Healthy Food & Healthy Living by Dr. Ayala

Can Google be trusted with your health?

It’s the middle of the night. Your baby’s sick. You’re sick with worry.

Ever thought of Googling his symptoms for some free medical advice or a second opinion?

Many people use the Internet for health-related information, and used correctly it’s a great resource. But how reliable or accurate is a search engine without medical guidance?

A group of British researchers found that health information on the Internet ranges from poor to excellent, depending on the topic and the resource. They Googled UK-based websites on five common pediatric issues in which the best practice is pretty clear, and found that only about 200 of 500 sites offered correct information. The results of their study were published in the Archives of Disease in Childhood.

The five search topics chosen for the study were "MMR autism" (current practice: there’s no association between the vaccine and autism), "HIV breastfeeding" (current practice: HIV-positive moms are advised not to breastfeed), "mastitis breastfeeding" (current practice: a mom with mastitis should breastfeed), "baby sleeping position" (current practice: a baby should be put to sleep on his back) and "green vomit"(current practice: if baby vomits green, go see a doctor).

Their analysis showed that governmental sites were accurate every time. Educational sites, companies, interest groups and individual’s sites performed rather well, and were accurate around 80 percent of the time. News sites did poorly (they had a 55 percent “correct” rate), and no sponsored site gave correct advice.

The authors conclude:

“Healthcare professionals should continue to strive to be the main source of information for patients but we should be aware that most will continue to use the internet to gather information. We suggest that in addition to verbal and written information, patients and parents should be signposted to NHS (National Health Service), governmental or other preapproved websites”

Google has no clinical judgment

This study posed to Google questions to which there are only two possible answers. Most health questions are much more complicated, and a search result brings in an enormous amount of information to sift through.

If your child has a fever—perhaps the most common reason to see a pediatrician—a search engine is practically of no help at all. A study looking at advice for kids with a fever found only three out of 22 sites visited gave information which matched current "best practice" guidelines. You may wind up worrying your head off over exotic and life-threatening causes of fever which have no relevance to your child. But how would you know? A study of Internet information on lumbar disc herniation ("slipped disc") found that less than 10 percent of relevant websites were of high-quality. Try searching “headache” and see what comes up.

Doctors don’t have secret information. Even complicated medical knowledge is widely available. The Internet is full of good information—and bad information and misinformation, too. Making sense of the information is what’s become harder and harder to do.

Doctors work many years to master clinical judgment—the application of information gathered from talking to and examining patients, combined with knowledge of the science of medicine, and that impossible-to-define art of medicine—that’s what makes a good doctor.

There’s no recipe for acquiring clinical judgment. The knowledge-base needs to be there (a service Google provides fairly well), but the thoughtful application of information comes from immersion in the care of patients, experience, interaction with peers and mentors, and a constant refinement and learning process. I don’t think a machine will ever be able to learn clinical judgment.

The Internet is one of my favorite inventions of all time, but it will never be able to answer complicated health questions, nor will it ever be able to offer comfort or compassion. Surfing health issues on the Internet is a great example of how a little knowledge can be a very dangerous thing.

Nevertheless it’s a great resource for gathering information—provided you use reliable and authoritative sources—and that knowledge can be a great starting point for a discussion with a health professional who can help make sense of it all, put things in perspective and individualize it to your specific health issue.

Do you use the Internet for health related issues? Who do you trust?

I promise to share some of my favorite online sources of reliable medical information in a future post.

Dr. Ayala

Misleading health claims finally under fire

Is the health claim party coming to an end?

This past week, the Food and Drug Administration released 17 letters of warning to food manufacturers whose product claims don't adhere to federal labeling rules. FDA Commissioner Margaret Hamburg, MD, also sent an open letter to the industry, encouraging food makers to rid their labels of misleading and downright bogus claims, and be part of the effort to make food labels a tool consumers can use to improve their nutrition and make healthier choices. (She of course said it in a much nicer way.)

The letters targeted mainly companies making unauthorized health claims and nutrient-content claims.

Please bear with me while we go through the different types of label claims; I promise it’s going to make you a more informed consumer:

• A health claim describes a relationship between a food or food component and a disease, and it must be pre-approved by the FDA. There are currently slightly more than a dozen of these approved claims.

Health claims must be phrased in the specific language the FDA requires. The claim must also indicate that the disease may be caused by a variety of causes, and must state that the food should be consumed as part of a healthy diet. The appearance of a health claim means a food meets certain nutritional requirements.

The POM Wonderful complaint is an example of misuse of health claims: POM was criticized for claiming its juice will treat, prevent or cure diseases, including hypertension, diabetes and cancer. These types of health claims are drug claims and are not allowed on food products. They are allowed on drugs only after extensive and rigorous testing.

• A nutrient claim is a statement that establishes the quantity of a particular ingredient, such as fat, cholesterol and fiber. Statements such as "low sodium," "high fiber" and "fat-free" are examples of nutrient claims. These statements can be included on the label only if the food product meets specifications established by the FDA.

Nestle’s Juicy Juice was criticized for an inaccurate nutrient claim: its labels implied that the products are 100% juice when they are actually juice blends with added flavors.

The giant loophole

Although Commissioner Hamburg’s actions are good news, I’m afraid the misleading label claim party isn’t over yet. There’s a giant loophole in the FDA’s rules, and many of the most misleading and absurd claims fall into a category that’s practically as regulated as the Wild West.

That loophole is the structure/function claim.

Structure/function claims describe a role of a nutrient or substance in a food or a food supplement in affecting the normal structure or function in the body. Unlike a health claim, it doesn’t relate to a disease or a health-related condition. The verbs “support,” “improve,” “boost” and “maintain” are often a telltale sign of a structure/function claim.

Nestle’s Juicy Juice Brain Development Fruit Juice was reproached for a nutrient claim—"no sugar added" isn’t allowed on products intended for kids under 2 years of age—yet the more glaring claim on the box is “Helps Support Brain Development”. I don’t think the FDA believes this juice develops young brains, but there’s no legal action it can take against such structure/function claims.

A structure/function claim requires no FDA pre-certification. It can be attached to any food, including junk food. There are no overarching nutritional requirements for structure/function claims. They can be phrased in many ways that are at the discretion of the manufacturer. While the claim “must be truthful and not misleading”, there’s no specification about how much evidence is needed to make the claim. It doesn’t require significant scientific agreement, unlike a health claim.

Those food labels luring us with endless promises to protect our joints, boost our brain and support our immunity make structure/function claims.

Unfortunately most consumers can’t tell the difference between a health claim and a structure/function claim. “Calcium builds strong bones” and "fiber maintains bowel regularity”—both structure/function claims—sound quite the same as “calcium reduces the risk of osteoporosis” and “fiber may reduce the risk of some cancers,” which are regulated health claims.

The structure/function claim has been a boon to food manufacturers. Since there are so few limitations on its use and the trusting public can’t easily distinguish between the different types of claims, structure/function claims have proliferated. Market research shows these structure/function claims really help with sales, putting great pressure on companies that don’t have claims to consider them, just to level the playing field. This is an arms race in which the consumer loses.

And until the FDA takes care of structure/function claims, food labeling won’t get any clearer.

In a recent commentary in the Journal of the American Medical Association, two of the most respected and independent nutrition and obesity experts, Marion Nestle, PhD, MPH, and David Ludwig, MD, PhD, explain why claims are inherently misleading: Few if any claims can be verified. Hyping the benefit of a select component of a food doesn’t give the whole picture. “Healthier” is not necessarily healthy. Junk food with a little less fat or sugar is still junk. Allowing claims poses an inherent conflict of interest—food companies want to sell more, while the label’s public health purpose is to educate consumers.

Their suggestion is very simple: do away with all health claims:

“If health claims are allowed on food packages, they should be regulated more strictly according to rigorous, evidence-based national standards. Because such standards are inevitably arbitrary and subject to manipulation, consideration should be given to an outright ban on all front-of package claims. Doing so would aid educational efforts to encourage the public to eat whole or minimally processed foods and to read the ingredient lists on processed foods.”

Kudus to Dr. Hamburg for taking on this difficult and important issue! I hope one of the next steps includes creating regulatory standards for structure/function claims, or following Nestle and Ludwig’s suggestion and get rid of them all.

Dr. Ayala

Further reading: The Center for Science in the Public Interest’s excellent Food Labeling Chaos

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

Related post: Are “functional” foods healthy foods?

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!