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 The Doctor=20 Is Online

By John P. = Martin
washingtonpost.com=20 Staff Writer

Tuesday, August 31, 1999; Page H1

Susan Zachary was a 39-year-old homemaker in = Gainesville,=20 Tex., when she learned multiple sclerosis was slowly crippling = her.

Zachary knew nothing about the disease. Her local = library=20 carried just two books on MS. It was 1987 and Gainesville, a town = of=20 14,000 north of Dallas, had no support groups.

Feeling alone and isolated, Zachary grew = embarrassed to=20 walk in public. She spent most of her time at home.

Nine years passed before she found the Internet = and typed=20 her first search term: multiple sclerosis. Links poured back.

Within two months, Zachary and five other women = who met=20 online launched MSWorld, a support group for people with multiple=20 sclerosis.

The nonprofit group now counts more than 1,000 = members=20 worldwide. Its site on the World Wide Web =A7 msworld.org =A7 = offers a library=20 of medical information, support chats at most hours of the day and = an=20 online magazine where members post poetry, art and other = contributions.=20 Doctors routinely direct patients to MSWorld, its operators = say.

Zachary serves as its vice president, a role she = calls the=20 most rewarding passion she's found short of motherhood.

"I've been to hell and back with this disease," = she said.=20 "And I thought I was the only one. I've found out there are = thousands of=20 us out there."

Millions, actually

Each day, the online audience for medical = information=20 grows. A Harris poll released this month said as many as 70 = million U.S.=20 adults have searched the Web for health information in the past 12 = months.

Online visitors find consolations and = consultations. They=20 want diet advice, fitness tips, miracle treatments, drug data and = doctor=20 directories. It's all there, usually free, unfiltered and = immediately=20 accessible.

Some health care experts envision a future where = doctors=20 routinely add an Internet component to their prescription for=20 treatment.

Other medical professionals are slow to embrace = such a=20 future, but acknowledge they might not have a choice. = Increasingly,=20 patients arrive armed with computer printouts, want to communicate = through=20 electronic mail, and use the Web to research the physician and=20 treatment.

Yet there is scant evidence that this new = empowerment for=20 patients is leading to better care, especially since so much of = the=20 information available online is not vetted by experts.

Still, for those seeking information about = disease, there=20 is an added bonus to the Internet: patient relationships that = allow=20 connections with others who share the same concerns.

Zachary's site represents this subset of the = Internet=20 society: health sites developed by people whose interest is purely = personal. They suffer or know someone who does. Confounded by the = Web's=20 disorganization, they form communities where unseen strangers lean = on each=20 other for information and support.

"It's a resource for health care that's not like = anything=20 we've had before," said Tom Ferguson, an Austin, Tex., physician = who has=20 written about the Internet's impact on health care.

Robert Levitan, president of BetterHealth.com, = remembers=20 that such groups weren't around when his mother contracted lung = cancer 15=20 years ago. She was confused and scared, but the doctors told her = little=20 about her condition or were more likely to talk just to her = husband,=20 Levitan said. She died in 1984.

When Levitan heard last year that a friend's wife = had=20 contracted ovarian cancer, he sought to help the family by turning = to the=20 Web and posting a request for information.

Within minutes, he received the e-mail address of = an=20 ovarian cancer patient described as a valuable contact, he said. = Then came=20 a second message offering a list of relevant Web sites and a = promise for=20 prayers. A third woman passed along her phone number. She didn't = have=20 cancer, but was willing to lend a supportive ear.

"There's nothing virtual about that," Levitan = said.

Caveat, Surfer

Estimates for the number of health-related Web = sites top=20 15,000 and are rising. Type "new cancer therapies" into a = newsgroup search=20 engine and you'll find 49,000 postings, starting with one that = boasts of a=20 Chinese herbal tea to heal all tumors for $60 a bottle.

Many sites are targeting an audience searching = for hope.=20 CyberDialogue, an Internet research firm, estimates that more than = half=20 the adults scanning online health information are looking for=20 disease-related content, most often about cancer.

But a significant number of sites provide bogus=20 information.

Last fall, FTC officials joined counterparts from = two dozen=20 countries to identify 1,200 sites and newsgroups promoting dubious = cures,=20 treatments or preventive measures for AIDS, cancer, heart disease, = arthritis, diabetes and multiple sclerosis. The commission later = announced=20 settlements with four companies it said had made unsubstantiated = promises=20 to consumers.

A study published this month in the Journal of = the American=20 Medical Association found that many medical Web sites contain data = that is=20 wrong or hasn't been reviewed by scientists for accuracy.

Even the Securities and Exchange Commission has = begun to=20 crack down on hucksters on the Web who promote outrageous cures to = improve=20 their stock prices. One of the most recent actions, detailed last = week by=20 the New York Times, was against a small automobile dealer, = Uniprime=20 Capital Acceptance Inc., that advertised on the Internet that it = had found=20 a cure for AIDS. But reports of research on the medication were = not well=20 founded, according to the SEC complaint.

Meanwhile, experts urge consumers to scan sites=20 carefully.

Roger Spott, an oral surgeon from Silver Spring = who teaches=20 other medical professionals how to use the Internet, tells his = students to=20 weigh a site's credibility and currency and its author's = credentials. The=20 Web, he warns them, "is like the Wild West."

Online watchdogs have also emerged. One,=20 www.quackwatch.com, lists what it calls questionable products and=20 advertisements and offers tip sheets such as "Fifteen Ways to Spot = an=20 Internet Bandit."

The highly publicized Drkoop.com Web site bills = itself as=20 "Your Trusted Health Network" and includes a section where it = rates other=20 health sites with one to five stars. But even its namesake, former = U.S.=20 surgeon general C. Everett Koop, said he expects the = "fly-by-night"=20 operators won't last long on the Web.

"There's always a downside to every new thing in = medicine,"=20 Koop said earlier this year, "but it shakes out pretty = quickly."

The Internet is a medium where everything happens = quickly.=20 When the federally funded Science Panel on Interactive = Communication and=20 Health first convened in late 1996, its members expected to study = the=20 impact of health-related CD-ROMs and other technology. Then the = Web=20 exploded as a vehicle for health information, and the panel = changed its=20 focus.

Some in the group were alarmed to discover Web = site=20 operators using sophisticated technology to identify users and = gather=20 personal health information they can sell or tailor for their own=20 marketing.

"The more we looked at, the more we realized how = dangerous=20 some of these sites can be," said David Gustafson, a University of = Wisconsin professor of industrial engineering and preventive = medicine who=20 chaired the panel.

In its report last spring, the group proposed = that health=20 Web sites voluntarily adopt labels that disclose standard = information and=20 the identity of their operators and sources for the information=20 posted.

Still evolving are ethical and legal questions = over the=20 electronic sale and distribution of medicine and advice. Currently = a=20 doctor in one state can prescribe treatment for a patient in = another,=20 without ever seeing the patient. But some health experts question = whether=20 that procedure should be allowed and some states are trying to = stop the=20 practice. Other experts have questioned whether e-mails constitute = professional advice.

Gustafson pioneered studies on a much deeper, but = unresolved, question: How can using the Internet affect a = patient's=20 health?

When his wife was diagnosed with breast cancer a = decade=20 ago, he devised a computer program to help her learn about her = condition,=20 communicate with other patients and read articles about other = women's=20 battles with the disease--activities now common through the = Internet.

Studies later showed that patients who used his=20 Comprehensive Health Enhancement Support System--or CHESS--had = better=20 relationships with their doctors, lower health care costs and a = higher=20 sense of social and emotional well-being than those patients who = didn't=20 use the program, Gustafson said.

But there's no evidence that CHESS had any effect = on their=20 cancer.

Changed Medical Practice

Beyond serving as an extended library and an = e-mail support=20 group, the Internet is also changing the delivery, speed and = business of=20 health care. Doctors can now view X-rays or lab tests from home, = consult=20 with colleagues around the world in seconds or retrieve patient = records at=20 any time.

The nation's largest HMO, Kaiser-Permanente, lets = members=20 in the mid-Atlantic and two other regions schedule appointments, = research=20 medications, join discussions or ask questions of an online = pharmacist or=20 nurse. About 40,000 members have registered for these services, = and Kaiser=20 officials predict the number will grow to 100,000.

Also under consideration is an interactive = questionnaire=20 that would enable the HMO to pair patients with physicians who = share=20 similar philosophies about treatment and other medical = issues.

In the Washington Hospital Center emergency room, = doctors=20 who might once have waited hours or days for a medical record or = lab test=20 are now just a few clicks away. Two Internet terminals are perched = in the=20 middle of the room and doctors use a portable "clipboard computer" = that=20 lets them log in from a patient's bedside.

"We who use the Internet all the time know it's = very=20 pragmatic," said Craig Feied, a physician and the informatics = director for=20 the emergency room. "It's good for doctors, it's good for = patients, it=20 saves lives."

A former computer programmer, he has been = preaching the=20 potential of the technology for more than a decade, largely to = deaf ears.=20 "Doctors are holding back for a very simple reason," Feied = believes.=20 "They're just swamped."

Take Carl Crimm, a family practitioner in = Annandale. He's=20 skeptical about the credibility of online information and worried = about=20 the legal issues. He believes that face-to-face care is crucial to = his=20 job.

"What I need now is time," Crimm said. "I don't = need more=20 information and anything that takes away my time, I will fight to = the=20 end."

Economics may also play a role. Doctors who are = paid a flat=20 fee or a fee based on patient enrollment in the health plan may = find=20 e-mailing a patient cost-effective. But doctors such as Crimm, who = are=20 paid based on the number of patients they see, may not.

Still, Crimm recognizes he can't avoid accepting = the=20 Internet. "I think I'll have to do it, yes, because the consumer = will want=20 it," he said.

Susan Zachary hears from more of those consumers = every day.=20 Some send e-mails to MSWorld the same day they are diagnosed with = multiple=20 sclerosis. They are shocked, scared and desperate for = answers.

Zachary remembers the feeling. It lingered for = nearly nine=20 years. "I had to go through everything alone," Zachary said.

One of her closest friends now is a woman with MS = who lives=20 just 60 miles away. They see each other only a few times a year, = but chat=20 most nights over the Internet.

"That's a big thing," Zachary said. "To know = you're not=20 alone."

John P. Martin is a staff writer for=20 washingtonpost.com.

=A9 1999 The Washington Post Company =

 

 

 

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