Finding reputable sources of
health information.
Who do you believe?
HNS 6.1
Spring 2004
Types of health info sought
Which contraceptives also prevent STD’s?
How can I lose weight?
What’s in a healthy diet?
How can I live longer?
Should I get immunized for the flu?
Do I need to exercise every day?
How can I avoid getting colds?
What is the best way to control my asthma?
How can I reduce the amount of stress in my life?
1. Good sources of information
2.
Evaluating the internet
Sources of health information
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Vendors and advertisements
Magazines and newspapers (ads and articles)
Broadcast media (ads and stories)
Billboards and subway posters
Friends and family
Health care providers and educators
Government sources eg. FDA
Public service and advocacy organizations eg. ALA
Peer reviewed journals
Possible health benefits
of kava kava?
• An herb which grows
•
•
in the South Pacific
and Hawaii
A traditional magical
drink used in
ceremonies where it
promotes calming and
sociability
Used to reduce
anxiety and pain
http://www.virilityhealth.com
www.herbex.com/
VENDORS AND RETAILERS
Advertising
From: www.kickbackwithkava.com
Stress Relief with Kava
"There are many situations likely to make us
stressed out and anxious. The use of kava
could potentially reduce the anxiety
associated with these stressful events, thus
minimizing worry and unpleasantness...we
are exposed to an enormous amount of
psychological stress: We drive to work in the
morning in horn-honking heavy traffic. Our
work involves difficult bosses, deadlines,
phone calls to return, and projects to
complete. We have the traffic again on the
way back home, dinner to prepare, active
children to keep under control, feed, an
nurture, bills to pay, and a home and garden
to maintain...Kava, if used appropriately,
could help us reduce the stress in our lives,
and it can even be used to prevent or
decrease the amount of stress or anxiety we
anticipate being exposed to." (quoted from
Kava: the Miracle Antianxiety Herb, Dr. Ray
Sahelian, 1998, pgs. 58-60)
THE GOVERNMENT:
FDA warning
•
KAVA-CONTAINING DIETARY SUPPLEMENTS MAY BE ASSOCIATED WITH
SEVERE LIVER INJURY
The Food and Drug Administration (FDA) is advising consumers of the potential risk of
severe liver injury associated with the use of kava-containing dietary supplements. Kava
(Piper methysticum) is a plant indigenous to the islands in the South Pacific where it is
commonly used to prepare a traditional beverage. Supplements containing the herbal
ingredient kava are promoted for relaxation (e.g., to relieve stress, anxiety, and
tension), sleeplessness, menopausal symptoms and other uses. FDA has not made a
determination about the ability of kava dietary supplements to provide such benefits.
• Kava-containing products have been associated with liver-related injuries – including
hepatitis, cirrhosis, and liver failure -- in over 25 reports of adverse events in other
countries. Four patients required liver transplants. In the U.S., FDA has received a report
of a previously healthy young female who required liver transplantation, as well as
several reports of liver-related injuries.
• Given these reports, persons who have liver disease or liver problems, or persons who
are taking drug products that can affect the liver, should consult a physician before
using kava-containing supplements.
March 25, 2002
NEWSPAPER ARTICLE
LENGTH: 550 words
HEADLINE: Popular herb kava may pose liver risk, FDA says
BYLINE: The Associated Press and Los Angeles Times
DATELINE: Washington, DC
BODY:
WASHINGTON The popular herbal supplement kava carries a "potential risk" of severe liver damage, the Food and Drug
Administration warned yesterday.
The advisory urged kava consumers and their doctors to be on the lookout for signs of liver injury. It came three months
after the FDA asked doctors to review their cases for links between kava and liver problems.
Kava ranks ninth in herbal supplements sold in the nation.
"This kind of liver damage appears to be extremely rare. But because it's severe ... we felt consumers needed to be aware
of it," said Dr. Christine Taylor, the FDA's supplement chief.
The agency has not yet determined whether kava, or its use with some other supplement or medication, actually causes
liver damage. It began investigating after a healthy 45-year-old woman who began using the herb suddenly required a
liver transplant.
European health officials report 25 similar cases of liver toxicity, including four transplants.
As a result, sales were halted in Switzerland and France and suspended in Britain; Germany is acting to make kava a
prescription drug; and Canada has urged consumers not to take kava until the safety question is settled.
Peer reviewed sources of information
• Peer reviewed journals
• Include both original research and reviews
• Characteristics of peer reviewed articles
–
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Abstract
Materials and methods
Results
Discussion/Conclusion
For example see: http://www.jfponline.com/content/2002/01/jfp_0102_00038.asp
PEER REVIEWED SOURCEAbstract only
Dtsch Med Wochenschr. 2001 Sep 7;126(36):970-2
[Fulminant liver failure after administration of the herbal antidepressant Kava-Kava]
[Article in German]
Kraft M, Spahn TW, Menzel J, Senninger N, Dietl KH, Herbst H, Domschke W, Lerch MM.
Medizinische Klinik und Poliklinik B, Universitat Munster, Germany.
HISTORY AND CLINICAL FINDINGS: A 60 year-old woman was admitted to hospital because of jaundice, fatigue,
weight loss over several months and icteric skin. Because of progressive liver failure, concomitant renal failure and
progressive encephalopathy she was transferred to an intensive care unit. INVESTIGATIONS: Biochemical tests
revealed acute liver failure with high levels of total and conjugated bilirubin (30 mg/dl) as well as aspartate
aminotransferase (921 IU/l) and alanine aminotransferase (1350 IU/l) concentrations. Prothrombin time was less
than 10 %. Serological tests could rule out viral hepatitis, metabolic or autoimmune causes of liver failure. On
abdominal computed tomography and ultrasonography no pathological changes were detected. Above all portal
vein thrombosis, ascites, focal lesions of the liver and extrahepatic cholestasis could be excluded. Liver histology
showed extensive hepatocellular necrosis with intrahepatic cholestasis. TREATMENT AND CLINICAL COURSE:
The patient's physical condition deteriorated. She had to be intubated because of respiratory insufficiency and
encephalopathy stage IV. Because of progressive liver failure under conservative treatment the patient received an
orthotopic liver transplant 11 days after admission. CONCLUSIONS: The exclusion of other causes and the
histological diagnosis made Kava-Kava as the cause of acute liver failure most likely. This is the 18th case of KavaKava induced liver failure reported to the European regulatory authorities.
Your studyDesign a study to examine whether magnets
reduce the pain associated with carpal
tunnel syndrome
A good study-See page 606 of your text
1. Peer reviewed
2. Clinical•
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3. Size
4. Results
Controls (eg. untreated, usually with placebo)
Randomized
Double blind
--subjects don’t know treatment
groups
--investigators don’t know
treatment groups
A peer review study
The Journal of Family Practice • JANUARY 2002 • Vol. 51, No. 1
The Effectiveness of Magnet Therapy for Treatment of Wrist Pain Attributed to Carpal
Tunnel Syndrome
Richard Carter; Thomas Hall; Cheryl B. Aspy, PhD; and James Mold, MD, MPH Oklahoma
City, Oklahoma
We conducted a double-blind placebo-controlled randomized clinical trial in which 30
patients with pain attributed to carpal tunnel syndrome had either a 1000 gauss
magnet or a placebo metal disk applied to the carpal tunnel area using a Velcro wrap
for a period of 45 minutes. Pain was measured on a visual analogue scale using 0
and 10 as anchors.
Presenting symptoms including numbness, tingling, burning, and pain did not differ
significantly between the 2 groups. There was significant pain reduction across the
45-minute period for both groups. However, t test comparisons found no significant
differences between the groups for beginning pain, pain at 15 minutes, pain at 30
minutes, or pain at 45 minutes. The use of a magnet for reducing pain attributed to
carpal tunnel syndrome was no more effective than use of the placebo device.
• KEY WORDS Carpal tunnel syndrome; magnet/therapeutic use [non-MESH];
pain/therapy [non-MESH]; alternative medicine. (J Fam Pract 2002; 51:38-40)
Introduction
Four recent randomized trials have provided conflicting results concerning the
efficacy of magnets in relieving pain. Two double-blind randomized trials have
found that magnets relieve pain in postpolio subjects1 and in patients with
postoperative wounds.2 However, double-blind randomized studies of magnet
therapy for treatment of low back pain3 and foot pain4 showed no benefit.
In an attempt to find alternate forms of therapy,5,6 many chronic sufferers of
carpal tunnel syndrome have resorted to using magnets to alleviate their
symptoms. The purpose of our study was to determine the efficacy of magnet
therapy on pain attributed to carpal tunnel syndrome when compared with a
placebo device.
Methods
Subjects
We contacted 160 patients who had wrist pain attributed to carpal tunnel
syndrome by their primary care physicians. These patients were identified from
the billing databases at a university-operated family practice clinic and a rural
private practitioner's office. The inclusion criteria for participation were
presence of chronic wrist pain in the area of the carpal tunnel and the
willingness to accept randomization into treatment or control group. Individuals
were excluded before randomization if the source of pain had been attributed
to some cause other than carpal tunnel syndrome, if they had taken pain
medication within 4 hours of beginning treatment, if their body mass index was
greater than 35, or if they were not experiencing pain at the time treatment
was started.
RESULTS
Of the 160 patients contacted by mail, 45 replied,
38 qualified for participation, and 30 patients
completed the 45-minute treatment protocol: 15
with a magnetic device and 15 with a placebo.
Descriptive statistics for the 2 groups are
provided in Table 1. Groups did not differ
significantly in age or any of the presenting
symptoms including numbness, tingling,
burning, and pain. There were no men in the
magnet group and 4 in the placebo group ( P
=.01).
DISCUSSION
The delivery of a unipolar static magnetic field through a magnetized device
directly applied to the point of greatest wrist pain resulted in no significant
difference in relief of pain when compared with an identical placebo device.
However, both magnet and placebo produced a significant decrease in pain
during the 45-minute application that was still detectable at the 2-week
follow-up. The decrease in pain observed in both experimental and control
groups could be attributed to a variety of causes. Most likely, this is a
placebo effect due to the patients' belief in the efficacy of the device. Also,
it is possible that pressure over the area of pain, due to application of the
bracelet, somehow reduces the amount of pain experienced.
A limitation of this study is the small sample size. It is possible that a larger
study would detect small improvements in outcomes, but it is questionable
whether these would be clinically significant.
CONCLUSION
Collacott and colleagues3 found that magnets were not effective in
treating low back pain. Although they proposed that the depth of
the pain source might have played a role in the outcome of their
research project, such an issue would not be a significant factor in
our study because of the relatively short distance from the surface
of the wrist to the median nerve. Future research might include a
measure of belief in magnets as healing devices to determine the
impact of the placebo device. The addition of another arm of the
study to include magnet placement adjacent to, but not touching,
the point of pain to determine the pressure effect might be
interesting. Although this study did not show magnets to be more
effective than the placebo, the reduction in pain with this simple
intervention was remarkable.
http://www.jfponline.com/content/2002/01/jfp_0102_00038.asp
http://www.jfponline.com/content/2002/01/jfp_0102_00038.asp
http://www.jfponline.com/content/2002/01/jfp_0102_00038.asp
1. Good sources of information
2. Evaluating the internet
Sources of health information-
ALL CAN BE FOUND ON THE INTERNET
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Vendors and advertisements
Magazines and newspapers (ads and articles)
Broadcast media (ads and stories)
Billboards and subway posters
Friends and family
Health care providers and educators
Government sources eg. FDA
Public service and advocacy organizations eg. ALA
Peer reviewed journals
Evaluating internet information
http://www.library.jhu.edu/elp/useit/evaluate/
1)
2)
3)
4)
Authorship-who wrote this?
Publishing body-who’s website is this?
Point of view-why does this website exist?
Referral to other sources-specific references
(links don’t count!!)
5) Verifiability-Is the information accurate?
6) Currency-How old it the website?
Evaluating internet information
http://www.library.jhu.edu/elp/useit/evaluate/
1) Authorship-who wrote this?
2) Publishing body-who’s website is this?
a. Organization or person sponsoring
a.
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url may provide clues
http://www.prairienet.org/~kagan/intro.htm = personal
http://vm.cfsan.fda.gov/~dms/addskava.html = FDA
http://nccam.nih.gov/health/alerts/kava/ = NIH
http://www.biopsychiatry.com/kava/ = commercial