By Susan Blumenthal M.D. and Nick Pruthi
From the dangers of diet drugs to the "miracle" of melatonin, from breast cancer breakthroughs to holistic help for heart disease, from sound bites on vitamin supplements to advice about preventing Zika virus infection, news reports about medical advances can bring you solid information, false hope or unwarranted anxiety. With the proliferation of media from broadcast news, to cable television, to internet sites and social media, consumers are bombarded with health headlines, creating both challenges and opportunities for education and action. News is now available at our fingertips and with the click of a mouse, but it is more difficult than ever to determine if health stories are accurate and unbiased. Additionally, health apps have exploded in popularity with more than 150,000 available today yet most have not been evaluated for their effectiveness.
READING BETWEEN THE HEADLINES
With a dramatic explosion of medical advances combined with the proliferation of new digital media sources, not a week goes by without another confusing or conflicting health message in the media. For example, on August 16, 2013 an article published in USA Today entitled "Heavy coffee consumption linked to higher death risk," cited research findings that drinking more than 28 cups of coffee per week (4 cups per day) could be harmful to your health. Just four days later, numerous other news sources ran stories about a study that contradicted these results. On its website, Fox News posted an article on August 20, 2016, "Drinking four cups of tea or coffee every day could help reduce fat in the liver. " The two studies that these news articles cited were published in reputable journals (Mayo Clinic Proceedings and Hepatology), so it can be very confusing for consumers to choose the one they should use to guide their decisions about how much coffee to drink. Another example: on March 7, 2016, a top story covered in the news was the resounding success of the first uterus transplant conducted in the United States. News reports gave much hope to women suffering from infertility, reporting no complications and often not including in the story that serious side effects from the procedure could still occur. Just two days after the initial news reports, the patient who received the transplant had major complications and doctors had to remove the transplanted uterus. Just 48 hours before the transplant failed, it had been heralded as a major success by media outlets. Many media sources had overreacted when the story broke, prematurely provided false hope. Additionally, many stories neglected to report that the recipient must take powerful immunosuppressant drugs and for most cases of infertility, this procedure is not the treatment of choice.
While some news reports provide comprehensive overviews of a medical issue, given time and space constraints, many media stories provide only headlines and may not provide a complete picture of the issue. Others are designed just to grab the public's attention. To interpret medical news and put it in perspective, it helps to understand the selection processes that take place long before a reporter types her or his first word. A 1991 report in the Journal of the American Medical Association suggested that the media are likelier to report on studies with alarming findings (for example, when an environmental factor is suspected of being linked to cancer) than comforting news (when no link is found). A study published in the British Medical Journal in February 2016 examined the reporting and publication of clinical trial results. This research provided a cross sectional analysis of over 4000 clinical trials conducted in 51 academic medical centers in the United States. It found that only 29% of the clinical trials were published within two years of completion and only 13% were reported on ClinicalTrials.gov (a government-sponsored online database of clinical research trials). And the American Journal of Public Health reports that the media most often cover findings from several well-known journals and often overlook studies in lesser-known periodicals.
There are several questions consumers should ask when evaluating news of medical "breakthroughs":
- How powerful is the proof? There are two major types of studies: observational, where scientists look at which subjects were exposed to risk factors and draw conclusions about how their health was affected, and experimental, in which people or animals are actively exposed to a particular substance or behavior so their reaction can be measured, often with a control group. Experimental studies are usually stronger than observational ones when it comes to proving whether something actually causes a disease, but they aren't always possible for ethical reasons. For example, scientists would not explore alcohol's effects on fetal development by asking pregnant women to drink four glasses of wine a day.
- Was the research done on humans? Research conducted with animals can provide important information as to which theories hold promise for studies in humans. But they shouldn't be considered conclusive. A 2013 study revealed that trials conducted on mice do not always generalize to people because the mouse genome response varies significantly from humans. The authors note that some drugs that can effectively treat inflammatory disorders in mice fail when they are tested on human subjects. It's a long way from mouse to man or woman! When animal testing is employed, it is the beginning of hypothesis generation, and a first step in the evaluation process. If you are reading about the results of a test conducted with animals, you should not apply the results to yourself, but rather look for findings from human testing. Last year, the NIH finally issued a policy requiring that basic science studies include female animals and cells and that data be analyzed for sex differences.
- How large was the study? Small studies can be misleading. For example, a local TV news site published a story about a study that showed playing video games could help children lose weight. However, the research included only 41 participants; a study that small can't provide enough information for scientists and consumers to make any definitive conclusions.
- How do findings compare to previous studies? Research that builds on a foundation of prior findings is often more reliable than research that doesn't build on an evidence base. Here too, study size is important. A new finding from a study of 1,000 people might be important and lead to further research. But if a study of 100,000 people has already led to a different conclusion, the findings from the 1,000-person study may be less significant.
- Was the research published? Scientists often first present their findings at medical conferences, where their results are picked up by media from all over the country and world. But this publicity is sometimes premature, because the research may not be complete enough yet to be submitted to a medical journal, where its reliability would be reviewed by other scientists before publication. On the other hand, even if a study's results are unpublished, it doesn't mean they're insignificant. It just means it's too early to make clinical decisions on the study's results.
- Who paid for the study? When drug companies develop products, they create publicity campaigns and sometimes have paid health care professionals in the past to speak out in support of their claims. A Washington D.C. radio station reported on a study suggesting that a compound found in wine might reduce the risk of breast cancer. The newscaster didn't mention that the news conference where the findings were announced was sponsored by a wine industry group, nor did he discuss the potential risks of alcohol consumption including alcoholism and liver disease.
- How great an increase in risk are we talking about? Some media present research results in terms of percentages. A recent WHO report classified red meat as carcinogenic, citing that studies have shown that each 50 gram portion of red meat eaten daily may increase the risk of colorectal cancer by 18%. However, what this really means is that a person's risk of colorectal cancer may be increased from about 5% to 5.9%. Taking a closer look at numbers like this can put a whole different slant on what sounds at first like a very frightening report.
Getting the Facts
The best way to interpret health headlines is to get the facts. Even if you don't have access to a medical library, you can find the latest research reports by visiting one of the following resources online:
• MedLine, www.ncbi.nlm.nih.gov/PubMed, contains brief summaries of findings from scientific journals. Journalists and consumers have long used this National Library of Medicine service, which is available free to the public.
•PLOS, a nonprofit that publishes peer reviewed articles and studies online.
• NIH Health Information, http://www.nih.gov/health-information, provides information on a variety of health topics, including infectious and chronic diseases
• The National Women's Health Information Center, 800-994-WOMAN, provides access to hundreds of health resources, including summaries of studies published current medical journals on women's health issues.
• Healthfinder, a website sponsored by the U.S. Department of Health and Human Services, links to reliable online sources of health information.
• ClinicalTrials.gov, a government database of medication prevention and treatment studies.
•4globalhealth.org -- my website that links to a wealth of trusted health resources.
How to Conduct Your Own Health Research
If you believe that a news report about a health finding might be relevant to you, find a copy of the study. It's easy: If you hear about a study on TV or through social media, check online for more information; there you can find the source of the study, usually a medical journal. Large libraries carry popular scientific journals or can tell you where to find them. You can also search for a study online. (For some favorite sources, see "'Getting the Facts," above). Articles that are disseminated through social media and chain emails sometimes come from obscure media outlets that are more interested in page views and marketing opportunities than responsible reporting, so it is important to dig deeper when investigating these types of sources.
When you have a copy of the study, consult your doctor for help interpreting how the findings might apply to you. Also consider your family and personal medical history before applying new research to your health. If a study finds that an aspirin a day might help prevent heart attacks, it may be fine for some people but dangerous to you if, for example, you have an ulcer. Similarly, if you read that wine helps prevent heart disease but you have a family history of alcoholism, you need to tread much more carefully.
With regard to health apps, you should explore the app's reliability. The FDA has released guidelines relating to this software, but the agency only reviews and regulates apps that are linked to a medical device (such as an app that connects to a blood pressure cuff). Furthermore, the app store evaluation process does not test how well apps actually work, so it is important to know how to effectively evaluate these interactive sources of information. Unreliable health apps exist in the online marketplace and can potentially have dangerous effects; for example, a highly popular blood pressure measuring app was recently found to be inaccurate. Some of these apps also may not protect your privacy, meaning that they can sell your data to marketers. A 2014 article from the Journal of Medical Internet Research summarizes ways to evaluate a health app. Recommendations include: (1) review the scientific literature, (2) search app clearinghouse websites, (3) search app stores, (4) review app descriptions, user ratings, and reviews, and (5) conduct a social media query within professional and, if available, patient networks. When in doubt, consult your doctor for his or her opinion on a specific health app.
The bottom line: The media is clearly an important resource for raising awareness about a range of health issues. However, there can be sensationalized and misleading headlines about important medical issues, so before taking a health article to heart, it is important to do a little investigative reporting of your own!
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at New America, Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research, and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. She provided pioneering leadership in applying information technology to health, establishing one of the first health websites in the government (womenshealth.gov) and the"Missiles to Mammogram" Initiative that transferred CIA, DOD and NASA imaging technology to improve the early detection of breast and other cancers. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired many national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Dr. Rosalind Franklin Centennial Life in Discovery Award.
Nicholas Pruthi is a junior at Dartmouth College majoring in Economics. He served as a Health Policy Intern at New America in Washington, D.C.
*This article was updated from a prior publication, Health and Headlines, written by Susan Blumenthal MD, that was published in American Health Magazine, January issue, 1998.