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JMIR articles are regularly making headlines - some examples (this list is no longer maintained, please use Google instead...).


Want to Quit Smoking? Technology Can Help

July 01, 2008 11:37AM


Technology is helping to make winners of quitters.
The internet has long been rife with self-help sites for those who wish to give up smoking, but new technologies are emerging to give smokers a leg up in their struggle.
There are websites that offer interactive resources to motivate quitters and keep them on track, mini-computers that can help you track your progress, and software for hand-helds that makes it easier for doctors to pitch in.

Beth Bock, a professor in the Department of Psychiatry and Human Behavior at Brown University Medical School, has been studying online resources for aspiring quitters for years. Her latest research, due to be published shortly in the Journal of Medical Internet Research, found that while web-based resources are plentiful, it may be difficult to locate the best sites.
An analysis of the top results for search terms like "quit smoking" or "smoking cessation" found three of every four sites offering little or no quality resources; many merely sold smoking-cessation products or listing articles.
The best sites followed U.S. Public Health Service guidelines, which include assessing how ready smokers are to quit, assisting them with plans, providing practical counseling tips and suggestions, offering social support, recommending mediation and arranging follow-up.
Interaction is crucial, Bock said, and while some sites provide ways for smokers to interact with each other, they could be doing much more.


CNN / TimesDaily 

But wouldn't it be easier? Why doctors don't e-mail

By Michelle Rupe Eubanks,
Staff Writer

Michele Aycock says she doesn't get sick often, but, when she does, it would help if she could get answers to follow-up questions faster, maybe even with the help of an e-mail exchange with her doctor.

"If I could do that, we could have continuous feedback," said Aycock, of Florence. "Instead, I have to wait three or four hours for the call, and then I get one shot to ask my questions. What if I forget something and have to call back? I'll wait three or four more hours or even until the next day for an answer at that point."

Being able to communicate electronically could potentially alleviate the problem, but even though most Americans are like Aycock and believe e-mails are the way to go, fewer than a third of doctors in the United States use this method to communicate with patients, according to a physician survey.

Dr. Nir Menachemi, associate professor in the Department of Health Care Organization and Policy at the University of Alabama at Birmingham, suspects he knows why.

"If I had to guess why doctors aren't more amenable to e-mailing patients, it would have to do with reimbursements," he said. "Reimbursements are the 800-pound gorilla in the room no one wants to talk about."

By and large, physicians are creatures of habit, having learned the ropes about private practice from the collective knowledge of generations of doctors who came before, Menachemi said, adding that his opinion is based largely on findings from a study he did in 2006 with Dr. Robert Brooks that was published in the Journal of Medical Internet Research.

"E-mail flies in the face of how they have been trained to that point," he said, but things are beginning to change as the health-care industry looks at ways to develop an information infrastructure so that a rural physicians' office in Lexington can upload a patient's medical information for a hospital in Tikrit, Iraq, if necessary.

"I can buy an airline ticket to fly to any spot on the globe; I can access the money in my bank account from any ATM in the world, but I can't make an appointment with my physician for tomorrow or even next week electronically," Menachemi said. "If you look at it that way, the health-care industry is still very much in the dark ages when it comes to technology."

Doctors have their reasons for not using e-mail more often. Some fear hackers could compromise patient confidentiality, even though doctors who use e-mail do so generally through password-protected Web sites, similar to the one Dr. Martha Aldridge uses to communicate with the patients she sees as part of an obstetrics and gynecology practice she shares with Dr. Stephen Keith in Florence and Sheffield.

"Many people who request services or information via e-mail have been using (this kind of software) in all aspects of their lives and feel it is more efficient, yet safe," she said. "We would enjoy even more information interchange via e-mail, but many patients either don't know about the service or do not feel they have access to a computer at the right time."

There are concerns among those in the industry that patients will send urgent messages that won't get answered promptly, and any problem raises the specter of legal liability.

Dr. Duane Carter, a pediatrician at Shoals Pediatric Group in Florence, said "being libel for information we give out is the crux. We're all afraid to say something that will cause the child to have a bad outcome and have it come back on the doctor."

Despite the potential for problems, Carter said he'd welcome e-mail as a way to communicate with his patients, especially if guidelines were set about what type of questions should be asked, such as when an infant should begin solids.

"At four months; it's textbook," Carter said. "But it wouldn't be appropriate for a parent to ask about a rash and for me to call in a prescription. That would require an office visit."

The American Medical Association says e-mails should not replace face-to-face time with patients, and the group also recommends doctors who use e-mail talk to patients about the technology's limitations.

Most studies have shown that patients don't abuse e-mail. They typically don't deluge doctors with messages, and this type of exchange may even increase a physician's productivity and cut down on office visits.

It's certainly been the case for Aldridge's practice.

"Interestingly, most of the e-mail requests are from professionals and students," she said. "We're encouraging our patients to try the service, and we're also trying to be responsive to check our e-mail at least every hour so that response time is minimized."

A 2007 University of Pittsburgh study published in the journal Pediatrics followed 121 families who e-mailed their doctors. Researchers found 40 percent of e-mails were sent after business hours and only about 6 percent were urgent. Doctors received on average about one e-mail per day and responded 57 percent faster than by phone.

A separate study by health-care giant Kaiser Permanente, published in the American Journal of Managed Care in 2007, found patients who used its secure Web system were 7 to 10 percent less likely to schedule an office visit. Patients also made 14 percent fewer phone calls than those who did not use the online services.

It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls.

Dr. Mary Robbins, an obstetrician and gynecologist with an office in Florence, said she's been slow to adapt to e-mail because there seems to be precious little time to return the mountain of phone messages that pile up throughout the day.

"We're just now getting into electronic medical records, and that will have to have time to take effect before we can use e-mail," she said. "You want everything to be on computer. If it's not, you're still going to have to pull the chart, and that takes time."

Robbins said her office is on track to be communicating via e-mail with patients within five years, but that will also take some technology retraining for her and her staff.

"The e-mail thing will be the way we communicate eventually, but I'm not even that computer savvy, so I'll have to improve my skills, too," she said.

By then, technology may have handed humanity another means of communication, and UAB's Menachemi suggests getting on board before it's too late.

"The first step is getting connected," he said. "The second is finding a system that will allow us all to talk to each other. We need to agree on these things now." contributed to this report.



Health records exposed on recycled computers


Researchers extract personal health information from computers purchased from second-hand vendors

Globe and Mail

A new study raises disturbing questions about the security of medical records that are increasingly being stored on computers.

Canadian researchers were able to extract personal health information from used computers they purchased from second-hand vendors. The computers had not been properly stripped of their data before they were resold.

"Some of the data we found was very startling - and very personal information," said Khaled El Emam, who led the study at the Children's Hospital of Eastern Ontario Research Institute and the University of Ottawa. The data included information about mental health, addictions, drug prescriptions as well as medical correspondence.

In some cases, the original owners had kept data about their own medical conditions. But in other cases, the computers were used by health care workers - including employees and subcontractors - who may have worked at home on patient files.

For the study, the researchers randomly purchased 60 used disk drives from dealers in several provinces.

They were able to retrieve data from 65 per cent of them. Of these disk drives, 18 per cent contained personal medical information, according to the study published in the Journal of Medical Internet Research.

Dr. El Emam noted that simply deleting a computer file does not actually remove the data from the disk drive. "With special software, you can recover a lot of that stuff," he warned.

That means computers used for sensitive health information should be specially encrypted to prevent the data from being easily accessed by a new computer owner.

Or the drive itself should be destroyed rather than ending up on the second-hand market.

Dr. El Emam fears a security breach could undermine the public's confidence in the health care system. What's more, it could lead to medical fraud, with people getting medical treatment using stolen insurance identification numbers.

"We really have to be sure that personal health information, especially when it is entrusted to other people, is protected and not inadvertently disclosed in this way," he said.

Source: Globe and Mail,




The Growing Clout Of Online Patient Groups

Laura Landro

The Wall Street Journal

June 13, 2007


When researchers at Harvard University were looking for a gene mutation in a group of rare blood cancers, they turned to Joyce Niblack, who put the word out to an online patient mailing list she manages, spurring more than 300 members to send in mouth swabs and bone-marrow samples. Later, Ms. Niblack mustered 1,179 participants from 30 countries for a Mayo Clinic-led study of how the cancers, known as myeloproliferative disorders, affect quality of life. The Mayo researchers are now running the clinical-trials page on her foundation's Web site, mpdinfo.org1, to keep participants up to date on developments. Online patient groups have become an increasingly powerful force for health-care consumers over the past decade, raising funds for research and offering patient information and support. Now, as the cumulative power of their memberships grows, these groups are becoming invaluable partners to researchers and physicians searching for cures. (...)

"We can bring information about studies, clinical trials and meetings to any patient world-wide who has computer access," says Ms. Niblack, a retired patent attorney who runs both an ACOR mailing site and the MPD Foundation and has been fighting the disease for almost 20 years. "People have told me the information has saved their lives."

The University of North Carolina at Chapel Hill teamed up with ACOR for the first large-scale scientific analysis of medical online communities, publishing its findings last month in the Journal of Medical Internet Research. Using software that analyzes message content to examine the type of support provided by the groups, the researchers found that the most common topics in messages were about treatment information and how to communicate with health-care providers.

"One of the real values in the mailing lists is their role in getting patients to seek second opinions and ask questions about clinical trials," says Barbara Rimer, dean of North Carolina's School of Public Health and an author of the study.

The software programs enabled researchers to study messages without identifying who wrote them.


Medical Googling helps patients but irks doctors

Julie Deardorff

Chicago Tribune

December 8, 2006

Increasing numbers of us are Googling our own weird headaches, rashes and unexplained symptoms before heading to the doctor. And although physicians are secretly Googling difficult medical situations, many aren't thrilled that we're doing the same thing. In fact, doctors used words like "nightmare," "annoying," "irritating" and "frustrating" when talking about the burden of dealing with patients who bring in stacks of Internet-based health information (and misinformation), according to a recent study in the Journal of Medical Internet Research. Even though 80 percent of North Americans access health information on the Internet, some doctors see it as an unwelcome intrusion and resent the new interpretive role they have been put in. The practice, they say, not only increases their workload but also leads patients to confusion, distress and a tendency toward detrimental self-diagnosis. Doctors aren't necessarily threatened when patients use Internet health information to educate themselves once they have a diagnosis. What bugs them is when their clients beat them to the punch. "Patients were perceived as 'challenging' when they used Internet information for self-diagnosis or self-treatment or to test the knowledge of physicians," the study found. Patients also were described as adversarial, neurotic and lacking trust in their provider.




ONLINE PHARMACIES: What the doctor downloaded.

Haymarket Business Publications Ltd.

As the dispensing of prescription drugs becomes big business online, Charlotte Goddard reveals the steps being taken to ensure the practice harms neither patients nor the reputation of pharmacies

Anyone with a Hotmail account or an easily accessible email address will be used to receiving emails with titles such as 'Viagra - Xenical - Phentermine and more!'; 'Cheap Viagra!' and 'POWERFUL LEGAL STEROIDS'. Anti-spam company Brightmail found that 10 per cent of all spam passing through its Probe Network over a 24-hour period this August was health-related. A search for Viagra on Google UK brings up eight sponsored links (a search for 'books' only brings six). Buying and selling of prescription drugs online is clearly big business.

But it's a grey sector, controlled by unclear legislation, and one in which legitimate online pharmacies need to position and market themselves well to differentiate themselves from less scrupulous individuals or organisations.

In 1999, the  Journal of Medical Internet Research (JMIR) tested a number of online pharmacies and found that many would sell Viagra without any kind of prescription. A number of other web sites sold the drug after a medical questionnaire was filled in - even when the questionnaire indicated that the person buying the drug was too old, obese, or had coronary artery disease and hypertension, all of which can make taking the drug dangerous. According to the report, the researchers 'ordered a total of 66 pills worth USdollars 1,802.84 (pounds 1,161.32). Three companies delivered within six, 10 and 34 days respectively, despite Viagra being clearly contraindicated (by the unsuitability of the drug for the patient).'

A further report from the JMIR, published in January 2001, estimated that at least 150 companies were selling Viagra over the web.