The Life Ledger

Fitness is a way of life.

photo credit: john-norris

I recently read an interesting article on Medical News Today reporting health insurers will begin covering online physician visits:

Health insurers Aetna and Cigna have announced that they will pay for online physician visits, and patients will be required to contribute a copayment for the visits, the Philadelphia Inquirer reports. Aetna on Jan. 1 expanded a pilot project in California, Florida and Washington state to the rest of the country, and Cigna said it would begin paying for online visits in January 2009. The insurers believe that members will like the service because it can improve efficiency and could prevent more costly problems, the Inquirer reports.

Of course, my initial reaction is - is anyone actually offering online physician visits? Apparently so, if heavies like Aetna and Cigna are getting in the game. Physicians don’t (typically) obtain technology degrees or have the programming skills necessary to open up their practice to an online community, so the first step is supplying physicians a “web visits” framework. Cigna and Aetna both partner with RelayHealth, a company that enables “web visits” through services including online medical chart storage, online appointment scheduling, automated interviews that serve to triage the patient before communication to the physician begins, online prescription center, and a payment/collections/insurance filing center. RelayHealth maintains an entire page describing the benefits and features available to patients, which can be summarized by these two FAQ answers:

What is a webVisit®?
A webVisit is an online consultation between a doctor and an established patient about a non-urgent healthcare matter. When conducting a webVisit, RelayHealth guides you through an interactive interview process appropriate for your specific symptoms, and then builds a succinct message to the doctor based upon the answers you provide.

How do I send a message to my doctor using RelayHealth?
Once you successfully register with RelayHealth and your doctor agrees to communicate with you through the service, easy-to-use, structured templates allow you to consult your doctor about specific health symptoms (we call this a webVisit consultation), request a prescription refill, request appointments, receive lab or test results, ask a simple question, or access health education information — depending on the types of RelayHealth services your doctor offers.

Apparently, companies that assist in enabling physicians to offer medical services online are stating to sprout up. But are any physicians actually offering online services? Recently, ReadWriteWeb reported on the Health 2.0 conference, part of which was dedicated to the “web visit” phenomenon:

Jordan Shlain founded the San Francisco On Call Medical Group, a group of doctors who make house calls almost anywhere their patients want to see them (home, office, even cruise ships) using a souped-up, hi-tech version of the doctors’ venerable black bag.

Jay Parkinson is aiming to be the “small town doctor of Brooklyn ,” using video camming, text messaging, email and chat to help treat his patients.

Both Jordan and Jay showed how different the standard model of health care can be — but also revealed the huge gap between the existing system of health care and the state-of-the art technology that potentially could be harnessed to serve patients at an ordinary level. In the end, this gap is the core dilemma facing the Health 2.0 efforts to transform the industry.

We’ve come a long way from using the Internet to display office hours and send X-rays to other countries for analysis. It appears that soon, patients will have true 24-hr access to non-emergency health care. Add Second Life to the mix, and things get even more interesting - take, for example, this Flickr slideshow demonstrating some interesting possibilities. And soon, with services like Carol getting a start, we may have access to a-la carte style healthcare, where patients purchase “care packages” and receive the care at any participating location.

With all these changes afoot, the real question is - will patients use the services? What about you - are you excited by the possibility of receiving healthcare with an instant-messaging client and web-cam, or will you always expect on face-to-face treatment?

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It began with WebMD and similar sites - patients started trusting and turning to Internet resources for medical information. Once patients began coming to the doctor’s office prepared with Internet-based diagnoses and medicine requests, doctors started paying attention to the Internet as well. Fast-forward to the present - not only do patients frequently turn first to the Internet for medical information before calling their doctor, they are now organizing into social networks like Wellsphere, DailyStrength and iMedix. We recently learned from sources like Mashable and TechCrunch that Internet heavies like Google, Microsoft and AOL are setting up systems for storing health records. And now, doctors are apparently getting into the scene with social networks and blogs of their own.

Digg recently directed me to this story at NPR about doctors who publish blogs. Apparently, according to the article, blogs published by doctors are on the rise and many people have concerns with this development. Physicians have been discussing patient information for years in journal articles, papers and books, so what is it that makes this story sensational and important to report? Is it the larger population and wider access Internet readership enjoys over published content? The fact that self-published blog articles are published faster than print material and not subject to any oversight (beyond that the law provides, of course)? Or is it just the Internet makes any story sexy and timely? Personally, I feel the issue is about the answer to this question - is it a doctor who blogs, or a blogger who happens to practice medicine? In other words, do we hold doctors (and perhaps other professionals, such as attorneys, who deal with confidential patient information) to a higher standard than anyone else who blogs?

Patient privacy seems to top the list of concerns, and the NPR article presents both sides of the debate. One the one hand, Dr. Deborah Peel, a psychiatrist and founder of the group Patient Privacy Rights, thinks these blogs may skirt close to invading patients’ privacy rights:

“The problem with physicians blogging about patients is the danger that that person will be able to identify themselves, or that others that know them will be able to identify them,” she says.

Peel’s group worries that information about a patient’s case could be traced back to the individual and adversely affect his or her employment, health insurance or other aspects of his or her life.

“If you [are a doctor and] are unhappy with the people that you’re supposed to be serving and taking care of, you probably need therapy,” she says. “You don’t need to be venting your frustrations in a public manner like that. That’s very inappropriate and unprofessional.”

On the other hand, Dr. Robert Wachter, author of a blog called “Wachter’s World,” disagrees:

“You might say we as doctors should never be talking about experiences with our patients online or in books or in articles.”

Wachter says taken for what they are — unedited opinions, and in some cases entertainment — blogs can give readers some useful insight into the good, the bad and the ugly of the medical profession.

This seems to be a movement that is growing, despite how you feel about possibly being the semi-anonymous subject of your doctor’s blog. The NPR article points to several particular blogs published by doctors, including KevinMD, which in turn links to many more. And privacy concerns will only get worse as “gated communities” like iMedExchange, who claim to verify all community members are themselves doctors, become more popular - the assumption will be, if all the readers are doctors, why even bother sanitizing the identifying information?

How about you - do you care if your doctor is blogging about you? Let us know how you feel in the comments and poll.

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I’m not too hip on multivitamins. Not only do we take on faith what’s in them, we take on faith they’re healthy. My own personal opinion - get your vitamins the way they’re meant to be processed, from food.

There’s a new study out that makes me even more wary of multivitamins. The U.S. News and World Report recently ran an article about a study from the National Cancer Institute that indicates taking more than 7 multivitamin pills a week could increase mens’ risk of “advanced and fatal” prostate cancer:

Researchers followed 295,344 men for five years and found that while high multivitamin use did not correlate with higher rates of localized cancer, it increased the risk of advanced cancer by 30 percent and nearly doubled the risk of fatal prostate cancer. Taking additional beta carotene and zinc supplements increased the risk even more.

…

Goran Bjelakovic, a researcher at the University of Nis in Serbia who has looked at the impact of nutritional supplements and wrote an editorial accompanying the study in the Journal of the National Cancer Institute, points out that the average American diet provides 120 percent of the beta carotene and vitamins A and C needed, suggesting that additional vitamins could upset the body’s balance of micronutrients.

Wow, the average American gets 120% of the body’s required beta carotene, vitamin A and vitamin C from diet, before even taking the multivitamin? The National Institute of Health has this to say about taking too much vitamin A:

Hypervitaminosis A refers to high storage levels of vitamin A in the body that can lead to toxic symptoms. There are four major adverse effects of hypervitaminosis A: birth defects, liver abnormalities, reduced bone mineral density that may result in osteoporosis (see the previous section), and central nervous system disorders [1,48-49].

Toxic symptoms can also arise after consuming very large amounts of preformed vitamin A over a short period of time. Signs of acute toxicity include nausea and vomiting, headache, dizziness, blurred vision, and muscular uncoordination [1,48-49]. Although hypervitaminosis A can occur when large amounts of liver are regularly consumed, most cases result from taking excess amounts of the nutrient in supplements.

Makes me wonder about the other vitamins and minerals we take “for health” without thinking about the damage we might be doing to ourselves.

Fast food burgers, fast food vitamins, fast food money - before long, we’ll be driving up to McDonalds and purchase hamburgers enriched with E. coli and vitamin A with our credit cards. All we’re missing is the vitamin A.

Well you haven’t been hearing much from me this week. I large part of that is because I pulled back on my exercise. This past Saturday, I tried to do a little bit of speed work. Nothing crazy, just moving my feet faster on the treadmill. And about 10 minutes into the run, my knee started hurting. And was located where most runners blanch - in the IT Band, or otherwise known as Runner’s Knee.

Since the run was 14 days away, I cut back. Way back. In fact didn’t run on Monday specifically, so was able to have a 3 day break. Around comes Wednesday, strapped on my shoes and sweated out another 3.5 miles no problems. Mentally wiping my brow, I worked through the different machines for weight lifting. When I hit something called Thigh Adductor, there was enlightenment. And boy howdy was it sharp, right in my knee. Or more specifically, where I was hurting before. Apparently I’m just to tall for that machine to use properly. Keeping my feet on its rest it induces me to use my knees instead of my legs.

While this story shows my foolishness, its perfect for demonstrating what happens as you get into shape. Part of the whole process is breaking down your muscles to rebuild them stronger. So as you do things : run, walk, lift, bike, whatever, except to be sore. Heck even be ready to be hurt! But it’s important to listen where you hurt. There are two criteria I use. First if you have any pain in your joints, you’re doing something wrong. Using a machine wrong or putting tension where you shouldn’t it doesn’t matter. Stop. Ask a doctor or trainer. Look for more information on the internet. So being sore in your muscles are to be expected. But at the same time it should be a general sore, about the size of the heel of your hand. If its a sharp pain and the size of a finger tip, again get to the doctor. Most likely you’ve over exerted and torn something.

Becoming healthy is an important thing, but a gradual thing. Any attempts to instantly be there can cause lots of pain. And your body will know when you are pushing to hard, so listen. It will prevent you from getting hurt and keep you on the healthy path.

Penny Arcade has a great strip today that sums up how I feel about consumer-targeted pharmaceutical advertising:

I especially like how drug ads are starting to use the verbage “Ask your doctor for a sample of Killzoudedia” - between the drug companies and the insurance companies, doctors are having less and less opportunity to actually diagnose their patients’ ailments.

This article at IOL about Australian artist Justine Cooper dovetails this topic nicely.  Justine invented a disease (Dysphoric Social Attention Consumption Deficit Anxiety Disorder, or DSACDAD) and a drug for its symptoms, Havidol.  According to the article:

But the multi-media exhibit at the Daneyal Mahmood Gallery in New York, which includes a website, mock television and print advertisements and billboards is so convincing people think it is authentic.

“People have walked into the gallery and thought it was real,” Mahmood said in an interview.

The Havidol website is a great read, especially the safety information including the following warnings:

In clinical trials, the most commonly reported side effects were mood changes, muscle strain, extraordinary thinking, dermal gloss, impulsivity induced consumption, excessive salivation, co-dependency with inanimate objects, hair growth, markedly delayed sexual climax, inter-species communication, taste perversion, terminal smile, and oral inflammation.

In rare instances, patients reported a sudden urge to change physicians. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden loss of interest in your physician let them know right away. Your doctor may need to make a change in the dose that is right for you.

Now that’s what I call truth in advertising.