What Do You Put Your Faith In?

Many things are done on the basis of faith. Religion is one example, relationships are another.  However, proper practice of medicine should be based on evidence not blind faith.

Making the headlines yesterday was the United States Preventive Services Task Force recommendation that doctors discontinue routine testing for Prostate Specific Antigen (PSA) in healthy men. This recommendation was based on two studies, one which showed no difference between men tested versus not tested, and the second study which showed that among tested men, there were many false positives that led to further unnecessary testing e.g. biopsies, which led to complications e.g. infections.

Not surprising, many urologists and oncologists came out against this don't test recommendation. What's the answer? My view is that if you have symptoms, you should test, and if not, you should not test. I believe this is true in many medical situations not because I have an opinion but because the facts support that conclusion.

Yesterday, I exchanged a number of correspondences with a lady on LinkedIn regarding the need to test everyone for Vitamin D deficiencies.  She emphatically believes that it is necessary to test everyone because most people who don't take Vitamin D supplements are deficient; I don't agree.  My reason for not agreeing is because that's not what the science shows. As I wrote the other day about Vitamin D and The Endocrine Society, the facts are inconclusive as to the effects of mega-dosing with Vitamin D. This lady insisted that she needed twice the normal lower level of Vitamin D to be healthy. It's not surprising that so many people are confused by what they need because rumors and false information often circulate unabated without correction about supplements. You may remember my blog titled Supplementum, The New Religion. It was a parody of Americans' growing blind faith in supplementation in the absence of compelling evidence.

I can understand why many put their faith in things that aren't true. We sometimes just want to believe; sometimes we just need to believe.  Oftentimes belief is a good thing if it gives you solace or helps you navigate an often confusing world. That's all fine as long as such belief does not lead to dangerous situations and irreversible harm. While I believe that it is important to be vigilant, I don't believe that it is proper to test for no reason. In the Longevity Project book, the authors concluded that a little bit of neuroticism is good for your long term health, but chasing diagnoses in the absence of symptoms is full blown neuroticism and that's not healthy.

My biggest issue with supplement marketers is that they give people false hope by promoting science fiction as fact, when there are better solutions available that won't be pursued because of reliance on placebo-like products. If people had all the facts, the supplement market would be a fraction of its size and it knows it. That's why it fights the FDA with everything it has because the FDA wants the facts to be known.

Faith works, but when it comes to your health, I think you would be better off relying on evidenced based medicine. I know I do.

One Person At A Time

The release of the Institute of Medicine's report last week about obesity and the airing of HBO's The Weight of the Nation the past two nights have created quite a bit of hoopla. Both associated reports have highlighted the growing epidemic of obesity in our country and the pressing need for a solution.

This morning at 5 AM, I watched two hours of the HBO show and was delighted by its even-handedness. The facts were presented in a non-sensationalistic fashion and flowed nicely, so if you haven't seen the show yet, I encourage you to do so.

For me, there was an immediate take-away from the individual stories of struggle and success that were reported. The take-away was that everyone had a unique story and everyone needed help to lose weight. Yet, despite this underlying theme, other than a discussion with a bariatric surgeon, there were no specific recommendations to seek such help. Suggestions were given to exercise more, eliminate certain foods like fruit juices and soda from one's diet, etc.;  but, never once was it stated that one seek consultation with a nutritionist or health psychologist. Neither were there any suggestions to discuss your weight problem with your physician, nor your difficulty, for whatever reason, to get the exercise you need, with a fitness trainer.

Ultimately, the show commits the cardinal error of simply telling people the oft repeated advice to eat better, exercise more, become more mindful, etc. If it were that simple to lose weight and modify one's lifestyle, there would be no obesity epidemic and 68% of Americans would not be overweight.

True, our country as a whole has a collective weight problem that merits the closest attention. But the problem can only be solved one patient at a time. I'm sorry to beat this horse to death, but the type of help people need can often not be determined by the individual alone. As I've said before, patients who are their own doctors, or what I call Doctients, have a fool for a doctor.

That is why I believe, when it comes to a weight problem, that a 360 degree assessment, provided by a primary care practitioner, registered dietitian/nutritionist, health psychologist, and fitness trainer is the best approach. That is why before we opened MDPrevent, before we had even a single patient, we hired all these professionals to be on hand full-time so that every and any patient who would benefit from their assistance could immediately access it.

While the sum of the parts means that the weight of our nation is a pressing, perhaps even the defining problem of this generation, the solution can ultimately only be accomplished by interventions geared to helping one person at a time.

I hope someone is listening, but if not, I'll raise my voice even louder. This nation's weight problem will not go away on its own and neither will I.

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Look In The Mirror. Part 2. Better To Buy A Bike!

Yesterday, I wrote about the dangers of using the services of a mobile testing company. As fate would have it, after writing my piece, I received a solicitation from one such company.

The solicitation included a marketing flyer, which on one side was titled, "6 Reasons for Regular Screening." Let's analyze their reasoning.

1. Your health changes over time.

Based on this logic, we should be doing all sorts of testing all the time because we never know when our health changes.  Applying this principle, this should include blood tests, ekgs, x-rays, CT scans, MRIs, PET scans, ultrasounds, cardiac-stress tests, spinal-taps, endoscopies, etc. If you agree with their thought process, why exclude more elaborate tests that are better detectors of problems. The answer is because most of the tests they do are unnecessary, because the tests are not free, because you can't obsess about your health by constant testing (a little neuroticsm is ok), and most importantly, because you are likely to get many false positives that will lead to further stress and unnecessary testing.

2. Your physician usually cannot order these screenings unless symptoms are present.

That's an easy one. Good physicians don't go on wild goose chases looking for problems. When they hear hoof-beats, they think of horses, not zebras, and they use the proper tools to diagnose the problem(s) the patient shares with them.

That said, certain medical tests are covered and recommended in the absence of symptoms because the evidence for thier prospective use has been carefully evaluated by the United States Preventive Sevices Task Force (USPSTF) and determined to be of good use. However, these tests are generally covered by insurance and can be ordered by your doctor.

3. Your previous results may have revealed important risk factors.

This is a doozey. It reminds me of my experience with the pre-diabetes. Do they think (or hope) you ignored the previous abnormal results, did not bother to consult a medical professional, and should now return for another test only to keep repeating the process of excluding a medical consultation?  Apparently so. Testing in the absence of follow-up is dangerous. Do not be a doctient, a person who thinks he is both a patient and a doctor and can self diagnose and treat.

4. Screenings can help prevent stroke.

Screenings do not help prevent stroke. They may detect your increased risk for stroke after which you can consult a doctor for preventive measures. The issue here is that in the absence of sign and symptoms of stroke related disease, such as heart disease, diabetes, obesity, high blood pressure, high cholesterol, atrial fibrillation, etc., the probability of having a stroke is extremely low. If you have these medical issues, you are at higher risk for a stroke and you don't need a test to confirm the risk. You should take action immediately to decrease your risk by changing your lifestyle and seeing your physician for medical intervention.

5. Screenings can detect serious risk factors in just minutes.

If you have nothing better to do with your life, then by all means go for these unnecessary tests in the absence of sign and symptoms because maybe, just maybe they may find some abnormality that requires action you should have already taken anyway. But don't worry, they will confuse you fast.

6. You may suffer from Peripheral Arterial Disease (PAD).

That's a true statement. You may suffer from hardening of the arteries and about a thousand other diseases. Again, PAD itself is associated with heart disease, diabetes, obesity, high blood pressure, and high cholesterol. If you eat what you want and barely exercise, there is a high probability you will develop PAD at some point in life. You don't need this test, and in the absence of signs and symptoms, that is why it is not covered by insurance.

Many insurances today, including Medicare, offer a full range of preventive benefits, including screening tests, that have, based on the scientific evidence, been to be found worthwhile. Don't succumb to fancy marketing and be sucked into getting unnecessary testing.

If you have any concerns about your health, speak to your medical provider as soon as possible.

One final note, a study just published in the American Journal of Cardiology, focused on men who had at least one parent who'd had a heart attack before the age of 55. The study found that despite this apparent gentic predisposition to heart disease, those men with a healthier lifestyle were less likely to develop heart failure over two decades.

"Healthy habits included not smoking, exercising regularly, keeping a normal weight and drinking alcohol in moderation."

Many screening companies use your family history to scare you into unnecessary testing. The bottom-line remains that testing doesn't prevent disease--you do by the lifestyle you live. Save your money on testing and buy a bicycle or some other piece of exercise equipment. It will do you more good.

Just Look In the Mirror

I read an interesting article yesterday on the Fox Business website titled DIY health care: The trouble with direct-to-consumer health screenings. DIY stands for Do It Yourself.

The gist of the article describes the dangers associated with participating in unsolicited screening tests offered by commercial, usually mobile, companies. The article states that if "you get a letter in the mail inviting you to participate in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other scary stuff, you should probably toss it out with the rest of the junk mail."

The article gives several reasons. One reason is the perils of self-diagnosis. (See my blog from March 14 titled, Are You A Doctient?) The article states, "People might buy direct-to-consumer health screenings for their own self-diagnosis and self-treatment for symptoms of disease. "It's difficult for the lay public to really appreciate the nuances and wholly understand the difference between screening and diagnostic testing. Many patients seek screening tests for symptom diagnosis. These patients can be dangerously falsely reassured by normal results if they have chosen the wrong test, or even led in the wrong direction with abnormal results."

The article adds, "Additionally, many of the medical screening tests are not supported by evidence-based guidelines and therefore expose patients to tremendous and unnecessary harm. "The data has shown that many of these tests [when used for disease screening] will produce far more harm than benefit for most patients." (See my blog on April 5 about unnecessary tests).  

One more consideration. According to Linda Sherry, director of national priorities for Consumer Action, agrees. "These tests have limited or no diagnostic value and may trigger stress [and] fear, and encourage further, more expensive testing to rule out false positives. Insurance won't pay for them unless they are ordered by a doctor for diagnostic reasons, not preventive reasons."

If you're looking to save money, "you can take your own blood pressure at most pharmacy chains and many communities have health screening days designed to educate people about symptoms that might require follow-up," says Sherry.

Read more: http://www.foxbusiness.com/personal-finance/2012/05/02/diy-health-care-trouble-with-direct-to-consumer-health-screenings/#ixzz1toa6ivop

On a personal note, I participated in such a screening program about a year ago offered by Lifeline Screening. I went for the whole megilla. I did so as part research and part curiosity. A routine blood sugar measurement revealed that I had a 105 level. Such a level is construed as elevated. (by the way, I noticed the tech eating a fruit shortly before th test and contact witht eh fruit could have skewed my result.) 

When sharing the blood results with me, the concerned technician told me that I was pre-diabetic and I should "watch" my number. The absurdity of the statement struck me immediately. What did "watch" my number even mean? He didn't tell me to consult with a physician. He just told me to "watch." Did he mean for me to use his services again to see how the number changed? He didn't say, but I suspect as much. Being pre-diabetic is a warning sign that requires intervention before you progress to full blown diabetes. Telling me to "watch" my number was worthless.

So what's a person to do?  I say instead of relying on marketing solicitations for tests that you probably don't need and should generally only be ordered by a physician when you do need them, let me offer some practical alternatives.

First get on a scale. Then calculate your BMI. Here's a good site to calculate it:

http://www.nhlbisupport.com/bmi/  

If your BMI is over 25, you are in unhealthy territory. Over 30 you are in a real danger zone. Over 40, start saying your goodbyes if you don't do something immediately about it.

Next measure your waist circumference. If you have a bulge around your waste, that typically means you are accumulating the unhealthy type of fat cells called white fat cells. They predict problems and just like with an elevated BMI, you should initiate changes to your lifestyle to improve your health prospects.  I recommend starting with a physician consultation and then moving on to a nutritionist and fitness instructor. If stress and/or sleep are a problem, consult a psychologist as well.

Finally, take a long, hard look at your naked self in the mirror. Do you see a healthy, vibrant, relaxed, age appropriate person in the mirror or a tired, slumped, over- or under-weight, stressed-out individual? Be honest with yourself. If you look good, you probably feel good and you are probably doing well. But if you look worn-out, haggard, depressed, older than your age, I think it's time to get serious about your health and to develop a personal wellness plan.By the way, while you are looking, check for any abnormal growths on any aspect of your body front and back, top and bottom.

Try doing this once a month to take stock of your life and health. It's free, it's easy and it will provide much valuable information that will not lead to unnecessary and expensive testing. So the next time you get a solicitation from a testing company, try making an airplane out of it for fun. Nevertheless, listen to your body and if you have any concerns, consult a physician.

I Just Don't Know

Today's blog has two parts and thought-trains.

Part 1

I typically don't read Glamour Magazine. However knowing my penchant for all things related to vitamins, my youngest daughter was delighted to share an article she came across in the magazine. The gist of the article were the responses from three experts to a question regarding the appropriateness of taking multivitamins after recent studies have suggested they may be harmful.

The first response came from a PhD who works at the Fred Hutchinson Cancer Research Center whose response was basically no, they are not needed. The second response came from a MD and professor of prevention at a Harvard teaching hospital who basically said no except in specific cases like folate during pregnancy shown to avoid birth defects. The third response came from Dr. Michael Roizen, the Chief Wellness Officer of the Cleveland Clinic who basically said yes because people don't eat good diets.

I was infuriated that he answered as he did. I met the man a little over a year ago when I visited the Cleveland Clinic in Ohio. The purposes of the trip was to explore partnership with him and the Clinic regarding my new prevention initiative. (For full disclosure, there were a number of subsequent conversations and correspondences after the trip as I vigorously pursued the opportunity. Eventually, however, I walked away because I found their terms of partnership to be highly lopsided.)

Notwithstanding, during the trip, I had an opportunity to speak to Dr. Roizen in privacy. During that time, which was relatively early in my auditing the field of prevention, I asked Dr. Roizen which dietary supplements he believed stood out among all others and that he would personally recommend for daily consumption. His list included baby aspirin, fish oil, probiotics, Vitamin D, and turmeric.

On the surface, it's not a bad list. Under the right set of circumstances, the first four have clear benefits. However, he did not know my medical history and therefore it was probably imprudent to him to make such specific recommendations, but then again I asked and he was happy to oblige. (Read more about this in part 2 of this blog.) 

For example, aspirin can prevent platelet aggregation (thereby decreasing blood clots) and some studies show some benefit in preventing colon cancer, but aspirin can also increase gastric bleeding and can lead to the development of macular degeneration. Given my history of gastric ulcer, aspirin is a tough choice.

One of my recent blogs dealt with fish oil at length, so just to summarize, its not the panacea everyone has made it out to be and given the option, eating fish like Wild Alaskan Salmon beats it hands-down.

Another one of my blogs dealt with probiotics and an extensive body of research supports my assertion that probiotics have no benefit if you have a generally healthy gut. They can be beneficial when taking antibiotics and when dealing with inflammation of the bowels, but they are not useful routinely.

Many people are apparently (I say apparently because no one knows for sure) Vitamin D deficient because of lack of sun exposure. However, treating anything on presumption, I believe is a mistake. First of all, many foods are fortified with Vitamin D so even though one does not get much sun exposure one is not necessarily deficient. Second, it is easy enough to check for a Vitamin D deficiency and by doing so the result will indicate if you there is a need to supplement and also how much should be taken.

So viewed in their entirety, the first four suggestions from Dr. Roizen were not outlandish as they generally do not cause harm (except for aspirin.) and may be beneficial at times. Tumeric, however, is another story.

Dr. Roizen told me that tumeric prevents Alzheimer's and is good for brain health. Based on Dr. Roizen's suggestion that day (and my hearing him repeat the same advice a few days later on the Retirement  Living TV channel), I naively purchased tumeric and began to add it regularly to my food.

Unfortunately, the highly staining substance turned my teeth bright yellow.  After this disconcerting turn of events, I began intensively researching tumeric and discovered two disturbing facts. First, tumeric has little validated science to support its use for the indications Dr. Roizen asserted. Second, I discovered that in the absence of a black pepper called piperine, tumeric is very poorly absorbed by normal ingestion and so adding it to my food was an effort in futility, except if turning my teeth yellow was my endgame. (By the way, I had to go to a dentist to get rid of the stain.)

Despite these five recommendations, I should have been even more wary of Dr. Roizen's advice when he also practically whispered to me, as to share a well-kept secret, that a certain statin drug had also been shown to decrease the development of Alzheimer's. The whispering should have been the giveaway. All statins are now widely accepted to have no efficacy for such purposes, but I suppose he was depending on some source of information to make his claim.

So now you know why it was disturbing for me to read about Dr. Roizen confidently disseminating advice about multivitamins.

Part 2

After reading Dr. Roizen's comments, I became curious about his background and read his bio available online. I find his credentials to be excellent.  I started thinking why a person like him would spew out what I believe is basically worthless, if not harmful advice, with such certainty. I also started thinking about Dr. Oz, a close friend of Dr. Roizen, (they've authored a number of books together and Dr. Roizen is an adviser to the Dr. Oz Show). Like Roizen, Oz's credentials are also top-notch.

Why, I asked myself, are such erudite men propagating such apparently bad advice about dietary supplements?  Why were they either ignoring or reaching different conclusions that I do from the numerous studies now widely available that show the dangers of dietary supplementation?

So let's assume for a moment that I am reaching the more valid conclusions. If so, what causes them to support the industry? Your first instinct may be to say money, but I dismiss money as the main motivator because I suspect they have already accumulated enough to live quite comfortably and I don't believe that for such distinguished and successful clinicians, it is the end to end all.

So what's the answer? I thought back to a recent episode of The Dr. Oz Show. The guest was a cryptographer (hand-writing expert). As part of the show, the expert analyzed a writing sample from Dr. Oz. His conclusion based on how Dr. Oz forms a wide-open at the bottom scripted 's.' was that this demonstrates that Dr. Oz is very susceptible to the opinion of others. Basically, he concluded that Dr. Oz's popularity stems from his genuine desire to please others. I think most people would agree that this is a pretty good trait to possess.

Let me preface my next comments by stating I have basically no training in psychotherapy. All that follows is conjecture. If you are interested, allow me to speculate why I think this trait of wanting to please others can be problematic especially for physicians in the limelight.

Most physicians are highly intelligent and possess a great deal of accumulated knowledge. Patients know this and expect doctors to be able to routinely answer their questions. However, the body of clinical knowledge, which continues to grow daily, is already far beyond anyone's grasp and that is why there are many specialties and sub-specialties in medicine.

For doctors in the limelight, however, they work hard to create a persona of all-knowing. They want to be viewed as saviors of sorts, able to help both small and wide audiences alike. They never want to disappoint by saying I don't know or I'm not sure.

This realization has caused me to think about my own approach. Until a few weeks ago, I grew more confident in my assertions and more provocative in my conclusions. Then a funny thing happened which I wrote about in another blog. During one of my lectures, an audience member challenged my statements virtually one by one. This forced me to recalibrate and make sure that everything I was saying was defensible. I think my conclusions were generally accurate, but generally was no longer good enough.  I realized after that talk that I was falling into the same trap that I think many before me have fallen into.  I realized that because almost nothing in regards to science can be said with absolute certainty, that it is not fair for someone who can get up and comfortably speak to an audience to assert otherwise.  A speaker should not be expected to always please his or her audience out of expediency if it is the truth that the audience needs and wants.

I believe that many of the doctors like Hyman, Oz, Roizen, etc, say what they say not because it will make them even more money; rather, because it will make their audiences like them more as they offer simple solutions to complicated problems. Some problems require the audience to work hard to accomplish effective solutions and promising quick fixes may be dangerous and inappropriate.

I promise to keep Mark Twain's words close to heart whenever I speak and write. Twain said "it's not what you know that gets you into trouble, it's what you know for sure that does."  Accordingly, as I continue to learn more about dietary supplements, I will work hard to report the facts (if they can be called as much), not my biases. I promise to answer "I just don't know" when that is the most appropriate answer. I think my patients and audiences deserve no less. What do you think?

Are You A Doctient?

A couple of days ago, I was at a health fair speaking to prospective patients about MDPrevent. During the course of the day, a young senior woman walked by and I tried to discuss our program. Whatever I said to her was responded to by sarcastic facial expressions. She claimed that she was well versed in wellness and supplement usage and rattled off an alphabet list of different supplements she was using including boron, calcium, magnesium, etc.  As she walked away, I thought to myself that there is truly a new kind of patient today which I will now forever call a Doctient, the word created by blending the words doctor and patient.

When I was in medical school in the early 1980s, we were taught that patients absolutely must own their health care and be active participants in approving any treatment. We even were shown a video in which a patient slugs a nurse trying to add a drug into her intravenous line after asking th nurse not to do so and were dutifully informed that the patient was right to do so because the drug was the wrong medication and would have harmed her.  Accordingly, I have always believed in patients taking an active role in their care.

Yet, in the past 15 years, with the meteoric rise of internet usage, and the immediate access it provides to almost unlimited medical information, good and bad, patients have become more empowered than ever about their health care.  In general, I think that's a good thing. Still, I am afraid because I find much of the medical information available on the internet to be superficial, confusing, incomplete, alarming, and most importantly, often inappropriate for the specific patient. I read that a study showed that Wikipedia was accurate 98% of the time in relation to health information. That's great, but how do you know when you are reading the other 2%? 

If patients use their internet and book found knowledge in conjunction with a medical consultation, I think the truth can be determined and the best course of action achieved. But when patients solely rely on information they gather on their own from various sources, they are playing with fire. Fire in this case may be life-threatening.

An article on Yahoo the other day attacked artificial sweeteners in soft drinks as potentially harmful while lauding regular soft drinks as healthier. Really? Soft drinks made of mostly added sugars, chemicals, and artificial colors are superior to diet drinks? That's news to me. Neither is good, but there's no defensible position to argue that soft drinks are healthy, relative to anything edible. We all know we can't believe everything we read, but it's really hard sometimes to ignore the written word when it includes known facts mixed in with conjecture, hyperbole, and misinformation.

So if you are a Doctient, that's great, because understanding you health is important. But don't be a Doctient in a vacuum. It's often been said that a doctor who treats herself has a fool for a patient.  Here's my new adage. A patient who treats himself has a fool for a doctor. Be knowledgeable about your health but don't get overly confidant. As I quoted Mark Twain in a previous blog, "It ain't what you know that gets you into trouble. It's what you know for sure that does."