Post-digital age syndrome

I thought of blogging about this topic after seeing so many teenage patients the past two weeks.

To have that many teenage patients in my pediatric practice meant that I must be gazillion years old because these kids have practically grown up with me.

The experience I have gained over the years of pediatric practice has been a life changing one. Observing how many of my patients have grown to become teenagers and adults, to parents, has been one helluva roller coaster ride, so to speak.

The youth of today are very much different from our times. I'm quite sure that the more "senior" generation will agree with me that technological advancements has correlated with the current state of today's youth.

I call it the post-digital age syndrome.

Let's face it. Even the more "senior" generation (like me) benefits from the technological advancement and that the digital age has contributed immensely to providing information at our fingertips. No more trips to the library, no more having to wait for days for a response from our clients, no more going to the bank to pay the bills, no more having to make long distance calls that charge an arm and a leg in order to speak to our loved ones, no more having to go through third parties to make reservations, no need for the yellow pages - yup, with the new techie gadgets, you've even got email on the go.

The only difference between the technological advancements is the time frame.

Obviously, the pre-digital age syndrome people had the benefit of searching for information in a more medieval way such as trekking to the library or poring over the voluminous books available to read. The post-digital age people just google it and you can even do advanced or narrowed searches. The latter, however, has the drawback that by making the computer and the world wide web or Mr Google search information for you, the information provided may be one that is lacking or biased (some information may not be published and so you won't see it on the net, such as theses or dissertations of graduate school students, etc.). Many information seen on the internet may not necessarily be complete - such as summaries or abstracts being provided as sneak previews - and because getting the full original versions will require payment, a lot of us end up making conclusions based on these summaries - a case of what you see is what you get! What also is distracting is the fact that anything and everything is published on the internet. Discerning what is factual and true is difficult for those that are not experts in the field of interest. This has its major drawbacks especially in the field of medicine, where patients and parents google symptoms in search for diagnosis, without the benefit of adequate knowledge on how to discern the right information to arrive at the correct diagnosis and eventually how to manage the disease. The piecemeal or "chop-chop" knowledge has contributed to a general sense of misconception, confusion, and panic among patients in the self-search of information for disease states.

Indirectly, the post-digital age has contributed to the obesity I am seeing in the clinics. Kids are growing up with just their fingertips doing the exercise. Some can spend days and days in front of the computer or some gamely gadget (PSP, DS Lite, iPad, Celphone or what have you) or in front of the TV surfing channels. I've noticed families at dinner tables (especially in restaurants) with some of their kids having the headsets of their phones or gadgets hooked to their ears (often times to a deafening volume that I can hear it a mile away even in a mall). No conversation, no discussion, just a deafening silence of words except the chewing of food or the clanking of utensils or the sound effects of the gadgets. Ask them to move their butts and many youngsters complain about wasting time on menial exercise. It's more cool to be on Facebook or be Twitting rather than to be sweating out all that fat from those uncool junk food and supposed healthy iced teas that are nothing but a bunch of flavored teas filled with sugar to the hilt!

While the purchasing power of the peso has supposedly dipped because of inflation, in reality, the household expenditure has increased in the post-digital era because of the added expenses in gadgets and top-ups (loads) for their mobile phones, cable, additional gadgets and games (not including apps and other downloadable items) or even for the poorer members of society - time consumed in the internet cafes. Hard earned money that can go to buying added food (eggs, bread, rice or even chicken) is not enough because the need to apportion at least 10% (some families average 20%) of their monthly wages only to keep up withe the techies.

I am saddened by the fact that the post-digital age syndrome has created a void in many families with gadgets and electronic baby sitters substituting for parenthood. While I agree that "we owe, we owe so off to work we go" has been the prime mover of our economy, I'm sure that everyone will agree with me that the quality time we share with our kids has been relegated to having a gadget or some trek to the mall substitute a day in the park or biking with your kids on Sunday. Sitting down with them for their assignments is relegated to Kumon and sending off the 2 year old to a day care center has become a run-of-the-mill solution to introducing kids to basic education because mom needs to make a career out of her life.

I am not saying that the pre-digital age babies had better lives and are probably happier than the post-digital age ones. I'm putting into perspective the influence that the digital era has imposed on many of our lives. Even the older generation has had changing values and lifestyles because of the rapid technological advancements.

I have nothing against technological advancement. But we need to take into perspective the impact it makes on our lives.

There's a saying that "we cannot have our cake and eat it too". There must be a balancing act in our lives in this post-digital age syndrome that should make relationships, families and friends be one where we end up not being strangers at the end. There needs to be more physical and emotional involvement and investment by each one of us. We cannot make technological advancements dictate the pace and quality of living we have. Otherwise, we end up as slaves to them.

It would be sad that as each of one exits this world, even condolences are sent digitally instead of a simple show of respect with our presence during the wake or burial.

There are many people who have found less meaning to life in the post-digital age than in the pre-digital age. Perhaps the rapid pace of technology has contributed greatly to this meaningless world of existence. Perhaps the post-digital age has made many of us engage in nameless and faceless relationships even with our closest of friends and kins because we've simply not valued spending more quality time with them.

Sadly put, the post-digital age syndrome is a lonely one. It may be a great disappointment in our journey of life if we forget to stop and smell the roses along the way.

Googled

In this day and age of technology at our fingertips, finding an answer to any question is a GOOGLE away.

Which is actually not bad, considering that the trip to the library eons ago took up a lot of wasteful time in search for the answers to our questions.

But does GOOGLING a query provide the accurate answer?

Let me zero in on the perfect example.

A few days ago, a friend on Facebook had "shouted out" that her family would be traveling soon and that they would need to bring their 1 year old child. The mother was apprehensive about the travel ahead and that the child may become eventually "fuzzy" during the long haul. As in any FB "shout-outs", a comment thread follows.

And so the "friends" began providing comments: "enjoy the trip", "put a pacifier", "let her drink milk", and so on and so forth and I provided my ten cents worth of consult over FB as well - "give her 5ml of Diphenhydramine (Benadryl) since that's over the counter 30 minutes prior to the trip."

Walanghiya!!! You should read the comment thread that came after my comment from the do-gooders: "don't give benadryl and then there's suddenly a link from about.com on the cons of giving benadryl!". The trail doesn't end there. The next suggestion you read is "give ibuprofen instead. Then another link to another website about what to give your kids if you're traveling by air". Then another suggestion crops up "give acetaminophen (paracetamol) during the trip. it's not advisable to give drugs to kids as they are harmful." Then you see another link somewhere from another God-forsaken site. Finally, there's a comment that "consult your pediatrician about the Benadryl. It's not good."

I felt tempted to agitate the comment thread, but decided against it for fear of harming the ignorant few.

I believe that while technology has changed the landscape in the search for answers to queries on the information highway, it has also been abused by people who "google" and pass on the "found" answers to others as the "definite remedy to the malady". This is most commonly seen in the medical field, but encompasses all - from entertainment to fashion to gossip to politics to science. What I cannot stand actually are people who are not in any capacity authorized to provide unsolicited advise to others. For example, when someone asks you what is atopic dermatitis, if you're not a doctor, do not attempt to google atopic dermatitis and then pass on the information link and say voila - there's the answer to the question and then pat yourself on the back. You have no idea how seriously dangerous information is in the wrong hands. Unless you are licensed to give a professional opinion on something as ginormous as the life of someone, you should not be Miss Do-Good-Know-it-All answering other people's concerns. You have no business here and should try to get a life! You can experiment on your children or next of kin for all I care (and I seriously pity your whole family with having to live up with your inanities).

And for discussion sake, I will not give the pros and cons of dosing a kid with diphenhydramine on the flight, but would prefer that the 15 hour trip be a restful one for both the parents and the child. After all, it's not their friend that will be carrying the "fuzzy baby" on the lap during the whole flight!

I have a lot of patients parents that come up to me and ask me if the information that is passed on to them as a link is true or not, or that she heard a colleague telling her that my prescription may be harmful to her child, or that she read somewhere that a certain vaccine purportedly has a link to Autism, and so on and so forth. I discuss with them all the issues in a very professional manner. And no, I really do not mind discussing the concerns with them because they have the right to know. Full disclosure and a healthy professional discussion after seeing the patient (even if they have a whole folder or downloaded information) is the right of every patient to quality health care. It is the patients' rights to search and read up on their diseases and the treatment options to it. These rights should extend to the clinic office where the parents discuss these with their health care provider, with the latter providing treatment options where the benefits outweigh the risks. If you have a good doctor, he/she should be capable of answering the questions you post spontaneously at the clinic!

It is inappropriate that the discussion includes a third party who happens to have no professional training nor experience on treating patients or any other credentials to a well informed discussion except the fact that that person is keen in the art of googling. A second opinion means seeking the advice of another professional adept in that field of expertise of concern. It does not mean that you ask your hair stylist on why, for heavens sake, you should not put a steroid cream on the atopic patch of your child. Wala akong pakialam sa payo o kuro-kuro ng manicurista mo!

With that said, let me remind everyone that googling information is an FYI. It does not provide the absolute solution to the problem, especially when it comes to diagnosing or treating patients. It is infuriating that there are so many wannabes that need to realize that while they are probably techie experts in this age of information technology, they are not cerebrally fit to provide opinions that should be left alone to professional providers. And while you can pass on some information, you need to be trained to discern what is correct and what is misinformation. After all, not everything googled is correct!

If you feel you're alluded to in this blogpost and don't get the point, I think you should just roll over and die. The world would be a better place if we googled you had passed away.

He said, she said....I say!

There's been so much exchange in opinions on various issues - from economics to politics to entertainment to health - in the newspapers lately.

Here are some of the news that made the headlines this week and while I post each side's viewpoint, here's my take on the them:

1. PACMAN AND STEROID USE.
He said: Mayweather tweeted a link to an obscure boxing news site that had an article claiming that a former sparring partner of Pacquiao, who happened to be Filipino, claimed that he was the one injecting steroids to Manny at the Wild Card Gym, and that it began before the Oscar De La Hoya fight (according to an ABS-CBN report)...

Pacman said: "An anonymous post on an Internet forum claims an unidentified former Filipino sparring partner injected me with steroids before my fight with Oscar De La Hoya and in subsequent fights. This is completely false, totally fabricated, and, not surprisingly, leveled by someone who will not even identify himself. I did not even have a Filipino sparring partner during my training for the fight against De La Hoya or for any fight since then."

"I have never taken steroids, HGH, or any banned performance-enhancing drug. Period. My success in the ring is due to hard work, belief in God, and the support of my fans.

"Like every boxer, I am required to take drug tests in connection with every professional fight in the United States. I have passed every one, including my fight against De La Hoya and my most recent victory against Shane Mosley."

"I will fight to protect my hard-earned good name and reputation."

I say: This allegation has been running around in circles for the last few years. Mayweather refuses to fight Pacman unless Pacman has a drug test done. While Pacman claims that he has "passed" the drug tests for every professional fight, there's still the question of why he refuses to take the appropriate drug tests Mayweather is asking of him as a requirement to their "dream match". And it's not true that taking a little amount of blood would make one weak. I mean, really now. Gimme a break! And just because he is Pacquiao does not give him the right to whine like a baby regarding this. Of course, there are the nincompoops who believe that we should give Pacman a break on this issue. After all, to them, he is king of the ring. Who the fuck cares if he fights well? Give us a real fight Congressman MP! Idiots are making him rich over these sissy, one-sided, entertainment galore! Take the challenge of Mayweather. Have the goddamn blood test done. And give us a fight that will shut up the world!

2. 300 Private Schools to Raise Tuition Fees this coming School year.
He said: The CHED announced Friday that close to 300 colleges and universities in the country will hike tuition this year...69 private colleges and universities in Metro Manila are expected to hike tuition this coming school year, with St. Luke’s College of Medicine eyeing a 12-percent increase.

Meantime, the University of the East-College of Medicine, Ateneo de Manila University, Ateneo Graduate School of Business, Miriam College, Assumption College and OB Montessori will increase their tuition by five percent.

On the other hand, University of Santo Tomas, De La Salle University and UE-Manila will have increases of 3.75 percent, 3.5 percent and 4.35 percent, respectively.

They said: They need it to improve the quality of education and the rising cost of maintaining a school.

I say: You ever wondered why it's these Catholic- and church-run schools that actually raise tuition fees year in and year out? And the teachers only earn a pittance compared to the staggering cost of the tuition fees the parents and families have to shell out. It ends up with only those who can actually afford these mind-boggling sky rocketing tuition fees (READ: THE RICH AND THE VERY RICH) that can send their kids to school. What is actually weird is that church run schools have tax incentives and holidays and rebates compared to private schools that are not under the domicile of a religious order.

A larger majority have to contend with government run institutions, but then again, the government run schools are now being infiltrated by the rich! Once upon a time, the University of the Philippines had more poor and deserving students. But because the quality of education there is excellent, the rich now shove their way into the state-run university so that their kids can get good education at the lowest possible cost.

Two solutions: CHED must investigate if these church-run schools are actually making a large profit from the tuition fees collected. If so, the church-run schools MUST pay taxes accordingly. NO exceptions to the rule. Government and state run schools must proportion the number of enrollees to benefit the mission and vision of the republic. Fix the admission rate at 75/25, where 75% are poor and deserving and 25% are the rich and deserving. The latter 25% should pay 400% of the actual tuition fee to cover the cost of enrolling 75% of the poorer but deserving students. After all, they can afford this.

3. Intravenous Glutathione warning from Philippine FDA.
He said.
With the new age of advance skin science, you can now have a celebrity skin and put an end to DARKness!

Glow2Thione™ Skin Whitening and Age Defying Supplement, with revolutionary L-glutathione: the Body’s Master Antioxidant, Detoxifier and Tyrosinase Inhibitor.

Now you can easily achieve the complexion you have always wanted.

This is the ad that you see on superwhiteningpills.net. And this is the exact same claim as all the other glutathione products in the market.

The Food and Drug Administration said.
Food and Drug Administration of the Philippines warns the public against the possible side effects of glutathione injection as whitening. Glutathione injectibles is not an approved skin whitener. High dosage might cause skin rashes, severe abdominal pain, steven-johnson syndrome, toxic epidermal necrolysis, derangement in thyroid function, kidney dysfunction and failure and gastrointestinal pain. When administered orally, it is hydrolyzed by gastric juices…Intravenous injection delivers very high doses directly into systemic circulation and may overload the renal function. Glutathione is an antioxidant, whitening the skin is just a side effect.

I say.
Glutathione comes in two forms - oral and parenteral. The oral formulation is rapidly and extensively destroyed by the gastric juice. Which means that taken orally, only a small amount of glutathione is present in blood. The parenteral or IV preparation is not legally commercially available or approved for skin whitening use because of the very high dosage it carries and that it is not registered as a drug or indication for this use in the Philippines. While it claims to have "antioxidant" properties, like all "food supplements", this carries a tag where there is "no approved therapeutic indication" for skin whitening.

I have given lectures on the scientific merits (and demerits) of "food supplements" and I have blogged about it already. The key word here is "supplement". Which means, that unless sound and scientific clinical trials have been thoroughly conducted on a product which purports to provide a clinical indication for treatment, the product is labeled as a supplement which has no approval as a DRUG. Supplements, undoubtedly have a larger margin of safety and hence, go through the back door approval of being approved for supplemental use at LOWER DOSAGES. Increasing dosages pose treatment problems because as the dosages are increased, so are side effects.

Which goes to the advertisements of these products. ALL supplements do not carry black box warnings, and neither is the public informed about their adverse events. The danger here is that the public is led to believe (or deceived) about taking more than what is recommended as a food supplement. The public (and some doctors) tend to think that increasing doses will provide more rapid and definite benefits.

Vitamin C for example, taken more than 1 Gm a day increasing the risk to formation of kidney stones. In the same vein, glutathione at the recommended oral dosages may provide some anti-oxidant effect. However, at the larger intravenous doses, which are by far experimental and have no scientific evidence (or clinical trials conducted), reports on allergic reactions resulting in death, destruction of the thyroid gland, renal dysfunction and congenital malformations during pregnancy are cause for alarm.

The only indications for giving the intravenous high dosages for glutathione so far are adjunct treatment for patients with Parkinson's Disease and as complement for ameliorating the toxicity among patients receiving Cisplatin (an anti-cancer drug)

Clinical trials serve as the backbone of the pharmaceutical industry because they not only provide evidence of efficacy, based on scientific data of the correct dosages for drugs (lowest dose to give the optimum effect), but on the safety of the products as well.

There is no one drug (or supplement for that matter) that is universally safe and it is wise to remember the saying that one man's medicine, is another man's poison.

I am thrilled that at least the local FDA has put out this notice and pray that the public heed the warning. There is no need to get that glitter white look by taking medications or supplements that may not suit you or have not been studied well enough, at the expense of developing fatal complications later on. You have enough time to look pearly white when you're dead.