How to assess credibility of health care information on the internet

                Following up from last week, I wanted to go more in depth on the importance of getting health information from credible sources. According to a recent study, 80% of people reporting to b internet users used the internet to research a disease or treatment. 82% of Pharmacists surveyed were asked a question by a patient about information they obtained on the internet. This shows how important the internet is to people when it comes to finding information about their health care.

                In the usual course, a patient is given a medication or treatment, diagnosed with a disease, or recommended something by their doctor. The patient types this subject into a google search, and clicks on the first 1-5 links that come up. Undoubtedly, Wikipedia is one of those first five links. However, Wikipedia content has been found to be inaccurate and incomplete when compared to other more credible sources of information. What was even more alarming to me than patients looking up health information on Wikipedia was the amount of healthcare providers that have admittedly used Wikipedia as a source. Convenience and ease of use is important, but it doesn’t always reflect the content of the website.

                Grossman and Zerilli wrote an article on how to discern a credible source from a not credible source on the web. The first recommendation is to consider the website on which the article is found. What is the purpose of the site? Is the information objective? Who runs the site? If the site is run by a commercial company about a certain drug, this is different from a blog run by an individual or a government-funded health library. What is the url? Url’s that end in .edu, .org, or .gov are more likely to have quality information when compared to .com sites which can be geared toward promoting a certain product or treatment. Are there advertisements on the website? Can you easily differentiate the advertisement from the content of the article? This is important because advertisements are notorious for being misleading. Websites that are intended for advertisement or promotion of a certain product must be carefully scrutinized for credibility, as it is not infrequent for manufacturers or a certain product to inflate the greatness of their product.

                Next, evaluate the article details before reading the article. Is the author listed? If an author is listed, especially if correspondence is provided so that questions may be asked, the site is likely more credible than an article that was written anonymously. Are references noted? It is very important to decide where the information found in the article came from. If the author has listed several primary literature sources and trials, the information is likely to be complete. When was the article written? If it was written in 1985, it might be helpful to find more recent information, as health care is a field that is constantly evolving.

                To make things easier, there are two organizations that rate websites or articles based on their content so that users can be more assured that the content is credible. These ratings are not concrete, and the organizations do not guarantee credibility, but it is a helpful step. The Utilization Review Accreditation Commission and the Health on the Net Foundation are these two organizations. Internet users can be more at ease with the content of an article if the HONcode or URAC-accredited stamp is on the article or website.  Sample seals are included at the bottom of this post.

                It is important that if you as a patient are looking for credible information on the internet, speak with your doctor about websites or articles that he/she recommends. Most health care providers understand patients’ desire to learn more about their conditions, and they try to make information available that will be easy for the patient to understand. I mentioned in the last post that regarding fertility, the majority of patients are very highly educated on their condition and their treatment or therapy. As patients understand their treatment at a certain level, they need information that is more challenging and informing. It is important for doctors to be able to provide “the next level” of information for their patients. Fortunately, there are several credible health care sites that offer different levels of information on different disease states.

                Ask your doctor or pharmacist about credible health information websites, or come back for a future post on individual reviews of credible websites.

Alexis Ireland, PharmD Candidate 2014

References

Grossman S, Zerilli T. Health and medication information resources on the world wide web. Journal of Pharmacy Practice. 2013 April 01;26(2):85-94.

Credible Fertility Resources

                My main area of interest in pharmacy is regarding fertility treatments and high risk OB management. The original idea of this blog was to focus on evaluating the credibility of fertility resources online. Today, I am going to do a section on that. See the links at the end of this post to go to the websites.

                For background, it is important to know the patient population that is looking for fertility resources online. Patients are usually very well educated and determined. There is a low incidence of non-compliance to medication in this population because of the motivation to achieve the end goal. Patients have usually done extensive research and read several books before they even come to their doctor for advice. They have also heard all the old wives’ tales from family and friends on how to improve their chances of fertility.

                The internet is a common first start for information. However, not all information found on the internet is credible. There are lots of personal posts or popular websites that post information, but the site might not be as credible as other sources. It is important to scan a source for credibility before even reading the information they put out. This post will be evaluating the more credible sources for general fertility treatment information.

                To start, I just conducted a google search for “infertility.” The first resources that come up are Mayo Clinic and WebMD, which are reasonably credible sources of information. Late on the first page, I was very happy to see uihealthcare.org/infertility, which is The University of Iowa Hospitals and Clinics page describing their services, their success rates, and other information for couples looking into fertility treatment. UIHC has a great fertility clinic that provides IVF, ICSI, egg donation, and much more.

                ConceiveOnline was an interesting find. This is a page with articles regarding social topics of fertility, which seems to be relatively accurate. It is written on a very generic level to appeal to all audiences. The focus on social issues, such as time off work and handling a family’s reaction, are good topics for people approaching fertility treatment. However, upon further inspection, it is run by Bonnier Corporation, which runs magazines on special interests, most regarding outdoor activities and travel. They do have a parenting magazine, but their main focus is not on fertility. I might recommend this site for social issues, but I wouldn’t take anything for fact when it comes to discussing medications or treatments. The descriptions are oversimplified.

                The CDC’s website has a section on reproductive health with infertility FAQ’s. I love the CDC’s website for everything, and I appreciate that they have a section on reproductive health. This would definitely be a place I send my patients to find true, accurate, credible information to answer their questions.

                MedlinePlus is the last search result I will go over. MedlinePlus is similar to MayoClinic or WebMD, but the information is much more complete. Most patients undergoing fertility treatments are very educated about their condition and what lies in front of them. Mayo’s site and WebMD might be too concise for this population. MedlinePlus would be a good resource to find more information that is still written in a way they can read and understand.

Alexis Ireland, PharmD Candidate 2014

http://www.uihealthcare.org/Infertility/

http://www.conceiveonline.com/

http://www.cdc.gov/reproductivehealth/infertility/

http://www.nlm.nih.gov/medlineplus/infertility.html

Use of Donor Human Milk in Premature Infants

                My last blog post discussed why breastfeeding is so important to an infant and how medications can play a role in a woman’s choice to breastfeed. Today is going to discuss the use of donor human milk in premature infants and how medications play a role here.

                Premature infants are a unique patient population.  We know that breastfeeding has many benefits for all infants, premature infants seem to gain even more benefits from this form of nutrition. Preemies, especially very low birth weight infants, are at increased risk for complications such as necrotizing enterocolitis, feeding intolerance, sepsis, and developmental delays. The American Academy of Pediatrics states that “The potent benefits of human milk are such that all preterm infants should receive human milk.” (Landers)

                With this knowledge, one would think that breastfeeding rates are higher for this population, but this is not true. Hospitals have adapted policies that encourage breastfeeding to mothers of premature infants, but exclusive breastfeeding is still difficult. These mothers have just undergone serious physiological and physical challenges that they were not expecting. This level of emotion can negatively impact the initiation of breastfeeding following delivery. Near the end of pregnancy, mammary growth completes, mammary epithelium is prepared to respond to the infant, and colostrum is produced, preparing for a full milk supply. If a pregnancy is shortened, these things might not have occurred. Milk production can be decreased due to stress, fatigue, and anxiety that many mothers feel in this situation.

                With these factors, most NICU mothers of preterm infants were not able to provide all of the milk necessary to feed their baby an exclusively human milk diet. Formula was used at first, but efforts were in place to find another way to provide human milk.

                Milk banks began to appear at big medical centers. These milk banks screened potential donors for eligibility regarding their health and medication use. They completed a blood test, physical exam, and medical forms. While mother’s own milk still remains first choice for any infant, donor human milk offers a viable alternative if the mother is unable to provide adequate nutrition for her baby. (Landers)

                We know that milk from mothers of premature infants can be different than the milk that mothers of term babies produce, so donor human milk was tested against babies who received formula or exclusive mother’s milk. No significant different in clinical outcomes regarding growth, anti-infectious processes, feeding tolerance, neurodevelopment, or necrotizing enterocolitis were noted between the use of mother’s own milk and pasteurized donor milk, but there was still an advantage over formula. (Giuliani) The American Academy of Pediatrics recommends using donor human milk for preterm infants if mother’s own milk is insufficient despite lactation consultation. (AAP) Donor human milk has largely replaced formula for nutrition supplementation following mother’s own milk.

                In order for a potential donor to pass eligibility, she must not be taking certain medications. This is because babies in this population have immature systems because they did not have the full opportunity to finish growing inside the mother’s womb.  Drug clearance and metabolism rates might be different, which could cause a problem for an preterm infant exposed to this drug even if a term infant was not affected.  Medication use is not seen as an obstacle to breastfeeding most babies, but the different in anatomy and development might pose a problem.  Current milk bank guidelines in the United States are that the only acceptable medications are as follows: prenatal vitamins, human insulin, thyroid replacement hormones, nasal sprays, asthma inhalers, topical treatments, eye drops, and progestin-only birth control products. This limits the amount of eligible potential donors. (HMBANA)

In the last year, Human Milk Bank Association of North America has been studying this topic. They put together a team of medical professionals, including pharmacists and pharmacologists, to determine whether certain medications are proven scientifically safe for donor mothers to take while donating their milk. Although the guidelines have not been released yet, it is rumored that they will be much more inclusive, to allow for other common medications to be taken by the mother. However, each individual milk bank has the option of accepting items that are deemed “acceptable” by these guidelines. It will be interesting to see the new guidelines and to see how the milk banks react to these.

Look for a future blog post on this subject.

Alexis Ireland, PharmD Candidate 2014

References

“Breastfeeding and the Use of Human Milk.” Pediatrics 129 (2012): 826-42.

“Donate Milk.” HMBANA.

Landers, Susan MD and Hartmann, Ben PhD. “Donor Human Milk Banking and the Emergence of Milk Sharing.” Pediatr Clin N Am 60 (2013): 247-60.

Medication use during breastfeeding

It has long been accepted by pediatricians that mother’s own milk is the best form of nutrition for an infant. When comparing breast milk to formula, most studies show a significant benefit to breast feeding. The American Academy of Pediatrics recommends that mothers exclusively breastfeed their babies for about six months, then introduce food while continuing to breastfeed until twelve months, and that breastfeeding should be continued after that as long as both mother and baby are interested.

There have been many benefits to breastfeeding found in studies comparing it to formula feeding. Breast milk is packed with antibodies from the mother, which help protect the baby from infections, illnesses, and allergies. The incidence of SIDS is also lower, the rate of neurodevelopment is faster, and the prevalence of infection is lower in infants who are breastfed when compared to those who are formula fed. The American Academy of Pediatrics states that “choosing to breastfeed should be considered an investment in the short- and long-term health of the infant, rather than a lifestyle choice.”

There are many reasons why women think that they cannot breastfeed, but most of the reasons stated are not true contraindications to breastfeeding. Some mothers think that since they smoke they cannot breastfeed, but this is not exactly true. Although mothers should be encouraged to quit smoking while they are breastfeeding a child, the benefits of breast milk are still enough to outweigh the risks of the baby’s exposure to nicotine. Other mothers might think that since they are on a chronic medication, such as an antidepressant, that they cannot breastfeed, but this is also a false presumption.  In reality, women can breastfeed safely while using most medications, but not all. Most medications due pass into the breast milk, but it is in such small amounts that there is not likely a pharmacodynamics effect on the infant. The American Academy of Pediatrics states that contraindication to breastfeeding are rare. All clinicians counseling a patient on the use of medications during breastfeeding should consult the most up-to-date resources and use these in combination with clinical experience to decide whether a medication is safe during breastfeeding.

Alexis Ireland, PharmD Candidate 2014

References

"Breastfeeding and the Use of Human Milk." Pediatrics 129 (2012): 826-42.

Rowe, Hilary, BSc(Pharm), et. al. "Maternal Medication, Drug Use, and Breastfeeding." Pediatr Clin N Am 60 (2013): 275-94.