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Can Medical Headlines be Trusted?

Photo Credit: MIke Kline-flickr.com

"The health hazzard from cell phones is real"
"Two studies report no link to cancer in cell phone use"
'EFFECTS OF STRESS ON YOUR BODY'  

It's easy to get whiplash when reading medical headlines. Coffee is good for your heath/Coffee is hazardous for your health; LDL cholesterol levels are important/LDL cholesterol levels don't matter; Low Vitamin D levels cause heart disease/Low Vitamin D levels are of no concern.

How does a lay person start to reconcile contradictory headlines?

The problem lies neither in medicine, nor in medical research but largely in the realm of medical reporting. What are the key elements to look for in a newspaper report about a new medical "breakthrough"?

Breakthrough discoveries are very, very rare. Most medical knowledge evolves over years of repeated studies. When results are consistent in many different settings and circumstances, there is a high likelihood that the findings are real. Statin medications, which both lower LDL cholesterol and block inflammation in the vessel wall, prevent heart attacks. That has been confirmed in every study ever done. Yes, there is controversy about the target LDL level, the need for intensive treatment and the role of adjunctive treatments, but today nobody contests that statins prevent heart attacks.

What is the target population?

Many treatments are assessed through vigorously controlled randomized studies in which matched groups of patients either take the drug being tested or take a matching placebo. In order to properly match the groups the population is usually narrowly defined. If a breast cancer drug is tested in women with stage II, HER-2 positive markers, after failing two courses of standard treatment, can the results of that experiment be extrapolated to all women with breast cancer?

What are the side effects?

Yes, a report may discuss dramatic benefits but are they also reporting side effects? If they are, how long were the patients followed? One may see a benefit of a particularly toxic chemical compound in a very short study, but is that enough time to measure the toxic side effects? If side effects are not discussed, ignore the article. The chances are it was a short phase 2 study; a study not yet designed to detect side effects. In fact, even the larger phase 3 studies which can involve thousands of patients followed for 2 to 3 years will miss those toxic effects that only occur with lower frequencies.

Who paid for the research?

Most large clinical studies today are funded by the large pharmaceutical and medical device companies. Reporting has been found to be biased in favor of positive findings. If one large study shows a positive result and a competing, equally valid study reports negative results, it is much more likely that the positive report will make it into both the professional literature and the lay press. Dramatic positive findings generate headlines; negative reports frequently do not. The FDA in the U.S. has taken many steps recently to obligate the reporting of negative findings. The need to regulate the industry only serves to emphasize the abuses.

What are the study's flaws?

Every large clinical study has flaws. It's in the nature of clinical epidemiology and study design. If it's a randomized controlled study, it usually represents a limited segment of the general population and the ability to extrapolate to all patients may be limited. If it's a large general population based observational study, it is more representative but in that environment, data may be missing or inaccurate, bringing bias into the results. If the news report doesn't discuss the flaws, skip the article.

This is just a brief introduction to a fascinating and challenging subject. For forty years now I have been be besieged by questions generated by poor medical journalism. Poorly written articles confuse the public. Learn to be critical in your reading. Don't take everything in the headline as gospel.

Dr Morton Leibowitz, MD, FACP, FACC 

 

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Sunday, 24 October 2021

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