Super Smart Health

A Presentation on The Foundation of Healthy Living

by Daniel Friedland | Jan 10, 2010 04:48:00 PM

This month Del Mar TV is featuring a presentation I gave on Navigating Stress, Uncertainty and Self-Doubt, the first of a series they are doing on Healthy Living. Starting the series with this topic is well-founded, since the ability to navigate stress and find a deeper sense of connection, meaning motivation and purpose in one’s life is foundational to healthy living.

This program expands on the presentation I gave in the blog from April 2009 to reveal:

• The four Principles of SuperSmartHealth.
  

• How stress and self-doubt fragments our foundational sense of health and well-being.
  

• How to identify and diffuse triggers of stress and self-doubt.
  

• How we instinctively fight and take flight in response to stress and self-doubt and how to assess when this does more harm than good.
  

• How to neutralize fear and reactive self-doubt and harness the power of creative Self-Doubt.
  

• Four key steps to make the turn from reactivity in limiting self-doubt experiences into inner wisdom and inspiration to rediscover your creativity, power and path to fulfillment.
  

In addition to viewing this presentation on the Del Mar TV station or live streaming on their website at the times described in the Events section of our website, this presentation can now also be viewed by by clicking on the video below:

(You may need to download QuickTime to view the video, which can be done for free.)

Please feel free to share this program with anyone you think may benefit, and if this is of interest, contact us for more information about Workshops and Coaching on this topic.

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Rise of the Smart Patient in the Global Health Market

by Daniel Friedland | Dec 22, 2009 07:48:00 PM

One of the fastest growing segments of the healthcare industry is medical tourism, where for a number of reasons, more and more patients are electing to travel away from their local healthcare systems to seek healthcare. Here navigating the healthcare system takes on a global context, with additional skills needed to do this safely and effectively.

If you’d like to learn more about this topic, take a look at the article I co-authored this month with Renée-Marie Stephano, the President of the Medical Tourism Association (MTA) and Vivian Ho, the Managing Director of MTA’s Asia Pacific region. It’s titled Rise of the Smart Patient in the Global Health Market.

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Video on Navigating, Stress, Uncertainty and Self-Doubt with Spirit Guided Health

by Daniel Friedland | Apr 18, 2009 10:43:00 AM

This video is a segment of a presentation I gave recently on how to “Become a Smarter Health Seeker.” The program outlined a unified approach to finding scientific and spiritual answers on the journey to health. This segment describes how the framework of Evidence Based Medicine – Frame, Find, Evaluate and Apply – which enables us to find external guidance in science, can also be used to tap inner guidance and inspiration, particularly in the face of stress, uncertainty and self doubt. If you’d like to view the video click below:

(You may need to download QuickTime to view the video, which can be done for free.)

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Become a Smarter Health Seeker:
From Evidence Based Medicine to Spirit Guided Health

by Daniel Friedland | Mar 28, 2009 02:25:00 PM

At SuperSmartHealth our mission is to empower you to become a smarter health seeker (or if you care for patients or support those who do, smarter healthcare providers and allied professionals).

We offer a Vision of SuperSmartHealth to support this mission. It rests on four principles:

1. You are the CEO of your health.
2. You define your vision for optimal health.
3. You recognize resources to support your vision.
4. You are empowered to harness resources to experience optimal health.

The fourth principle leads you to the following 3 gateways that provide knowledge, support and inspiration to empower you achieve your vision of optimal health.

In acknowledgement of “Wholeness” being the root of the word “Health,” these gateways provide a framework and resources that represent the mind, body of spirit of a system of healthcare that ideally supports the mental, physical and spiritual well-being of individual health seekers.

The gateway to Navigating the Healthcare Literature (the “mind” of health) enables you to navigate scientific uncertainty using the framework of evidence based medicine. This powerful system, which has become the standard by which health care providers make medical decisions, enables one to:

1. Frame better questions relating to one’s health concerns.
2. Find the best available scientific evidence on the Internet.
3. Evaluate scientific information to ensure it’s believable.
4. Apply this information to healthcare decisions.

While Evidence Based Medicine is immensely helpful in providing scientific answers to our health concerns, science alone is insufficient to facilitate an experience of individual or societal health and well-being. Science informs us what is likely to work, but does not convey direction, motivation, purpose or inspiration that infuse our lives with inner meaning or provider inner guidance to take wise action on what is likely to be good for us and others.

Therefore, to find a sense of balance in health (“wholeness”) both science and spirituality are vitally important. The gateway to Navigating Stress and Uncertainty – Spirit Guided Health – provides a framework for tapping into inspiration.

What has most excited me in putting this website together, and finding my own sense of wholeness, is discovering that the evidence based medicine framework used to navigate uncertainty to find external guidance in science – Frame, Find, Evaluate and Apply – can also be used to navigate personal uncertainty to find inner guidance and inspiration. As such this framework serves as a unified approach to finding scientific and spiritual answers on one’s journey to health and well-being. May we help you become a smarter health seeker and travel well!

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Who Are We on our Journey of Health –
Patient, Consumer, User, or Seeker?

by Daniel Friedland | Feb 28, 2009 03:19:00 PM

On the home page of this website I’ve mentioned that this resource is offered to healthcare providers and patients. I’ve wrestled over the use of the word “patients.” I’ve used the term simply because it is well recognized, but at the potential expense of the full spirit for whom the website is intended: individuals who are looking to be more fully empowered in their ability to partner with their providers in decisions around their healthcare.

The root of the word “patients” comes from the Latin, “patiens,” one who suffers. On one hand the term does capture a dimension of the relationship between healer and patient. Many patients suffer from fragmentation of mind, body and spirit. The role of healer then is to restore patients back to an experience of essential wholeness, which as mentioned on the home page, is the root of the word “health” (and “healer”).

On the other hand, not all who search for knowledge, support and inspiration in health suffer. And some may feel the word, “patient,” subordinates them in a relationship with their healthcare provider.

So what are the descriptive alternatives for “patient?” Nancy Turett, the Global President for Health at Edelman, an independent global PR firm, has written a thought provoking blog which discusses the limitations of other commonly used terms such as health “consumer” or health “user.”

Many searching for health information are not looking to consume more, and would not identify with the term health “consumer”. If anything many would like to consume less. Rampant consumption is often a symptom of the need to escape underlying stress and anxiety, which may exacerbate the experience of dis-ease and ill health.

The term health “user” is commonly used by the technology industry. As much as technology empowers humanity it can also sterilize it. While individuals do “use” resources, they do and are far more.

So what term best describes the whole essence of an individual searching for information to empower their health and well-being. Nancy Turett offers, “people” or “individuals.” These terms are certainly more holistic than the others, but may be too indiscriminant, because individuals provide and receive care, and this does not distinguish between for physicians and patients for example.

The term I favor is “health seeker.” It is a term that can be substituted for patient, consumer and user, but does not require an individual be suffering, consuming or using. While one may seek knowledge support and inspiration to restore a sense of wholeness, one can also be experiencing wholeness and seek all the same. It the essence of being human, the desire to seek, grow and experience the full vitality life has to offer.

At SuperSmartHealth it is our mission to empower you as a smart health seeker with skills and resources to find knowledge support, support and inspiration on your journey of health.

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Rise of the Smart Patient

by Daniel Friedland | Jan 07, 2009 01:53:00 PM

Take a look at this article published in 2008 in the San Diego Physician Magazine. It outlines a vision of physicians and patients partnering in medical decisions using the framework of Evidence-Based Medicine.

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The Rise and Role of Patient-Generated Research

by Daniel Friedland | Dec 08, 2008 08:39:00 PM

ALS (Amyotrophic Lateral Sclerosis), or “Lou Gehrig’s Disease,” is a relentlessly progressive disease affecting the nervous system and leading to an inevitable decline in voluntary muscle use around the body. Currently, only one drug, riluzole, has been FDA approved to treat ALS and it has limited efficacy.

So when a prestigious medical journal published a study in February 2008 titled, “Lithium delays progression of amyotrophic lateral sclerosis”, it offered a glimmer of hope to all those who suffer with the disease.

The study, led by Francesco Fornai from Italy, was a small randomized controlled trial that compared 16 patients with ALS who took lithium plus riluzole with 28 patients who took riluzole alone. Over the 15-month duration there were no deaths in the group of patients taking lithium. In contrast about 30% of patients died in the group that did not. The progression of ALS symptoms also slowed dramatically in patients taking lithium.

The Rise of Patient-Generated Research

The seeds of promise from any first study, particularly a small one, begs the confirmation of others – but these studies often take time to do. In this era of Health 2.0 (see previous blog) the results of follow up research in this case came far more quickly than anyone would previously have imagined. Most remarkably, this research was initiated and conducted by an ALS patient and a family member of another patient leveraging the power of online communities.

In January, 2008, within 2 months of the first announcement of the Italian study, Karen Felzer, a PhD earthquake researcher from the U.S. Geological survey, whose father was diagnosed with ALS, and Humberto Macedo, a 42-year-old computer systems analyst and father of six from Brazil who has ALS, recruited 191 patients with ALS from the Internet to follow-up with a 6-month study on the safety and efficacy of lithium.

The researchers collaborated with the online community, PatientsLikeMe to collect and publish the data, a good fit for this type of study since it enables users to share information on a number of neurological conditions, including ALS, and provides tools for patients to describe their symptoms in detail.

In the study 60% of the patients self-elected to take riluzole with the lithium, while 40% decided to take lithium by itself. Patients then self-reported the progression of their symptoms using a well-validated instrument called the ALS Functional Rating (ALSFRS-R). Patients electing to take lithium were compared to 66 similar patients in the PatientsLikeMe database who did not take lithium.

By 6 months more than a third of patients had stopped taking lithium because of side effects, lack of efficacy, or doctor’s advice and only 50 patients reported their outcomes on the 6-month ALSFRS-R evaluation.

The findings of the study are available at the PatientsLikeMe research on Lithium and ALS section as well as the original website of the study. In contrast to the Italian study and to the disappointment of many, the study found no effect of lithium in slowing the progression of ALS.

So what does this all mean? How do we reconcile the findings of these two studies and what is the role for this new breed of patient-generated research?

The Role of Patient-Generated Research

At first glance it seems easy to dismiss the patient-generated research as an unreliable upstart. After all, this type of research falls lower down on the hierarchy of studies referred to in Evidence-Based Medicine (for more on this, see the section on Classification of Medical Research ). And with a large drop-out of patients, the study is certainly flawed.

The Italian study was an experimental design, a randomized controlled trial (RCT), considered the gold standard in research methodology.

The patient-generated study simply observed what happened to patients who elected to take lithium (i.e., it was observational research). In studies such as these it is difficult to tell whether the findings are due to the drug or the differences in the characteristics between the groups compared, the natural history of disease or a number of other issues, some of which have been nicely laid out in the the following blog. So does this type of research have any merit at all?

It adds another dimension to the clarifying the puzzle, and has value, as long as one knows how to jigsaw the pieces together.

While RCT’s are the gold standard, it is important to remember that these studies are usually conducted on highly selected patient populations under ideal circumstances. Observational studies, on the other hand, provide additional insight, because they peer into the experience of real world populations.

Rather than dismissing observational studies, any differences found between this type of research and the more highly regarded experimental designs should provide a spark for important questions. Often real world studies provide insight into the challenges of implementing therapy or what happens in different patient populations.

For example in the case of these lithium studies we would ask whether the lack of effect in the patient- generated research occurred because the patients did not have enough lithium in their bloodstream. In the RCT, researchers carefully titrated the dose of drug to blood levels between 0.4 and 0.8 mmol/l. In the patient-generated research, about two thirds of the population had blood levels below 0.4 mmol/l. Aha!

Yet the progression rates in the observational study were also not altered in the patients who obtained a 0.4 mmol/l blood level of lithium. Further, it did not seem to depend on whether they took riluzole with the lithium, or whether patients were early or late in disease progression at the time that lithium was started.

The unexplained discordant findings between these two types of research invite other trials to clarify the potential efficacy of lithium in ALS, especially since the initial RCT itself had its own limitations. It was a small study and only “single-blinded.” (Patients did not know whether they were receiving lithium, but one of the researchers did, and this opens the door to potential bias.)

Thankfully, another RCT is on the way. The new trial is sponsored by the ALA Association and will be led by Dr. Merit Cudkowicz, an Associate Professor at Harvard Medical School. It will randomize 84 patients to lithium or placebo and this time it will be “double-blinded.” (Neither patients nor researchers will know who is taking what medication).

Part of the story then is that real world patient-generated research can raise questions about the efficacy of a drug. Still we have to remember this kind of research is observational and does not yet incorporate statistical methods, academic rigor, or a thorough review to rise to the level of observational research published in peer reviewed medical journals. As such it is unlikely to ever provide the definitive word on efficacy. Yet, by stimulating questions it does contribute to clarifying the picture on efficacy. The fully realized potential of this type of research, however, probably lies elsewhere.

The Promise of Patient-Generated Research

Currently, the greatest challenge in evaluating drugs does not relate to establishing its efficacy, but rather its safety. The gold standard RCT, typically randomizing 200 to 300 patients, can give a good indication as to whether a drug is more effective than a comparitor.

However, the size of these studies is hopelessly inadequate to evaluate potentially serious or life threatening events that occur only infrequently. One usually requires thousands, or even tens of thousands of patients, to thoroughly evaluate safety concerns. This is very expensive to do in an experimental research setting and is therefore rarely done.

So what is done? We have to rely on observational research. Ideally, we observe what happens in large populations. And this is where the full power of Health 2.0 and online communities comes in. Networking the collective wisdom of the masses, and now with sites like PatientsLikeMe providing patients the ability to record their health experiences in great detail, we have the opportunity to pick up safety signals like never before.

With its speed, efficiency and reach the trend towards patient-generated research will inevitably continue, as will the sophistication with which this research is done. Given the power to contribute, patients frustrated with bureaucracy and current speed of research will not want to wait for answers. They will want to take an active role in moving the science along, and will likely do so.

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Harnessing Health 2.0

by Daniel Friedland | Nov 19, 2008 08:55:00 PM

The challenge in searching for health information doesn’t lie in the broad questions such as, “how do I treat diabetes,” but in asking narrow focused personalized questions like, “how does a brand new drug I’m taking interact with another specific drug in someone with a disease condition just like mine.” In Health 2.0 lingo these specific questions involve searches into the “long tail” (the head being the frequently asked questions on a topic and the tail very specific infrequently asked queries – if you’re interested to read more on this click here).

Health 2.0 endeavors to solve the challenge of searching into the long tail. A single definition of health 2.0 is not easy to come by as there are a number and it still seems to be evolving (you can read more here and here). As best I can synthesize and simplify, Health 2.0 empowers patients with the specific information they need to make rational health decisions and involves three main components.

The first two components were memorably illustrated at last months’ Health 2.0 Conference, in an opening slide by Mathew Holt, one of the conference co-founders, showing a comb and beer suds. This image captured the complementary function of combing for specific information using intelligent search solutions and enabling it to bubble to the surface by harnessing the power of crowds in online communities. The third component of Health 2.0 involves the use of smart tools to facilitate many areas of healthcare such as making diagnosis, assessing personal risk, managing health conditions, selecting affordable drugs and health plans, checking drug interactions, organizing personal health records, managing health finances, finding and communicating with healthcare providers and more.

Be on the lookout for offerings that can empower you in each of these areas. At the Health 2.0 Conference many companies showed their wares. A sampling of a few making an impression:

Intelligent Search:

• RightHealth: noteworthy for the 360 degree view they provide on any given search using an algorithm to identify trusted resources.

• OrganizedWisdom: provides a human generated list of recommended links on a comprehensive list of health topic reviews.

Online Communities:

• PatientsLikeMe: enables users to share information on a number of neurological and mood conditions and HIV/AIDS and provide them tools to describe their symptoms in great detail, which lends itself to user generated research (more of this in a future blog).

• Sermo: the largest community networking site for physicians.

Tools:

• American Well: enables you to log on and engage a selected healthcare provider in an online visit, typically within 20 minutes.

• DestinationRx: a helpful resource to find lower cost drugs and compare the total costs of the numerous Medicare Part D plans (including health premium and drug costs).

• PharmaSURVEYOR: enables you to trouble shoot your medication list for drug interactions.

We’ll be incorporating many of these resources into the gateways at SuperSmartHealth and will keep you abreast of others we discover in future blogs. Please feel free to comment or share with us any other resources you find helpful here too.

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Welcome to the SuperSmartHealth Blog!

by Daniel Friedland | Oct 21, 2008 05:47:00 PM

We’re delighted you’ve found your way to our site, especially since we’ve just flipped the switch on October 22nd to put SuperSmartHealth online. We welcome any feedback you may have how we can improve any aspect of the site (feedback@supersmarthealth.com).

Our website provides gateways to knowledge, support and inspiration through which healthcare providers and consumers can harness tools and resources to navigate scientific information, the healthcare system and stress and uncertainty. 

The primary purpose of this blog is to explore “SuperSmart” concepts and resources within each of these gateways, with a goal of becoming a clearinghouse for the many smart initiatives in healthcare. In addition to commentary I will be interviewing leaders in the healthcare industry and look forward to your comments. I hope this blog will be of interest and usefulness to both healthcare providers and consumers in supporting your partnership to better health.

To give you a brief background about me (my bio is available in the About Us section), I’m Daniel Friedland, an internal medicine physician and author of one of the early textbooks on Evidence-Based Medicine (EBM, the framework laid out for you in the gateway for navigating health information). Over the last decade I’ve taught thousands of health care providers and allied professionals throughout the U.S. how to practice EBM. I am excited with the launch of this website to begin teaching EBM to consumers. My passion for doing this is to support doctors and patients with this common framework to strengthen a shared-decision making bond.

As much as I understand the tremendous value that EBM offers to navigate scientific knowledge, I also recognize that it is not enough to cultivate an experience of health in the broadest sense of the word (captured more fully by wholeness, the root from which the word is derived). A large purpose of this website is to incorporate EBM within a holistic vision of health and to balance the important roles that both science and spirituality play in health and healing. I’ll share more about this and what’s driven my interest and perspective in future blogs.

If you’d like to be kept updated when any new blogs are published please sign up.

I’ll be traveling this week to San Francisco to the Health 2.0 Conference, and look forward to reporting back when I return…

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