Monthly Archives: September 2010

The Online Patient’s Bill of Rights

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We need a bill of rights for online, empowered patients

You are an empowered patient. I know this because you’re reading my blog. You are an empowered patient because you participate in social networking, because you comment on blog posts, because you share links about health.

Social media and health 2.0 allow you to learn about your health, to connect with other patients, to share stories, and to encourage one another. They enable you to become an empowered patient, and empowered patients like you are changing medicine.

This heralds a new model for healthcare, a model where I am less of a paternalistic practitioner and more a professional facilitator. A model where you, the patient, are equipped, enabled, empowered, and engaged — you are an e-patient.

The benefits of patients taking an active role in their health will revolutionize medicine. Patients helping patients and patients helping doctors will be as important to our collective health as doctors helping patients was in the past.

Along with this great promise comes great risk. Engaging in health discussions online means sacrificing your privacy. It means making yourself vulnerable to mortification, to misinformation, and to mendacious drug companies and health providers.

Helping traditional patients become powerful e-patients is also a risk for physicians. Fear of lawsuit is a common reason why physicians do not participate in social media. Physicians are also concerned that information about their private lives might compromise their ability to care for patients.

Consider these other risks:

  • What if your discussion about endometriosis with a few online friends is suddenly shared with thousands of people without your consent?
  • What if photos of you partying on Facebook were used by your health insurer to deny your claim for liver disease?
  • What if a well-meaning online patient gives you wrong advice or alarms you needlessly?
  • What if you were my patient, and you learned about my political or religious beliefs with which you disagreed?
  • What if the information you read online was biased or funded by big pharma?
  • What if the stories and comments you shared on patient community sites were secretly collected by drug or healthcare companies who then used the information to spam you?

Medicine needs empowered patients. Empowered patients need protection. Following President Obama’s kick-off of the congressional Patient’s Bill of Rights last week, let us start crafting The Online Patient’s Bill of Rights. Our own crowdsourced bill will:

  • Protect your privacy in a way that is meaningful online.
  • Ensure that above all, you are treated with dignity.
  • Allow physicians to participate in social networks without paralazing fear of being sued.
  • Ensure that healthcare providers discuss but never practice medicine online.
  • Promote content that is based in scientific and medical truth.
  • Encourage discussion of all healing arts including Eastern medicine, spiritual healing, and natural treatments.

I invite you, patients, physicians, health providers, pharmaceutical representatives, government officials, and insurers to help write this online bill of rights. We’ll sign it together on Wednesday 23 March 2011.

If you would like to participate, then tweet about the bill using hashtag #TOPBOR (The Online Patient’s Bill Of Rights) or join the Facebook group: The Online Patient’s Bill of Rights.

Photo: Robert Huffstutter

Fall Is Here, Time To Change Skincare Products In Your Vanity

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Your skin needs a change this fall, too.

Fall is finally here. It’s time to change the clothes in your wardrobe to flared pants, mid-length skirts, strong-shouldered blazers and power parkas, says Vogue. It’s also time to change your skincare products, says @dermdoc.

Most of us associate changing seasons with changing wardrobes, but it’s also the time to evaluate your skincare routine. Humid, warm air will change to dry, cool air like greens to reds on maple trees. Your skin is a living organ and actively responds to these environmental changes.

  • Dry air means your skin will produce more oils to protect itself.
  • Cool air means that previously flushed skin will pale.
  • Less sun means that thick skin will shrink.
  • Less ultraviolet B light means that tanned skin will fade to allow for maximum vitamin D production.

When you start packing away your shorts and spaghetti strap dresses, remember that your skin needs you to pack away some of your summer products.

  • Dryer, thinner skin is more sensitive; consider exfoliating less frequently. Some scrubs or at-home microdermabrasions should be reduced to once every few days or week.
  • Some retinoids like Retin-A or Renova, can be reduced from everyday to every other day to minimize irritation in fall and winter.
  • Listen to your skin. Is it increasingly red and stinging as the weather changes? You might have to stop some peels or toners completely until spring.
  • Consider switching soapy facial washes to soothing or creamy washes.
  • Change from a lotion moisturizer to a thicker cream moisturizer. If you haven’t moisturized everyday, then you might start now.
  • Depending on how far North you live and your skin tone, you might be able to cut back on sunscreen for winter. Although complete sun protection is the best way minimize all damage to your skin, wearing sunscreen year-round may not be necessary. If you’re not sure, talk to your dermatologist.
  • Remember that even in winter, at high altitudes and where the ground is covered with snow, ultraviolet light can be strong, more like summertime sun. So you always need sunblock when skiing.

Photo: j-No

Poison Ivy Is Having A Great Year

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Poison ivy is growing faster than ever. That’s not the bad news. The tormentingly toxic plant is also packing more rash-inducing resins than ever. Increased carbon dioxide in the atmosphere, of global warming fame, is the cause.

Plants take in carbon dioxide (CO2) and release oxygen. More CO2 leads to happier plants. Because of increased CO2, trees now grow about 10% larger. Poison ivy now grows nearly 150% larger. This is because vines love CO2, which leads to larger-than-ever poison ivy plants. If you’re allergic to poison ivy as I am, then the risk of running into the virulent vine is greater than ever.

But it’s football season, and crisp nights mean the poison ivy growing season is nearly over. So, you’re safe, right? Wrong. You might think you’re less likely to get poison ivy in the fall. I used to think that too until I learned the hard way.

When I was in college I worked as a landscaper to pay my rent. Every fall, without exception, I got my worst poison ivy rash of the year. For a guy who could spot poison ivy at 100 yards in the dark, it always surprised me.

The reason is that the poison in poison ivy stays active long after the leaves fall and plant is dead. When you think you’re raking maple and oak leaves, you often don’t realize you’ve got fallen poison ivy leaves mixed in, like a dye-pack in a stack of $100 bills waiting to explode when you touch it. Fortunately for me there are no leaves to rake in downtown San Diego.

What’s the worst case of poison ivy you’ve had?

Do you have any home remedies for treating poison ivy?

Have you noticed more poison ivy this year?

Photo: Steve and Sarah Emry

Super Glue, Super Smooth, and the Bald Truth

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1. One of the funniest moments of my first decade of life was when my grandmother accidently super-glued her finger to her tooth while trying to fix her dentures. If we had eHow back then, I could’ve told her how to get the super glue off her finger. Instead, I just went back to my Atari. That is, when I could breath again.

2. Less is more, says Cosmo. After polishing your face smoother than marble with this new microdermabrasion, you’ll be able to go makeup free by carrying your own glow. Just don’t over-do it.

3. Dr. Bernstein breaks down baldness on Men’s Health.

Sweating Out Your Toxins

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Can you sweat out toxins?

The guy next to me on the bike yesterday morning was working like Lance Armstrong in training; he had laid towels on the floor to absorb the impressive perspiration he was generating.

He shouted over to me: “I’m hitting it hard to cleanse out the toxins from last night. Too much Captain Morgan and Buffalo wings, ya know?”

“Really,” I said.

“Actually, I’m a dermatologist, and sweat does not contain any toxins,” I said to myself so that he could not hear. (Gym decorum dictates men do not correct men in the middle of a workout — especially if prefaced by “Actually, I’m a dermatologist”). I left him to his aerobics and wrote this post in my head while I finished mine.

You might not want to believe me, but it’s fact: you cannot sweat out toxins. Sweat is composed of 99% water and a tiny percent of salt, urea, proteins and carbohydrates. Salt, proteins and carbohydrates are natural. Urea is a by-product of protein metabolism and is non-toxic. It’s regulated to keep your blood at a healthy pH. Most excess urea is eliminated in urine (hence the name) and a small amount is in sweat.

Toxins like mercury, chemicals, alcohol, drugs, and spicy BBQ sauce are eliminated by your liver and intestines.

Sweat glands, all 2.6 million of them, regulate your temperature — they’re not designed to expel toxins.

The primary ingredient in sweat is pure water. The water evaporates from your skin, cooling you. Excess sweating doesn’t eliminate excess salt or help hangovers. By forcing your body to copiously perspire, you’re only forcing your kidneys to save water (and ironically actual toxins) elsewhere. The water that ends up in the towel on the floor is the precious water you needed to stay hydrated, not a puddle of poison.

In some ways sweat is the opposite of toxic, it’s a vital fluid. When you are working out hard, replace it. I recommend water, not Captain Morgan Rum.

Photo: Lafrancevi