HEALTHNET NEWS VOL. XV, NO. 2 SUMMER 1999
Lyman Maynard Stowe Library
University of Connecticut Health Center

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TABLE OF CONTENTS

UPDATE
- Healthnet Internet resources list updated
PROFESSIONAL READING
- Trash or treasure - medical information on the Internet
ORGANIZATIONS
- Let's Face It - for people with facial differences
NETNEWS
- Y2K and health care
- Cut and paste -- the medical way
- New edition of Merck manual available online
- Important information for and about men
- Resources on prevention and treatment of skin disorders
FOR YOUR CONSIDERATION
-Recently published books:
   *Harvard Medical  School Family Health Guide
UCHC RECENT ACQUISITIONS
   * Lyme disease - Daniel W. Rahn and Janine Evans.
   * Physician's Desk Reference for nonprescription drugs and dietary supplements
 



UPDATE

HEALTHNET  INTERNET  RESOURCES LIST  UPDATED

We recently updated the  list of recommended Internet resources on our web site.  The category "Government Resources" was eliminated and each site previously listed here has been placed in a more specific category -  i.e. Healthfinder is now listed under "Diseases and Medical Conditions - General" as is MEDLINEplus since the primary focus of these sites is to offer information on diseases and medical conditions and their treatments.  A new section "Traveler's Health" has been added with links to sites for information about recommended immunizations for travel to different countries and warnings and precautions for overseas travel.

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PROFESSIONAL  READING
TRASH OR  TREASURE - MEDICAL INFORMATION ON THE INTERNET

Two recent articles in the New York Times by health columnist Jane Brody describe the potential and pitfalls of searching for medical information on the Internet.  In the lead article in the Science section for Tuesday, August 31, Ms. Brody reports on a research study conducted at the University of Michigan which attempted to analyze the accuracy of information on Ewing's sarcoma, an uncommon bone cancer that affects children and young adults.  The researchers found  "shocking" errors in the information posted on the Internet, with about a third of the information lacking any reference to peer-reviewed information.  Peer review is the process by which medical and scientific research is evaluated for accuracy and reliability by an independent body of experts in the field.   Virtually all medical journal articles are subjected to a rigorous peer review process before publication.  Six percent of the Web pages looked at in this study and which were not peer reviewed contained clearly erroneous information.

As an example of the misinformation found, some sites stated that Ewing sarcoma has a mortality rate of 95 per cent.  Dr. J. Sybil Biermann, the lead author of the study, said in an interview that, in fact, Ewing sarcoma is among the most curable of cancers and has a survival rate of 70 to 75 percent.  She further commented that the danger of such inaccurate information may cause parents of a child with the disease unnecessary anxiety and may be lead them to consider refusing therapy with such a dismal prognosis.

Ms. Brody also describes another study conducted by pediatric specialists at the Ohio State University College of Medicine and Public Health.  In this study, published in the June 1998 issue of Pediatrics,  researchers examined 60 web sites established by major medical institutions for information on treating childhood diarrhea.  They found that only 20 percent gave current and accurate information on treating this condition.  The remaining sites had inaccurate information that conflicted with the authoritative guidelines developed by  the American Academy of Pediatrics.

In an accompanying article, Ms. Brody describes the concerns doctors have about the biased, inaccurate, misleading, and  often potentially dangerous medical information posted on the Internet.  Of particular concern are the widely promulgated reports on  unproven , so called "nontoxic",  treatments for serious medical conditions.   At the same time, Ms. Brody points out, individuals have found invaluable sources of information and guidance for their health problems from chat rooms and discussion lists where others who have the same medical condition share their tips on treatments.  She concludes the article with practical tips on how to evaluate medical and health information on the Internet.

Biermann JS, et. al.  Evaluation of cancer information on the Internet.  Cancer 1999 August 1;86(3):381-90.

Brody JE.  The health hazards of point-and-click medicine.  New York Times 1999 August 31: F1 (col. 3).

Brody JE.  On-line health care for the savy surfer.  New York Times 1999 August 31: F6 (col. 1).

McClung HJ, Murray RD, Heitlinger LA.  The Internet as a source for current patient informtion.  Pediatrics 1998 June;101(6):E2.

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;           ORGANIZATIONS

Let's Face It  is a  nonprofit network for people with facial difference, their families, friends and  professionals. Their motto is "To support someone with a facial difference, look them in the eye and smile." Let's Face It offers information and support to adults and children who have scars from facial burns or have genetic disorders which result in any type of facial  difference such as cleft palate or facial feature asymmetry.  Other types of facial differences may include vascular birthmarks or hemangiomas and diseases such as scleroderma, skin cancer or neurofibromatosis which can result in changes in facial structure.

The organization maintains a web site at www.faceit.org/letsfaceit/index.html which has information about organizations concerned with aspects of facial differences, a list of resources for  children and families, and a reading list of books and journal articles about issues related to living with a facial difference.  Educational tools listed include resources to teach tolerance and to combat teasing.  Their resource directory is also available in print.  For a free copy, send a 9" x 12" self-addressed envelope with $3.20 postage and a note requesting the publication to:  Let's Face It, P.O. Box 29972, Bellingham, WA  98228-1972.

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NETNEWS

Y2K AND HEALTH CARE

"The Health Care & Y2K Personal Planning Guide" offers important information for consumers concerned about how the Y2K "problem" will affect their health care. The guide is endorsed by the President's Council of Year 2000 Conversion.

The planning guide provides a brief overview of specific concerns and offers suggestions on what users can do to alleviate any impact on their health care. Common concerns addressed include whether 911 emergency services will be affected and whether Medicare payments for medical bills will be paid.  Sections of the guide discuss  issues related to medical devices and equipment, medical records, medications and supplies,  emergency and hospital services, and insurance.

Many of the recommendations given are common sense precautions.  They include steps a person can take to learn if adequate health care will be available during a disruption from any source, such as snowstorms, hurricanes, and power outrages.  A basic healthcare checklist is provided with specific tasks individuals should complete to prepare for any service disruption.  Simple things such as keeping up to date on prescription medication refills and creating a personal health history for each family member can go a long way in lessening the impact of any potential Y2K problems. Concerned individuals can enjoy greater peace of mind with just a little planning.

The guide also includes a  personal medical history form and a list of resources for further information.  The guide may be viewed online or downloaded in .pdf format, which requires Adobe Acrobat software.  Print copies of the guide are also available and may be ordered online.

CUT  AND  PASTE - THE MEDICAL WAY

YourSurgery.com  has multimedia tours of some common medical procedures written specifically to educate patients. The site was developed and is maintained by the Animation Education Group (AEG), a private company with over 50 years of experience in medically oriented computer graphics.  AEG does not provide details as to the sources of their information.

The procedures are organized according to their location on the body - head, back, abdomen, etc.  Surgeries included are craniotomy, cataract removal, gall bladder removal, carpal tunnel release, hernia repair, mastectomy, and twelve other procedures.   Plans are to add more procedures on a regular basis.  Each procedure describes the anatomy involved, causes of the medical condition necessitating the procedure, how the condition is diagnosed, non-operative treatments available, and a detailed summary of what is done during the procedure.  Animated illustrations are given for each of the procedures.  Possible complications and aftercare instructions are also given.

NEW EDITION OF MERCK MANUAL NOW AVAILABLE ONLINE

The seventeen edition of the Merck Manual of Diagnosis and Therapy is now available free of charge from the Merck and Company web site at www.merck.com/pubs/mmanual.  Users will find over 300 chapters on medical diseases and disorders and their treatment in 23 specialty areas including nutritional disorders, cardiovascular diseases, infectious diseases, gynecology and obstetrics, clinical pharmacology, and poisoning.  Entries for each disease or disorder provides information on symptoms and diagnosis, causes and risk factors, prevention, and treatment.

The contents are searchable by keyword. Hyperlinks are used throughout to related chapters, topics, diagrams, and tables.

IMPORTANT INFORMATION  FOR  AND  ABOUT MEN

Healthfinder, the consumer health site developed by the U.S. Department of Health and Human Services,  has added a new feature to address the health concerns of men. The link to this information may be found in the "Just For You" section on Healthfinder's homepage. This new resource brings under one umbrella  the vast health information resources of the federal government and its many partners, including private health agencies and organizations.

News releases announcing this new feature points out that many men are not educated about the value of prevention for prolonging their life span and maintaining their role in the family. The release  also notes that men's health is a family issue because of its impact on wives, mothers, daughters, and sisters.  The site is also a resource for women since they are often the main influences on health and medical care in families and are in a unique situation to influence the health of the men in their lives

The men's resource section includes full-text information on important topics such as prostate health, baldness, Viagra,  heart disease, sexually transmitted diseases, divorce, and child support.  Links are provided to other related information from national and state governmental agencies and organizations where the user can find additional full-text information.  Information from federal government agencies is highlighted with a graphic of the U.S. flag.

Another men's health site recently debuted at the National Women's Health Information Center (NWHIC) web site.  "What About Men's Health" is specifically geared to help women learn more about the leading health concerns of the men in their lives.   Women are the major healthcare givers and providers in families and consult a doctor 150% more frequently than men.

Topics covered include exercise, nutrition, stress,  heart disease and stroke, violence prevention, HIV and AIDS, prostate health, and smoking. Sections for older men, college age men, and minority men focus on unique issues related to these special groups. Much of the information is duplicated on the Healthfinder web site mentioned above.

RESOURCES  ON  PREVENTION  AND  TREATMENT  OF  SKIN DISORDERS

American Academy of Dermatology  is the professional association for physicians who specialize in the diagnosis and treatment of skin diseases.  Their web site offers on-line versions of their patient education pamphlets on common skin conditions such as rosacea, herpes simplex, hair loss, vitiligo, and hives. A few publications are available in Spanish.  Free print copies of their pamphlets may be obtained by sending a stamped self-addressed envelope to: American Academy of Dermatology, PO Box 681069,  Schaumburg, IL  60168-1069 or call 888-462-DERM.

The patient information section of the AAD web site also includes a directory of members to help in locating a dermatologist in the users geographical area.  Most of the entries provide only an address and telephone number. Complete profiles with education, training, fellowships, residencies, and specialties are given for a limited number of members.

Links to other dermatology and skin disease web sites are also included on the AAD site.  The link to “Dermatology in the cinema”  is a feature you shouldn’t miss.  A dematologist has put together a listing of old and new movies that feature characters who have different skin diseases or conditions.  Some examples are the movie “Elephant man”, Mel Gibson in “The Man Without a Face”, and Tom Hanks as the AIDS patient in “Philadelphia”.  He also has included information about actors who have skin consitions.

An additional feature on the AAD web site is a link to AcneNet, a comprehensive information resource on acne developed by Roche Lagoratories and the AAD.  AcneNet may be accessed directly at www.Derm-infonet.com/acnenet/.

Mayo Clinic Health@Oasis  has fact sheets on many different skin conditions (select "Library", then select "Skin").  Included here is information on the new anti-wrinkle creams, benign skin markings, prevention of cold sores, UV skin protection, the risks of getting tattoos, and many other common skin related topics.

The National Psoriasis Foundation (NPF)  offers information for people who have psoriasis and psoriatic arthritis, their family members, friends, and health professionals.  NPF's mission is to improve the quality of life for people who have psoriasis and psoriatic arthritis, to educate the public about psoriasis and to support psoriasis research.  Select "NPF Site Index" (upper left corner) for a list of topics  dealing with psoriasis, treatments available, and current research.  Links to other psoriasis web sites and general dermatology sites are also featured.  Other information includes benefits of membership and services available, online ordering of a free information packet, and current news about psoriasis.

DermWeb is the homepage for the Division of Dermatology at the University of British Columbia.  Much of the site is geared towards professionals, but two features may be of interest to consumers.

The Skin Therapy Letter on this site is an online publication written for professionals but with many articles accessible to the educated consumer.  Although print subscriptions are available for a fee, many of the clinically relevant articles are published full-text online.  Current full-text articles include the treatment options for oral lichen planus (Vol. 3, #6, July 1998), use of thalidomide for the treatment of cutaneous manifestations of erythema nodosum leprosum (ENL) (Vol. 3,  #3, Dec. 1997), and  current review of alpha-hydroxy acids (Vol. 3, #5, May 1998).  The entire issue of Volume 4, #5 1999 is available online, but it is not clear if this will be continued for future issues.

Another feature of DermWeb is DermLinks, a list of links to other web based resources on dermatology and skin diseases.  The section labeled "Disorders" contains many links to patient oriented information from other academic dermatology sites and from organizations concerned with skin diseases and disorders.

Other useful sites on skin diseases and disorders include:

            New York Online Access to Health (NOAH)
                      Consumer oriented links to information on skin diseases and conditions.
            Virtual Hospital - Iowa Health Book:Skin
                      Peer-reviewed information on skin diseases and conditions - tattoing and body piercing,
                       indoor tanning, scabies,  exzema, etc.
            American Society for Dermatological Surgery
                      Chemical peeling, dermabrasion, lasers in dermatology, liposuction, before and after photos.

For information on skin cancer –
             Oncolink – University of Pennsylvania
             American Cancer Society
             MEDLINEplus – Skin Cancer

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FOR YOUR CONSIDERATION

The following consumer health book may be of interest to public and health sciences libraries. It is not part of the UCHC library collection.

Harvard Medical School family health guide.  Anthony L. Komaroff, ed.  Harvard Medical School.  Simon & Schuster, 1999.  1288 p.  (ISBN 0-68484-703-5), $40.00.

Edited by 167 faculty members of the Harvard Medical School, this compendium of medical information is dsigned to answer questions “…to keep our family healthy and help you cope with illness.”  It includes easy-to-understand information about the diagnosis, treatment, and prevention of diseases affecting children and adults.  The comprehensive information aims to help the reader decide when to seek medical care and what questions to ask his or her doctor.  Introductory chapters offer advice on navigating the health care system.  Other topics include health and wellness issues such as diet and nutrition, stress, safety, and immunizations.  A section on basic anatomy describes the structure and function of the different body systems and organs.  Flow charts of symptoms of common diseases and conditions guide the reader through simple “yes” and “no” questions and the answers provide advice on steps to take regarding the possible diagnosis, possible self-treatment remedies, and whether a doctor should be consulted.

A section on diseases and disorder, arranged by body system, offers information on the diagnosis and treatment of common medical conditions.  In some instances, alternative treatment options are also included.  Other features include special sections on women’s health, men’s health, health of seniors and health of children and adolescents.  A separate chapter of medications offers information on the safe use of drugs, advice on managing your medicines, potential drug-herb interactions, and a drug index with profiles of ober 200 commonly prescribed drugs.  A glossary of medical terminology, a directory of information resources, and examples of medical forms are included in the appendices.

This new guide is comparable to the Mayo Clinic Family Health Book and the Johns Hopkins Family Health Book.  One feature that sets this new guide apart from similar guides is that information updates are available on the Harvard Medical School Family Health Guide web site at www.health.harvard.edu/fhg/. This interactive site includes many of the guide’s special features plus updates on new research, treatment options, and medical and health news.  Highly recommended for public library reference collections.

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UCHC RECENT ACQUISITIONS

The following titles were recently added to the UCHC Library and may be of interest to public and health sciences librarians.

Lyme disease. Daniel W. Rahn and Janine Evans.  American College of Physicians, 1998.  254 p.  (ISBN 0-943126-58-4).  (UCHC Library Call #: WC/406/L986a/1998)

This book was written for primary care physicians, but may be a useful resource for the educated consumer.  Topcis covered include the natural history of Lyme disease, management of tick bites, Lyme carditis, neurologic manifestations, musculoskeletal features, and Lyme disease in children.  Also covered are disease management guidelines and long-term consequences.  Written before the new Lyme vaccine became available, a section on current research describes progress to date and the problems associated with developing an effective vaccine.

Each chapter is accompanied by brief case studies.  An entire section of “Clinical Vignettes” tests the reader’s knowledge and shows how experts in the field approach common clinical problems.  Black and white photos and color plates illustrate the physical symptoms and manifestations of the disease.

Physician's Desk Reference for nonprescription drugs and dietary supplements.  Medical Economics Co., 1999.  888 p. (ISBN 56363-298-5).

This familiar over-the-counter drug reference recently inaugurated a new dietary supplement section devoted entirely to the nutritional and natural products marketed under the Dietary Supplement Health and Education Act of 1994.  Products in this section "...include vitamins, minerals, herbs and other botanicals, amino acids, other substances intended to supplement the diet, and concentrates, metabolites, constituents, extracts, and combinations of these ingredients."

The supplement profiles are arranged by manufacturer and include such widely publicized products such as Quanterra, a ginkgo biloba herbal supplement purported to promote mental sharpness and concentration,  Kyolic, a garlic extract supplement used to promote healthy  circulation, and osteobiflex, a glucosomine and  chondroitin sulfate combination used to maintain healthy, mobile joint function and connective tissues.  Other familiar products listed include the multivitamin Centrum Silver,  Os-Cal chewable calcium supplements, Beano, and Lactaid.

The descriptions include information on the active and inactive ingredients, actions, warnings, cautions, interactions, symptoms and treatment of oral overdosage, dosage and directions for use, and how supplied.  The descriptions in this section are in compliance with the Dietary Supplement Health and Education Act.  The Act permits claims regarding a product's effect on the structure or functioning of the body, but forbids claims regarding a product's ability to treat, diagnose, cure, or prevent a specific disease or medical condition.  The Act also created the Office of Dietary Supplements (ODS) , which is part of the National Institute's of Health.  For information about the Act and the ODS, visit their web site at odp.od.nih.gov/ods/default.html.  Additional information about the Act may be found at  vm.cfsan.fda.gov/~dms/dietsupp.html, the web site for the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition.

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Healthnet News is written by Alberta L. Richetelle with the assistance of Judith Kronick. If you have questions about anything in the newsletter or about Healthnet services for Connecticut public libraries, please call 860/679-4055; e-mail address: richetelle@nso.uchc.edu.

© 1999 University of Connecticut Health Center. All rights reserved.