by Peter Pitts

Like they say, everything you read in the newspaper is true – except for those things you know about personally.

Case in point: the Wall Street Journal reporting that, regardless of which of the remaining three amigos gets elected in November, “drugs from Canada” is a done deal.

Nope. Here’s why not:

(1) It won’t save any money. Let’s not forget the non-partisan CBO study that showed that such policy would reduce our nation’s spending on prescription medicines a whopping 0.1% -- and that’s not including the millions of dollars the FDA would need to set up a monitoring system.

(2) The drugs being sent to U.S. customers from Canadian internet pharmacies are not “the same drugs Canadians get.” That bit of rhetoric is just plain wrong. Canadian internet pharmacies – by their own admission – are sourcing their drugs from the European Union. And while they may say their drugs come from the United Kingdom, let’s not conveniently forget that 20% of all the medicines sold in the UK are parallel imported from other nations in the EU – like Spain, Greece, Portugal, and Lithuania.

And the important political point here is that when Americans are asked if they want drugs from nations other than Canada – the answer is a resounding “no thank you.”

(3) The state experience has been dismal and politically embarrassing. Remember the high profile “I-Save-RX”program? Over 19 months of operation, a grand total of 3,689 Illinois residents used the program -- which equals approximately .02% of the population. They don’t call him “Wrong Way” Rod Blagojevich for nothing.

And what of Minnesota and Governor Tim Pawlenty’s RxConnect program? According to its latest statistics, Minnesota RxConnect fills about 138 prescriptions a month. That's for the whole state. Minnesota population: 5,167,101.

And remember Springfield, MA and “the New Boston Tea Party?” Well the city of Springfield is now out of the drugs from Canada business.

(4) National Security concerns. According to a recent report from the federal Joint Terrorism Task Force, a global terrorist ring with ties to Hezbollah, is importing counterfeit drugs into America by way of Canada. They are doing so for profit today - but could just as easily do so for more nefarious and deadly purposes. And legalizing importation would only facilitate such actions.

So while the candidates may opt for “drugs from Canada” as a useful political talking point – a way to say “look how tough I can be on those bad drug companies. The real issue lies elsewhere.

When it comes to health care reform, there’s one major policy difference that sets Senator McCain apart from Senators Obama and Clinton – Senator McCain believes in the strengths of a market economy. He sees drug importation as an access issue. The other side sees it as a way to import price controls and a first step towards government-run health care.

Don’t get fooled by the importation rhetoric. It’s nothing but a side-show. And it ain’t gonna happen. It's more dangerous as a smoke screen.

Posted by peterpitts at 08:10 AM
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February 13, 2008

Step Up to Debar

by Peter Pitts

According to the Pink Sheet:

"The integrity of FDA's drug approval process is being undermined by the agency's failure to actively and consistently prohibit participation by companies and individuals previously convicted of crimes associated with drug approval, the House Energy and Commerce Committee's minority staff concludes in a report released Feb. 11 by Rep. Joe Barton, R-Texas."

Does Mr. Barton have any evidence that folks who should have been disbarred haven't been? Does a lack of disbarments equal a lack of enforcement?

"FDA's debarment authority comes from the Generic Drug Enforcement Act of 1992, which was enacted in response to the generic drug scandal of the late 1980s. It allows debarment of generic drug companies, but FDA has failed to take action against even one firm, the report says."

"The report also notes deficiencies in the law and suggests FDA be given authority to debar brand-name and biologics companies, as well as those that make animal drugs and medical devices, that debarment be allowed for misconduct that occurs after a drug is approved and that incentives be devised to encourage FDA to start and complete debarments more quickly and efficiently."

Is Mr. Barton recommending that "crimes" be broadened to include "misconduct?" What does this mean -- and what does "misconduct" include?

Posted by peterpitts at 12:59 PM
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February 12, 2008

Hoosier Daddy?

by Peter Pitts

Oh well, so much for, um, pulling one's own weight.

According to a story in the Chicago Tribune, “Executives at an Indianapolis health-care system, frustrated by rising benefit costs, proposed a new program to get employees fired up about staying healthy.

Rather than offering incentives, Clarian Health Partners would fine employees who didn't try to quit smoking or lower their cholesterol or blood pressure. The threat of hiking their medical premiums by as much as $30 per paycheck surely would get their attention, executives reasoned.

They were right, but the proposal also generated so much resentment that Clarian Health never rolled out the program.”

Here’s a link to the complete article:

http://www.chicagotribune.com/business/chi-sun_health_0210feb10,0,1758041.story

Wonder how these folks in the Circle City feel about another type of health care mandate – government-run health care?

Posted by peterpitts at 12:57 PM
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February 11, 2008

Make Mine a Rubin

by Peter Pitts

By way of Forbes, a real "call it like I see it" piece by Paul H. Rubin, Professor of Law and Economics at Emory University and former Chief Advertising Economist at the Federal Trade Commission and Chief Economist at the U.S. Consumer Product Safety Commission. The topic is the important role of drug reps and, more broady, drug marketing> Rubin's article is both important and timely -- and should serve as an education for those who opt for soundbites rather than sound public health policy.

On My Mind: A Free Lunch
Paul H. Rubin

There's nothing wrong with letting drug reps schmooze with doctors. What's the matter with Americans? They think there is something incestuous about the connection between drug companies and doctors.

Politicians tell them that the drugmakers wine and dine physicians while pushing the latest antibiotic or statin. Utterly corrupted, doctors impose those medications on patients, whether or not the drugs are better than cheaper alternatives.

A pending U.S. Senate bill would require drug companies to report gifts to doctors of more than $25; the House is investigating marketing practices. New York State's legislature plans to hold hearings this year on the relationship between doctors and drug companies. One congressional critic has even compared the drug industry with the tobacco industry, and Senator John McCain has called drugmakers the "bad guys."

What drugs are these legislators taking? Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful. (Disclosure: I consult for the drug industry from time to time, most recently for Pfizer.)

Marketing and research are both information activities; they work together to get effective drugs to patients. The two activities are not in competition for resources. The denouncers of drug companies don't understand this. One of the senators sponsoring the bill suggests that "the millions of dollars these companies spend on marketing ... could be put into research." In fact, drug companies would not switch money from marketing to research. If they cannot market drugs in the best way, they will reduce spending on research. What's the point of inventing a new drug if doctors and patients don't know about it?

Academic physicians think that doctors should obtain information by reading medical journals. Practicing doctors do not have time to comb through the International Journal of Medical Sciences or the Annals of Internal Medicine. A meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs, or perhaps a better therapeutic alternative, or a drug with easier dosing or fewer side effects than the old drug. Physicians interact with more than one drug rep, so they have competing sources of information.

Another argument made by supporters of the Senate bill is that promotion leads physicians "to prescribe the expensive new drugs that are being marketed to them when a more affordable generic would do," in the words of one senator. There are three things wrong with this argument. First, manufacturers of generics do not promote those drugs, so it might be
difficult for the physician to learn about generics at all. Second, new drugs lead to better health outcomes. They keep people out of the hospital. A 2007 study by business professor Frank Lichtenberg of Columbia University estimated that a prescription for a new drug (5 years from FDA approval) costs an average $18 more than an older one (15 years on the market) but reduces other medical costs, including hospital and office visits, by $129. Finally, by leading consumers to purchase newer drugs, marketing increases investment in innovation and thus makes research more likely.

A widely cited 2000 article in the Journal of the American Medical Association summarized 29 published studies critiquing the interaction between doctors and drug reps. Notable feature of these articles, as quoted in the summary paper: "No study used patient outcome measures."
That is, in all of the medical literature on drug sales, there was no evidence of harm to patients caused by doctors and drug reps breaking bread. These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure.

A recent report shows that the life expectancy of Americans is at its highest level ever and will continue to increase. It is truly amazing that this society keeps coming up with ways to demonize and penalize an industry that has provided us with so many benefits.

Posted by peterpitts at 11:07 AM
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February 08, 2008

ScienceBoarding the FDA

by Peter Pitts

Terrific editorial in the edition Wall Street Journal. And the title says it all, "The Real FDA Scandal."

It puts the FDA Science Board report into the appropriate context -- that despite all of the Congressional bloviating about the FDA "not doing its job," there's plenty of blame to go around -- much of it belonging to those same elected representatives who are the first to throw stones. And you know the proverb.

"Scienceboarding" shouldn't be used to torture the FDA and score political points, rather the Science Board report should be recognized and utilized for what it really is -- a clarion call for appropriate budgeting, smart reform, and strong support for the Critical Path program and the Reagan/Udall Foundation.

Posted by peterpitts at 04:31 PM
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February 04, 2008

Stone of Arc

by Peter Pitts

Yes, Virginia, while some media will exploit public health myths for their own venal purposes, others can play an important role in advancing the public health.

By now you are certainly familiar with the controversy surrounding the ABC program “Eli Stone” – where the title character (an attorney who has spiritual visions) goes to court to prove that childhood vaccinations cause autism.

Well, rather than piling on to the already crowded anti-pharma bandwagon, here is what the New York Times said in an editorial:

“Nevermind that such authoritative bodies as the Institute of Medicine of the National Academy of Sciences, the Centers for Disease Control and Prevention and the World Health Organization have found no evidence of a causal link. Nevermind that the incidence of autism continued to rise even after mercury preservatives were phased out of almost all childhood vaccines. As far as Eli Stone is concerned, you can’t just rely on science. Sometimes you have to go on faith.

The American Academy of Pediatrics tried unsuccessfully to get the episode canceled, fearing that it could deter parents from getting their children vaccinated, exposing them to far greater dangers from disease. Let’s hope that any parents who watched don’t make that mistake. And let’s hope that in future episodes, Eli Stone and ABC show better judgment in picking causes.”

Posted by peterpitts at 09:49 AM
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