Richard G. Petty, MD

New Treatment Options: Knowing What to Use

One of the main reasons that I created this blog is that I want to empower you: I want to give to give you the information that you need to care for yourself and the people around you.

One of the problems with many new treatments is that they promise the earth, sometimes drag people away from things that may help them and then fail to deliver.

This is something that I struggled with in the field of holistic medicine for thirty years. I constantly hear and see fantastic claims that cannot be right and are often based on a complete misunderstanding of how the body functions. On the other hand there are some highly unorthodox methods and techniques that can be amazingly helpful. My job has been to find out which is which!

But it is not only in the field of unorthodox medicine. I have recently heard about something very questionable in the field of psychotherapy. Somebody has invented a new form of therapy that cuts across and ignores decades of research. He is now offering certifications in his method. So long as you have a very basic healthcare qualification, you pay him a few hundred dollars, do an online training and then you can set up shop as a therapist. Many members of the public do not know how little regulation there is for some of these therapies.

Here are some guidelines for checking out a new therapy or remedy:

1. Efficacy
Be suspicious of any treatment or therapist if they:

  • Claim that a treatment works for everyone: I have yet to find ANY treatment that works for everyone
  • Only use case histories or testimonials as proof. The plural of anecdote id not evidence. If we see or hear about something that looks promising, it is essential to confirm the reports with systematic, independent controlled research. Be aware that if that has not been done, the person selling you the treatment or the therapist claiming to help is essentially experimenting on you. And if they want to experiment they need your consent and the approval of an Institutional Review Board. And don’t buy into the “my work is so brilliant and cutting edge that nobody will publish it in a journal.” It is hard to publish really new work, but we cannot believe what people are saying until it has been subjected to peer review: other experts go through the work with a fine toothcomb to see if it is right.
  • Cite only one study as proof. Hundreds of promising studies have turned out to be dead ends when someone else tried to repeat it. You can be a lot more confident if several studies have shown the same thing.
  • Cites a study that did not have a control (comparison) group. That is always a first step in evaluating a new treatment.
  • Cite a study that you cannot see yourself. We spend a lot of time checking some of the claims made on infomercials and websites. They often talk about some obscure study in a hard-to-find journal written in a foreign language. We go and find the papers and if necessary translate them. We constantly find that the studies quoted contain results that are 180 degrees away from what they claim.
  • Only reference themselves. This recently came to light with a form of therapy that comes with a short book. There was not one scientific citation, but loads of self-references, so it looked as if there was something credible behind it.
  • Testing a treatment without a control group is a necessary first step in investigating a new treatment, but subsequent studies with appropriate control groups are needed to clearly establish the effectiveness of the intervention.

2. Safety?
Be wary if:

  • A therapist or someone promoting a remedy cannot tell you the exact consequences of not following up with some other treatment. Safety is not only about the safety of a product or a therapy: it is also about the risks of declining a proven treatment
  • A therapist tells you stop any other treatment that you are on without discussing the risks of stopping it, and without discussing the situation with any previous therapist. It does not matter whether you were on a medication or having acupuncture. Different treatments interact, and stopping and starting can be risky. If a therapist who does not prescribe medications tells you stop them, be very, very careful. There are precise ways to discontinue most treatments
  • A remedy comes without precise directions about how to use it
  • Something does not list its contents or ingredients
  • A product has no information or warnings about side effects
  • If a product or therapeutic approach is described as natural, with the implication that natural means safe. Hurricanes, arsenic and deadly nightshade are all natural!

3. Promotion
Be very cautious if a therapy or treatment:

  • Claims to be based on a secret formula or a secret that has been deliberately hidden from you
  • Claims that the particular treatment or therapy is being suppressed or unfairly attacked by the medical or therapeutic communities
  • Claims to work immediately and permanently for everyone
  • Is described as an “Amazing breakthrough” or a “Miracle.”
  • Claims to be a cure for something that other experts believe is incurable. They could be right, but then we have to go back to the first point about efficacy
  • Is only promoted through infomercials, self-promoting books, online or by mail order

4. Evaluating Media Reports

  • When evaluating reports of health care options, consider the following questions:
  • What is the source of the information? Good sources of information include medical schools, government agencies (such as the National Institutes of Health and the National Institute of Mental Health), professional medical associations, and national disorder/disease-specific organizations. Information from studies in reputable, peer-reviewed medical journals is more credible than popular media reports.
  • Who is the authority? The affiliations and relevant credentials of “experts” should be provided, though initials behind a name do not always mean that the person is an authority. Reputable medical journals now require researchers to reveal possible conflicts of interest, such as when a researcher conducting a study also owns a company marketing the treatment being studied or has any other potential conflict of interest.
  • Who funded the research? It may be important to also know who funded a particular research project.
  • Is the finding preliminary or confirmed? Unfortunately, a preliminary finding is often reported in the media as a “breakthrough” result. An “interesting preliminary finding” is a more realistic appraisal of what often appears in headlines as an “exciting new breakthrough.” You should track results over time and seek out the original source, such as a professional scientific publication, to get a fuller understanding of the research findings

5. What Are the Financial Implications of This New Therapy or Remedy?

  • Is the treatment covered by health insurance?
  • What out-of-pocket financial obligation will you or your family have?
  • How long will this out-of-pocket financial obligation be?
  • Is there any kind of guarantee?

Tips for Finding Reliable Information Online
The good news is that the Internet is becoming an excellent source of medical information. The bad news is that with its low cost and global entry, the Web is also home to a great deal of unreliable health information.
In addition to the tips cited earlier, Web surfing really needs some special considerations:
Know the source. The domain name tells you the source of information on the Web site, and the last part of the domain name tells you about the source. For example:
.edu = university/educational
.biz/.com = company/commercial
.org = non-profit organization
.gov = government agency

The same rules do not always apply if you are looking at websites in other countries.
Obtain a “second opinion” regarding information on the Web. Pick a key phrase or name and run it through a search engine to find other discussions of the topic or talk to your health care professional.

Experts who spend time and trouble evaluating reports and then publish their findings online will often answer questions. is one that does, and there are many others.

Open Access

I have had a number of kind comments about my brief piece concerning the revolution in open access to information.

Few people have yet realized the impact that it will have on our lives.

I am most honored to have just received this note from Peter Suber:

Hi Richard: PLoS is part of a larger movement for open access to
peer-reviewed research literature, and a lot has happened since PLoS
was launched in 2001. For details, see my Timeline [ ], and for daily updates see my blog, Open Access News [ ].

I have had a good look at Peter’s material, and I have also subscribed to his blog, so it will now appear on the left-hand side of this blog under
“What I’m reading,” so you can access his writings without having to dart all over the place.

The entire open access movement encompasses a great deal more than just scientific and medical research, and is all precisely aligned with my aim of achieving greater personal empowerment, so that you can take control of your life, your health, your future and the legacy that you leave behind.

Several correspondents have agreed with my point, that the next imperative is to teach people how to use this information.

Six Ways to Improve a Blog

Regular readers might have noticed that in the "What I’m Reading" section on the left hand side, I list If you haven’t already, you may want to check it out.

I have no personal connection with any of the writers, but they produce a steady stream of good sensible advice on productivity, better ways to get things done, and life hacks.

One recent article caught my eye: Six Improvements to Your Blog.

Like most people I am eager to make all my work as good as it can be, and if you are a blogger, you will doubtless feel the same way. So I thought that I would share the advice:

  1. Display Contact Info Prominently
  2. Fix comments
  3. Format Your text
  4. Use Tagging
  5. Link, Link, Link
  6. Stay Vibrant

I hope that I am doing all of those, with one exception. I have for the time being left the "capcha" feature – the “write what you see here” thing – enabled. The reason is that – like an awful lot of blogging friends who write about health or psychology – we have had some weird and sometimes obscene comments, to say nothing of some rather amusing – and some less amusing – Spam.

I am always grateful for feedback. I want this blog to be of service to you, so if there is any way in which I can improve it, please let me know!

Has Blogging Peaked?

One of the many impressive presentations during the Healthcare Blogging Summit in Washington DC on Monday was by Steve Rubel.

He made a number of important points. One was that he predicted that blog post volume has peaked. He pointed to the most recent Technorati report on The State of the Blogosphere. There is indeed a small dip in their post volume graph, but as he pointed out, we need more data than that to be sure. As I was walking though the airport on my way home I saw an advertisement about the growth of the internet in China. Perhaps there is some slowing in English language posting, but Paul Walker also made the point that blogging in China is only in its early stages and China’s blog and post volumes may led to an overall increase in global blogging.

I have just seen that the BBC is carrying an article entitled, "Blogging ‘set to peak next year," based on  a wide-ranging report from Gartner.

The analysts say that during the middle of next year the number of blogs will level out at about 100 million and that 200 million people have already stopped writing their blogs. Technorati is tracking more than 57 million blogs, of which it believes around 55% are "active" and updated at least every three months.

It may well be that everyone who is going to blog has already started, and that  many  people will move on to something new. But I am going to make a prediction that the power of blogs is actually going to increase. Many of the early adopters used blogs like diaries: highly personal and mostly ephemeral. That has gradually been changing as people in business, experts and such disparate groups as whistle blowers and independent reporters have grasped what we can do with blogs.

I was initially surprised to see a study by Fard Johnmar which indicated that 40% of healthcare bloggers to it anonymously, until I realized how valuable they are: many are likely to be spreading information that would at one time have been unavailabe to most of us.

In July I wrote a piece about blogging and the tipping point. Everything that I have seen in the last six months convinces me that the blogosphere is gradually changing, maturing and gaining greater depth and strength. So even if we are left with a measly 100,000,000 bloggers, I think that they have the power to change the world forever.

In Healing, Meaning and Purpose I pointed out that the Age of Enlightenment was the child of no more than 1,000 people. And one of the most striking things at the conference on Monday was that we had men and women of every ethnic, political and philosophical stripe, yet they were all talking about how blogging could represent an important opportunity for improving the world.

When I see such a diverse group of knowledgeable and intelligent people talking in those tones, I feel cautiously optimistic about the future.

Healthcare Blogging Summit

I had the pleasure and privilege of speaking at the Healthcare Blogging Summit in Washington DC yesterday. Here is a short summary with some interesting observations.

It was an extremely interesting meeting which will likely have a major impact on the role of blogs in health care and wellness.

I met many fine and memorable peple and was very struck by one in particular: F. Nicholas Jacobs, who is said to be the first hospital CEO to blog. It was not just what he had to say, but the energy with which he said it.

I wanted to quote something from his blog which is entirely in line with my own thinking about how a place of healing should function:

If you treat people with respect and dignity, with love and a total commitment to their health, it works. They don’t sue you because they know you care about them. They don’t hate you because they know that you respect them. They recommend you to their friends and relatives because they trust you.

As the brain surgeon says: “This is NOT rocket science.” And as the rocket scientist says, “This is NOT brain surgery.” If you put people into a healing environment, they heal. If they are not living in complete terror about the next unknown that is going to happen to them, they heal. In fact, their white blood cells may actually be given a chance to work!

You can wash your hands 24 hours a day, seven days a week, and you should. But… people will still get infections if you restrict their loved ones from being with them, if you treat them like a body part, if you don’t tell them what’s coming next, and don’t give them choices in their care. Instead, one of our senior leaders always says about Windber Medical Center, “We do not make our patients leave their dignity at the door.”

Nick had never heard of Integrated Medicine. He is quite evidently just a smart, kind and loving person who sees the big picture.

We need more people like him.

But here is the good news, there are more people like him that are rising through the ranks in medicine. They are realizing that in the same way that patients should not leave their dignity at the door, a successful administrator or departmental chair does not have to leave behind his or her humanity, caring and compassion.

The Author Revealed!

I’ve had a great many very kind comments about this blog. So to all the people who’ve said nice things, “Thank you!” And for all the people who’ve wanted to discuss, debate, criticize and clarify, I thank you too: that’s the way that we’re going to move forward and create a more comprehensive science-based approach to personal growth, health and wellness.

I’m also constantly asked who writes all these blog items, the podcasts, the articles and the book reviews at Amazon? It can’t be one person can it? Well, it actually is all one person: C’est moi, a.k.a. RP.

So I take full responsibility for everything that I write. And, of course, any errors of omission or commission are my own.

Though I try exceptionally hard to ensure that all the entries are as accurate as I can make them. That being said, I also give you follow up resources and things like the search box so that you can check on what I say. I want to guide, educate, help and support you, so that you can make you own decisions. And if you are working with someone else, then I would like your next meeting with your health care provider to be even better informed.

This weekend I was horrified to hear a fairly well known doctor give a very glib and somewhat inaccurate summary of a new medicine that’s just just been given "approvable" status by the US Food and Drug Administration.

Several people challenged his evaluation: “Where did you get that from?” they asked. “The Wall Street Journal,” was the response. Now I like and respect the WSJ, and the doctor was, in fact, misquoting the article. But that’s not the point: nobody who has responsibility for providing medical care or advice should be doing it without carefully reviewing the evidence. What we call examining the “Primary sources.”

An important study was published a year ago, and we saw an extraordinary spectacle: some doctors and psychologists began making statements about how patients should be treated, and about how healthcare policies should be changed. Based not upon the evidence, but on newspaper reports of the evidence. In the end, the National Institute of Mental Health issued a press release to clarify what the study did and did not say.

On the topic of evidence and primary sources, let me turn to one of the other pieces to our work, and that is self-help.

There are many people in the self-help movement who have revolutionized the lives of millions. But there are some others who have not.

The days of people being able to get away with telling others how to live their lives or how to achieve health or success, based only on their personal opinions, rather than on something tangible, are finally coming to an end.

When a self-help guru says, “If I can do it anyone can,” they are just plain wrong. They are dismissing so many factors in a person’s life and then claiming that one size fits all. It’s so sad that many people who have failed to fulfill all these gurus’ proclamations and promises blame themselves rather than the bad advice. And as a result some end up being much worse off, for they feel that they have failed.

I have seen countless people racked by guilt because they had bought into the idea that all illness is self-created. I recently read something outrageous: that all depression is caused by unexpressed anger. So according to this nonsense, if you stop being angry, you’ll stop being depressed.

I have no idea where the writer got this from, and of course, sometimes a person’s depression can be traced back to anger about trauma, abuse or a failed relationship. But as a generalization it’s utter bovine excreta. I’ve seen people attempt to kill themselves because of profound depression, and it most assuredly had nothing to do with unexpressed anger!

Attitudes and emotions can have a huge impact on health, but people certainly don’t need to be made to feel guilty because they are ill!

This website and blog and the many others that I highlight are quickly transforming the world of self-help, health and wellness from hyperbole and opinion to an empirical science. Naturally enough, there are people with vested interests who want to keep things as they are, but they are like King Canute whose courtiers believed that he could turn back the tide!

With your help, I’m going to continue to do this work, and I would like to thank all the people around the world who are already helping us to introduce, what a great Sage has called:

"The Prophecy of a New Dawn in Health and Healing."

Healia, I Thank You!

I’ve written before to extol the virtues of the new seacrch engine

Well now you can color me REALLY impressed.

My Web Mistress (I’m STILL not at all sure that I should be calling her that {!}), Carol Kirshner and I both asked for two extra things: a widget in the sidebar of a blog that allows you to search Healia directly. And second that it would be possible to open a search result in a new window. So now you can get all the information that I offer, and do all your searching to follow up on things that I’ve said or suggested, without having to go tearing all over the Internet.

We wanted to offer you "One stop shopping."

A single place where you can find out what’s new, or what’s tried, tested and true, in Health, Wellness and Personal Development. And a place where you can receive free guidance and support on your journey.

Your time is very valuable, and these new developments should help you enormously.

Healia did all this within seven days of our request, and any company that’s going to be that responsive tells me exactly where they are coming from.

So read and enjoy the articles, and be sure to use the Healia search box to follow up on anything that you need.

All the best to you!

Healia is Here!

Several months ago, I wrote about, a new and innovative search engine for all things to do with health.

This morning I got the news that I’d been waiting for from Carol Kirshner my Web Mistress (I’m still not sure that’s a PC term for her) and researcher. Healia will be officially launched to the public tomorrow, September 18th.

As a writer on health, wellness and personal development, I think that this is going to become a major source of information for me. Much as I love Google, this is a search engine dedicated to these topics.

From a release that I’ve just received, Healia says that:
The newest version of Healia has several major improvements over our initial version:

  • We have enhanced the accuracy and performance of our filtering algorithms
  • We are offering additional filters to allow people to filter by the topic of the document when they submit a disease or drug-related search (Try searching on a disease and drug name to see how they are handled differently)
  • We provide a “Suggested Result” from a reference site for disease and drug-related searches
  • We detect and provide expanded equivalents to common medical abbreviations and acronyms

I’ve been putting it through its paces, and I must say that I’m very impressed. I’m probably a lot more demanding than most users, and it’s very quick and accurate.

If you are a consumer or potential consumer, Healia will likely be the best place to research an illness. Or ways of keeping healthy.

I agree with the points in Carol’s evaluation: It would be nice if search results opended in a separate window. Even though I use a laptop for everything (Macintosh, of course), and don’t have much screen real estate, with Macintosh OS X, that’s not a problem: navigating from one screen to another is a snap. Having to keep going back is a pain in the posterior.

And my cri du coeur: please, please, please could we have a Healia Search widget to add to our blogs??

I do everything that I can to provide my readers with totally accurate, up to date information, and I encourage them to check on everything. I’d love readers to be able to search directly from within medical blogs. It would be a real win/win, IMHO.

Wouldn’t it be great to be able to demonstrate it at the Healthcare Blogging Summit in Washington in December???

People Dangerous to Your Health

I found a terrific blog with the title “Warning: Bores and buffoons may endanger your health.”

Our ability to self-regulate is a limited resource that fluctuates markedly, depending on our prior use of willpower, tiredness, stress and our personal resilience.

A new study by a team lead by Professor Eli Finkel of Northwestern University has shown that poor social coordination impairs self-regulation. What does this mean? If you are forced to work or interact with difficult individuals you may be left mentally exhausted and far less able to do anything useful for a significant period of time. In other words, draining social dynamics, in which an individual is trying so hard to regulate his or her behavior, can impair success on subsequent unrelated tasks.

In the research, volunteers were asked to work in pairs to maneuver an icon around a computer maze, with one volunteer giving the instructions, the other moving the joystick. Those operating the joysticks were actors, primed to respond to instructions in slow, stupid, inefficient and generally irritating ways. What was interesting was that the effects were not mediated through participants’ conscious processes: they were almost entirely going on below the level of conscious awareness.

There is extensive literature on the consequences of social conflict. But until now, very little research has been conducted on the effects of ineffective social coordination. That has been a big gap in the research literature, particularly given the fact that most of the higher systems in our brains are dedicated to social functions, and since the earliest days of our hunter-gatherer ancestors, tasks requiring social coordination have been the norm. In our day-to-day activities we have to cooperate with other people. Ineffective social coordination consumes a great deal of mental resources and has high costs for subsequent self-regulation. This is so important, because self-regulation is essential to living life well. It is also essential to the existence of a well functioning society.

What to do with this new information?

Identify people who drain you. If you need to work with them, do it in short bursts, and give yourself plenty of time outs.

And continue to build your resilience.

There’s also one other piece, that we’ll look at another time. Some people may also drain your energy directly. You may have come across "energy" or "psychic vampires." They really do exist, though there is nothing supernatural about them, and they don’t have fangs or an aversion to garlic. In another post I’ll show you some techniques for dealing with those people as well.

The researchers have done us a great service by putting the entire paper on the departmental website. Access is free.

When Being First Is Not the Only Thing

Regular readers and anyone who’s looked at my blogroll, knows that I like Zach Lynch’s consistently insightful blog.

He has been working on a project for four years, and now it appears that someone is coming out with some of the same ideas in a book that is due to arrive in late September.

This does not look to me like plagiarism. Once a new idea is out there, it quickly spreads, and people will run with it.

You might be interested to see some of the comments that I made on Zach’s site.

The other book may be superb. But the important point is that although being first is the only thing in competitive games, in the world of ideas that will help us, being first is not the only thing.

Being correct is the only thing.

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