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Chapter 2: Health
Headlines: Making Sense of Medical Stories in the
News
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it’s all story telling, you know. That’s
what journalism is all about.
- Tom Brokaw
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All of us rely on the media (TV, radio, newspapers,
magazines) to remain updated with the latest news.
While making sense of the share prices in the financial
section is straightforward, how does one interpret
or understand the medical stories?
We are now awash in a flood of health information,
and barely a day goes by without a report of a spectacular
new cure for a formerly incurable illness. However,
many people find themselves increasingly frustrated
in the face of the media barrage of confusing and
contradictory health advice. One day, drinking alcohol
is bad for your health; the next day it is reported
to help prevent heart disease. One day, margarine
is healthier than butter; the next day it's not.
One day fish prevents heart disease, then it doesn't!
You may be exasperated enough to ask: Why can't
researchers get their facts right the first time?
And how are you supposed to make sense of what you
read, if the experts themselves can't make up their
minds?
In order to maintain a balanced perspective, it's
important to remember that news, by its very definition,
implies something new and unusual. This is why medical
stories in the media often seem to be at loggerheads
with what common sense tells us. After all, the
hundredth study showing a relationship between high
cholesterol and heart disease is hardly news, but
the one study that shows that eating fat helps prevent
heart disease is likely to become a headline —
no matter how flawed it may be! The media is often
guilty of oversimplifying or exaggerating results.
Moreover, headline writers may focus on an angle
that gives a distorted impression, which often means
that facts are sacrificed at the altar of readability
or circulation figures.
Many reasons can be attributed to the somewhat shoddy
standard of reporting in the lay press with respect
to medical matters. Editors crave for stuff which
is ‘new’ and doctors and hospitals are
only to happy to tom-tom their latest gadgets and
gizmos. Reporters are often not specialized enough
to understand the medical technical background.
Often, they do not do their homework properly, which
results in misreporting, which is, unfortunately,
a common occurrence in India. It is a sad fact that
although most newspapers and magazines have a battery
of expert financial reporters, few have full-time
knowledgeable health medical reporters.
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The outcome of the foregoing drawbacks is that patients
are often confused and are not sure how the latest
advances apply to them. They often flood their doctor’s
clinics with ‘false alarms’. As a result,
the media loses credibility, so that they often
end up performing a disservice to patients and their
doctors. Because the public is eager, for any scrap
of medical news, the media often reports individual
studies out of context, as if each study could stand
alone. However, single studies rarely yield a simple
‘yes’ or ‘no’ answer to
a medical question. One ought to realize that scientific
discovery is a process that often takes years to
unfold. In a sense, medical researchers are weaving
a large tapestry that will eventually tell a complex
story when one stands back to look at the whole
picture. An individual medical study can only contribute
a small strand to the overall fabric. While the
findings of individual studies may even seem to
contradict one another, evidence accumulates gradually
from scores of such studies. A coherent picture
emerges slowly over time, and only then can we make
definitive recommendations. One way of solving the
problem arising due to misleading, inaccurate or
piecemeal reporting on the medical front would be
for newspapers or magazines to appoint medical doctors
as consultants on their editorial panel, who can
be used as a sounding board to assess the reliability
and validity of a medical story. Also, as the media
realizes the importance of health stories, hopefully,
we will soon have full-time reporters who specialize
in covering health stories exclusively. Till then,
what can you do to separate the wheat from the chaff
?
First of all, identify the source. Does the information
come from a reputed publication (such as The
Lancet) or a leading medical professional organisation
(such as the American
Heart Association)? Not that such identification
can guarantee its reliability or trustworthiness
either, but it helps to know that the information
is coming from a respected and respectable source.
At the other extreme of unreliability is information
from a commercial source, or from an Internet newsgroup!
Second, look beyond the statistics. When reports
hurl at you statistics like ‘a 30 per cent
increase’ or phrases such as ‘a 50 per
cent higher risk ,’ take a closer look at
the exact numbers. Many of us get ‘turned
off’ by numbers, but this attitude can prove
dangerous: you need to ask yourself what the numbers
really mean and how they apply to you? Benjamin
Disraeli once remarked that there are three kinds
of lies: lies, damned lies and statistics. Remember
that statistical methods are simply tools, and they
can produce blatantly wrong conclusions unless sensibly
used. One common way in which statistics can be
misleading pertains to reporting of relative and
absolute risk. A headline that screams ‘X
Doubles the Risk of Y’ is way off target if
your chance of contracting ‘Y’ is one
in a million to begin with. Doubling the risk of
‘Y’ only makes it two in a million!
The relative risk (doubled) is nothing to worry
about if the absolute risk (an increase from one
to two in a million)
is tiny.
Third, scrutinize the results. Does this information
reveal a direct cause-and-effect relation between
two factors? Or is it merely an association? For
example, someone could argue there’s an association
between matches and lung cancer because matches
light the tobacco that causes lung cancer. But common
sense would tell you that lighted matches don’t
cause lung cancer.
Typically, years of consecutive studies are required
to prove a cause-and-effect relation and the results
of one study usually don’t provide enough
proof. If just one medical study has documented
an unusual or peculiar finding, and if the results
have never been replicated by any other study, then
this situation suggests that the study is not reliable!
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None of us wants to become a medical researcher,
but it does help to know a little bit about the
various types of medical research as well as their
limits.
Basically, medical studies
can belong to three categories:
- Laboratory experiments.
- Epidemiological research.
- Clinical trials.
Laboratory experiments can be carried out in test
tubes or on animals such as mice, rabbits or guinea
pigs. Results obtained from animal trials should
never be applied directly to humans for several
reasons. For starters, of course, people are not
lab animals. Also, mice and other small creatures
are not naturally subject to many of the common
ailments that afflict humans; therefore, scientists
have to alter them genetically or physiologically
to create animal ‘models’ for human
diseases. The results of such studies are interesting
and useful to scientists, and often pave the way
for important advances, but they don’t tell
doctors which medicines to prescribe for people.
In epidemiological research; scientists closely
study a large group of people and then collate their
findings. Next, they extrapolate these findings
to the general population . Because such a study
is observational, it is a fairly useful method to
uncover possible risk factors but it can never actually
prove a cause-and-effect relation, because the interactions
between humans and the environment are extremely
complex.
In contrast to epidemiological studies, which scrutinize
the complexity of real-life cases, clinical trials
provide a systematic way of testing the effects
of one particular factor, such as a drug, under
tightly controlled circumstances. Clinical trials,
which are experiments performed on people, are thus
the most reliable of the three categories, because
they compare two carefully controlled groups of
people. However, remember that these trials have
their own limitations as well.
Often, the process of reading the original research
study in a medical journal can be an intimidating
task. However, editorials in the journal help place
things in proper perspective. Also, review articles
can help provide a broad overview of the research
and its importance. Consumer health magazines also
help demystify some of the research by providing
understandable commentary.
One important safeguard against imperfect or flawed
scientific reporting is peer review; i.e., scientists
scrutinize each other's work in advance. Almost
all well-respected scientific journals rely on peer
review to select papers for publication. Any study
that has not undergone peer review should be regarded
with the utmost scepticism. For example, one should
be wary of findings announced at a press conference
that are not accompanied by publication in a journal
or by a presentation at a scientific forum. At the
same time, it's also true that peer review is no
guarantee by itself that a study is reliable. For
example, expert reviewers have no way of knowing
if an investigator has falsified the data in an
article. And even if a study is well-designed and
scientifically valid, it may have absolutely no
relevance to most people.
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The next crucial question is: how do you apply what
you have learnt? Let's imagine for a moment that
you've read a report about a new clinical trial
and all the signs appear encouraging: its results
confirm conclusions drawn from similar trials and
the experts seem to agree that it has been well
designed and has generated valid information. Now
comes the difficult part: how can you use these
new findings to improve your own health?
Initially, ask some basic questions: How likely
am I to get this disease in the first place? Were
the symptoms of the participants in the study at
all similar to mine? Because perspective on depth
is so often missing from news reports, some people
focus on the latest details at the expense of the
big picture. You should ideally follow the dictum:
Be quick to question, but slow to change. Moreover,
if the ‘new’ information is in conflict
with ‘conventional wisdom’, you should
regard it warily. Trying to heed all the advice
all the time can prove overwhelming and disconcerting.
You should evaluate your individual risk profile,
based on your lifestyle and family history, and
then make appropriate changes that will give you
the highest returns for your effort.
If a news report raises nagging doubts in your mind
about your treatment , diet or lifestyle, make it
a point to ask your doctor whether or not the report
applies to you. However, most of the time you simply
need to rely on your common sense. After all, it's
rather silly to worry about having missed one's
daily quota of beta- carotene supplement while smoking
the twentieth cigarette of the day !
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