Study questions the value of family medical history

It's the first thing you do at a doctor's visit after producing your proof of insurance -- fill out a family medical history. Many doctors ask detailed questions or require patients to complete long forms, and patients sometimes worry about not knowing or forgetting something important.

But does a medical history collection actually do any good? A new study casts some doubt about its value. Researchers funded by the Agency for Healthcare Research and Quality reviewed 137 studies on various aspects of family history-taking. The studies were performed between 1995 and March of this year. Researchers set out to examine three aspects of the issue: the pros and cons of collecting a family medical history; how well the history predicts an individual's risk of disease and how accurate patients report it.

They found that there were few studies that actually examined these questions thoroughly. Overall, there was not enough evidence to say how history collection affects patients' outcomes. The analysis found that patients tend to report the absence of disease in relatives better than the presence of disease.

"We understand the absolute importance of family history in assessing the risk of genetic conditions," said the lead author of the study, Dr. Brenda J. Wilson, an associate professor of epidemiology at the University of Ottawa. "But when you are looking at complex diseases, such as heart attacks, strokes, diabetes and so forth, we wouldn't expect the family history to tell us everything we need to know. Family history plays into it, but it's one of many factors."

Family history has been thought to serve two purposes. One is to assist doctors in assessing a patient's risk. The other is to motivate the patient to make changes that might lower risk. But the authors concluded that more research should be done to pinpoint what is helpful about a family history and how much it matters along with other risk factors. For example, Wilson says, a doctor looking at the risk of heart disease will take a patient's blood pressure, weight and will perform cholesterol and perhaps other tests.

"What we don't know is how useful family history is along with this other risk information," Wilson said. "For complex disorders, we need to develop the evidence for how to use it -- so physicians know how it factors in."

Methods for collecting family medical history should be simpler, she added. Electronic medical records and other information-gathering tools should be helpful.

"I think we are going to have to take family history more seriously," Wilson said. "We may want to put this in the hands of family members and have them gather it and be the custodians of it."

The study was published Monday in the Annals of Internal Medicine.

-- Shari Roan

Photo credit: Christopher Nielsen  /  For The Times

Blood, bones, smallpox, herbs, cadavers at the Huntington Library

If you like old, old books and you're curious about the history of medicine, check out a permanent  exhibition recently opened at the Huntington Library in San Marino. Stroll through the rose garden, maybe sip a nice cup of tea, then pop into the Dibner Hall of the History of Science where you'll see:

-- prints of elegantly posed human bodies peeling back their own skins;

-- 16th century herbal books filled with illustrations of plants and their medical uses;

-- a little ivory figure of a pregnant woman that was used to teach students in the 1500s -- you can take the front of the abdomen off and see the baby underneath;

-- a book by the "first microbiologist," Antoni van Leeuwenhoek, who was the first to view single-celled organisms (he called them "animalcules") including some from matter between his own teeth;

-- the oldest illustrated printed medical textbook, from the 15th century, by Johannes de Ketham, opened at an image of a dissection;

-- so-called overlay drawings by Andreas Vesalius that allowed one to peel back layers of a human body and see the anatomical structures that lie underneath, with a replica for the museum-visitor to play with;

-- a book by Edward Jenner, discoverer of vaccination. It's open at the page at which he tries his cowpox vaccine against smallpox on an 8-year-old boy and an illustration of the resulting pustule and red radiation on the boy's arm; 

-- a 1610 reprint (you know, modern) of the works of the Greek physician Hippocrates in which he declared, among other things, that "blood ... through the mouth is bad, but through the bowels, less bad." (Is that true?)

Roll up, roll up for books on blood flow, books on head anatomy and a richly illustrated text on how to treat battle injuries that really shouldn't be looked at too soon after having that nice tea. And of course there's more in this display than medicine: A section on natural history features lots of Darwin and lots of plants; a display on light carries a cool collection of Edison light bulbs; and a section on astronomy comes with works by such notables as Aristotle, Copernicus, Galileo.

Some of the art in these old science and medicine books is so gorgeous that I seriously coveted posters to take away with me. There weren't any -- disappointing. I did, however, snag a shopping bag decorated by Robert Hooke's famous flea (below).

-- Rosie Mestel

Images:

Twins. From George Spratt, Obstetric Tables, London, 1841. Photo credit: Huntington Library

Aloe from an early herbal, a book describing plants and their uses. From Hieronymus Bock, Neu Kreuterbuch (New Plant Book), Strasburg, 1551. Photo credit: Huntington Library

Flea under magnification. From Robert Hooke, Micrographia, London, 1665. Photo credit: Huntington Library