Consumer Health, Eighth Edition
Chapter Summaries
Chapter 1: Consumer Health Issues
Consumer health encompasses all aspects of the marketplace related to the purchase of health products and services. Although health care in America is potentially the world’s best, many problems exist.
Health information is voluminous and complex. Many practitioners fall short of the ideal, and some are completely unqualified. Quackery is widespread. The marketplace is overcrowded with products, many of which are questionable. Rising costs and lack of adequate insurance coverage have reached crisis levels. Consumer protection is limited.
Only well-informed individuals can master the complexity of the health marketplace. Intelligent consumers maintain a healthy lifestyle, seek reliable sources of information and care, and avoid products and practices that lack scientific substantiation.
Chapter 2: Separating Fact from Fiction
Consumers obtain health information from nonprofessional, professional, and pseudoprofessional individuals as well as from educational institutions and the media. Unfortunately, much of this information is misleading, inaccurate, or false.
Scientific methods offer an objective way to evaluate information to determine what is false, but even scientists sometimes find it difficult to sort fact from fiction.
The intelligent health consumer should:
- Maintain a healthy degree of skepticism toward health information received through the media.
- Select practitioners with great care.
- Become well-informed before making decisions to purchase and use health products and services; pay little or no attention to health advertising.
- Seek reliable sources of information.
- Be familiar with the fundamental concepts used in the scientific method, including statistical concepts.
Chapter 3: Frauds and Quackery
Despite the tremendous advances in medical science and health education, health frauds and quackery are still common. Americans waste huge amounts of money on unproven and unscientific approaches to health care. Faced with the prospect of chronic suffering, deformity, or death, many individuals are tempted to try anything that offers relief or hope. Health frauds and quackery can cause financial, physical, and psychologic harm.
It is extremely important for consumers to understand the concepts of spontaneous remission and the placebo effect. The mere fact that someone feels better after trying a remedy does not prove that the remedy was effective. Most diseases are self-limiting, and placebos can relieve a broad range of symptoms.
Modern quacks can be difficult to recognize. However, certain behavior patterns should help consumers identify them.
It also is important for consumers to complain to appropriate authorities when they encounter deception in the marketplace.
Chapter 4: Advertising and Other Promotional Activities
The health marketplace is flooded with misleading messages. Some marketers use scare tactics to promote their wares. Some attempt to exploit people’s common hopes and fears. Many advertisers use puffery, weasel words, half-truths, or visual imagery to misrepresent their products. Except for chiropractors, most health professionals who advertise tend to represent their services accurately. Ads by professional societies, hospitals, and prescription drug manufacturers also tend to be useful and informative. Food advertising tends to promote dietary imbalance. Dietary supplements and alleged weight-control products are promoted in a wide variety of misleading ways. Many ads for tobacco products have been intended to distract attention from their dangers. Health-related products promoted by mail, by telephone, by television infomercials, through the Internet, or through multilevel distributors rarely live up to the claims made for them. Although government agencies can stop many misleading promotions, regulatory action provides only limited protection and cannot substitute for intelligent consumer behavior.
Chapter 5: Science-Based Health Care
Intelligent consumers should locate and use a primary care physician (or medical group) who provides care that is scientific, considerate, and compassionate. They should take an active role in dealing with health professionals. They should endeavor to understand the nature of any health problem they experience and the mechanisms and potential hazards of treatment. They should not hesitate to ask questions about fees or request consultations for complicated problems. Good medical care should be a partnership between patient and physician. It should include preventive approaches and periodic examinations, as well as effective two-way communication.
Chapter 6: Mental Health Care
Although excellent help is available for the treatment of mental and behavioral problems, selecting a suitable therapist can be difficult. Some people respond best to a conversational approach, some to medication, and some to both. Before seeking treatment, it is advisable to understand the types of help available and the training that various types of practitioners undergo. Although most practitioners with accredited training are competent, some engage in practices that are unscientific or reflect underlying problems of their own. For this reason, consumers should also be able to recognize the common signs of inappropriate therapy.
Chapter 7: Dental Care
A combination of nutrition, oral hygiene, and professional care will enable most people to maintain their teeth in good condition throughout their life. Adequate amounts of fluoride during childhood will help make teeth resistant to decay. The most efficient way to accomplish this is through water fluoridation and the use of fluoridated toothpaste. Daily brushing and flossing of the teeth can prevent tooth decay and periodontal disease. Professional care may include administration of sealants, removal of calculus (tartar), restoration of decayed or missing teeth, and cosmetic measures. Most dentists provide competent care, but consumers should be alert to the signs of dental quackery. Dentists who practice “holistic” or “biological” dentistry should be avoided.
Chapter 8: The "CAM" Movement
“CAM” practitioners espouse a wide variety of theories and methods not based on scientific evidence. Some of these practitioners seem sincere in their beliefs, whereas others are clear-cut frauds. In some cases they mix effective methods with ineffective ones. In some cases their methods may relieve symptoms related to tension. In many cases they claim credit for spontaneous improvements. Some “CAM” practitioners know their limitations; others will attempt to treat any ailment. The vast majority make no effort to test the validity of what they do. The National Center for Complementary and Alternative Medicine was established through the influence of political insiders rather than any scientific merits of “alternative medicine.” Consumers should be wary of the practitioners described in this chapter and use them cautiously, if at all. Current consumer-protection laws need strengthening rather than weakening.
Chapter 9: Self-Care
Self-care (also called “self-help”) encompasses individual activities that augment or substitute for professional care. It includes health promotion; self-diagnosis; home treatment of chronic diseases; and the use of home medical tests, self-help publications, and self-help groups.
Health-promotion activities should include tobacco avoidance, a well-balanced diet, reasonable weight, exercising regularly, moderate (if any) alcohol intake, immunizations, brushing and flossing of the teeth, periodic medical and dental examinations, and many types of safety precautions.
Most forms of health care involve at least some degree of self-care. Consumers need to distinguish between major and minor illnesses and to know when a physician should be consulted. Excellent self-help publications are available for this purpose. People with asthma, diabetes, and high blood pressure can be treated most effectively and inexpensively with a professionally supervised program that includes in-home testing.
The Internet offers many opportunities to gather information and interact with other people. Self-help groups provide opportunities to exchange information, share feelings, and network with others who have had similar experiences. Online support groups offer anonymity, convenience, and a rapid response, but they may also attract unsubstantiated testimonials, irrational advice, and sales pitches for questionable products. Web users should also guard against bogus interactive tests, dubious products, and privacy risks.
Chapter 10: Health-Care Facilities
Many types of community facilities are available to help with illnesses and infirmities.
Outpatient medical facilities include private medical offices, student health services, work-related facilities, ambulatory care centers, ambulatory surgical centers, and hospital emergency departments and outpatient clinics.
Inpatient facilities include hospitals and nursing homes. A wide variety of home care services may enable disabled individuals to avoid institutionalization.
More than 20,000 facilities are accredited by the Joint Commission on Accreditation of Healthcare Organizations and other accrediting agencies.
The best choice of facility depends on the type and urgency of the problem as well as insurance coverage and other financial considerations. Prudent consumers know and try to avoid the pitfalls of the various facilities.
Chapter 11: Basic Nutrition Concepts
The basic principles of nutrition are moderation, variety, and balance. These can be achieved by daily selection of appropriate numbers of moderate-sized portions from each of the food groups. The Food Guide Pyramid and the Internet-based Food Guidance System enable consumers to select foods from groups rather than having to calculate the amount of each nutrient in each individual portion of food. The Dietary Guidelines for Americans provide additional advice about moderating dietary fat (to help prevent heart disease) and consuming adequate amounts of fiber. Vitamin deficiencies are rare in the United States, but many women do not consume enough iron or calcium in their diet. Vegetarian diets can be a healthful alternative to those that include meat, but must be constructed carefully to avoid nutrient deficiencies. Many qualified professionals can provide consumers with reliable information and advice about diet and nutrition. Nutrition labeling enables consumers to ascertain the nutrient contents of most foods.
Chapter 12: Nutrition Fads, Fallacies, and Scams
Most Americans probably are harmed to some degree by nutrition fads and fallacies. Promoters of nutrition quackery are well-organized and skilled at arousing and exploiting fears and false hopes. Their most persuasive sales pitch is that everyone should take supplements to be sure of getting enough vitamins and minerals. However, it is more sensible for individuals worried about this to keep a food diary for several days and have a physician or registered dietitian determine whether any problem exists.
Supplements and “health foods” have been recommended for virtually every ailment. However, there is little or no scientific evidence to support such recommendations. Megadoses of vitamins and minerals have few legitimate uses and should never be taken without competent medical advice. Anyone who sells supplements or recommends them for everyone should be ignored.
Chapter 13: Weight Control
To lose weight, people must eat less, exercise more, or do both. Although hundreds of “miracle” products and “revolutionary” diets have been marketed, no pill, potion, or dietary plan can produce weight loss without exercise or lowering of caloric intake. To lose 1 pound of fat, it is necessary to burn 3500 more calories than are taken in. Professional help may be required to clarify and modify the behavior that contributes to overeating.
The most sensible weight-loss methods aim for a steady reduction of about 1 pound a week. The diet that experts recommend most often is a balanced, low-calorie, low-fat food plan that is easily adapted for long-term maintenance. Although unbalanced diets can cause weight loss, they are usually too monotonous for long-term use and are followed by weight gain when the user returns to “normal” eating. Repeated dieting followed by weight gain (“yo-yo dieting”) may increase the risk of premature death from heart disease and several other diseases, but the research on this is not conclusive. For most people, the most important factor in successful weight control is exercise.
Many people diet even though they are not overweight. The majority of people concerned about their weight would probably do better to focus on exercise, healthful eating, and minimizing cardiovascular risk factors rather than on counting calories.
Chapter 14: Fitness Concepts, Products, and Services
Regular exercise can increase strength, endurance, flexibility, motor fitness, and cardiorespiratory efficiency. It can also lower blood pressure, improve blood cholesterol levels, help with weight control, help lower abnormal blood sugar levels, reduce stress, improve sleep, help prevent osteoporosis, and increase longevity. The risks of injury are greater for sedentary individuals and those who thrust themselves into activities that are either too strenuous or too prolonged.
Exercises can be classified as aerobic, anaerobic, isometric, isotonic, and isokinetic. The type and amount should be adapted to the age and fitness level of the individual. A minimum program to achieve cardiorespiratory fitness should be 20 to 30 minutes, 3 days a week, at 60% to 90% of one’s maximum heart rate.
Exercise equipment should be selected by considering potential benefits, effects on body areas, costs, and personal suitability. Advertising claims should be regarded skeptically because many devices have little or no value.
Health clubs and fitness centers are popular because they provide equipment, the opportunity for social interaction, and a structured program. Prospective members should carefully scrutinize advertisements and contracts from these centers. Fitness usually can be achieved at home with less equipment and less expense. It also is possible to maintain an exercise regimen while traveling. Children’s centers have been established, although their value is questionable.
Weight loss can be achieved only through a combination of dietary changes, eating behavior changes, and regular aerobic exercise. Sports drinks and energy bars can be useful, but cool water and common carbohydrate foods can provide the same benefits at much lower cost.
The use of anabolic steroids and steroid precursers by athletes is dangerous. Protein supplements and concoctions of vitamins, minerals, and/or low doses of amino acids convey no athletic benefits and are a waste of money for people who eat properly.
Chapter 15: Cardiovascular Disease
Cardiovascular diseases are the leading cause of illness and death in the United States. The majority of cases stem from atherosclerosis, a condition in which cholesterol, fat, and fibrous tissue build up in the walls of large and medium-sized arteries. The important risk factors for coronary heart disease include hereditary predisposition (a family history of premature heart disease), being male, advancing age, cigarette smoking, high blood pressure, diabetes, obesity, lack of physical activity, and abnormal blood cholesterol and homocysteine levels. The more risk factors a person has, the greater the risk of developing heart disease. Heredity, gender, and age cannot be controlled, but the other risk factors can be influenced by the individual’s behavior.
Medical authorities recommend that all adults have their blood cholesterol and blood pressure checked and take action if abnormal elevations are found. The cornerstone of a cholesterol-reduction program is a balanced, low-fat, high-fiber diet plus regular aerobic exercise. These measures may also be effective in lowering high blood pressure. If nondrug methods are insufficient, drug therapy may be advisable—often on a lifetime basis.
Great progress has been made in both medical and surgical treatment of cardiovascular disease. More research is needed to evaluate newer techniques. If problems arise, expert guidance should be sought from a physician who is well trained and pays close attention to recent developments.
Chapter 16: Cancer
Cancer is a general term applied to more than 100 diseases characterized by cell growth. Early diagnosis and treatment are likely to produce the most favorable results. Victims may turn to quackery because of fear, loss of hope, inadequate information, and other psychosocial factors. This chapter describes many types of quackery and tells how to obtain competent professional help.
Chapter 17: HIV/AIDS
HIV/AIDS is a disease of the immune system that is incurable but largely preventable. It is caused by the human immunodeficiency virus, which escapes the body’s immune defenses by inserting its genes into the genetic material of the body’s cells. This organism can remain in a person’s body for years before symptoms appear and the person is considered to have AIDS. By disrupting the functioning of the body’s immune system, it renders the infected individual progressively unable to resist organisms that would normally be harmless.
Regardless of the stage of the disease, an infected individual can transmit the virus to others. The best way to minimize HIV transmission through sexual contact is to (a) use a latex condom and (b) abstain from sex outside of a mutually faithful relationship with a partner who is unlikely to be infected with the AIDS virus. Easy access to sterile needles and syringes can greatly reduce the spread of AIDS by intravenous drug abusers.
In most parts of the country, reliable testing can be obtained anonymously and free of charge through a local health department. It can also be ordered through one’s personal physician.
Chapter 18: Drug Products
The two basic types of medicines that can be purchased in the United States are prescription and OTC drugs. Prescription drugs generally are more powerful and have more side effects. Prudent consumers learn the name, purpose, dosage, side effects, and other significant characteristics of drugs that are prescribed for them. This information can be obtained from one’s physician, a pharmacist, product labels, package inserts, and drug reference books.
OTC drugs are intended mainly for self-treatment of minor illnesses and injuries. Since 1972, expert advisory panels have reviewed the ingredients in these products to determine their safety and efficacy. As a result, most ingredients that were hazardous or ineffective have been removed from the marketplace. In addition, many potent ingredients that were available only by prescription 30 years ago are now available over the counter.
The commonly used OTC products include pain relievers, antacids, antihistamines, cough and cold remedies, laxatives, and remedies for diarrhea and motion sickness. The best way to choose most OTC remedies is to determine what ingredients are desirable and select products that contain them. In most cases, single-ingredient products are best. It is also prudent to have medical supplies and drug products available at home for the self-treatment of minor illnesses and injuries and for first aid. Generic drugs usually are equivalent to brand-name drugs and usually are less expensive. Prudent comparison shopping can save money, especially through the Internet, but sources should be carefully checked.
Chapter 19: Skin Care and Image Enhancement
Consumers spend over $30 billion yearly on skin care and beauty aids that may help their appearance but will not perform miracles. Much of this expense occurs because our youth-oriented culture prods people to try to look younger. For cosmetic products, price is generally not a reliable indicator of quality.
Soaps and various cosmetic products can help keep the skin clean, moist, and soft. But no cosmetic can eliminate wrinkles, repair sun-damaged skin, or retard or reverse the aging process of the skin. Mild cases of acne can be improved through hygienic practices and generally can be treated with OTC products. Severe conditions should have professional assistance.
The three most important things you can do for your skin are (1) keep it clean, (2) protect it from the sun, and (3) don’t smoke cigarettes.
Cosmetic surgery can improve many people’s appearance. Consumers contemplating cosmetic surgery should investigate thoroughly to determine the potential benefits, the risks, and the surgeon’s credentials.
Pills, potions, and vacuum devices claimed to permanently enlarge the breasts or penis are bogus.
Chapter 20: Sexual and Reproductive Health
Many people are faced with health problems related to the anatomy and physiology of their reproductive organs. Menstrual cramps that begin during the first year after the onset of menstruation are usually mild and self-treatable. Premenstrual syndrome will usually respond to self-help measures. Persistent menstrual irregularity is a reason to consult a physician.
Many choices are available to sexually active individuals who wish to prevent pregnancy. Contraceptive methods should be judged by considering effectiveness, safety, convenience, reversibility, and personal acceptability.
Genetic testing, counseling, or other procedures may be advisable when there is a significant risk of producing an abnormal fetus. Childbirth education and appropriate provider choice can reduce the stress and risks of delivery.
Everyone should attempt to prevent osteoporosis by avoiding or correcting the lifestyle factors that tend to increase the risk of it developing.
Chapter 21: Health Devices
Medical devices include several thousand types of health products, from simple articles to complex medical equipment. Federal laws define “medical device” as any health-care product that does not achieve any of its principal intended purposes by chemical action in or on the body or by being metabolized. The general quality of professionally used medical devices is high.
The devices commonly used by consumers include eyeglasses, contact lenses, and hearing aids. Purchase of these products should be preceded by a thorough professional examination. Since prices vary considerably, comparison shopping may also be wise.
Some devices have been marketed with misleading claims. Some hearing aid manufacturers and salespeople have exaggerated what hearing aids can do. Scare tactics are often used to sell water-treatment devices that are unnecessary or overpriced. Quack devices are still a significant problem—especially the “electrodiagnostic” devices used by certain “alternative” practitioners.
Chapter 22: Copng with Death
The burden of death may be eased by understanding the emotions involved and planning ahead to deal with various issues that pertain to dying. The need to prepare for death has become more pressing because machines often can keep a dying, permanently unconscious patient alive, sometimes indefinitely. An advance directive can help people control what care they receive if terminally ill. Hospice care provides another way to reduce suffering for patients with a terminal illness.
The technology and success rates of organ transplantation have improved greatly during recent years, but the cost is high and there is a serious shortage of available organs.
The intensity and duration of grief and mourning depend on the nature of the relationship to the dying person and emotional makeup of the survivors.
Most decisions about body disposition are made by people who are grieving and under time constraints, leaving them vulnerable to price-gouging and fraud.
Many entrepreneurs have capitalized on people’s wishes to prolong life and delay aging.
Chapter 23: Health Insurance
Health insurance enables people to budget in advance for health care and is important for nearly everyone. A health insurance policy is a business agreement formalized by a written contract that details both benefits and obligations. Basic health insurance includes benefits for hospital, surgical, and medical expenses. The extent of these benefits differs from contract to contract. Major medical contracts take over where basic insurance plans leave off. Managed-care policies combine insurance with health-delivery systems.
Group policies generally offer more coverage and cost less than individual policies. Most people are insured through a group policy obtained through their place of employment. Because the extent and type of covered services vary widely from contract to contract, policies should be read carefully to understand what protection they provide.
Managed-care plans tend to have lower premiums and result in fewer out-of-pocket costs. Traditional indemnity policies tend to cost more and involve more paperwork (in filing claims) but provide greater choice of providers. Health savings accounts offer special tax savings to eligible persons. To get the full benefit of their health plan, consumers should understand the extent of their coverage and any procedures (such as preauthorization) required when seeking care.
Chapter 24: Health Care Economics
Skyrocketing costs and inequalities in the distribution of services are persistent problems in the U.S. health-care system. This, plus the prospect of greater government intervention, has stimulated rapid and sweeping changes in the way in which the health marketplace is organized. Managed-care enrollment has risen rapidly. Widespread concerns that small organizations will be unable to compete with large ones have been stimulating mergers and other alliances that can achieve economies of scale.
Many of the problems are inherent in the system as it is organized today. Individuals can minimize some of their expenses through prudent consumer strategies.
Insurance fraud and abuse are serious problems. Some frauds can be detected by examining insurance payment reports to see whether they accurately reflect the services rendered.
An ideal national health-care system would provide equity, access, efficiency, and quality. However, even though most people want “reform,” no plan has been able to satisfy the many competing interests.
Chapter 25: Consumer Laws, Agencies, and Strategies
Consumer protection in health matters has two components: education and law enforcement. Intelligent consumers accept personal and public responsibility for the protection of health. They actively pursue the information needed to make wise decisions about health products and services. They are willing to speak out and encourage social and governmental action against misrepresentations and fraudulent practices. Government agencies, in turn, must establish and enforce standards for professional competence and honest marketing of products and services.
This page was revised on July 20, 2006.