The Baltimore Sun

Sometimes, they stay up all night, tossing and turning.

And messaging and blogging and posting.

"Went to bed about 9 p.m. and hoped to get a good night's sleep, but here it is 1:30 a.m. and I am wide awake after about 2 and a half hours of sleep," said a post on the Can't Sleep Cafe, an Internet group discussion board for people with sleep disorders. "Anyone have any suggestions other than taking medication, which I would rather not do?"

Responses were not immediate, but ultimately five members of the group offered advice, including Dr. Steve Poceta, a San Diego-based sleep disorder specialist who launched Can't Sleep Cafe as a place where the sleep-deprived can offer encouragement, share suggestions, critique medicines and vent about what keeps them awake.

"Don't worry about not sleeping, get up and read or knit if you can't sleep," Poceta replied. "Be sure your wake-up time is consistent, and go to bed about 7 hours before your wake-up time."

The Can't Sleep Cafe is among several health Web sites that give new meaning to the term "socialized medicine." Poceta and hundreds of other specialists and health care organizations offer an array of services free of charge through the Web. They're linking people with similar conditions and concerns to create self-help groups throughout cyberspace.

While such Web sites have been prevalent over the past decade, they've seen an increase in hits of late - as they're offering more interactive features and have become reliable resources when medical-related stories make news.

The Can't Sleep Cafe was created by Revolutionhealth.com, an online medical information site launched by a Washington-based health company, Revolution Health. Founded by AOL co-founder Steven Case, Revolution Health launched its community health groups in January in part to assist users in sticking to such New Year's resolutions as losing weight and exercising.

"These kinds of groups are becoming more and more popular," said Michael Chamberlain of Dorris, Calif., who lost about 30 pounds after joining a Revolution Health weight-loss group shortly after its launch.

"You can share [information] and encourage others, which sometimes is encouraging in itself," Chamberlain said. "Also, there is some sort of responsibility; people expect you to check in and stay on track - and you don't want to let them down."

The U.S. National Library of Medicine's Web site, Medlifeplus.gov, saw a spike in hits to its brain cancer topics during the days after U.S. Sen. Edward M. Kennedy's diagnosis of a malignant brain tumor last month. And the Web site for Minnesota-based wellness company Optum Health, Healthatoz.com, saw more traffic in April when it announced new features such as a fertility calculator.

The operators of such sites insist that their content is for information purposes only and not intended to substitute professional medical advice, diagnosis or treatment.

Dr. Michael Smith, chief medical editor at WebMD.com (a health site that says it receives 51 million hits a month), said that a decade ago, doctors were reluctant to send patients to the Internet. But a credible online resource enables patients to be better prepared for their doctor's visit, he said.

Dr. Armando Sardi, director of the Institute for Cancer Care at Baltimore's Mercy Medical Center, said that he recommends health care Web sites because they allow people to gain medical information that is not readily accessible to the public. However, he cautions patients from relying solely on data culled from the Web.

"You must check for quality, because you can be misled," said Sardi. "One of the problems we see is that people can read so many things that it can become more confusing than helpful. They start looking beyond the basic principles of care."

Still, such sites have become invaluable for those seeking answers about a child's nasty cough in the early-morning hours, those who must wait for weeks before their next doctor visit while symptoms persist or those who want unbiased advice about the latest diet pill on the market.

"The online groups are the most powerful way for behavior modification," said Val Jones, senior medical director at Revolution Health.

The sites aren't necessarily launched by those in the medical profession. Web designer John Swapceinski co-founded RateMDs.com three years ago after his college-rating site, Ratemyprofessors.com, drew widespread traffic and notoriety.

"Instead of picking a name at random out of a phone book, patients can now read about what other patients think of their doctors," Swapceinski said. With more than a half-million ratings since its launch, Swapceinski said, "hopes are high that within a few more years we will have ratings for essentially every doctor in the USA."

Some sites offer users opportunities to chat with medical professionals. Healthatoz.com, for example, has nurses on call. WebMD's staff often initiates discussions for Web users. One staffer recently queried about the widely publicized exercise video console, the Nintendo Wii Fit: "Does the Wii Fit contribute to a quality workout?

"It's definitely not a strenuous workout, but before you know it, you've worked out for 30 minutes," one contributor replied.

Paula Kitendaugh, head of references and Web services for the National Library of Medicine, which launched Medlifeplus.gov, says that more people are becoming advocates for their own health - in part because specialized medicine has grown less consumer-friendly.

"You can't just call up your doctor or go to the offices, sit down for a while and have a lengthy discussion about your newly diagnosed mother with diabetes," she said. "Clearly many people have had the situation where their child wakes up at 11 o'clock with a horrible earache, and they need that information right now, and the doctor's office isn't open. They can go right to the Internet.

"And there is also the embarrassment factor. There are things that maybe someone says, 'I'm really embarrassed about this. Do I really need to go to my doctor to talk about this?' "

Most of the Web sites contain disclaimers that strongly caution against using them in lieu of professional care. Yet given the reasons people use the sites, it appears that the disclaimers are self-defeating. If you're on the site because you can't get to a doctor or have no medical insurance, then it's safe to assume that in some cases you might not follow up your fact-finding with a doctor visit.

"Our hope is that a better-educated patient is going to go to their doctor with hopefully smarter questions," Kitendaugh said. "But that they might also take something seriously that they might otherwise decide, 'Oh I just got this little white patch on my tongue; I'm sure it's nothing.' But maybe you go to some of our dermatology resources and realize that maybe it's an early cancer of the tongue and that would prompt a visit to the doctor."


Online health resources

WebMD.com: A source for information on how to find a doctor or hospital, reviews on pharmaceuticals and tips on how to create a personal health record.

RateMDs.com: A free Web site for finding information about and rating doctors and dentists.

HealthAtoZ.com: A health resource developed by health care professionals.

Medlineplus.gov: A service of the U.S. National Library of Medicine, the nation's largest medical library, that features sources on more than 750 diseases and conditions, a medical encyclopedia and links to thousands of clinical trials.

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