Some Useful Medical Databases

Following along the lines of the last post, here are some recommendations for Web databases that may help you avoid worst-case outcomes for any health-related conditions. After all, the best way to avoid the dangers of a hospital visit is to avoid the visit in the first place if possible. All of these databases are either on a list recommended by the Medical Library Association or ones I have used and trusted in the past. All except the ConsumerLabs service below are free.

Starting with the Medical Library Association, visit their list of the Top 100 Health Websites You Can Trust. Here you can browse by ten different categories including General Health, Women’s Health, Men’s Health or Senior Help. You also can download and save to your computer the list in PDF searchable format.

If alternative approaches such as naturopathy, Chinese medicine or other supplementary therapies interest you, then  the National Institutes of Health “A to Z” database provided by the National Center for Complementary and Integrative Health can help. Through this site, you can subscribe to updates on specific topics.

An authoritative database of disease conditions and treatment is available at the Medscape site. You can browse conditions or search by keywords.

If pondering what to do next about a diagnosed specific condition, the Patient Decision Aids provided by the Ottawa Hospital Research Institute may be helpful. According to this database, “The A to Z Inventory of Decision Aids is designed to help you find a decision aid to meet your needs. It contains up-to-date and available decision aids that meet a minimal set of criteria.” The list allows searching by key word or browsing. Retrieval lists how well each decision aid met the established criteria plus a link to the article itself.

A very useful service, well worth subscribing to, is the U.S. Food & Drug Administration 
Animal & Veterinary Safety & Health Recalls & Withdrawals. Sign  up at that site for frequent updates, warning and recalls regarding medical devices, drugs, cosmetics, foods and veterinary medicine.You might be surprised at the number of recalls constantly happening. Trader Joe’s seems to be having a number of problems in the past few weeks.

Given a prescription for a new drug, I recommend checking it on rxlist.com. This provides readable (as opposed to the 4pt Myopic type size on pharmaceutical companies package inserts) information in areas such as side effects, precautions (note Geriatric effects for that age group), precautions, warnings and contraindications. To cover all bases, double check a new drug with the Pill Finder search on this site. By entering any imprint on the pill and the color, plus optionally the shape, you can verify you are taking the medicine you thought you were prescribed. This way you may avoid one of the significant causes of morbidity and mortality in the health care field, prescribing mistakes and/or pharmacy errors (the latter rarer than actual wrong prescriptions).

An inexpensive fee-based database of information on supplements is available from consumerlab.com . For $36 a year or $59 for two years, you can check on quality and cost comparisons in laboratory tested product reviews of over 1,000 supplements by brand. In addition, there is an online encyclopedia of natural products plus recall and warning notices.

Finally, to avoid being taken in by “health-related frauds, myths, fads, fallacies, and misconduct,” visit Quackwatch. Be sure to read the various explanatory links on this site so you understand the background of the site and its founder, Stephen Barrett, M.D.

The Best Defense Is Preparation

I don’t as a rule repeat blog postings, but for two reasons I am re-posting a blog from February 27, 2013.
1) I have gained some new subscribers over the past year, and there are particular postings that I consider more important than others in the area of protecting yourself from medical errors.
2) I intend to pursue a line in the next few blogs that follows the most recent post on medical information. That is, rather than focusing on all the problems that may occur in hospitals or with the health care system, I want to talk about being pro-active in arming yourself with the best information before you encounter a health professional.

Here is the post describing a book I believe every potential patient should own before visiting a doctor. It is still available through Amazon.com but perfectly good used copies can be found in my favorite used book source, bookfinder.com.

When you visit a primary care doctor (or specialist) for a specific problem or symptom that has been troubling you, one of the most important questions you can ask your doctor, after he or she gives you a diagnosis is, “What else could this be?”  Jerome Groopman, M.D., in his book How Doctors Think includes this in a list of five questions titled, “Questions to Make Your Doctor Think.” This book is one of the most important publications for the lay person, which anyone interested in their own health should own.

The reason Groopman includes these questions is a study that found many doctors make up their minds about a diagnosis in the first four minutes of a consultation and then, following a flow-chart approach, where each step is based on a yes or no answer to the preceding step, proceed to a solution, never realizing they may have gone off track early on in the interview. Here are the rest of Groopman’s questions:

  •       Tell the doctor your story afresh—as if he/she had never heard it before.
  •       What is the worst case scenario for the symptoms?
  •        Is there anything about your diagnosis that doesn’t fit the symptom(s)?
  •       Is it possible that I have more than one problem?

There’s no doubt that this process may add a little time to the interview, but if your doctor objects or starts looking at the clock, you might want to consider another doctor.

The importance of the above is strengthened by a recent study at the Johns Hopkins University School of Medicine in Baltimore. Dr. David Newman-Toker at Johns Hopkins wrote a commentary on the study, telling Reuters Health that, “”We have every reason to believe that diagnostic errors are a major, major public health problem.” “You’re really talking about at least 150,000 people per year, deaths or disabilities that are resulting from this problem.”

The study was based on electronic health care records tracking 190 errors in diagnosis made during primary care visits at one of two healthcare locations. “In each of those cases, the misdiagnosed patient was hospitalized or turned up back at the office or emergency room within two weeks.” Nineteen percent of the errors caused permanent damage and 14 percent died.  The kinds of inaccurate diagnoses varied, including “Pneumonia, heart failure, kidney failure and cancer, each accounted for between five and seven percent of conditions doctors initially diagnosed as something else.” The full study is “Types and Origins of Diagnostic Errors in Primary Care Settings,” found online in JAMA Internal Medicine. A similar study in the same publication, “Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors,” covered “669 cases were reported by 310 clinicians from 22 institutions. After cases without diagnostic errors or lacking sufficient details were excluded, 583 remained. Of these, 162 errors (28%) were rated as major, 241 (41%) as moderate, and 180 (31%) as minor or insignificant.”

The leader of the study, Dr. Hardeep Singh from the Houston VA Health Services Research and Development Center of Excellence, said most of the problems occured because of fairly common complaints like mild breath shortage and a bit of a cough. The primary care doctor might diagnose bronchitis, but two days later the patient could be back with heart failure. Singh stressed the importance of patients coming to the doctor with “all of the relevant information about the nature and timing of their symptoms.” Newman-Toker added, “”I do think it’s important for a patient to question or observe the doctor. Ask pointed questions: ‘What else could this be? What things are you most concerned about?'” In addition, Newman-Toker told Reuters Health that patients should  “not just assume that once the diagnosis has happened the first time, that everything is said and done and that it’s all over. You just can’t have blind obedience to the doctor’s diagnosis.”

Finding Medical Information Online

Out of the millions of Web pages, how can you find valid medical information? Using general search engines is not the best approach
Nowadays, anyone who receives a medical diagnosis, particularly of a serious condition in himself or herself or a loved one, may turn to resources on the Web. In the worst case, you or someone you care about is either in or about to enter one of the most dangerous places in the country—a hospital. Getting the best information possible is critical.
Typically, people will try one of the major search engines such as Google. If you have experimented at all with online searching, you have seen the incredible number of “hits” that can be retrieved—often in the hundreds of thousands or even millions. For example, a simple search of Google on lung cancerfinds more than 39 million pieces of information. If you use Google’s advanced search technique to find that specific phrase (click on Advanced Search or enter the words within quotation marks), this only reduces the results to over 27 million pages—hardly a manageable amount.
Figuring out which are the most authoritative from this huge mass of information is close to impossible. While there are general guides for trying to judge the value of web pages, there is a better way. With a little practice, you can access the same detailed medical information that health care practitioners use. In the next paragraphs, I’ll describe some basic ways to get at and retrieve information from major medical databases.
The largest and most respected collections of online medical information are the U.S. National Library of Medicine (NLM) databases. Before the days of general public access through the Web, the NLM maintained a computer database of medical information called Medline. All of this information and considerably more is available to anyone with Internet access. The general link is through a service called PubMed and you can visit the starting point through this link: U.S. National Library of Medicine. These databases include more than 24 million citations to biomedical information with abstracts or even full text from MEDLINE and other life science journals for biomedical articles back to the 1950s. Even if the full text is not available for free, either your doctor, who probably has a subscription or the local public library should be able to order a copy for you.
The above URL leads right to a search page. Still, with so many articles and books indexed, just typing in a simple phrase like lung cancer today found 248,483 references. (NOTE: All retrieved numbers of citations in this article are examples taken from a search at the moment of writing; the results change constantly.) Even using quotation marks to restrict the search to the phrase only reduced the result to 98,580. This is where some more sophisticated searching techniques come into play.
The phrase lung cancer seems to be the obvious way one might look for information on this disease. However, medical personnel, particularly researchers, do no always use common terms. If you try what you think is obvious, almost certainly you will miss things or get too many hits. Better than this scattergun approach, take some time to learn about PubMed. It will pay off in the end.

On the bottom part of the original PubMed page, you will see a list of helpful links. Start with the links in the left hand column under Using PubMed:

  • PubMed Quick Start Guide
  • Full Text Articles
  • PubMed FAQs
  • PubMed Tutorials
  • Then explore the link MeSH Database link under “More Resources” in the right-hand column where there are Help and Tutorial guides.
    Still using lung cancer as an example and searching the MeSH database, it appears the preferred term is “lung neoplasms.” Scanning down the list that appears is a row reading “Allowable Qualifiers” that looks like this: BL BS CF CH CI CL CN CO DH DI DT EC EH EM EN EP ET GE HI IM ME MI MO NU PA PC PP PS PX RA RH RI RT SC SE SU TH UL UR US VE VI. These are all links. Click on any two-letter code to see an explanation of the qualifier and its use. For example, TH stands for Therapy in the broadest sense and does not include specific forms of therapy. There are more specific terms such as DH (diet therapy), DT (drug therapy), RT (radiotherapy) and SU (surgery). As you begin to use MeSH and PubMed, it will be easy to remember the specific abbreviations most useful but these always can be checked easily.
                The other useful technique in searching PubMed is an understanding of something called Boolean searching. There are three basic Boolean terms (there are more but not used as often), AND, OR and NOT. AND simply tells the search engine to make sure two terms separated in the search entry must both be present. OR says give me hits with either term. NOT does what you would expect, makes sure a term is not present in any hits. Why use this? One example might be when there are many studies that include patients of all ages but your interest is only in the elderly. Using “NOT child” in the search string will narrow down the results.
    Armed with these techniques, let’s carry the example further and assume we are interested in any dietetic approaches in the treatment of lung cancer. Return to the PubMed entry page from the first link above. In the Search Box at the top of the page enter (without the quotes) “lung neoplasms.” The result today was 216,025 articles. Now revise the search by adding “AND DH.” The result is 404 hits. In the left hand column is an option to restrict the results to free full text. Click on this and see 118 full text articles available without charge. Some results are extremely complex; others easier to comprehend. When you find an interesting one such as “Estimated intake of vitamin D and its interaction with vitamin A on lung cancer risk among smokers,” click on it to see the full article. If the result looks truly useful, then scan in the right-hand column for related articles.
    You are not limited to just the subheadings that you saw on the MeSH page either. Once you become familiar with the way the AND, OR, NOT operators work, you can do freewheeling searches directly in the PubMed databases. For example, a hot topic for several years in the prostate cancer area has been the use of pomegranate juice in prevention and perhaps even treatment. Just enter “prostate cancer” AND “pomegranate juice” using quotes this time in the PubMed search box. It is better to use the actual quotation marks on phrases to narrow the search when you are not using MeSH terms. You can get even fancier with your searches.
    There are far more capabilities in using PubMed than I can discuss in this already lengthy blog entry. I’ll mention just one more very worthwhile online source, the Clinical Trials database, http://clinicaltrials.gov/. Here you can locate ongoing trial approaches. Enter congestive heart failure in the search box on this site, mark the checkbox for only open studies and find 1,355 studies.
    Searching PubMed can be tricky, but in these days of ever-expanding medical knowledge, it is important to be an informed consumer of medical services, particularly when facing a disease.