Surfing the Web for Nutrition and Health Information: Separating Fact from Fiction Section 1: Welcome Welcome to Surfing the Web for Nutrition and Health Information: Separating Fact from Fiction, a Texas A&M AgriLife Extension Service online professional development training. This session is approximately one hour in length. This course will be presented in a voice-narrated format that allows you to follow along with a PowerPoint slide presentation. A high-speed Internet connection is required. Content for this module is divided into multiple sections (see menu bar on the left for course outline), enabling you to complete and/or review content at your own pace. Printable handouts, when applicable, will be presented prior to the section in which they are referenced. In the next section, you will be directed to complete a brief, multiple-choice pre-learning assessment. Once you have completed the pre-learning assessment, you will be free to advance to the course content by checking the Next Section button at the bottom of the page. At the conclusion of this session, you will be directed to complete a post-learning assessment that will determine if you successfully pass the course. If at any time you wish to take a break from the module, simply log out and return to the course when you are ready to continue. When you sign back in to the session, you will be taken directly to the section where you left off. To review a section you have already completed, click on the desired section on the left menu bar. Slide 1 Section 2: Introduction and Learning Objectives Thank you for your interest in this online course on Internet nutrition and health information. The Food and Nutrition Unit of the Texas A&M AgriLife Extension Service offers several online courses developed for a variety of audiences including: childcare providers, health professionals, educators, and county Extension agents. Slide 2 Before we begin today s session, let s discuss some of the consequences of reading health information online. Some people use online resources to conduct their own healthcare diagnosis and treatment plan based on a limited understanding of diseases and their symptoms. Have you ever heard of the word cyberchondriac? A cyberchondriac is someone who has an unfounded concern about common symptoms based on online search results and information 1
posted on the Web. For example, unfounded anxiety can be caused by looking up the symptom of headache on the Internet. The possible causes of a headache can range from caffeine withdrawal to brain tumor. This is one reason why having information is not a substitute for talking with a doctor. Any questions or concerns about an individual s health should be discussed with a physician. Slide 3 After attending this session, you should have a better understanding of: Slide 4 health literacy, signs of misinformation, how to conduct an online search, evaluating online information for credibility, and communicating with your doctor. Today, we ll briefly discuss health literacy and how it relates to your medical care. We ll review online information providers and how they may intentionally or unintentionally provide health misinformation. We ll also review some online tactics to help limit or avoid misinformation. We ll end this session with some words of wisdom about surfing on the Web for nutrition and health information. Slide 5 Section 3: Health Literacy First, we re going to review a little about health literacy. Health literacy has to do with the extent you understand your own health and what affects it. Today, receiving quality medical care is complex and too often, it s difficult. A single patient may be seen by two or more physicians for different reasons. This places a burden on the patient to be their own advocate, retain copies of their health records, and communicate effectively, so that all attending physicians are aware of all ailments, medical concerns, and prescription medications. The more you understand about your own health, the easier it is to navigate the medical system. Slide 6 Health literacy involves the degree to which a person can obtain, process, understand, and communicate basic health information needed to make health decisions. Being able to effectively communicate with licensed health professionals, including physicians, is key. Communication is vital, especially given the brief appointment visits and harried, time-stressed health professionals. 2
Slide 7 About 80% of adults who have Internet access say they have searched for health information on the Internet, and nutrition is the third most popular health topic. Have you or your family members ever searched for health information on the Internet? Internet health information can increase or decrease your health literacy. Health literacy is a stronger predictor of health than age, income, employment, education, and race or ethnicity. Having poor health literacy can hinder medical care and reduce the chances of getting and staying well. Slide 8 Section 4: Online Information Providers How much do you trust the information about nutrition and health on the Internet? Do you subscribe to the it must be true or they would not be able to say it philosophy? Or are you a prove it s true kind of person? How much should you trust the information about nutrition and health on the Internet? Slide 9 It might be of interest to first consider who is talking to consumers about nutrition and health. They have many voices and many different perspectives. Some information providers, such as scientists and physicians, may have a broad understanding of nutrition and health. However, the quality or truthfulness of their information could become compromised if they are selling a treatment, remedy, or supplements. Universities and their associated Extension Service are generally less biased than individuals and are more likely to communicate evidence-based research. Medical journals report evidence-based research to professionals. A formal health education may be required to understand and apply such research. The U.S. government provides research-based information to a variety of audiences, including scientists, health professionals, school educators, and the public. Non-profit and advocacy groups sometimes have a narrow mission and often communicate selected research that supports their beliefs. This could result in a distorted view from hearing only half of the story. The food and beverage industries communicate nutrition information about their products. Remember, ultimately the goal of industry is to get more consumers to buy more of their products more often. Sometimes, media may report on nutrition and health findings that are just published or presented at a meeting. However, media may not provide the context to understand the significance of the research outcome. The rush to publish may preempt the necessary scrutiny of research outcomes by other scientists and health professionals. Consumers should be leery of health information that comes in the form of sound bites. 3
Slide 10 Believing health and nutrition misinformation can harm a person s health, well-being, and/or economic status. Misinformation can include food faddism, health fraud, and misdirected claims. Food fads are unreasonable or exaggerated beliefs that eating or not eating specific foods, nutrient supplements, or combinations of certain foods may cure disease, convey health benefits, or offer quick weight loss. Weight loss diets that involve the elimination of certain foods, food groups, or meals are examples of food fads. Health fraud is deliberate and done for profit. It may involve a health remedy or dietary supplement that doesn t work or hasn t been proven to work. Such promotional items may be marketed to promote or improve health, well-being, or appearance. An example of health fraud may involve protein powders marketed to accelerate weight loss. Misdirected claims include the statements that lead consumers to make incorrect inferences or generalizations about the health benefits of a food or product. Misdirected claims may involve labeling a product so as to lead a consumer to believe it is more healthful than it is. A bag of potato chips labeled no cholesterol or gluten free is an example. Potato chips don t contain cholesterol or gluten; the advertised product is not unique among potato chips in general. The handout accompanying this section, 6 Tip-offs to Rip-offs, by the Food and Drug Administration provides additional information on this subject. Slide 11 Belief in misinformation can actually impede health literacy and make communication with health professionals, including busy physicians, more difficult. The burden is on the reader to determine fact from fiction prior to seeing the physician. There are some common red flags that may suggest misinformation. Here are some examples. Some websites promise a quick fix to an ailment or medical concern. Some websites may also exaggerate the consequences of a real or imagined ailment. Others may state claims that sound too good to be true, which may actually be misinformation. Some websites make research conclusions that are too general. For example, studies performed on animals, such as rats, may not apply to humans. Some websites include dramatic, over-the-top statements. This may be a red flag that the website contains misinformation. Other websites encourage you to narrow your eating plan so as to avoid certain foods or over-consume others. These websites may be based on junk science. Some websites report recommendations based on one or two research studies. Evidence-based recommendations are based on a consensus of research. 4
Some websites sell products or services. Be especially cautious that the claims are evidence based. Evidence-based claims will be consistent with information found on government health websites and information from respectable medical organizations. Some don t report research that is published in medical peer-reviewed journals, such as the Journal of the American Medical Association. Lastly, some websites make broad general recommendations that fail to recognize differences in individuals or populations, such as age groups. Statements like, Everyone needs more Vitamin C may not be true. If the website is trying to convince you of an ailment, to sell you the cure beware. Slide 12 A clearinghouse of sorts has been established by the Health on the Net Foundation. It s one way to help consumers and professionals make sense of identifying fact from fiction. Health on the Net recognizes that to make decisions about what health information they will trust or what products or services they will use, individuals need to know what standards a site uses in developing subject matter content. Health-related websites must make clear the sources they used and make sure the information presented is appropriate, independent, and timely. Health-related websites should also identify who is most likely to visit the site and ensure that the information presented is as clear and available as possible to all visitors, including disabled persons. Since some sites may be sponsored by one party but hosted by a different one, these relationships should be clearly disclosed on the website. Slide 13 Heath on the Net has a seal, which can be found on the bottom of approved websites. While Health on the Net cannot guarantee the accuracy of medical information presented by a site and its completeness at any given time, the possession of the HONcode seal allows a site to demonstrate its intention to contribute to quality medical information. To display the Health on the Net seal, website sponsors or contributors must follow certain standards or Code of Conduct, which include the following: Authoritative They must indicate the qualifications of the authors. Complementary Information on the website should support, not replace, the doctorpatient relationship. Privacy The website must respect the privacy and confidentiality of personal data submitted to the site by the visitor. Attribution The website must cite the source or sources of published information and date medical and health pages. Justifiability The website must back up claims relating to benefits and performance. Transparency The website must have an accessible presentation and an accurate email contact. 5
Financial disclosure The website must identify funding sources. Advertising policy The website must clearly distinguish advertising from editorial content. Slide 14 Section 5: Online Surfing Recommendations Online health information should assist, not hinder, informed decision making. Slide 15 Any website should make it easy for you to learn who is responsible for the site and its information. The person or organization that runs a website and the site s funding sources determine the site s purpose. Many websites have a link to information about the site, which is often called "About This Site." This Web page should clearly state the purpose of the site and help you evaluate the trustworthiness of the site s information. Although many legitimate websites sell health and medical products, keep in mind that the website owner s desire to promote a product or service can influence the accuracy of the health information they present. Looking for another source of health information that is independent and unbiased can help you validate the accuracy of the material presented on a website. Experts should review and update the material on websites on a regular basis. Medical information needs to be current because medical research is constantly coming up with new information about medical conditions and how best to treat or prevent them. Websites should clearly post the most recent update or review date. Even if the information has not changed in a long time, the site owner should indicate that someone has reviewed it recently to ensure that the information is still valid. Many health and medical websites post information that the owner has collected from other websites or sources. If the person or organization in charge of the site did not write the material, they should clearly identify the original source. Health-related websites should give information about the medical credentials of the people who prepared or reviewed the material on the website. Websites should identify the medical and scientific evidence that supports the material presented on the site. Medical facts and figures should have references, such as citations of articles published in medical journals. Also, opinions or advice should be clearly set apart from information that is evidence based. That is to say, evidence that is based on research results. Testimonials from people who said they have tried a particular product or service are not evidence based and usually cannot be corroborated. 6
Websites should always offer a way for users to contact the website owner with problems, feedback, and questions. Slide 16 Every Internet domain name has a suffix that indicates its origin. There are a limited number of such domains. For example:.edu is used for educational institutions. Sites using this domain name are schools ranging from kindergarten to higher education. Information from sites within this domain must be examined very carefully. If it is from a department or research center at an educational institution or university, it can generally be taken as credible..gov is used for government agencies. If you come across a site with this domain suffix, then you re viewing a federal government site. All branches of the United States federal government use this domain. The information is considered to be from a credible source..org is traditionally used for non-profit organizations. Organizations such as the American Heart Association use this domain suffix. Generally, the information in these types of sites is credible and unbiased; however, there are examples of organizations that strongly advocate specific points of view over others. You probably want to give this domain closer scrutiny. Some commercial interests might be the ultimate sponsors of a site with this suffix..mil is for military. This domain suffix is used by the various branches of the Armed Forces of the United States..net is for a network. You might find any kind of site under this domain suffix. It acts as a catch-all for sites that don t fit into any of the preceding domain suffixes. Information from these sites should be given careful scrutiny..com is for commercial sites. The information provided by commercial interests is generally going to shed a positive light on the product it promotes. While this information might not necessarily be false, you might be getting only part of the picture. Remember, there s a monetary incentive behind every commercial site. In addition, domain names can also identify county of origin. Slide 17 You ve been provided with a handout, Surfing the Web for Nutrition and Health Information - Recommended Websites. Trusted nutrition and health search engines can be found at the websites for: the National Institutes of Health, the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the U.S. Department of Health and Human Sciences, and 7
the U.S. Department of Agriculture. This handout also provides the website address for Evaluating Internet Health Information: A Tutorial from the National Library of Medicine. This 16-minute tutorial teaches you how to evaluate health information you find on the Web. Additionally on this handout, we ve listed websites that expose health misinformation, and updates on rumors, myths, and lies. Slide 18 The National Institutes of Health is a part of the U.S. Department of Health and Human Services. Thanks to evidence-based research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years, as reported in 2009. Disability in people over age 65 has dropped dramatically in the past three decades. The National Institutes of Health is made up of 27 Institutes and Centers, each with a specific research agenda, often focusing on particular diseases or body systems. Let s take a brief look at some of the Institutes you may find particularly helpful. The National Cancer Institute was established in 1937. It leads a national effort to eliminate suffering and death due to cancer. It also conducts and supports research that will lead to a future in which we can prevent cancer before it starts, identify cancers that do develop at the earliest stage, eliminate cancers through innovative treatment, and biologically control those cancers that we cannot eliminate so they become manageable, chronic diseases. The National Heart, Lung and Blood Institute was established in 1948. It provides leadership for research, training, and education to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives. The National Institute on Aging was established in 1974. It leads a national program of research on the aging process, the prevention of age-related diseases and disabilities, and the promotion of a better quality of life for all older Americans. The National Institute of Diabetes and Digestive and Kidney Disease was established in 1950. Its mission is to conduct and support medical research and to disseminate science-based information on diabetes and other metabolic diseases; digestive diseases, nutritional disorders, and obesity; and kidney, urologic, and blood diseases, to improve people s health and quality of life. The National Institute of Mental Health was established in 1949. It provides national leadership dedicated to understanding, treating, and preventing mental illnesses through basic research on the brain and behavior. The National Institute of Neurological Disorders and Stroke was established in 1950. Its mission is to reduce the burden of neurological disease, which are burdens borne by every age group, every segment of society, and people all over the world. To accomplish this goal, it supports and conducts research on the normal and diseased nervous system. 8
The National Library of Medicine is part of the National Institutes of Health and was established in 1956. It collects, organizes, and makes available science information to scientists, health professionals, and the public. The Library s web-based databases, including PubMed/Medline and MedlinePlus, are used around the world. Slide 19 Section 6: Words of Wisdom Perhaps you ve heard of the Latin expression, CAVEAT EMPTOR, which means: let the buyer beware. It means that the person who is buying a product or service is responsible for making sure of its condition and/or quality. This expression can certainly apply to anyone seeking health information on the Internet. Information and misinformation are both present on the Internet, and it s up to the reader to tell the difference. Slide 20 Always be careful. Do not trust any promises of miracle treatments, magical drugs, or any other statements that are not supported by evidence. Try to avoid purchasing medicines and drugs via the Internet. Do not trust online medical consultants. Only a doctor can give you personal advice based on your testing results during a face-to-face medical appointment. Slide 21 Self-diagnosis can be dangerous, especially if it results in the delay of seeking medical advice or treatment from your physician. Some conditions, such as cancer, need to be treated as soon as possible. Information on the Internet should not cause you to modify, augment, or discontinue your medical treatment advised by your physician. Some prescription medications need to be taken regularly, such as high blood pressure medications, even though you may think you no longer have that ailment. Some medications should not be stopped abruptly but instead require a gradual reduction in dosage. Your doctor will know if this is the case for the medications you may take. Slide 22 Never take the information found on the Internet, in a textbook, or anywhere else as medical advice. Only a healthcare professional is able to give you personalized health care advice that is tailored to your needs. Instead, use health information found on reputable websites to help you form questions you would like to ask your doctor. This should help you to better understand your disease and its treatment. If you aren t satisfied with the quality of your care, ask for a second opinion from another doctor or specialist. 9
Section 7: Learning Application To help pull together the information provided in this session, we recommend you complete this learning activity on evaluating information obtained from the Internet. Please download and print the PDF file, Weight Loss & Nutrition Myths, and the activity handout, Weight Loss Myths. Slide 23 Section 8: Author I hope this session has been helpful to you and will give you some new tools to use when surfing the web for nutrition and health information. This session was developed by Dr. Sharon Francey Robinson. She is an associate professor and registered dietitian with Texas A&M AgriLife Extension Service at the Texas A&M University System in College Station, Texas. Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating 10