Patient Power! 

THE Internet has given rise to an empowered and better-informed
citizenry and never more so is this apparent as in a subject as personal
and affecting as healthcare. 

By all accounts, the proliferation of medical Web sites has enhanced the
patient-doctor relationship. The ill and their families are more
prepared, and have greater understanding of the issues involved, while
the medical community can reach out in ways never before possible. 

"Visits are now focussed on the real concerns and specific questions
about their condition or symptoms as a result of a pre-visit done in the
privacy of their home. When patients know what to ask, the results are
often more satisfying to all," says pediatrician Dr Paula Elbirt who
operates her namesake Web site drpaula.com. 

Chief operating officer at drkoop.com Dennis Upah agrees. He says that
consumers are taking charge and control of their interactions with
physicians. "We¹ve gone from a period of physician talking and the
patient listening to a true dialog as a result of a more empowered and
educated consumer," he adds. 

Upah points out that this also created better doctors because an
enlightened patient is one that brings information to the physicians.
"Good physicians are never threatened by that. In fact, they undoubtedly
look up the information themselves immediately after the patient leaves
the office," he said. 

But how do you tell the bonafide from the online quacks? Internet users
often ignore warnings on such sites that information given should be
validated by a physician. 

Is There a Quack in The Mouse? 

Dr Paula in an e-mail response says that medical information on the Web
is subject to the same potential errors, and may deliberately mislead,
as medical information obtained elsewhere. 

"Claims made that seem extraordinary are not likely to be valid but at
least looking for peer-reviewed literature supporting the claims are
likely to result in getting valuable info," she points out. 

She advises consumers to check credentials of all professionals by
searching for their history at major medical associations. "Be wary of
degrees that are not licensed and always check with your own physician
before trying any treatment recommended on the Net," she reiterates. 

Upah, also in an email, proposes that consumers deal with trusted brands
and sources of content that clearly disclose both the author and any
financial relationship that may have tainted the content itself. "This
information should be clearly posted directly on the article and the
site itself," he says. 

Malaysian physician and Web site operator Dr Muruga Vadivale says that
consumers can verify information by looking for the Hon Code or Medinex
logo or similar certified sites. "There is no guarantee, but chances
that the information is authentic are better." 

Nonetheless, quack sites are quite difficult to spot, according to
consultant physician and haematologist Dr Alan Teh. He recommends
consumers check out Quackwatch or Federal Trade Commission for recent
postings. Due to the sheer volume of misinformation on the Net,
consumers must develop a critical mind and the ability to filter out
unreliable information, Dr Teh adds. 

Most medical professionals agree that the Net is a proven resource to
families with ailments, chronic diseases and life-threatening illnesses.
Public discussion boards and advocate groups have created useful and
supportive online communities. 

At drkoop.com, there are 130 chat support groups peer-led by a person
who either has the condition or a specific interest in the condition.
"Interest and involvement in those communities continue to grow." 

Adds Dr Paula: "The suggestions shared between families dealing with
similar illnesses can be invaluable and this information would not have
been easily obtained without the far reaching arms of the Web." 

Medical practitioners too have developed a healthy camaraderie online.
Dr Teh set up a mailing list for doctors in 1996. Within a year, it grew
to a doctors-only bulletin board system or Dobbs providing doctors a
forum to discuss sensitive issues privy to the group. To date, 700
Malaysian doctors have registered with Dobbs. 

"Solo practice can be quite a lonely experience. Dobbs has enabled
doctors to reach out to fellow colleagues no matter how remotely
situated, as long as they have Internet access," he confides. 

Doctor Dotcoms 

Upah adds that drkoop.com recently announced a Physician "Dashboard,"
which provides physicians with browser-based access to real-time patient
results, clinical databases, eligibility verifications and much more
that will be available to physicians in the third quarter of this year. 

"It¹s extremely expensive to set up a Web site, and unless a doctor has
the business acumen to raise millions of dollars and the willingness to
subject themselves to a level of celebrity scrutiny like they¹ve never
been subjected to before, they may be better-off participating in one of
the initiatives already set up," he adds. 

drkoop.com was set up by the former US Surgeon General, Dr C. Everett
Koop and attracted a huge following based on branding alone. Says Upah:

"It certainly helps to have a recognizable brand to exist in a very
cluttered environment." 

Yet not every doctor needs to have star status to start a Web site. Dr
Paula believes that doctors can also grow their credibility if they
start a site for their own practice first. 

"Invite your patients to ask the doctor a question and post the answers
in an open forum. The availability of this alone will attract a crowd.
If you are compassionate and competent, your site will flourish despite
not having a superstar name," she says. 

Dr Paula also advises doctors operating Web sites to be creative and try
to avoid advertising as a revenue source. 

The pediatrician, who is on the staff of three prestigious New York
Hospitals, set up the site because she felt frustrated at not being able
to share and teach what she does to a larger number of people. "I love
my day-to-day practice but the Web has allowed me to reach out and touch
a lot of Osomeones¹. The end of the road is not visible and I intend to
keep it that way—good outcomes come from chasing dreams." 

Similarly Dr Vadivale designed his own homepage five years ago just to
see whether he could do it, and later as a means to access his favorite
Web sites from anywhere. 

"That all dramatically changed after the enterovirus outbreak in Sarawak
in 1997. Children were dying and the public and medical community were
looking for answers. I researched the information and posted it online.
The response was very encouraging," he recalls. His early success
prompted the Malaysian Medical Association to invite him to write a
Cybermed column for the Malaysian Medical Newsletter on a regular basis.
When Malaysia was hit by the regional environmental crisis, labelled
with the politically-friendly term Haze, Dr Vadivale was asked by his
online following to do something similar. "This time the reaction was
global," he adds. 

First Do No Harm Online

Even as medical Web sites continue to multiply online, the long arm of
the law is rapidly gaining on them. 

The Internet Healthcare Coalition hosted a health summit last month in
Washington DC to forge a set of commonly accepted principles and
international guidelines for ethically administration of healthcare on
the web. 

"We at drkoop.com believe that legislation is needed to make it illegal
to share medical information without user¹s consent. Self-regulation is
also best. That is why we founded the e-Health Ethics Initiative to
develop voluntary standards for minimum content as it relates to
privacy, advertising and content on e-health sites," says Upah. A key
concern online is easy access to drugs even though prescription
practices and legislation differ from country-to-country. 

Naturally drugs under scheduled acts or classified as poisons should not
be made available on the Net. Proper enforcement and hefty penalties are
effective deterrents but a verification system online is necessary
before drugs are prescribed online, says Dr Vadivale. 

Dr Paula advises against buying online drugs, especially generic
medications, unless it is a known source. "Medications have many side
effects and the quality of generic ones are suspicious. Only by giving a
thorough history can someone safely prescribe medication. See a
physician first and once prescribed, ask about using an online source to
order it to save money or for convenience," she says. 

Though the Net is empowering those in need of medical care, Dr Colin Q T
Lee, a Malaysian physician in Toronto, Canada says that empowerment can
sometimes be a hindrance. The net-savvy tend to have less faith in the
diagnosis or the prescriptions, he says. 

But Lee concedes that the Internet has helped patients and physicians
keep up with the vast amounts of new medical information available.
"When patients come to me with information they have downloaded from the
Net that I am unaware of, I make it a point to note the URL and verify
the information." 

However, at the end of the day, Dr Lee who has worked in India and
Africa, says nothing can replace the face-to-face relationship a
physician has with his patients. "I insist patients return to me for any
follow-up. A real-life doctor would be in a better position to judge
whether a patient is better or worse from his return visit and prescribe
accordingly," he says. ends. 

By Anita Devasahayam

Published in CNET Asia, March 24, 2000