An engaging and informative look at the real science behind our most common beliefs and assumptions in the health sphere
There is a lot of misinformation thrown around these days, especially online. Headlines tell us to do this, not that-all in the name of living longer, better, thinner, younger. In Hype, Dr. Nina Shapiro distinguishes between the falsehoods and the evidence-backed truth. In her work at Harvard and UCLA, with more than twenty years of experience in both clinical and academic medicine, she helps patients make important health decisions everyday. She’s bringing those lessons to life here with a blend of science and personal stories to discuss her dramatic new definition of “a healthy life.”
Hype covers everything from exercise to supplements, diets to detoxes, alternative medicine to vaccines, and medical testing to media coverage. Shapiro tackles popular misconceptions such as toxic sugar and the importance of drinking eight glasses of water a day. She provides simple solutions anyone can implement, such as worrying less about buying products labeled organic or natural, and more about skipping vaccines, buying into weight-loss fads, and thinking you can treat cancer through diet alone. This book is as much for single individuals in the prime of their lives as it is for parents with young children and the elderly.
Hype provides answers to many of our most pressing questions, such as:
*Are online doctor ratings valuable and what conditions can you diagnose online?
*What’s the link between snoring and ADHD?
*What does “Doctor Recommended” and “Clinically Proven” mean?
*Do “superfoods” really exist?
*Which vitamins can increase your risk for cancer?
*Do vaccines introduce toxins into the body?
*What’s the best antiaging trick of the day that’s not hype?
*Can logging “ten thousand steps a day” really have an impact on your health?
Never has there been a greater need for this reassuring and scientifically backed reality check.
|Publisher:||St. Martin's Publishing Group|
|Product dimensions:||5.60(w) x 8.40(h) x 1.20(d)|
About the Author
Kristin Loberg is the #1 New York Times, Wall Street Journal, and USA Today bestselling co-author of Grain Brain, A Short Look at a Long Life and others. She attended Cornell University and lives in L.A. with her husband and two sons.
Read an Excerpt
A SITE TO BEHOLD: THE WILD WEST OF INTERNET MEDICINE
How to Yelp Your Doctor, Check Your Symptoms, and Google If You're Dying
Does the internet have quality health information?
How do you know if a website is legitimate?
Are online doctor ratings valuable?
What can you diagnose online?
Not too long ago, a friend emailed me late one evening: "Just wondering — my daughter [about fifteen months old] pooped out white poop — I looked it up and it's either something she ate or she has acute liver failure and needs to be rushed in to surgery. What should we do?"
Well, he had already looked it up, which saved me some time, as neither of these possibilities was in my knowledge toolbox. I hadn't thought about other people's poop since my own kids were in diapers, and even on those poops I tried not to focus. While I reassured this pal, via email, since nobody talks to anyone anymore, that this was likely nothing to worry about, I was struck by his well-prepared differential diagnosis of white poop, all from the touch of a button. No, he's not a gastroenterologist, medical resident, or surgeon. He's a movie director. But in under three minutes, he learned the possible causes of white poop. Another friend, who is a doctor, tragically lost her eleven-year-old dog by sudden death. "I'm not sure how this happened. Dogs just don't die like that," her vet declared. But this one did. At the touch of a button, this doctor for humans quickly learned about the potential causes of sudden death in dogs. My nine-year-old son wanted to know the score of a recent Golden State Warriors game. He doesn't have his own computer, so he asked Alexa, Amazon's version of a voice-activated internet knowledge base.
Our internet-based access to knowledge is boundless. From poop to death to basketball, nary a question cannot be answered somewhere online. This has changed the world as we knew it just one to two decades ago, and the world will continue to be changed by the ever-expanding growth of this technology. On a smaller, albeit pretty important, scale, it has altered the way medicine is learned and practiced, the way health care is delivered, and how non-medically-trained individuals access knowledge about their own health and that of their families, including their pets.
When I first became a member of our institution's interdisciplinary craniofacial team, which consists of surgeons, geneticists, nurses, dentists, orthodontists, speech pathologists, audiologists, and social workers, who work together to treat children and families with complex facial abnormalities, we always had a copy of the venerated Gorlin's Syndromes of the Head and Neck at the workstation. This tome contained descriptions, including photographs, and information on associated medical issues and the genetic heritability of nearly every syndrome seen in humans, from the most common such as Down syndrome to less common ones such as Apert syndrome, to the extremely rare such as Cornelia de Lange syndrome. More often than not, the team would come across a patient with a disorder with which we were not familiar. The lot of us would gather over the dog-eared pages of this textbook to try to find what the patient had, based on the physical findings and genetic testing. I still have my own copy of Gorlin's in my office, but I haven't cracked it in years. Nowadays, if a child comes in with an unknown disorder, we, just as my friend the movie director, can tap in descriptions of facial features, genetic testing, and other parts of the physical exam, and in less time than one would have taken to thumb through an index, our laptop, desktop, or even phone will spit out a nifty list of possible diagnoses.
Resident teaching conferences in past years used to involve harsh grilling sessions, where we attendings would present a patient to the group, pick the most anxious-looking trainee, and expect the trainee to recite the most current literature from the journal articles he or she had copied that morning. In the hour before these conferences, the residents would huddle in a small office, flipping through pages of articles they had collectively found that morning or the evening before. Nowadays, before we even finish asking the question, residents are using just two thumbs to type in the query on their smartphone, and a list of possible article references from sites such as PubMed or Google Scholar pops up in a heartbeat. While we no longer get to see the trainees sweat it out, this remarkable improvement in access to information has changed medical and surgical training worldwide. Not only does one have access to the latest research articles, one can see videos of surgeries, of diagnostic studies being performed, and even of patient testimonials. The downside is that little if any thought is required in searching for information, and while academic institutions may have more ready access to scholarly publications, we as doctors primarily see the same sites and articles seen by nonmedical Web searchers. While we do have access, via our university or hospital passwords, to more academic sites such as PubMed and Google Scholar, we often see the same articles that our patients can see.
Not only are we looking up new information online, we are looking at patient information nearly exclusively online. The days of paper charting and file rooms are history. Electronic medical record systems are now used for an overwhelming majority of patients, initially meant to streamline and unify care. In many ways, they have. In my institution, I can find information about other physician visits, I can view laboratory test results, X-rays, and operative reports. In the near future we will be able to link this to other hospital systems, to provide an even wider net of coordinated patient care. Patients can also communicate with doctors via such record sites, via an in-network emailing system, and they can securely access their own records, without having to request reams of paper charting from a medical records department. All sounds great, right? Well, nothing is perfect.
Physicians are now even more locked in to charting, with the cumbersome requirements to click boxes and fill in fields that are, for the most part, completely irrelevant to patient care. Electronic medical record-keeping has led to increased charting time, decreased direct patient interaction (doctors now look at screens, not patients), and to its share of errors. In the heyday of the Ebola virus epidemic of 2014, when it had entered the United States, a man who had recently been to Africa came to an emergency room in Texas with fever and fatigue. The electronic medical record system had autopopulated his recent travel history after he mentioned it to his initial caregiver, but then a provider taking over didn't notice this critical piece of information. The man was sent home from the emergency room with a diagnosis of a mild flu-like illness, but he had an active Ebola virus infection. Computers can take over a lot of work, but not human-to-human contact. Had the providers communicated directly, as opposed to relying on the clicks on a screen, the man's travel history would likely have set off concerns for his diagnosis. Our increasing use of automated health-care information is growing as exponentially as our decreasing use of human-to-human communication.
WHY IT'S SO HARD TO CHANGE YOUR MIND
Nothing in medicine is black-and-white, but there's plenty of sound data — if you can find it — to help you make the best decisions. The problem is, many people choose the wrong options based on misinformation, or they continue in erroneous beliefs and biased opinions, accepted as dogma, despite irrefutable evidence to the contrary.
The explosion of widely available health-related information leads to misinterpretation, and Americans more easily trust people with high profiles, fancy websites, lots of likes and followers on social media, and stories that tug at our heartstrings than dry medical data with no real people attached to the graphs on a page. Joseph Stalin, Russia's notorious dictator in the first half of the twentieth century, once said, "The death of a man is a tragedy; the death of a million is a statistic." People are more apt to trust doctors with shiny ads, oftentimes pseudo-accolades, and posh waiting rooms than those with yellowed, tattered lab coats, tacky artwork in the hallways, and receptionists who are neither models nor wannabe actors. Websites that look nice may be more appealing than those without bells and whistles that provide more solid, albeit bland, information.
While my office is an academic one, we have some pretty nice chairs, a wide-screen TV in the waiting room, and state-of-the-art technology. We're a well-dressed group, and our lab coats are clean. But don't be fooled by appearances. We are academicians who aim to provide evidence-based care. We don't just pose for glitzy websites — we write the peer-reviewed articles, we review the peer-reviewed articles, deeming them worthy or not worthy of publication, and we sit on editorial boards of peer-reviewed journals. We've sweated in labs, given licensing exams for board certification, and treat all comers in our emergency rooms. When we're not in the office with new floors and laser machines, many of us are working in county facilities and VAs. That being said, many of us, myself included, have individual websites. My site is informational — I do not advertise my practice per se. I do, however, promote books and media events. Thanks to the power of the internet, I can track when people are looking at my website, what their landing page is, how long they stay on the site, what city they are in, their search engine, etc. Many are viewing my website while in my waiting room. How do patients know that the information on my site is reliable, accurate, up-to-date, and unbiased? They don't. But they've come in to see me, so they likely have some preconceived notion that what I say must be right. Right?
When patients entrust their care to a given doctor, deciding that doctor is trustworthy, it links to an ever-increasing challenge in health circles that is adding to the confusion: the "Curse of the Original Belief." Once you believe in something, it's hard to change your mind, despite evidence to the contrary. This can be harmful to individual and public health, as well as divert people's limited attention from real dangers. If they like a doctor, they will like their website, and vice versa. I've heard countless conversations along the lines of "That doctor charges [X] dollars, just for a consultation. She must be the best." Preconceived notions of most anything — a place, a culture, a religion, a gender, or, in this case, good medical care — are hard to change. As open-minded as you might think you are (or want and strive to be), internal bias is real, and not necessarily a sign of overt discrimination. This has been studied on countless occasions in training human-resource professionals how to recognize, and ideally avoid, bias. But this takes conscious effort. The unconscious bias related to what you think should be good more often than not overtakes your ability to assess a situation from scratch.
THE GOOD AND BAD SIDE OF GOOGLE (AND OTHER SEARCH ENGINES)
Perhaps more noteworthy than any individual website, newspaper, television show, or magazine is the behemoth Google. This amazing power has become so widespread worldwide that, in 2006, both The Oxford English Dictionary and Merriam-Webster's Dictionary added google as a verb to that year's print and online editions. And you can google that. Don't get me wrong: Google is an amazing entity. I use it all the time — all doctors do — and one of its offshoots, Google Scholar (scholar.google.com), is a bona fide academic search engine. Google Scholar's titles are listed both chronologically and by topic. The list order is also determined by the number of citations a given article has received in academic publications. In academic circles, the number of times a given article is cited in other academic articles is one metric to measure its quality, validity, reproducibility, and even popularity.
Google has many strengths, yet some of these strengths, such as rapidity of high-volume information, order of information provided, and how that order is determined, can be quite skewed, especially when it comes to searching medical information. Let's try googling something commonly searched: breast cancer treatment. No surprise that it's frequently searched given that women have a one-in-eight lifetime risk of getting breast cancer (meaning that for every eight women in the United States, one will be diagnosed with breast cancer during her lifetime). When I googled this term, it took 0.52 seconds to come up with 110 million sites (the dynamic nature of the internet means you may find a different number of sites). Enough information for you? Should keep you busy while in the doctor's waiting room. But look a little closer. The top four sites are advertisements (you will load pages that are different from what I see today, but the gist of this lesson remains the same). That green ad box should be an alert that the site is biased, or at least commercial in nature. This does not necessarily mean that it is bad, inaccurate, or trying to swindle you, but it is what it is — an advertisement. The American Cancer Society's page doesn't appear until number five. At the bottom of Google page one are three more ads. Page two is similarly laid out — four ads on the top and three on the bottom of the page. Page three is no different. You get the point. These are what draw the eye in. They are the first sites you see, and the last, giving you one more chance to click on a visually pleasing ad before going to page two. Despite the 109-million-plus other sites you have access to, few people will get beyond two pages of a Google search, even though close to half of those sites presented are advertisements.
These Google ads, or AdWords, are a great way for a business to grow. The business has an incentive to use Google AdWords because the payment system is tiered; the business only pays when the ad is clicked or a visitor links to the business from the ad on the Google page. It is a slightly less blatant way to advertise, as payment is only made when the ad sees results, translated as site traffic. The larger issue than advertisements is SEO, or search engine optimization. In this free technique sites use specific key words to drive internet traffic/visitors to their site. This technique will bring in more users and will, in turn, get the site higher and higher on page one of a Google search. Because it is not inherently seen as advertising, it can be thought of as more genuine, informational, and unbiased. In general, this technique is considered legal and, more important, useful. For instance, if you are searching for symptoms of the flu, a site with key words such as fever, body aches, cough, fatigue, and flu shot will likely pop up higher than a site that just has fever as a key word. The gray area comes when SEO becomes SEM, or search engine manipulation. This is, indeed, a domain of vague terms. With SEM, a site overuses, or improperly uses, key words, overstuffing Web pages, and even creating false, or spammed, links. While this practice has led to lawsuits and penalties, it is hard to regulate the fine line between SEO and SEM.
So how does one possibly assess the validity of this glut of information on such an important issue as breast cancer treatment? Some basics to know are, first, whether the site is an ad. Again, it doesn't mean it's wrong, but it does mean it's biased, by virtue of being paid for by the site to Google if you click on the link. Second, look at those three letters after the dot: .com is commercial; .gov is government funded;. org is a nonprofit organization; .net is internet based, similar to .com; .edu is an educational site, usually tied to a university, private or public. There are a multitude of other codes, but those are the biggies. The number one site on page one of Google for breast cancer treatment is a.com pharmaceutical-company site, advertising a particular drug for metastatic breast cancer. While it also provides information, the first visual you see is the company's name, the logo, and the name of the drug.
Google recently developed a more tongue-in-cheek reputation when the actress Jenny McCarthy claimed that her knowledge of the vaccine/autism connection was obtained at the University of Google. She is not only an actress, mom, and strong advocate for her son, but also a comedian. While she said this partly in jest, she wasn't kidding. This comment went viral, providing more and more fodder for those who found her claims to be unfounded. How can one possibly consider Google to provide such university-level authority on major health issues? Let's check again. When I google vaccine/autism, I am provided with a mere 1,050,000 sites in 0.54 seconds. Thankfully, the breast cancer treatment search beats out vaccine/autism by about 108 million. The format is the same — four ads on the top of page one, three ads on the bottom, and the same goes for page two and beyond. As this was and remains a controversial issue, some of the sites are relaying information about how vaccines cause autism, and other sites are relaying information on how they don't. Let's assume for a moment that you have been living on another planet and have never heard or read anything about this controversial issue. The overwhelming extremes of differing information, both appearing quite dogmatic and true, are startling, if not confusing.(Continues…)
Excerpted from "Hype"
Copyright © 2018 Nina Shapiro.
Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction: Worrywarts and Fearmongers ix
The Dangers of Magical or Misinformed Thinking
1 A Site to Behold: The Wild West of Internet Medicine: How to Yelp Your Doctor, Check Your Symptoms, and Google If You're Dying 1
2 Risky Business: What Ebola And Your Car Have In Common: How to Put Risk into Perspective 19
3 Turf Wars: An Important Lesson in Correlations: How to Understand Cause, Link, and Association 46
4 Get Me off Your F*Cking Mailing List: A Study Worthy of Your Attention: How to Make Sense of Medical Research Jargon 66
5 Tipping the Scale on a Balanced Diet: You are not Always What You Eat: How to Filter Out the Noise on Juicing, Going Gluten-Free, Detoxing, and GMOs 82
6 Fat-Free Sugar, Organic Cookies, and "Fresh" Produce: A Walk Through the Supermarket: How to Read a Label 101
7 The True Cost of Being Fortified: Supplements, Powders, and Potions: How to Remain Vital Without Vitamins 117
8 Raise Your Glass: Water, Water, Everywhere: How to Be Smart Without Drinking Smart Water 132
9 Putting the C Back in Cam: Complementary Alternative Medicine: How to Stay Natural While Taking Your Medicine 149
10 Take A Shot: The Perils of Losing The Herd: How Vaccines Save the Community, the Home, and Your Health 167
11 Testing, Testing, One, Two, Three: From the Outside Looking in: How to Determine When to Get Checked, X-rayed, Swabbed, or Poked 192
12 When 50 is the New 40: Drinking from the Fountain of Youth: How to Age Gracefully, Without Really Trying 212
13 Hyped Exercise: Climb Every Mountain: When Walking Beats Running 232
Conclusion: Don't Believe the Hype: Is It All Hype? 246