The Smart Searcher: A Guide to Online Medical Advice

The American Heart Association July 2013

Searching the Internet for medical advice can leave anyone with a bad case of information overload. The Internet can be very helpful, of course, but you have to know how to sort the reliable science from the junk.

The first thing to do when reading a medical site is to know your source. There should be an “About Us” tag that tells you who maintains the site and why. If this section is missing, or if the site seems focused on selling something, look elsewhere or proceed with skepticism.

Who can you trust?

The most reliable sources include accredited medical schools, university teaching hospitals and reputable nonprofit organizations such as the American Heart Association. These sites (which end in .edu and .org) provide health information and libraries. Government sources such as the National Institutes of Health, the Centers for Disease Control and Prevention and the Department of Health and Human Services are also reliable. (These sites end in .gov.)

Getting your source is only part of the equation. “You should also check with your healthcare provider,” said Mary Cushman, M.D., a professor of medicine at the University of Vermont Medical School.

“I encourage my patients to share what they’re reading online with me,” said Cushman, also an American Heart Association volunteer. “It’s not just about verifying the credibility of the source. It’s also an opportunity to provide context and follow-up on a topic they may be learning about for the first time. I also point them to sites I trust and approve of.”

If it sounds too good to be true …

You should be especially skeptical of news headlines about miracle cures or unlikely treatment breakthroughs. Again, apply the “know your source” principle.
In general, the most credible research is done in large academic institutions or government centers such as the NIH or CDC. The highest-quality studies are published in “peer-reviewed” or “refereed” journals such as Circulation: Journal of the American Heart Association, the New England Journal of Medicine or the Journal of the American Medical Association. These publications only accept articles that have been rigorously evaluated by medical experts. For a list of peer-reviewed journals, visit Ulrich’s Periodical Directory Online.

According to my best friend’s cousin’s boss …

Medical blogs or chat rooms are a great way to connect with others who share your health concerns, but remember that these people may not be experts.

“You don’t really know who that person is online,” Cushman said. “No matter how good their intentions, don’t take their word for it. Check with your doctor.”

The National Library of Medicine has created a 16-minute online tutorial that teaches you how to evaluate health information on the Web. Find the tutorial here.

Learn more:

Getting a Second Opinion
Heart-to-heart: Talking to Your Doctor
Finding the Right Doctor
A Guide to Understanding Clinical Trials
Also in this section:
Insurance Information
You and Your Healthcare Team
Questions to Ask Your Doctor
Medication Information
Health Trackers

Recent Updates on OTC Medicines Containing NSAIDs

If you’ve seen news recently about OTC non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) in regards to a hearing at the Food Drug Administration (FDA), you may have questions about how to use them safely.

NSAIDs are a class of commonly used pain relievers and fever reducers. NSAIDs have been well researched and have a long history of safety and efficacy when used as directed. It is important to distinguish the use and safety of OTC NSAIDs from that of long-term and/or high-dose prescription NSAID use. OTC NSAIDs, including ibuprofen and naproxen sodium, differ from prescription NSAIDs in indication, dose and duration of use.

The OTC Drug Facts label contains the information that consumers need to determine if the medicine is right for them to use, how to take the product, and when to see a doctor if needed.

Tips for the Safe Use of All OTC Medicines Containing NSAIDs:

Always read the OTC Drug Facts label carefully. The label tells you everything you need to know about the medicine including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.
Do not take an NSAID for longer than what the label instructs unless you are under the supervision of a doctor.
Talk to a healthcare professional before using more than one pain reliever/fever reducer product at the same time.
Stop use and contact your doctor if your fever gets worse or lasts more than three days or if your pain gets worse or lasts more than 10 days.
If you have signs of stomach bleeding, such as feeling faint, vomiting blood, bloody or black stools, or stomach pain that does not get better, contact your doctor.
If a severe allergic reaction occurs and you experience symptoms such as hives, facial swelling, asthma (wheezing), shock, skin reddening, rash, or blisters, seek medical attention immediately.
Do not take more medicine or for a longer period of time than what the label recommends unless you are under the supervision of a doctor.
Ask a doctor before use if you have high blood pressure, heart disease, liver cirrhosis or kidney disease.
If you are pregnant or breastfeeding, talk to a doctor before using an NSAID.
If you are a woman in the last three months of pregnancy, do not use an NSAID unless you are specifically told to do so by a doctor.

ADULT ONSET OF ASTHMA

SOURCE: This information should not substitute for seeking responsible, professional medical care. First created 1995; fully updated 1998; most recently updated 2005.
© Asthma and Allergy Foundation of America (AAFA) Editorial Board

What is Asthma?

Asthma is a common disease that affects the lungs. About 15 million Americans have asthma. People who have asthma may experience wheezing, coughing, increased mucous production and difficulty breathing. These symptoms are caused by inflammation and/or obstruction of the airways, which transport air from the nose and mouth to the lungs.

People with asthma may have allergies “triggered” by various allergens. Allergens are substances found in our everyday environment

What is Adult Onset Asthma?

Many people develop asthma in childhood. However, asthma symptoms can appear at any time in life. Individuals who develop asthma as adults are said to have adult onset asthma. It is possible to first develop asthma at age 50, 60 or even later in life.

Adult onset asthma may or may not be caused by allergies. Some individuals who had allergies as children or young adults with no asthma symptoms could develop asthma as older adults. Other times, adults become sensitized to everyday substances found in their homes or food and suddenly begin to experience asthma symptoms. About 50 percent of older adults who have asthma are allergic.

Who Gets Adult Onset Asthma?

We do not know what causes asthma. There is evidence that asthma and allergy are in part determined by heredity.

Several factors may make a person more likely to get adult onset asthma. Women are more likely to develop asthma after age 20. For others, obesity appears to significantly increase the risk of developing asthma as an adult.

At least 30 percent of adult asthma cases are triggered by allergies. People allergic to cats may have an increased risk for developing adult onset asthma. Exposure to cigarette smoke, mold, dust, feather bedding, perfume or other substances commonly found in the person’s environment may trigger the first asthma symptoms. Prolonged exposure to certain workplace materials may set off asthma symptoms in adults.

Hormonal fluctuations and changes in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can develop asthma symptoms for the first time. An ongoing Harvard Nurses Health Study found that women who take estrogen supplements after menopause for ten years or more are 50 percent more likely to develop asthma than women who never used estrogen.

Different illnesses, viruses or infections can be a factor in adult onset asthma. Many adults first experience asthma symptoms after a bad cold or a bout with the flu.

Adult onset asthma is not caused by smoking. However, if you smoke or are exposed to cigarette smoke (secondhand smoke), it may provoke asthma symptoms.

What are the Signs and Symptoms of Adult Onset Asthma?

Asthma symptoms can include:

Dry cough, especially at night or in response to specific “triggers”

Tightness or pressure in the chest

Difficulty breathing

Wheezing—a whistling sound—when exhaling

Shortness of breath after exercise

Colds that go to the chest or “hang on” for 10 days or more

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New Peanut Therapy Alters DNA

By Shannon Firth Jan. 31, 2014
In the not too distant future, kids with peanut allergies may be able to chomp into sandwiches, candy bars and cookies without their parents fretting that their throats might close up, thanks to new experimental research which has found concrete differences in the DNA of people allergic to peanuts.

At the moment, the best advice doctors can give to those who suffer from peanut allergies is avoid peanuts and carry an epi-pen. But researchers have made amazing strides using new technologies to better understand peanut allergies and how to treat them.

“The biggest impact of this study is that we were looking for mechanisms, and we found them at the DNA level. Now the next question is how sustained are they at the DNA level and whether they can be passed on,” says senior author Kari Nadeau, a physician scientist at Stanford University, who is also an allergist and immunologist.

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Using blood tests and DNA sequencing technology, researchers at Stanford University were able to successfully predict which subjects with peanut allergies would react to a peanut test and which had grown tolerant after more than two years of an experimental therapy that exposed subjects to the very source of their allergies. The answer lay in a protein nicknamed FOXP3.

Researchers at Stanford University divided their peanut-allergic subjects, into two groups: one group of 23 subjects was given a nearly invisible speck of peanut flour mixed in with food, usually apple sauce, while a second group of 20 subjects was told simply to avoid peanuts.

Everyday the subjects in the experimental group would eat just a speck of flour. And every two weeks, their dose would increase by 25 percent. Both groups would return to the lab every three months where researchers would assess their reactivity to peanuts in a protected environment. After two years, those who were successfully treated could tolerate 4000mg of protein, about half a tablespoon of peanut flour.

Patients wanted to know whether they would have to continue to eat peanuts everyday for the rest of their lives if they wanted to stave off an allergic reaction, so researchers and Stanford looked for an answer. They stopped patients from taking their daily dose of peanut flour for three months then tested their blood and sequenced their DNA. At 27 months, seven patients passed the challenge and showed no “detectable allergic reaction” to a peanut test. But after another three months of withdrawal from treatment – at 30 months into the trial – only three subjects continued to have a strong immune response.

The determining factor, says Nadeau, was the effectiveness of certain T-cells, a type of white blood cells known as “peacekeepers” because they suppress other “bad actors” – the cells that trigger allergic reactions.

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Researchers next wanted to understand why allergic people’s T-cells are weaker than others. They found their answer by looking at their subjects DNA at a very specific type of protein using a groundbreaking new type of research called epigenetics and a certain gene called FOXP3.

“FOXP3 is a marker in our body that can help us with decreasing allergic reaction,” says Nadeau.

“Kids who are born without it actually have horrible allergies and autoimmune disease. Most all people have FOXP3 but the question is how is it modulated,” she added later.

Epigenetics looks at tiny globs of genetic material, that scientists used to think were junk. Now we know that this extra DNA is not junk and actually changes how our DNA is expressed. Sometimes these globs cause the DNA to produce proteins and sometimes they stop the DNA from producing proteins. But in the case of people with peanut allergies, this extra layer of DNA is harmful. Getting rid of these globs, these chemical modifications actually improve T-cell function so that the body can fight allergic reaction.

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