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E-Cigarettes — Helpful, Risky, or Both?

By Mark A. Kelley, MD |4/9/18
Founder, HealthWeb Navigator

Walking down the street, sometimes I see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device could make it easier and safer for smokers to kick the habit.

As a pulmonary physician, I wince when I hear about people voluntarily inhaling any foreign substance. We are already exposed to more environmental toxins than we realize, and adding something else seems unwise. However, quitting smoking is extremely difficult. Most remedies have been only slightly effective at best. Could vaping help?

After a decade or more of scientific studies, we know a few facts about e-cigarettes, although many questions still remain. Here are the key points:

1. The e-cigarette market is growing. Several studies have shown that between 2010-2013, the use of these devices had more than tripled to include 7% of the U.S. population. Most users are young and/or former smokers. About one-third have never smoked before. Nicotine is highly addictive which is why smokers have difficulty stopping. Vaping is popular among high school students, and their teachers fear that this will lead to cigarette smoking and other addictive habits.

This effect has been observed in a few studies but the trend is unclear. In 2015, the e-cigarette use rate among high school students declined from 16% to 11%. However, there is some evidence that e-cigarette use in high school students is a risk for taking up cigarette smoking.

2. E-cigarettes are safer than regular cigarettes. Both e-cigarette vapor and cigarette smoke contain nicotine, but only cigarette smoke has the harmful products of tobacco combustion. For that reason, most experts consider the e-cigarette to be safer than a regular tobacco cigarettes. However, in both cases, inhaled nicotine stimulates the cardiovascular system. It is unknown whether this effect has long-term consequences such as heart disease or hypertension.

3. E-cigarettes may help smokers quit — but the effect is small. The vast majority of e-cigarette users are current or former smokers. Based on research surveys, these patients are either trying to quit smoking or at least reduce their cigarette consumption. Many studies have compared e-cigarettes to other methods of smoking cessation such as nicotine patches, counseling etc. These studies have been inconclusive. A panel of experts recently suggested that e-cigarettes may slightly improve smoking cessation but the magnitude of the effect is small.

4. It’s too early to know all the risks of using e-cigarettes. These devices expose the user to liquid nicotine and chemicals that create the vapor. The chemicals involved with vaping — propylene glycol and glycerol — when heated, are known to produce carcinogens and compounds that irritate the airways. The exact risk from this exposure is currently unknown, though it is thought to be much lower than that of a regular cigarette. Therefore, for a smoker, switching to the lower risk e-cigarette is a good trade-off. But for non-smokers, using an e-cigarette introduces potential risk for lung disease and cancer. Outbreaks of asthma have already been reported in association with vaping.

5. E-Cigarettes are regulated differently around the world. The World Health Organization has called for strict regulatory control of e-cigarettes by keeping them away from non-smokers and minors. Some countries have banned the devices altogether.

In the U.S, many initially opposed these devices, presuming that they would lead to an increase in cigarette smoking. Some of this fervor has died down and is now focused on minors. At the moment, most states prohibit the sale of e-cigarettes to minors — the same policy as for cigarettes.

The FDA’s new director, Dr. Scott Gottlieb, has taken a fresh approach this problem. The FDA has established a program to fight nicotine addiction by reducing levels in tobacco and other products. Included in this mandate is continued surveillance of the safety and public health effects of e-cigarettes.

If this program is implemented, the role of e-cigarettes in public health may become clear. Ideally, e-cigarettes will rescue smokers from their habit — without recruiting new ones.

Of course the e-cigarette industry has other plans. Although some vaping devices carry a hefty price tag, overall vaping is relatively cheap and safer than cigarettes to boot. The industry is using those facts to leverage the market. Analysts predict that the vaping industry will see annual growth of 20% over the next decade with worldwide revenues of $50 billion by the next decade.  Most of those dollars will come from the industry’s best customers — Americans and Europeans.

If vaping becomes widely used, we may learn that it is safe. But we can’t rule out the opposite outcome either. Widespread vaping across large populations may introduce us to new diseases that could have been prevented.

There is a high cost for ignoring such potential risks. Just ask any patient who has suffered from the toxic effects of asbestos, second-hand smoke, or radon exposure.

U.S. Health Leads the World in Costs, Technology, Not Much Else

By Mark A. Kelley, MD |3/28/18
Founder, HealthWeb Navigator

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is that the U.S. uses more expensive technologies with high numbers of surgical and cardiovascular procedures and imaging studies.

Other sources of high costs include brand-name drugs and administration of insurance programs. And while the U.S. has fewer physicians per capita, our physicians earn more than counterparts in every other nation.

With fewer doctors, hospitalizations, and office visits, one might conclude that U.S. health care is poor. In some respects, that is true. The U.S. has a low life-expectancy and high maternal and infant mortality compared to other wealthy nations.

One explanation is that the U.S population is larger and more geographically and economically diverse compared to its peer countries. As the Harvard group explained, if the state of Minnesota were compared to a similarly prosperous European country, it could hold its own. In contrast, Mississippi, a poorer state, would rank much lower.

The message is that if you cannot access the U.S. health system due to income or distance, your wellbeing is at risk. The ACA tried to fix this problem by expanding insurance eligibility with federal support. Surprisingly, some states whose citizens would have benefitted refused to cooperate.

The Harvard report suggests two remedies for curbing health care costs: price control of new brand-name drugs and curbing the proliferation and costs of new technology. These ideas are not new—as the famous economist Uwe Rinehart once wrote, “It’s the prices, stupid.”

Some countries like Great Britain and Canada have taken measures to control such costs. But little has been done in the U.S.

What we are left with is a dysfunctional system that creates high costs, expensive drugs and technology, and lacks a stable national health insurance plan. Is it any surprise the U.S. healthcare system has been ranked last among developed countries?

Worse, we may soon have another embarrassing statistic to report—medical bankruptcy. As healthcare costs continue to rise, many patients can’t afford to pay their medical bills. A recent study revealed that many patients deal not only with hefty hospital bills, but also lost wages and even unemployment when they are ill.

It’s also important to remember that medical bills remain the number one reason for bankruptcy in the United States.

Four years ago, experts in medical bankruptcy grew tired of seeing families lose their homes because of medical debt. They founded a nonprofit organization called RIP Medical Debt (RMD) to solve this problem.

Like a mortgage, some medical debt is discounted and sold on the open market as a commodity. In some cases, the debt can be purchased for pennies on the dollar. The buyer then owns the debt and recovers whatever payment they can.

RMD purchases such debt and then raises donations to settle the account. For example, a donation of $100 can settle a debt of $10,000. A donation of $15,000 can retire $1M of medical debt. Over four years, the organization has retired millions of dollars of debt for patients and their families. While I applaud this program, its very existence speaks volumes about the inadequacies of health insurance in the U.S.

As I write this blog, the stock market has fallen dramatically due to the looming threat of trade warfare between the United States and China. If this crisis continues, the price of imported goods will rise for American businesses and consumers. It’s possible that companies may trim their healthcare benefits to cut costs, shifting the burden onto employees through higher premiums and/or higher deductibles. Such changes will nudge many employees even closer to financial ruin if they get sick.

An equally depressing but plausible scenario is that patients will choose to go without routine care because they cannot afford it.

The current national political agenda is aimed at creating more jobs for Americans. Unless those jobs offer adequate health insurance, medical bills will devour wages.

If elected officials are serious about helping Americans, they should stop playing political football with health insurance.

Only a stable single-payer system, similar to Medicare, will keep the average American family secure in times of illness. And armed with the same power of national price control enjoyed by Medicare, such a plan can tackle the escalation of health care costs.

The Affordable Care Act: Moving the Public Closer to “Medicare for All”?

By Mark A. Kelley, MD |8/30/17
Founder, HealthWeb Navigator

The Affordable Care Act (ACA) debate resumes when Congress returns from its summer recess on September 4th. In the meantime, the debate has already had major effects on public opinion.

A recent report describes how Americans currently view the ACA. According to national polls, over 90% of Americans would change the current law. Most Democrats would expand ACA coverage while most Republicans would reduce ACA benefits or rewrite the law completely. Only 8% of those polled would repeal the ACA without a replacement.

The most surprising result is the public’s response to the following statement: “It is the responsibility of the federal government to ensure that all Americans have health coverage.”

Last year, 51% of Americans agreed with that statement. In 2017, the approval rate jumped to 60%. It appears that a government health insurance option is gaining popularity.

Meanwhile, contrary to some reports, the ACA program is stable. Most regions of the country still have private insurance plans available through the ACA. Many insurers increased premiums to cover losses, but that one-time intervention seems to have stabilized the markets.

The reality of health insurance is that it must be profitable to cover unexpected losses. The insurance company has several tools to ensure a profit: charge high premiums, select consumers with low risk, or limit the services and/or payments of coverage.

The ACA eliminated most of these options. High-risk consumers could not be denied coverage or be overcharged. Further, every health plan was required to pay for a standard portfolio of services.

To offset losses, the federal government has provided supplements to cover costs on a year-to-year basis. The ACA has proven even more expensive than anticipated because the uninsured have been much sicker. The ACA had plans to offset these costs but they have had no major effect to date.

To force Congress to pass a new law to replace the ACA, President Trump has threatened to stop its federal supplements. That threat has already caused some insurance companies to leave the ACA. Congress, however, does not favor this action since it would leave millions of Americans without health insurance.

This situation has exposed the major weakness of the ACA — its financial fragility.

• The ACA required all Americans to purchase health insurance to create a new funding source. That plan failed because the law was poorly enforced. Now the ACA has no consistent source of revenue to offset costs.

• On the costs, the ACA is also vulnerable. The ACA insurance plans are managed by the private insurance industry. As long as insurance companies can rely on federal subsidies, they have little incentive to reduce costs.

• The bottom line is that the federal government must continue to subsidize the ACA.

This challenge is not new. With Medicare for the elderly, the federal government has a long experience with publicly supported health insurance. Medicare is a popular plan that is predictable, understandable, and accepted across the nation. Because it controls national pricing, Medicare has kept inflation low compared to private insurance.

“Medicare for All” was popular with some voters during the 2016 presidential campaign. Many now wonder why they cannot have the same federal insurance plan as their parents and grandparents.

That is a timely question. For most Americans, employee health insurance has become too expensive and unwieldy. Our U.S economy rewards workers who have geographic mobility and job flexibility. For such employees, finding health insurance in differing local markets can be a nightmare. A national health plan, like Medicare, solves that problem.

Companies see the rising cost of employee health insurance as a threat to the bottom line. Many businesses pass these costs to their employees through higher deductibles, co-pays, and co-insurance. That maneuver may reduce company costs, but it puts economic stress on employees and does little to curb medical inflation.

Americans are beginning to understand these issues and envision a future where the federal government ensures access to health care for everyone. During the ACA debate, voters sent several strong signals to Congress:

• Do not repeal the ACA without a replacement plan in place.

• Do not reduce current benefits.

• Do not interrupt or threaten any current insurance.

The message seems clear: most Americans want Congress to improve the ACA and move forward—not backwards. The only institution with the experience, power, and resources to lead the way is the federal government. If that happens, the country will be on the path to a “public option” like Medicare where the federal government is the insurer.

That option was proposed for the ACA in 2010 but was withdrawn due to political pressure from the insurance industry. Reviving the public option will likely provoke the same industry reaction. However, if voter support continues to grow, the public option could prevail. That will be a game-changer.

How to Effectively Manage Appointments with Your Doctor

By Mark A. Kelley, MD |7/12/17

Everyone in health care is busy these days. Most doctors have full schedules and patients often can’t afford to take time off from work.

Neither patients nor doctors are satisfied with this situation. However, once you and your doctor get together, there are ways you can make the visit more valuable.

Doctor appointments fall into two different categories:

• Urgent visits: For true emergencies, you should seek immediate medical attention. For a problem that is not an emergency but worries you,  the best approach is to contact your doctor’s office. Your doctor may be able to solve the problem by phone or work you quickly into the office schedule.

• Routine planned visits: These visits are usually for a new consultation or a follow-up for a known condition. You can get more from these scheduled visits if you do some preparation.

The New Consultation

You can take a few steps to ensure a new consultation goes as smoothly as possible.

Educate yourself beforehand: Understand the reason for the consultation from your referring doctor. Have you read up on your particular problem? Have you checked the credentials and experience of the new doctor? Is this new doctor affiliated with a hospital that you like? Does the doctor accept your insurance?

Bring your medical records, drug list, and results of any lab/radiology studies: This step can make a major difference in your first visit. Medical records provide a clear picture of your health history. The doctor can read faster than you can talk, and this written information frees up time for the doctor to have a better conversation with you. The information may also reduce the need for more tests, allowing the doctor to focus on a diagnosis and treatment plan.

Prepare a list of questions in advance: Make a list that you can share with the doctor. This conversation will help you to understand the medical issues involved, as well as help the doctor understand your concerns.

Ask a close relative or friend to accompany you on the visit: This has several advantages. Your relative may remember something about your medical history that you forgot to mention. They may also be helpful in remembering specific details that the doctor mentions. Additionally, it is always comforting to have a close companion with you to provide support.

Ask the doctor to summarize their findings and recommendations for you: Then, in your own words, repeat the summary back to the doctor. This will help you remember details and ensure that you and your doctor are on the same page regarding your problem and action plan. Don’t be shy about asking questions. Doctors want their patients to be well informed.

Understand the plan and goals before the next visit: These may include any new medications, tests, procedures, or therapies. For each one, consider asking the following questions: How does this test or therapy work? Why do I need it? How long will I need it? What are its benefits? What are its risks? For a new medication, what side effects should I look for? Will it interfere with my current medication? If I have a problem, who should I contact?

Ask for a printout: Request hardcopies of any diagnosis, medications (especially new ones), or tests before you leave the office. You can also ask the doctor to send you a written summary of the visit for your records. By law, you are entitled to this information, and physicians are usually glad to provide it.

Learn more about your condition: Although you may have read about the subject beforehand, your doctor may direct you to other helpful resources. The information may come in the form of written materials or online resources. HealthWeb Navigator can direct you to the most trustworthy, independently reviewed health websites online today.

The Follow-Up

Follow-up visits are scheduled so that the doctor and patient can monitor progress together. You should expect to discuss the following issues with your doctor:

• Are you feeling better or worse?

• Are there any problems to report? If so, let the doctor know early in the visit. They can evaluate whether this issue is serious and/or related to other conditions.

• Are you taking your medicines as prescribed?

• Have you had any new tests or other doctor visits recently? The doctor may not have the results but should be able to get them quickly.

• Do you have any questions about your condition?

• Do you understand the treatment plan? Before you leave the appointment, be sure you receive written summaries and instructions.

Based on my decades of practice, this preparation makes the office visit more productive for doctor and patient alike.

Final Tip

Sometimes routine follow-up visits become “too routine.” Physicians know that patients spend a lot of time and money on medications and doctor visits. If you are doing well and everything has been under control, you may want to pose the following questions to your doctor:

• Can I cut back on any of my medicines (or even stop them)?

• Can I reduce the number of routine follow-up visits?

• Can some of these follow-ups be done by phone or email?

Physicians are modernizing their practices to suit your needs. I suspect that most are more than willing to discuss these requests.

Firearm Fatalities – What Are the Issues?

By Mark A. Kelley, MD |6/22/17

The recent shooting at a Congressional baseball practice is another example of firearm violence. When such crimes grab headlines, it is helpful to review the national statistics concerning guns and safety.

According the Centers for Disease Control, 33,000 Americans die from gun injuries annually. About 65% of these deaths are from suicides. Easy access to firearms, especially in the home, is associated with higher rates of suicide.

Because self-inflicted gun injuries are highly lethal, most suicide attempts by this method are successful. However, patients with unsuccessful suicide attempts rarely succumb to suicide later. Therefore, keeping these patients away from guns is life-saving.

The second major cause of firearm death is homicides (33%). Nearly all of these deaths are in the home or among people who know one another. Random shooting fatalities are rare.

The final cause of firearm deaths is accidental shootings, usually in the home, and often involving children. These deaths account for 2% of firearm fatalities.

Mass shootings, such as at the Sandy Hook Elementary School in 2012, are heart-breaking tragedies. From 2007-2016, the national fatalities per year from mass shootings ranged from eight to 67 victims. Over that decade, the nation averaged 38 deaths per year, or 0.3% of the total gun-related homicides.

Firearm mortality statistics can be summarized as follows:

• The majority of Americans who die from gunshot wounds are the victims of suicide.

• Most other fatalities are due to domestic violence or among people who know one another.

• Mass shootings, while dramatic, are a very small part of this problem.

In all these scenarios, easy access to firearms increases the likelihood of a fatal outcome.

Mass shootings are a relatively new phenomenon in our country. Many hypotheses have been raised to explain this change. Among them are the expansion of social and news media, the availability of automatic weapons, and weak gun control laws.

These who commit these crimes share some common characteristics. In many cases, they do not know their victims. Most of the perpetrators act alone, have no plans for escape, and die violently, often by their own hand. Many obtain firearms legally.

Why motivates such people? Psychologists have suggested that this violence stems from rage at society because of some grievance. The result of this anger is mass casualties and usually the shooter’s own death by gunfire, often self-inflicted.

This raises several issues. Are mass shootings a form of public suicide? If so, will they occur more often? While no one has the answers, one fact is clear. The behavior behind these shootings is highly abnormal and suggests serious mental health problems as the root cause of the violence.

Our society has two problems that are closely linked—lethal weapons and mental health. Those with mental health issues and violent intent are more likely to harm themselves or others if they have access to guns. However, gun control is only a partial solution.

The major challenge is early recognition and treatment of mental illness. We need to help mentally ill patients well before their depression or rage reaches the breaking point.

Our elected officials are now considering cuts to healthcare benefits, particularly in mental health. Such cuts would be a major public policy mistake. In this era of gun violence, public safety requires that we make mental health one of our top priorities.

What Can We Expect From the Proposed American Health Care Act?

By Mark A. Kelley, MD |6/1/17

Our last blog focused on the political movement to replace Obamacare. Since then, the U.S. Senate has been busy revising a new healthcare bill passed by the House of Representatives called The American Health Care Act (AHCA). Some of the specifics of the bill have been clarified.

The Facts to Date

If the AHCA replaces Obamacare, the Congressional Budget Office (CBO) predicts the following outcomes:

• 14 million Americans would lose their coverage within the next two years. Most of them have little or no income and have serious healthcare challenges.

By 2026, over 51 million Americans would be uninsured compared to 28 million if Obamacare remained in place.

By 2020, insurance companies would be able to exclude those with pre-existing conditions. As a result, millions of sick Americans could lose their current health insurance.

The AHCA also cuts taxes for the rich, and reduces federal revenue by $700 billion over ten years. The impression is that health care is being sacrificed to help the top 1% of wage earners in the nation.

The Key Issues – Insurance Availability and Cost

Most Americans are focused on two health insurance issues: availability and affordability. There are reasons to worry on both counts.

Insurance Availability: The AHCA cuts Medicaid and threatens other forms of insurance coverage. Obamacare defined the benefits for all health insurance, including no penalty for pre-existing conditions. The AHCA offers “waivers” for insurance companies to “customize” these features to reduce cost. These waivers could include denying coverage for pre-existing conditions or any future expensive illness. In a worst-case scenario, pre-existing conditions might include common problems like hypertension, asthma, and obesity that affect many Americans.

Insurance Affordability: The AHCA may lower premiums by limiting benefits or covering only low risk patients. However, this would deny health insurance from those who need it most.

Even more worrisome is a long-standing problem of national healthcare costs. The reality is that cost inflation continues to drive higher premiums and threatens the national economy. There has been little attention paid to that major challenge.

Can we afford to cover more people when health care cost inflation continues to rise? The answer is “No”…unless we change the current status quo.

Health Care Cost Inflation – A National Problem

The cost problem can only be solved through a national system that has a budget, reliable revenue, and the tools to control costs.. The best example is Medicare, which covers the elderly. With the advantages of national price and policy controls, Medicare has begun to curb the rate of medical cost inflation.

Why is this example important? Medicare is a federal insurance plan that sets prices, controls costs, and covers its beneficiaries through taxes. Private health insurance is different. It is an industry that operates as a free market, like any other type of insurance. No country has successfully used the free market to provide health care for its citizens. The reason is that many people cannot afford to buy private health insurance. Only a government program can help them.

Obamacare was a major step forward. The law standardized benefits and offered subsidies to help cover the cost of private insurance. The result was that over 14 million Americans were newly insured.

But that plan will fail without a system that has enough predictable revenue to cover everyone and has the power to control costs. That is a task that only the federal government can manage.

We have already started down that pathway. The federal government manages, directly or indirectly, more that half of all U.S. health care expenditures: Medicare, Medicaid, the Veterans Administration, and the Armed Forces. In effect, we have a large national health portfolio supported by taxes.

Voters are becoming weary of the politics of health care. Soon they will wonder why they cannot enjoy the same benefits as their parents on Medicare. If that bandwagon gains momentum, politicians will scramble aboard.

The process may take time but as Winston Churchill quipped, “You can count on Americans to do the right thing…after they have tried everything else.”

Tips for Reviewing a Website’s Usability

By Nathan Blake |2/15/17

Following up on our previous blog post, this week we will explore how usability reviewers analyze health websites while also providing some tips for becoming a more informed web user.

HealthWeb Navigator’s content reviews and usability reviews are distinct but complementary. Whereas a content review analyzes what information is provided (its accuracy, completeness, currency, depth, etc.), user-experience reviews are focused on how information is provided; that is, whether or not the presentation and organization of material, in your opinion, is easy to use and navigate, visually appealing, readable, widely understandable, speedy, and geared toward its audience appropriately.

Reviewers should always include direct evidence from the website to support any judgment made about a website’s usability.

Below you will find some specific tips for using your web experience as you review a health website’s usability. Due to time and space constraints, you won’t be able to touch on each one of these aspects in your review, but we hope that they can guide you to think more critically about a website so as to be a stronger resource for consumers.

Evaluating a Website’s Usability

A usability expert for HealthWeb Navigator should be prepared to:

Scan the pageReviews of usability should take visual appeal into account. Design is often unconsciously linked to credibility, and though a website’s credibility doesn’t necessarily hinge on its appearance, it does play a part. Let your eyes wander around the page; where’s the first place you look? What does your instinct prompt you to click on first? Do advertisement obstruct navigation, or is the focus directed toward content? Is the content well-organized? Do the colors or font make it difficult to read the type? How about pop-ups? Answering these questions will train your eye to slow down and analyze what it’s seeing. They will also help you determine whether or not the website is effectively designed, allowing you to articulate what could be done to create a more pleasant user-experience.

TIPPut down in writing or speak aloud your initial impressions about the layout of the page and what you think of the colors, graphics, photos, etc. Is it on par with other websites, or is it better or worse than you expected? What can the website do to catch the reader’s eye, and where does it excel at grabbing your attention?

Take the wheel. Think of each website as a vehicle for disseminating information. Each has a different design, yet there are widely shared features such as navigational schemes, search options, editorial disclaimers, etc. Some websites have site-wide search bars, while others only allow users to click links when searching for material. Usability reviewers should try to understand how the site functions and whether or not it’s easy to “drive,” testing out its various components before casting judgment. Is the website easy to use, and can you find what you are looking for? What’s the loading speed of individual pages? Are there any dead links? Can you get around the website intuitively, or does it have you spinning in circles?

TIP: An easy way to focus on a website’s functionality is to disregard the actual content on the page. Play with the website and test out as many of its features as you can, which often helps reviewers discover user-experience issues. It can also be helpful to search for a specific topic that falls under the website’s scope, testing out the various organizational schemes to determine if the site is user-friendly.

Identify the audience(s) and purpose. All texts presume an audience and a purpose, and it is the job of the reviewer to understand those potential audiences and purposes implied by a given web resource. Start with the idea that all writers, consciously or unconsciously, have an ideal audience in mind when they write, and with that knowledge they determine the shape, form, and scope of the ensuing content. The important concept to understand is that readers and listeners will vary in how much they know about the health information being offered, and websites will vary in what they want to accomplish. Some websites listed on HealthWeb Navigator have very little interest in providing medical content. Some are strictly focused on providing social media capabilities, others act as advocates on behalf of patients, and others simply list resources. Identifying these varying purposes can help you understand if the website successfully meets its goals or not.

TIP: Approach each website as an educator: If you had to give the website a grade, from A to F, what grade would you give it and why? What audiences does the website exclude and how? Is material offered in multiple languages, and it is accessible for people with disabilities? What’s the site’s purpose; is it to inform or persuade, describe or convince, define or influence, review or argue, notify or recommend, instruct or change, advise or advocate, illustrate or support?

Paraphrase information. A paraphrase is a restatement of an idea into your own words. Part of a usability reviewer’s duties involves assessing a site’s understandability, how easy it is to read and follow. One quick way to determine whether or not a website is easy to read is to try and summarize material after reading. Imagine teaching the content to someone else. Can you articulate the material’s substance, or are you floundering for meaning? If you find it easy to paraphrase a website’s content, especially as a layperson, then chances are the site is written clearly. If not, try to hone in on what makes the website difficult to understand and mention that in your review.

TIP: Think about how to articulate information in your own words. Of course some of the more clinical concepts will be difficult to summarize without using the resource’s exact language, but you should at least understand the gist of what is being said. Read over a page, look away from the website, and then write down or speak aloud the essential meaning. If you find this difficult, then the website may have a readability issue.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our usability review process. Check back to our previous blog post that focuses on how our volunteers conduct content reviews.

Finally, if you are a web user and are interested in a becoming a usability reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Usability Reviewer.

Tips for Reviewing a Health Website’s Content

By Nathan Blake |2/1/17

It is estimated that 40% of the global population uses the internet every day, including over 88% of the U.S. population. As healthcare costs continue to rise, more and more patients turn to the web for health information to learn about diseases and conditions, insurance costs, patient advocacy, and more.

But how can you be sure that the information you find online is credible, up-to-date, and easy to understand?

HealthWeb Navigator is a free online service that helps consumers make sense of the internet’s rapidly expanding collection of health-related websites. Our team continuously publishes reviews of online health resources. The idea is that these reviews will allow consumers to take control over their own health care by guiding them toward only those websites that are accurate, clear, and user-friendly.

Our credibility rests on the expertise of our volunteers, whom we group into two categories: content reviewers and usability reviewers. Medical authorities are tasked with evaluating a health website’s content, while our usability reviewers come from all walks of life and are responsible for reviewing a website’s user experience.

Whereas a usability review analyzes how information is provided (its organization, visual design, user-friendliness, speed, etc.), reviews of content are focused on what information is provided and whether or not that information can be trusted to be accurate, complete, up-to-date, and sufficiently explored.

Below you will find some tips that our health authorities keep in mind when judging a website. We hope that consumers can incorporate these tips into their web-browsing routine, helping them distinguish a reliable web resource from a misleading one.

Evaluating a Website’s Content

A content expert for HealthWeb Navigator should be prepared to:

Look for gaps. If you’re a mental health professional reviewing a website focused on teen mental health, and you notice that the website does not include information about self-harm, then clearly there is a gap in the site’s scope. Consulting a website’s site-map can give you an aerial view of what can or can’t be found on the site. Use your review to make note of any noticeable gaps you find. This is equally true for websites that feature a doctor/provider-finder tool; if, when searching a familiar ZIP code, you see that a specific doctor/provider is missing, then that too is appropriate to mention in your review in regards to completeness.

TIP: Gaps in content are often found simply by browsing a website, keeping an eye out for information that could be present but is in fact missing. You might also consult a site-map when available, allowing you to get a quick idea of those topics the website covers without having to browse every single page. A litmus test for a site’s content might be: On content alone, would you recommend this website to a patient? If “yes,” give examples of what you liked. If “no,” explain what is missing and why it concerns you.

Test the depths. Some websites cover the breadth of a particular subject, including numerous topics and subtopics for consumers to explore. But how useful is the breadth of a site’s material if individual articles are too shallow to gain anything substantive? Use your knowledge to determine if a website’s materials are sufficiently examined in enough depth to provide consumers with quality information. Some websites sacrifice depth for breadth, others go very deep into a limited amount of subjects, while still others manage to strike a balance between the two.

TIP: The key to fairly judging a site’s depth is using your medical expertise to determine whether or not the page with less detail offers enough information to be of use to the public. It may be shallow, but sometimes shallow is all that is necessary, depending on the topic. Consequently, too much depth can overwhelm some readers, especially if the tone is clinical in nature.

Verify the research. Suppose the website you’re reviewing makes a variety of claims but does not provide research or evidence to support those claims—would you trust that website more so than an organization that includes direct links to outside sources? Or what if the site in question relies on misleading or downright false information to prove its points? In both cases, it is the job of the content reviewer to look for and judge the research (or lack thereof) being used by a website to determine whether or not it is credible and accurate. Follow up on any research you see linked on a page, and make note if you see either a lack of verifiable research or an abundance of biased materials.

TIP: Always look for evidence. Remember that good science relies on data and statistics, although even the most objective data can be influenced by bias. Keep the phrase “prove it” in mind, then assess the quality of that proof. Websites that lack research or only reference internal research should be analyzed with caution.

Check the dates. Imagine how you would go about reviewing a website on heart surgery that cited research from 1983. Would you trust that the research holds up after all these years? Or what if a website publishes material on a rapidly-evolving subject like the Affordable Care Act, yet the material has not been reviewed or updated since 2012? Look for dates of both publication and revision to determine if the website is maintaining its currency; the same goes with any outside research or support a site relies upon.

TIP: When you’re looking for evidence, take publication and revision dates of individual articles into account. Usually these dates are found at the top or bottom of web pages. Using your expertise, you can determine whether or not the website maintains currency in a rapidly changing medical landscape.

Know Who’s Who. Everyone approaches the world with particular biases, and it’s important to recognize that occasionally these viewpoints are not necessarily rooted in observable fact. When it comes to website content, always look for names to which information can be attributed including parent and affiliate organizations, leadership, sponsors, advisors, editorial boards, writers, etc. Approach it from the angle of expertise: Would you be more willing to accept an article’s claims if they were written by a layperson or a trained medical authority? If information is generated by laypeople, then there should be some form of expert oversight to maintain quality.

TIP: If individual authors cannot be attributed, do some digging on the website to find out who is responsible for writing and editing content. If you can’t find this information, then that is an appropriate issue to raise in your review.

Follow the Money. Have you heard the phrase “follow the money”? A good tool for assessing the influence of bias and allegiance starts with recognizing the power of financial transaction—determining who’s being paid and who’s providing the money. Look for any products being sold and ask yourself if the website is unduly advertising those products over established medical knowledge (that is, a “cure all”). What organization or sponsors support the website? Who is responsible for generating content, and can you see any financial incentive for what content is generated and what stance the content promotes? You can learn more about how to find out who sponsors a website HERE.

TIP: If you don’t recognize the organization providing the information, some cursory digging can reveal who finances the operation. Most websites you encounter through HealthWeb Navigator will provide this information in an “About Us” or related section. You can also dig deeper into a charity or nonprofit by looking up their listing on Charity Navigator.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our content review process. Stay tuned for our next blog post, which will focus on how our volunteers conduct usability reviews.

Finally, if you have medical training of any kind and are interested in a becoming a content reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Medical Reviewer.

When Your Doctor Doesn’t Accept Your New Health Insurance Plan

By Nathan Blake |1/17/17
Updated|10/17/17

Ruth finally made a career change and is loving all the extra free time she has to spend with her granddaughter. But when she called to schedule an annual physical with her longtime doctor, she wasn’t prepared to hear bad news: Ruth’s doctor doesn’t accept her new employer’s health plan.

Now she faces a unpleasant decision. Either look for new health insurance outside her employer’s plan, or start from scratch by finding another primary care physician.

Losing access to a doctor you trust isn’t just demoralizing. It’s also incredibly time-consuming. Finding a good “fit” often requires trial-and-error and a fair bit of luck. But the effort pays off in the long run. Research shows that the more satisfied a patient is with their healthcare provider, the better the odds they will experience a successful treatment.

Like Ruth, you may have changed jobs and are on a different health plan. Or you may have had to find another health insurance policy with lower co-pays just so you could afford the costs of your prescription medications. In either case, it’s possible that your medical provider doesn’t work with your new insurer.

What happens when a strong doctor-patient relationship is suddenly jeopardized because of health insurance compatibility?

When You Just Can’t Stand to See Your Doctor Go

So your preferred doctor doesn’t accept your new health insurance, and you don’t want to find another provider. Totally understandable. The first step you should take is an easy one: Ask your doctor what insurance carriers they DO accept.

Rather than searching for a new doctor, you can switch to a different health insurance policy that you know your doctor will work with.

Unfortunately, Marketplace plans can only be changed during certain times of the year or for specific “special enrollment” scenarios like having a baby, getting married, losing a job, etc. Check online to see if you qualify for special enrollment before you make any big decisions. If Ruth is eligible for special enrollment, this is by far the most painless solution.

But there are other options if you can’t afford the cost or hassle involved with switching policies. If you desperately want to keep your doctor, you can:

• See if your plan will work with out-of-network coverage. If your doctor isn’t in your insurer’s network, call the insurer directly to see if they would consider adding your doctor to their network of providers. If they refuse, always ask for specific reasons. You can also present the doctor with reasons why they should join a particular network. Sometimes a vocal patient is enough to do the trick. It can’t hurt to ask!

• Negotiate a discounted price with your doctor. More and more medical providers are choosing not to take on contracts with insurers in today’s tumultuous insurance market. The result is that patients insured through incompatible plans are forced to pay the market price for medical services up-front. However, some doctors are willing to negotiate prices with patients on an individual basis, especially if there’s already a long-standing relationship. The key to these negotiations is knowing the fair price for a given health expense and working from there. Again, it costs nothing to ask, and the potential payoff is worth it.

• Visit an urgent care center or walk-in facility. Urgent care centers and walk-in clinics are set up to treat patients with non-life-threatening illnesses and injuries like fevers or the flu, bleeding/cuts, sprains/strains, etc. They’re also good for immunizations and some diagnostic services such as X-rays and routine lab work. What’s great about these centers is that they are relatively inexpensive, require no appointments, and are generally open seven days a week. If you can save money on “small” issues, then you may be able to afford seeing your doctor for the more serious issues that crop up from time to time.

Pay the difference out of pocket. This one hurts. But if you have the financial resources to do so—and if you absolutely MUST keep your doctor—then you can pay for their services out of pocket and then submit insurance forms for reimbursement. It’s important to note that insurers will often apply reimbursements to your policy deductible (how much you’re expected to pay before the insurer picks up the bill) rather than give you the money outright. There’s also a good chance you will be reimbursed for only a portion of the original cost. Always keep in touch with your insurer during the reimbursement process and make sure your voice is heard.

When It’s Time to Move On

If you can’t afford to see your doctor without health insurance, and none of the above options works for you, then it might be easier to simply move on and find another doctor in your new network. Most health plans these days provide a list of physicians in their network. Call your plan directly for more information.

For tips on how to find the right doctor, we have an entire post dedicated to choosing a primary care physician. Or, you can search our collection of physician websites by browsing the “Physicians” tab on our homepage.

Being prepared for change and informing yourself of available options is your best bet for making a smooth transition between providers. Comment below and let us know if we helped!

What Are the Health Risks of Exercising Outside in Winter?

By Nathan Blake |1/4/17
Updated | 10/27/17

Who doesn’t love this time of year? Leaves are changing color, the breeze smells like campfire, and pretty much everything comes in “pumpkin spice” (chicken sausage, anyone?). In just a few months, you’ll be making yet another list of New Year’s resolutions.

Last year, 41% of Americans said they wanted to “live a healthier lifestyle,” while an additional 39% wanted to “lose weight.” And let’s be honest—most of us can sympathize. 40% of U.S. adults are considered obese, a record high.

But gym memberships aren’t getting any cheaper. Rising costs have inspired health buffs to develop fitness routines requiring little or no cost such as bodyweight exercises, yoga, and dancing, or incorporate old standbys like running and cycling.

What most people don’t realize is that the physical cost of cold-weather exercise can mean devastating heart and lung damage. In fact, numerous studies show that heart attack rates tend to spike in colder months, especially December and January.

Those of you who choose to brave the cold this fall and winter should be aware of the potential benefits—and dangers—that lie ahead.

Benefits of Cold Weather Exercise

It’s a myth (more like a half-truth) that chilly weather means greater weight loss. Unless you’re noticeably shivering and expending more energy than usual, your winter workout won’t burn more calories than usual.

That’s not to say athletes should hibernate until spring.

Want to improve your mood? Exercise helps combat the symptoms of seasonal affective disorder, a form of depression affecting 20% of Americans. Additionally, more sunlight exposure increases endorphin levels, putting the “sunny” in “sunny disposition.”

Some research even suggests that 45 minutes of running in cold weather can reduce flu-risk during the winter months by as much as 20-30%.

You may be able to up the intensity of your workouts in the cold, too, since hot weather has been shown to negatively impact physical performance. Factor in the lack of humidity and the invigorating wind chill, and all of a sudden colder climes don’t seem so bad for training.

But as with life in general, moderation is key.

Now for the Dangers (and How to Prevent Them)

Don’t fall into the trap of thinking you’re capable of doing the same activities in winter as you could in summer without a hitch. If you’re in excellent health, you probably won’t experience any major issues exercising outside this winter—barring accidents, of course.

However, if you have a history of heart, lung, or circulation issues, you’re putting yourself at risk for increased discomfort, injury, and even death.

Here’s what you need to be on the lookout for if you want to stay well and fit this winter.

Muscle TearsWhen temperatures drop, our bodies overcompensate to perform tasks that would be easier in milder weather. Our muscles and tendons lose more heat, which causes them to tighten up and become less flexible. This leads to muscle soreness or damage like strains and tears.

What You Can DoTake time to warm-up properly before exercising, but save the stretches for your post-routine cool-down. Ease into your workout with some light cardio instead. Brisk walking, for instance, is great for raising your core temperature and increasing blood and oxygen circulation. Common problem areas include your hamstrings, chest, shoulders, and quadriceps. Show them some extra love!

Asthma: Ever hear of exercise-induced asthma? Coughing, wheezing, chest-tightness, shortness of breath, excessive fatigue. Winter athletes frequently report these symptoms even though they may never experience them in other seasons. Cold, dry air and exercise both aggravate asthma individually. Combined, they’re downright dangerous.

What You Can Do: Cover your mouth with a mask or scarf to warm the air you breathe. If you use an inhaler, use it 15-30 minutes before exercise to open your airways, and carry it on your person at all times. You can also drink extra water, which thins the mucus in your lungs and helps your body move more efficiently.

Heart Attack: Cold temperatures can cause vasoconstriction, or narrowing of your blood vessels. As these passageways constrict, blood pressure rises, which reduces oxygen supply and blood flow to your heart. The result is your heart works harder than it would under normal circumstances. People with heart conditions are inviting additional cardiovascular strain that may result in angina or, potentially, a full blown heart attack.

What You Can DoPeople with a history of high blood pressure and/or heart disease should consult a doctor before starting a new exercise routine. Begin physical activity slowly, and give your body a break every 15-20 minutes. If you begin to feel chest pain, or pain that radiates down your left arm, call 911 immediately or visit the nearest emergency room.

Frostbite: Frostbite occurs when the body’s skin and underlying tissues begin to freeze. As blood flow slows, ice crystals form inside your cells, killing them in the process. People with frostbite will immediately notice numbness and skin discoloration in localized area(s). Left untreated, the resulting skin tissue death can result in gangrene and amputation.

What You Can Do: Limit your exposure to cold, windy, wet weather. Keep an eye out for signs of frostbite like red or pale prickling skin, and stay dry (wet clothes increase heat loss). Dress in layers; aim for clothing that is comfortable, loose, and light; and make sure your outer layer is both windproof and waterproof. If you do notice signs of frostbite, don’t rub or aggravate the frostbitten area. Instead, find shelter as soon as possible, and treat the affected area using either warm—not hot—water or body heat.

Hypothermia: Prolonged exposure to cold weather causes the body to lose heat through the skin and lungs faster than it can be produced. A dramatic drop in body temperature (generally recognized when core temperature falls below 95 degrees Fahrenheit) slows brain function, heart rate, and breathing. Soon, confusion, fatigue, and organ failure set in.

What You Can Do: Layer up, and wear a hat, scarf, and mittens to conserve body heat. Stay dry, being especially mindful of your feet and hands. Avoid alcohol and caffeine, both of which stimulate heat loss. Seek medical attention immediately if you notice any symptoms of hypothermia. In the meantime, remove any wet clothing and wrap yourself warmly in a blanket or other covering. However, do not immerse yourself in hot water. This can lead to shock.

Even though the above scenarios may sound dire, it never hurts to be prepared when it comes to your health. Stay warm this winter, but enjoy the chill. Your body will thank you come spring.

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