4 questions | Applied Sciences homework help

1. Clinical consultation over the Web by credentialed pro- viders should include procedures that protect the patient, including informed consent, information security and privacy protection measures, and documentation of the clinical encounter.

√ Consumer Tip Part One Dynamics of the Health Marketplace26 fallacious reporting wastes media resources that could be better used to provide useful information about health and disease issues. pruDent uSe oF tHe internet The amount of health-related information accessible through the Internet is huge and expanding rapidly. Any- one with access to a computer, a modem, and appropriate software can explore this wealth of information. Students can do so, free of charge, through computers at their school. Free access is also available at public libraries. Health information is available in several electronic formats. Online databases can be searched by key- word. MEDLINE, the National Library of Medicine’s database of references to the medical literature, can be accessed through various commercial and noncommer- cial channels. It is the world’s largest such database, with more than 18 million references published since 1966 and about 14,000 new ones added per week. Newsgroups, bulletin boards, and “blogs” enable people to hold discussions by posting and responding to messages. “Chat groups” permit discussions with all participants typing at once. Electronic mailing lists en- able designated groups to hold discussions by electronic mail. Many Web sites offer free podcasts and e-mail newsletters. Online sources provide peer communica- tion, anonymity, convenience, and rapid responses. The information is voluminous but not necessarily accurate. Virtually anyone can create an online resource and make it generally available. This includes not only health professionals but also ordinary people who believe they have been helped by a product, people with complaints, companies with a financial stake in the information they provide, and even outright charlatans. Locating Information The Internet has no central index, but the World Wide Web offers search engines that comb large portions of the Internet. The most efficient is Google (www.google. com), which can search billions of pages in about 1 second. Its advanced search page enables display of as many as 100 links at a time. The “Cached” links sometimes access pages archived on Google’s servers that are no longer on the Web. For most efficient use, it is advisable to save one’s preferences and add Google’s advanced search page to your personal toolbar. The Wayback Machine, located at www.archive.org, provides archived versions of many Web sites as they appeared as far back as 1996. MEDLINE can be searched efficiently with the Signs of a Misguided Web Site The best way to avoid being quacked is to reject quackery’s promoters. Each item listed below signi- fies that a Web site is not a trustworthy information source: General Characteristics • Any site used to market herbs or dietary supple- ments. Although some of these products are useful, it is impossible to sell them profitably without deception, which typically includes: (a) lack of full disclosure of relevant facts, (b) promotion or sale of products that lack a rational use, and/or (c) failure to state who should not use the products.

• Any site used to market or promote homeopathic products. No such products have been proven ef- fective.
• Any site that generally promotes “alternative” methods. There are more than 1000 “alternative” methods. The vast majority are worthless.
• Any site that promotes “nontoxic,” “natural,” or “holistic” treatments.

False Statements about Nutrition • Everyone should take vitamins. • Vitamins are effective against stress. • Taking vitamins makes people more energetic. • Organic foods are safer and/or more nutritious than ordinary foods. • Losing weight is easy. • Special diets can cure cancer. • Diet is the principal cause of hyperactivity. False Statements about “Alternative” Methods • Acupuncture is effective against a long list of diseases. • Chelation therapy is an effective substitute for bypass surgery. • Chiropractic treatment is effective against many diseases. • Herbs are generally superior to prescription drugs. • Homeopathic products are effective remedies. • Spines should be checked and adjusted regularly by a chiropractor. False Statements about Other Issues • Fluoridation is dangerous. • Standard vaccinations are dangerous. • Amalgam (“silver”) fillings should be removed because they make people sick. • All teeth that have had root-canal therapy should be removed because they make people sick. √ Consumer Tip Chapter Two Separating Fact from Fiction 27 National Center for Biology Information’s “Clinical Queries” page at www.ncbi.nlm.nih.gov:80/entrez/query/ static/clinical.html. It is generally much safer to use professionally recommended sites rather than searching blindly with a search engine. Slater and Zimmerman65 warn: Listings of search results provided by the most widely used Web portals often do not provide basic information a consumer would need to select an objective and reliable health informa- tion Web site. Search descriptions of health sites ideally should permit consumers before actually accessing a Web site, to determine more consistently and accurately the source of the information and whether the site is selling products or provid- ing information free of commercial intent. Commercial sites are of particular concern given evidence that the large majority of such sites promote unregulated supplements and unproven remedies and services and that pseudoscientific claims made by such promotional sites may be persuasive even to readers with college-level scientific training. Even MEDLINE searches have potentially serious shortcomings. Without expert guidance, it can be difficult or impossible to judge whether individual reports are significant and how to integrate them with other relevant information. Judging Credibility The following questions can help evaluate the credibility of an online information source: (a) Who maintains the information? (b) Is it linked with other reputable sources of medical information? (c) When was it last updated? and (d) Is it selling a product? Larkin and Douglas66 sug- gest that if you find something interesting, write it down (and the site’s location) and ask your doctor about it. Barrett67 recommends avoiding all sites that are market- ing dietary supplements, herbs, or homeopathic products. Unsolicited commercial e-mail messages (“spam”) for health-related products should also be ignored. Many efforts have been made to develop quality standards and rating systems.68 Two Canadian research- ers examined 47 systems used to rate Web sites providing health information on the Internet and found that 14 of these described their rating criteria, only 5 provided in- structions for their use, and none provided information on whether they had been validated. The researchers concluded: Many incompletely developed instruments to evaluate health information exist on the Internet. It is unclear, however, whether they should exist in the first place, whether they measure what they claim to measure, or whether they lead to more good than harm.69 Each of these sites contains extensive practical information. However, some articles about “complementary” and “alternative” methods on the sites marked with an asterisk (*) are not sufficiently critical. Academy of Nutrition and Dietetics www.eatright.org American Academy of Family Physicians www.aafp.org/family/patient.html American Academy of Pediatrics www.aap.org American Cancer Society www.cancer.org American Council on Science and Health www.acsh.org American Heart Association www.americanheart.org American Medical Association www.ama-assn.org Consumer Reports Health www.consumerreportshealth.org Federal Trade Commission www.ftc.gov Food and Drug Administration www.fda.gov Center for Food Safety & Applied Nutrition vm.cfsan.fda.gov Information for Consumers www.fda.gov/opacom/morecons.html Mayo Clinic Health Oasis* www.mayohealth.org Merck Manual Home Edition* www.merckhomeedition.com National Cancer Institute* www.nci.nih.gov National Institutes of Health* www.nih.gov Oncolink (cancer database) oncolink.upenn.edu Quackwatch www.quackwatch.org Science-Based Medicine http://www.sciencebasedmedicine.org U.S. Preventive Services Task Force www.ahrq.gov/clinic/uspstfix.htm Internet Health Pilot (www.ihealthpilot.org) provides a trustworthy guide to additional sites. recommenDeD web SiteS Table 2-3 Part One Dynamics of the Health Marketplace28 Most of these rating systems excessively weighted ap- pearance, ease of use, and other factors unrelated to information quality.70 Most guides to health-related Web sites judge good sites accurately but fail to appropriately criticize bad ones. The HONcode system encourages voluntary compli- ance with high standards, but it does not ensure that con- tent is accurate. (See Consumer Health Insight box.) Quackwatch’s screening list enables rapid identifi- cation of “quacky sites” to avoid. (See Consumer Tip box on page 27.) However, judging the accuracy of science-based sites requires expert knowledge. So even if a “perfect” yardstick were developed, no organization is likely to have sufficient resources to apply it to the huge number of sites available for laypersons. Table 2-3 lists the URLs of several reliable sources. Consumer Health Insight Significance of the HONcode Seal The Internet’s most widely recognized standard-setting organization for health information is the Geneva- based Health on the Net (HON) Foundation (www.hon.ch). Sites that follow its code of conduct are welcome to display the HONcode seal. The HONcode’s eight principles, listed below, evolved from discussions with Webmasters and medical professionals in several countries. These principles are sound, but compliance is voluntary and some sites displaying the seal contain unreliable information or link to other sites that contain unreliable information. To legitimately use the seal, a Web site must apply for registration. If accepted, it must subsequently comply with all the principles enumerated in the HONcode. When a noncompliant site is reported, HONcode officials ask that the seal be removed—and most sites comply. More than 5000 sites display the HONcode seal. To check whether a site is actually registered, click on the seal, which should be linked to a registration status report on the HON site. The HON Foundation also reviews Web sites and posts the results. However, its reviews of sites providing unreliable information on “alternative” methods have been descriptive rather than critical—and thus offer little or no guidance to Web browsers. In addition, its search engine does not limit its searches to reliable sites. HON officials are aware of these problems and have indicated interest in correcting them. Quackwatch has identified several HONcode violators.71