Finding reputable sources of Finding reputable sources of health information.health information.

Who do you believe?Who do you believe?

HNS 6.1 HNS 6.1 Spring 2004Spring 2004

Types of health info soughtTypes of health info soughtWhich contraceptives also prevent STD’s?Which contraceptives also prevent STD’s?How can I lose weight?How can I lose weight?What’s in a healthy diet?What’s in a healthy diet?How can I live longer?How can I live longer?Should I get immunized for the flu?Should I get immunized for the flu?Do I need to exercise every day?Do I need to exercise every day?How can I avoid getting colds? How can I avoid getting colds? What is the best way to control my asthma?What is the best way to control my asthma?How can I reduce the amount of stress in my How can I reduce the amount of stress in my

life?life?

1.1. Good sources of informationGood sources of information

2. 2. Evaluating the internetEvaluating the internet

Sources of health Sources of health informationinformation

• Vendors and advertisementsVendors and advertisements

• Magazines and newspapers (ads and articles)Magazines and newspapers (ads and articles)

• Broadcast media (ads and stories)Broadcast media (ads and stories)

• Billboards and subway postersBillboards and subway posters

• Friends and familyFriends and family

• Health care providers and educatorsHealth care providers and educators

• Government sources eg. FDAGovernment sources eg. FDA

• Public service and advocacy organizations eg. Public service and advocacy organizations eg. ALAALA

• Peer reviewed journalsPeer reviewed journals

Possible health benefits Possible health benefits of kava kava?of kava kava?

• An herb which grows An herb which grows in the South Pacific in the South Pacific and Hawaiiand Hawaii

• A traditional magical A traditional magical drink used in drink used in ceremonies where it ceremonies where it promotes calming promotes calming and sociabilityand sociability

• Used to reduce Used to reduce anxiety and painanxiety and pain

www.herbex.com/

http://www.virilityhealth.com

VENDORS AND RETAILERSVENDORS AND RETAILERSAdvertisingAdvertising

Stress Relief with KavaStress Relief with Kava"There are many situations likely to "There are many situations likely to make us stressed out and anxious. The make us stressed out and anxious. The use of kava could potentially reduce the use of kava could potentially reduce the anxiety associated with these stressful anxiety associated with these stressful events, thus minimizing worry and events, thus minimizing worry and unpleasantness...we are exposed to an unpleasantness...we are exposed to an enormous amount of psychological enormous amount of psychological stress: We drive to work in the morning stress: We drive to work in the morning in horn-honking heavy traffic. Our work in horn-honking heavy traffic. Our work involves difficult bosses, deadlines, involves difficult bosses, deadlines, phone calls to return, and projects to phone calls to return, and projects to complete. We have the traffic again on complete. We have the traffic again on the way back home, dinner to prepare, the way back home, dinner to prepare, active children to keep under control, active children to keep under control, feed, an nurture, bills to pay, and a feed, an nurture, bills to pay, and a home and garden to maintain...Kava, if home and garden to maintain...Kava, if used appropriately, could help us used appropriately, could help us reduce the stress in our lives, and it can reduce the stress in our lives, and it can even be used to prevent or decrease even be used to prevent or decrease the amount of stress or anxiety we the amount of stress or anxiety we anticipate being exposed to." (quoted anticipate being exposed to." (quoted from Kava: the Miracle Antianxiety from Kava: the Miracle Antianxiety Herb, Dr. Ray Sahelian, 1998, pgs. 58-Herb, Dr. Ray Sahelian, 1998, pgs. 58-60)60)

From: From: www.kickbackwithkava.com

THE GOVERNMENT:THE GOVERNMENT:FDA warningFDA warning KAVA-CONTAINING DIETARY SUPPLEMENTS MAY BE ASSOCIATED WITH KAVA-CONTAINING DIETARY SUPPLEMENTS MAY BE ASSOCIATED WITH

SEVERE LIVER INJURYSEVERE LIVER INJURY• The Food and Drug Administration (FDA) is advising consumers of the potential 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 risk of severe liver injury associated with the use of kava-containing dietary supplements. Kava (supplements. Kava (Piper methysticumPiper methysticum) is a plant indigenous to the islands in ) is a plant indigenous to the islands in the South Pacific where it is commonly used to prepare a traditional beverage. the South Pacific where it is commonly used to prepare a traditional beverage. Supplements containing the herbal ingredient kava are promoted for relaxation Supplements containing the herbal ingredient kava are promoted for relaxation (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal symptoms and other uses. FDA has not made a determination about the ability symptoms and other uses. FDA has not made a determination about the ability of kava dietary supplements to provide such benefits. of kava dietary supplements to provide such benefits.

• Kava-containing products have been associated with liver-related injuries – Kava-containing products have been associated with liver-related injuries – including hepatitis, cirrhosis, and liver failure -- in over 25 reports of adverse 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., 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 FDA has received a report of a previously healthy young female who required liver transplantation, as well as several reports of liver-related injuries. liver transplantation, as well as several reports of liver-related injuries.

• Given these reports, persons who have liver disease or liver problems, or 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 persons who are taking drug products that can affect the liver, should consult a physician before using kava-containing supplements. physician before using kava-containing supplements.

March 25, 2002March 25, 2002

NEWSPAPER ARTICLENEWSPAPER ARTICLELENGTH:LENGTH: 550 words 550 words

HEADLINE:HEADLINE: Popular herb Popular herb kavakava may pose liver risk, FDA says may pose liver risk, FDA says

BYLINE:BYLINE: The Associated Press and Los Angeles Times The Associated Press and Los Angeles Times

DATELINE:DATELINE: Washington, DC Washington, DC

BODY:BODY:WASHINGTON The popular herbal supplement WASHINGTON The popular herbal supplement kavakava carries a "potential risk" of severe liver damage, the carries a "potential risk" of severe liver damage, the Food and Drug Administration warned yesterday.Food and Drug Administration warned yesterday.

The advisory urged The advisory urged kavakava consumers and their doctors to be on the lookout for signs of liver injury. It came 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 three months after the FDA asked doctors to review their cases for links between kavakava and liver problems. and liver problems.

KavaKava ranks ninth in herbal supplements sold in the nation. 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 "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.needed to be aware of it," said Dr. Christine Taylor, the FDA's supplement chief.

The agency has not yet determined whether The agency has not yet determined whether kava,kava, or its use with some other supplement or medication, 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 actually causes liver damage. It began investigating after a healthy 45-year-old woman who began using the herb suddenly required a liver transplant.the herb suddenly required a liver transplant.

European health officials report 25 similar cases of liver toxicity, including four transplants.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 As a result, sales were halted in Switzerland and France and suspended in Britain; Germany is acting to make make kavakava a prescription drug; and Canada has urged consumers not to take a prescription drug; and Canada has urged consumers not to take kavakava until the safety until the safety question is settled. question is settled.

Peer reviewed sources of Peer reviewed sources of informationinformation

• Peer reviewed journalsPeer reviewed journals

• Include both original research and reviewsInclude both original research and reviews

• Characteristics of peer reviewed articlesCharacteristics of peer reviewed articles– AbstractAbstract– Materials and methodsMaterials and methods– ResultsResults– Discussion/ConclusionDiscussion/Conclusion

For example see: For example see: http://www.jfponline.com/content/2002/01/jfp_0102_00038.asphttp://www.jfponline.com/content/2002/01/jfp_0102_00038.asp

PEER REVIEWED SOURCE-PEER REVIEWED SOURCE-Abstract onlyAbstract only                                   [Fulminant liver failure after administration of the herbal antidepressant Kava-Kava][Fulminant liver failure after administration of the herbal antidepressant Kava-Kava]

[Article in German][Article in German]

Kraft M, Spahn TW, Menzel J, Senninger N, Dietl KH, Herbst H, Domschke W, Lerch MM.Kraft M, Spahn TW, Menzel J, Senninger N, Dietl KH, Herbst H, Domschke W, Lerch MM.

Medizinische Klinik und Poliklinik B, Universitat Munster, Germany.Medizinische Klinik und Poliklinik B, Universitat Munster, Germany.

HISTORY AND CLINICAL FINDINGS: A 60 year-old woman was admitted to hospital because of jaundice, 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 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: 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 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 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. 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 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 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 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 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 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 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 causes and the histological diagnosis made Kava-Kava as the cause of acute liver failure most likely. This is the 18th case of Kava-Kava induced liver failure reported to the European regulatory authorities.18th case of Kava-Kava induced liver failure reported to the European regulatory authorities.

Dtsch Med Wochenschr. 2001 Sep 7;126(36):970-2Dtsch Med Wochenschr. 2001 Sep 7;126(36):970-2

Your study-Your study-

Design a study to examine whether Design a study to examine whether magnets reduce the pain associated magnets reduce the pain associated with carpal tunnel syndromewith carpal tunnel syndrome

A good study--A good study--See page 606 of your textSee page 606 of your text

1. Peer reviewed1. Peer reviewed2. Clinical-2. Clinical-

• Controls Controls (eg. untreated, usually with (eg. untreated, usually with placebo)placebo)

• Randomized Randomized • Double blind Double blind

--subjects don’t know --subjects don’t know treatment treatment groupsgroups

--investigators don’t know --investigators don’t know

treatment groupstreatment groups3. Size3. Size4. Results4. Results

A peer review studyA peer review studyThe Journal of Family Practice • JANUARY 2002 • Vol. 51, No. 1The Journal of Family Practice • JANUARY 2002 • Vol. 51, No. 1

The Effectiveness of Magnet Therapy for Treatment of Wrist Pain Attributed to Carpal The Effectiveness of Magnet Therapy for Treatment of Wrist Pain Attributed to Carpal Tunnel SyndromeTunnel Syndrome

Richard Carter; Thomas Hall; Cheryl B. Aspy, PhD; and James Mold, MD, MPH Oklahoma Richard Carter; Thomas Hall; Cheryl B. Aspy, PhD; and James Mold, MD, MPH Oklahoma City, Oklahoma City, Oklahoma

We conducted a double-blind placebo-controlled randomized clinical trial in which 30 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 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 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 for a period of 45 minutes. Pain was measured on a visual analogue scale using 0 and 10 as anchors.10 as anchors.

Presenting symptoms including numbness, tingling, burning, and pain did not differ Presenting symptoms including numbness, tingling, burning, and pain did not differ significantly between the 2 groups. There was significant pain reduction across the 45-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 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 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 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. carpal tunnel syndrome was no more effective than use of the placebo device.

• • KEY WORDS Carpal tunnel syndrome; magnet/therapeutic use [non-MESH]; KEY WORDS Carpal tunnel syndrome; magnet/therapeutic use [non-MESH]; pain/therapy [non-MESH]; alternative medicine. (J Fam Pract 2002; 51:38-40) pain/therapy [non-MESH]; alternative medicine. (J Fam Pract 2002; 51:38-40)

IntroductionIntroduction

Four recent randomized trials have provided conflicting results Four recent randomized trials have provided conflicting results concerning the efficacy of magnets in relieving pain. Two double-concerning the efficacy of magnets in relieving pain. Two double-blind randomized trials have found that magnets relieve pain in blind randomized trials have found that magnets relieve pain in postpolio subjects1 and in patients with postoperative wounds.2 postpolio subjects1 and in patients with postoperative wounds.2 However, double-blind randomized studies of magnet therapy for However, double-blind randomized studies of magnet therapy for treatment of low back pain3 and foot pain4 showed no benefit. treatment of low back pain3 and foot pain4 showed no benefit.

In an attempt to find alternate forms of therapy,5,6 many chronic In an attempt to find alternate forms of therapy,5,6 many chronic sufferers of carpal tunnel syndrome have resorted to using magnets sufferers of carpal tunnel syndrome have resorted to using magnets to alleviate their symptoms. The purpose of our study was to to alleviate their symptoms. The purpose of our study was to determine the efficacy of magnet therapy on pain attributed to carpal determine the efficacy of magnet therapy on pain attributed to carpal tunnel syndrome when compared with a placebo device.tunnel syndrome when compared with a placebo device.

MethodsMethods

SubjectsSubjects

We contacted 160 patients who had wrist pain attributed to carpal We contacted 160 patients who had wrist pain attributed to carpal tunnel syndrome by their primary care physicians. These patients tunnel syndrome by their primary care physicians. These patients were identified from the billing databases at a university-operated were identified from the billing databases at a university-operated family practice clinic and a rural private practitioner's office. The family practice clinic and a rural private practitioner's office. The inclusion criteria for participation were presence of chronic wrist pain inclusion criteria for participation were presence of chronic wrist pain in the area of the carpal tunnel and the willingness to accept in the area of the carpal tunnel and the willingness to accept randomization into treatment or control group. Individuals were randomization into treatment or control group. Individuals were excluded before randomization if the source of pain had been excluded before randomization if the source of pain had been attributed to some cause other than carpal tunnel syndrome, if they attributed to some cause other than carpal tunnel syndrome, if they had taken pain medication within 4 hours of beginning treatment, if had taken pain medication within 4 hours of beginning treatment, if their body mass index was greater than 35, or if they were not their body mass index was greater than 35, or if they were not experiencing pain at the time treatment was started. experiencing pain at the time treatment was started.

RESULTSRESULTS

Of the 160 patients contacted by mail, 45 Of the 160 patients contacted by mail, 45 replied, 38 qualified for participation, and replied, 38 qualified for participation, and 30 patients completed the 45-minute 30 patients completed the 45-minute treatment protocol: 15 with a magnetic treatment protocol: 15 with a magnetic device and 15 with a placebo. Descriptive device and 15 with a placebo. Descriptive statistics for the 2 groups are provided in statistics for the 2 groups are provided in Table 1. Groups did not differ significantly Table 1. Groups did not differ significantly in age or any of the presenting symptoms in age or any of the presenting symptoms including numbness, tingling, burning, and including numbness, tingling, burning, and pain. There were no men in the magnet pain. There were no men in the magnet group and 4 in the placebo group ( P group and 4 in the placebo group ( P =.01).=.01).

DISCUSSIONDISCUSSION

The delivery of a unipolar static magnetic field through a magnetized The delivery of a unipolar static magnetic field through a magnetized device directly applied to the point of greatest wrist pain resulted device directly applied to the point of greatest wrist pain resulted in no significant difference in relief of pain when compared with an in no significant difference in relief of pain when compared with an identical placebo device. However, both magnet and placebo identical placebo device. However, both magnet and placebo produced a significant decrease in pain during the 45-minute produced a significant decrease in pain during the 45-minute application that was still detectable at the 2-week follow-up. The application that was still detectable at the 2-week follow-up. The decrease in pain observed in both experimental and control decrease in pain observed in both experimental and control groups could be attributed to a variety of causes. Most likely, this 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 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 device. Also, it is possible that pressure over the area of pain, due to application of the bracelet, somehow reduces the amount of to application of the bracelet, somehow reduces the amount of pain experienced. pain experienced.

A limitation of this study is the small sample size. It is possible that a 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 larger study would detect small improvements in outcomes, but it is questionable whether these would be clinically significant.is questionable whether these would be clinically significant.

CONCLUSIONCONCLUSION

Collacott and colleagues3 found that magnets were not Collacott and colleagues3 found that magnets were not effective in treating low back pain. Although they proposed effective in treating low back pain. Although they proposed that the depth of the pain source might have played a role that the depth of the pain source might have played a role in the outcome of their research project, such an issue in the outcome of their research project, such an issue would not be a significant factor in our study because of the would not be a significant factor in our study because of the relatively short distance from the surface of the wrist to the relatively short distance from the surface of the wrist to the median nerve. Future research might include a measure of median nerve. Future research might include a measure of belief in magnets as healing devices to determine the belief in magnets as healing devices to determine the impact of the placebo device. The addition of another arm impact of the placebo device. The addition of another arm of the study to include magnet placement adjacent to, but of the study to include magnet placement adjacent to, but not touching, the point of pain to determine the pressure not touching, the point of pain to determine the pressure effect might be interesting. Although this study did not effect might be interesting. Although this study did not show magnets to be more effective than the placebo, the show magnets to be more effective than the placebo, the reduction in pain with this simple intervention was reduction in pain with this simple intervention was remarkable. 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

1.1. Good sources of informationGood sources of information

2. Evaluating the internet2. Evaluating the internet

Sources of health information-Sources of health information-ALL CAN BE FOUND ON THE ALL CAN BE FOUND ON THE INTERNETINTERNET

• Vendors and advertisementsVendors and advertisements

• Magazines and newspapers (ads and articles)Magazines and newspapers (ads and articles)

• Broadcast media (ads and stories)Broadcast media (ads and stories)

• Billboards and subway postersBillboards and subway posters

• Friends and familyFriends and family

• Health care providers and educatorsHealth care providers and educators

• Government sources eg. FDAGovernment sources eg. FDA

• Public service and advocacy organizations eg. Public service and advocacy organizations eg. ALAALA

• Peer reviewed journalsPeer reviewed journals

Evaluating internet informationEvaluating internet informationhttp://www.library.jhu.edu/elp/useit/evaluatehttp://www.library.jhu.edu/elp/useit/evaluate//

1)1) Authorship-who wrote this?Authorship-who wrote this?

2)2) Publishing body-who’s website is this?Publishing body-who’s website is this?

3)3) Point of view-why does this website exist?Point of view-why does this website exist?4)4) Referral to other sources-specific Referral to other sources-specific

references references (links don’t count!!)(links don’t count!!)

5)5) Verifiability-Is the information accurate?Verifiability-Is the information accurate?

6)6) Currency-How old it the website?Currency-How old it the website?

Evaluating internet informationEvaluating internet informationhttp://www.library.jhu.edu/elp/useit/evaluatehttp://www.library.jhu.edu/elp/useit/evaluate//

1)1) Authorship-who wrote this?Authorship-who wrote this?2)2) Publishing body-who’s website is this?Publishing body-who’s website is this?a.a. Organization or person sponsoringOrganization or person sponsoring

a.a. url may provide cluesurl may provide clues• http://www.prairienet.org/~kagan/intro.htmhttp://www.prairienet.org/~kagan/intro.htm = =

personalpersonal• http://vm.cfsan.fda.gov/~dms/addskava.htmlhttp://vm.cfsan.fda.gov/~dms/addskava.html = FDA = FDA• http://nccam.nih.gov/health/alerts/kava/http://nccam.nih.gov/health/alerts/kava/ = NIH = NIH• http://www.biopsychiatry.com/kava/http://www.biopsychiatry.com/kava/ = commercial = commercial