Miles of information for medical librarians

Google Health® is not very new, but I have not taken the time to really evaluate the service. I didn’t really take the time to evaluate Google Health® because I was not interested in looking at personal health records (PHRs); however, I recently saw a note about Google® entering the health encyclopedia business with Google Health® OneBox in the U.S. http://bit.ly/19C0O2 and http://bit.ly/1JA3xo from Ves Dimov. After seeing this announcement I decided to dig a little deeper into Google Health® and what I found might surprise you.

I have done an evaluation on some of the product, more focused on the information provided than the program or services.

Google Health® Privacy, Terms, etc.:

First, I want to point out that Google® is not bound by the Health Insurance Portability and Accountability Act (HIPAA) privacy rule; therefore, anyone using Google Health® needs to be aware of what information they share.

While Google® is not bound by HIPAA, they do seem to have good privacy and security in place. I must admit I will probably not start using Google Health® due to security concerns. I also do not use Google Documents® for the same reason. I know it is considered a very secure service; however, if information was leaked what would happen? Google® is not liable.

Plus, what if you put information on Google Documents® that was related to work? Then you would have the same problem Twitter has had recently when an employee’s account was hacked and access to Twitter documents on Google® were obtained. The summary at the official Twitter blog clearly states it was not a flaw in the Google® Application; however, it reminds us how vulnerable data on the web is to hackers. It is important to remember some data may not be meant for ‘the cloud.’

Keep in mind that data stored in Google Health® can be sent to and used by other Google® products; however, no personal medical information is transmitted, used or stored by other Google® products:

9. Does the data I store in Google Health get used for other Google products, like Search?

Yes, we share information between Google products to enable cross-product functionality. For example, Google Health can help you save your doctors’ contact information in your Google Contact List. But no personal or medical information in your Google Health profile is used to customize your Google.com search results or for advertising. Also, other users cannot access your personal medical records through a search on Google.com. Quote is from the Google Health FAQ page

Let’s take a step away for a minute from the cloud of Google Health® and discuss health information through Google Health®.

First, Google Health® is not a system to search for information according to Google:

4. Is Google Health a new way to search for health information?

Not really. Google Health is mostly about helping you collect, store, manage, and share your medical records and health information. There is a search box at the top of every page in Google Health, and if you enter a search query there, you go to the Google.com search results page that you are used to. There is also useful health information built into Google Health, but Google Health is not a new health-specific search engine.

The fact that Google Health® says it is not meant for health information is surprising after seeing the new release of the Google® OneBox in the United States, which was explained on the Google® Blog and mentioned by Ves Dimov’s daily health news.  It is surprising to see the health information from Google’s® health database returned during a search for say ‘diabetes’ when it has clearly stated it is not a new way to search for health information.

Google Health®: Health Information Database?

While Google® states it is not meant to be used as a health information database, it does provide several extra tools that can display health information:

Example:

Go Red Heart CheckUp

Welcome to the most important choice you may make today- take the Go Red Heart CheckUp. This free American Heart Association’s Go Red For Women assessment uses values from your Google Health profile to estimate your risk of having a heart attack or dying from heart disease over the next 10 years. Registration is required. Choose to beat heart disease. Our Hearts. Our Choice.

The various add on tools: https://www.google.com/health/directory?cat=exploremedsandtreatments

Although you can use these various tools, Google® makes sure to state on the directory page of personal health services that it is not responsible for any medical information found or used on outside websites:

Google doesn’t own or endorse these websites and isn’t responsible for their content or performance. The Google Health privacy policy does not pertain to other web sites, so check each service’s privacy policy and share information only with sites you trust.

If you actually read the user agreement when signing up for Google Health® (I know I do not always read through all of this information), then you would have seen:

2. Not Medical Advice; U.S. Use Only

Google Health does not offer medical advice.  Any content accessed through Google Health is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects.  This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition.  Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment.  Do not ignore or delay obtaining professional medical advice because of information accessed through Google Health.  Call 911 or your doctor for all medical emergencies. (Cannot provide link since it was embedded in the user agreement which was in a pop-up window)

Having all of these disclaimers and statements about the information not being medical advice is an excellent idea since many will take this information and implement it without ever talking to their physician.

Google Health® & Marketing

I will state I like the fact that Google Health® has removed all advertisements from the Google Health® pages. This is something I do not like on WebMD®. Whether the company influences the health information or not, just having the ads next to the information can influence a consumer.

Then again, as Rachel pointed out when you search Google® now for drug information, just a basic search in Google® and not in the Google Health® database, MedlinePlus® no longer appears. Check out Rachel’s post about this topic.

I think it is great that there is a link to MedlinePlus® on the information page of any topic in the health topics within Google Health®. The link shows that this content information is also available on MedlinePlus®, a TRUSTED resource. Excellent wording! The link on the left hand side is fine since it is just directing people to MedlinePlus® and not stating the website is sponsored by NLM® or MedlinePlus®.

Google Health® Topics

Figure 1Figure 1: Screenshot of Google Health Topic: Diabetes. The images have been removed since they are copyrighted by A.D.A.M. ®

Google Health® partnered with A.D.A.M. ® recently to host the A.D.A.M.® encyclopedia online. It is an interesting partnership, one the person at A.D.A.M. ® didn’t know about when I called! Thanks to Nikki (@eagledawg) who pointed out the press release!

It is a great partnership, and I commend Google® for not only partnering with a well-known health resource such as A.D.A.M. ® but for also providing the link to MedlinePlus®.

Although, Google® does have permission to post the A.D.A.M. ® content it is interesting that some information is left out. The one difference I noticed under the diabetes topic is Google Health® does not include the references. Why?

Figure 2Figure 2: Screenshot of MedlinePlus® Medical Encyclopedia displaying the information on Diabetes. Note the link to References in the bottom of the right column.

Figure 3

Figure 3: Screenshot of Google Health Topic: Diabetes. The images have been removed since they are copyrighted by A.D.A.M. ® Again, note the reference section is missing.

Figure 4 Figure 4: Screenshot of Google Health Topic: Diabetes. Notating the A.D.A.M. license information.

It could be the information in the Google Health® topics was limited to certain items, but why would you exclude the reference section?

After finding this missing information, Nikki (@eagledawg) pointed out another missing item—Date stamp. Just out of curiosity, does Google Health also exclude the A.D.A.M.® review update data stamp?

Figure 5

Figure 5: Screenshot of Google Health Topic on Diabetes showing the date stamp is not on the bottom of the page as it usually is.

Whenever you view a page on MedlinePlus® the date stamp is always provided to inform users when information was last updated and by whom.

Figure 6

Figure 6: Screen shot of MedlinePlus® Medical Encyclopedia information on Diabetes. I added the red boxes for emphasis.

The date stamp is very important in the medical field since information changes so quickly. If a date stamp is not provided then users have no idea when a topic was last updated, or if it included new guidelines or if a new FDA warning on a drug was included.

Another interesting fact on the MedlinePlus® page in Figure 6 is it states exactly who reviewed/updated the information last. Yes in Figure 5 Google Health® tells us the information is provided by A.D.A.M. ® but who updated that information? This may be a nitpick question; however, it is important to know which reviewer updated the information so you can research their credentials if you wanted.

I cannot say whether the reference section, date stamp, and reviewer information were excluded due to content limitations, a mistake, etc. All I can say is that it appears odd.

So even if Google® has the permission from A.D.A.M. ® to post their encyclopedia information, it is still very odd that Google® has left out the reference section. As a librarian, I am leery of any database, article, textbook, or any health information that does not provide references, does not state when a topic was last updated, and does not provide information about the specific reviewer updating the topic. The references serve as a way to check the information provided.  When evaluating databases for use in the library, it is very important that each page contains a reference section.

Google Health® Drug Interaction Program:

Perhaps the need for a reference section is even clearer in the drug interaction program in Google Health®. I was very curious in the drug interaction program on Google Health®. If it is a good interaction then doctors who cannot afford other drug databases could use Google Health® to find Drug Interactions, at least until the National Library of Medicine offers their own program (I believe one is in the works for sometime in the distant future. If you have more information on an NLM® Drug Interaction program then please leave a comment about it!)

So I wanted to test the drug interaction program. I decided to use Paxil since it interacts with several other drugs.

****Please note I made up this entire medication list. These are not drugs I am currently taking and I just made up the doses. I am simply trying to compare the interactions in the Google Health® Database to other interactive drug databases.***

This is the list of drugs I added in Google Health®:

Figure 7

Figure 7: Screen shot of the drugs I added in Google Health®. Again, these are not drugs I am currently taking.

After adding all of the drugs, I then looked at the interactions between the drugs. These are the results:

Figure 8

Figure 8: First screenshot of the drug interactions in Google Health®. Please note they would not all fit on 1 screenshot.

Figure 9

Figure 9: Second screenshot of Google Health® drug interactions.

Let me state again, I am not a medical professional. I am only comparing this product to other products and proposing questions about the Google Health® drug interaction database.

Observations:

  • Google Health® does not have Tamoxifen and Paxil interaction.
  • Google Health® does not have any of the interactions with Tylenol® Allergy Multi-symptom.

Tylenol® interacts with all of the other drugs on this list according to other databases (Lexi-Comp®, FDA Website, and others checked for reference).

Also, Tamoxifen and Paxil interact negatively. According to the label on the FDA website these drugs should be with caution when used in conjunction. It actually states:

“Tamoxifen is a pro-drug requiring metabolic activation by CYP2D6. Inhibition of CYP2D6 by parozetine may lead to reduced plasma concentrations of an active metabolite and hence reduced efficacy of tamoxifen.”  Found line 790-792 of the Tamoxifen label: http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020031s061,020710s025lbl.pdf

And in Lexi-Comp®:

Discussion Several studies have shown that decreased CYP2D6 activity (secondary to either genetic variants1,2,3,4,5 and/or drug interactions3) in patients taking tamoxifen is associated with decreased disease-free survival,1,2,3,4 decreased time to relapse/progression,2,3,5 more recurrences,2 nonresponse to therapy,5 and fewer hot flashes.4 These poor outcomes appear associated with decreased concentrations of the highly antiestrogenic tamoxifen metabolites 4-hydroxy-tamoxifen and 4-hydroxy-N-desmethyl-tamoxifen (endoxifen),1,2,3,4,5 both of which are highly dependent on CYP2D6 for their formation.6,7Studies examining tamoxifen pharmacokinetics when coadministered with strong CYP2D6 inhibitors have shown 58-72% reductions in endoxifen concentrations with concurrent CYP2D6 inhibitors.8,9,10

Copyright © 1978-2009 Lexi-Comp Inc.

Yet this interaction is not even mentioned on the Google Health® drug interaction.

Google Health® makes it clear on EVERY page that the information provided is not meant as health advice.

Figure 10

Figure 10: Screenshot of Google® Health disclaimer posted on Drug Interaction page.

I will state that I checked to make sure my profile was updated and the page was refreshed before comparing the drugs.

Google® cannot and should not be held liable for the missing information in the Drug Interaction Database; however, this brief example shows some of the flaws in the program. It also reminds everyone to check several databases for information concerning drugs; even if you are in the medical field it is always good to double check sources.

The information on the drug interaction page, according to Google®, came from Anvita Health® and First DataBank®:

Figure 11

Figure 11: Screenshot of the bottom of the drug interaction page previously shown in Figure 9. The screenshot points out where the drug interaction information originated.

Again, I do not know if Google® left out information sent to it from First Databank® or Anvita Health®, if it was a programming glitch, or if the information is not in either database currently fueling the Google® Health Drug Interaction Program.

If you are looking for drug information check out some of these sources:

Note this list is not inclusive of all resources. If you have a resource to suggest then please leave a comment! Also, remember it is important no matter what resource you use to check the references, last updated stamp, reviewer credentials, and compare it to at least 1 other source.

Please note I did not do a full blown evaluation of the drug interaction database. I only pulled some drugs and evaluated those based on information gathered from other database and the FDA Drug website.

Conclusion

I think Google® is a creative company with unlimited possibilities. I use several different Google® products and find them very helpful. I am not saying you should not use Google Health®. It is a good product; however, it should be used with caution. Remember Google Health® is not bound by HIPPA, resources should always be double or triple checked, the Google® Health Drug Interaction program is missing some key interactions, and the Google Health® Topics are missing the reference section, reviewer information, and date stamp.

Again, I applaud Google® for its efforts and for including links to MedlinePlus® as a trusted resource. As with any information source, even MedlinePlus®, all information should be checked against at least 1 other source.

**I want to think Nikki (@eagledawg) for her advice and review of this post!**

Additional Reading:

Note: There have been several blogs about Google Health® and I could not list them all.

These links have been included as references only and not as endorsements of the statements or of the websites. If a link has been included from your blog or website and you want it removed please send an email request for removal.

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Comments on: "Google Health® Information: Surprising Facts" (8)

  1. [...] This post was Twitted by laikas [...]

  2. Thank you for taking the time to write such an informative post.

    Please not that the correct link is:
    http://casesblog.blogspot.com/2009/08/health-news-of-day_28.html

    and the correct name:
    Ves Dimov

    • I’m sorry about the name typo. I have updated the post and corrected the spelling of your name and the link. Thank you for taking time to read my blog and for posting a comment! I enjoy reading your posts and news summaries. I have even recommended it to several residents and physicians as a good blog to help you stay up-to-date with information.

      Thank you,
      Alisha Miles

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  4. [...] » Google Health® Information: Surprising Facts « Alisha764’s Blog [...]

  5. Bill Bartmann said:

    Great site…keep up the good work. I read a lot of blogs on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks,

    A definite great read…:)

  6. [...] We like: The extensive and well-argued post reviews she writes around new services she has been testing. One which is impressive and interesting to read is Google Health information: surprising facts. [...]

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