How to Understand Medical Headlines—Part 2
How do you handle medical headlines that seem to make things more confusing?
Last week I discussed the issue of medical studies and how to interpret them. Specifically I addressed the common mistakes people make when trying to figure out what they mean. If you didn’t read that article, please do that before reading this one.
How to Understand Medical Headlines
Today I am going to continue on this issue, covering how to listen critically when you hear sensational headlines and determine what to worry about and what to ignore. That’s the essence of this issue, after all.
To give useful information, I am going to give different scenarios you may face. The type of information you have to deal with will determine your reaction.
How to Understand Headlines About Medications
The first scenario is when you hear about studies that pertain to a drug you are taking. These studies will either say that the drug is harmful, or that it doesn’t work as advertised (studies that say a drug is great won’t usually make the evening news). Here are a few things you should remember when dealing with this kind of headline:
Don’t Panic – Prescription drugs have a very detailed approval process, so even though the drug may have problems, it probably won’t make you die, get terribly sick, or have arms or legs fall off.
Don’t assume the worst – I assume that you trust your doctor; if you don’t, then you should find one you do trust. One of the main tasks of a physician is to know the drugs she prescribes. When I prescribe something, I don’t do so blindly; I know the majority of side effects, risks, interactions, and benefits of any drug I prescribe. If your doctor is using an electronic medical record, chances are good that they are checking interactions for every drug prescribed. Most of the medical headlines don’t catch me by surprise.
Don’t assume the best – Many people think that if there is a problem, their doctor will contact them and tell them to come off of the medication. That is true in the ideal world, but not in real life.
When you hear of potential dangers of a drug, you should call your doctor to see if you should continue it. If the headline is about the effectiveness of a drug, you can probably wait until your next visit to address the issue, but you should bring it up. If you don’t have an appointment, then you should schedule one. These are usually longer discussions and a face-to-face visit will allow you to ask questions and not feel things are being rushed as you would with a phone call.
In my office, we discuss any headlines we may get calls about. If it is serious, we send letters out to people who are on the drug; otherwise, we give our nurses instructions on how to handle the calls we will be getting.
How to Understand Findings from Medical Studies
This kind of headline is one of the more common types you hear. They sound like this:
“A new study has determined that listening to podcasts may cause osteoporosis.”
“Scientists have found a link between humming and cancer of the nostril”
“In a groundbreaking study, scientists now believe that drinking lots of water may increase urination.”
The evening news is riddled with these types of headlines. Let me say categorically that they are almost never anything earth shattering. News organizations are always trying to gain viewers, and one way they do this is to get scoops on things that competitors don’t get. To do so, it is common for them to make something borderline sound like a must-hear headline.
How to Tell if Medical Studies Apply to You
But not being earth shattering is not the same as not being significant. All studies have to be put in perspective by considering the following:
Whom is the study looking at?
Is it on men, women, or both?
How many people were in the study? The more people involved, the more likely it is to be accurate.
What does the study actually say? Look for words like “is associated with X” and “have a higher rate of Y.” Remember the story of the farmer and the roosters. Two things happening at the same time doesn’t mean one causes the other. Studies often indicate an association, meaning that scientists.
How does this fit in with other studies? Sometimes one negative study can make the headlines despite the fact that there are numerous positive studies. Sometimes studies appear to contradict, but the various studies are really looking at different groups. But other times studies examining the same groups of people do contradict. That happens fairly often, and is just the nature of science. So what do you do when studies seem to contradict? See who wins the angry scientist cage match. Scientists are always fighting about this kind of thing.
How to Know Which Recommendations to Follow
Once enough of these studies have been gathered on a single issue, a group of smart people sits down and tells us what this all means. They give their recommendations on all sorts of things, such as: how to manage diseases like diabetes, how to treat ear infections, what a particular immunization schedule should be, and what you should do to prevent cancer, and that’s what the big deal is about now. The newest breast cancer screening recommendations put out by the U.S. Preventive Services Task Force caused a real brouhaha by changing their recommendations. It seems appropriate to use them to demonstrate how you should deal with this kind of recommendation.
Should You Follow the Latest Breast Cancer Recommendations?
Here are my quick and dirty tips on how you should approach the breast cancer recommendations:
Know who is making the recommendations. The US Preventive Services Task Force is the panel of health experts that made the breast cancer recommendations. They are a mix of government appointees from groups like the Centers for Disease Control and representatives from physician professional organizations like the American Academy of Family physicians. They are generally felt to be independent and impartial.
Read the recommendations carefully. The breast cancer recommendations are based on a huge number of studies, and the studies are all listed in the recommendations. They call into question the reliability of mammograms and self-breast exams as tools to prevent cancer.
Here are the main points:
The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. Based on patient context, including patient values concerning specific benefits and harms, individual decisions should be made regarding starting regular, biennial screening mammography before age 50 years.
Women aged 50 to 74 years should undergo biennial screening mammography
Current evidence is insufficient to determine additional benefits and harms of screening mammography in women 75 years or older
In women 40 years or older, current evidence is insufficient to determine the additional benefits and harms of Clinical Breast Exam (CBE) beyond screening mammography.
The USPSTF recommends against clinicians teaching women the technique of Breast Self Exam (BSE).
Remember they are just recommendations. These recommendations are in no way binding, and each of them has a notation about how convinced they are of their reliability. The purpose of these new recommendations was not to alarm the public or make a political statement; it was to raise an alarm. Many health professionals have felt that the effectiveness of mammograms and breast exams has been exaggerated. These tests are the best we have, but that just means we need to find better tests.
Personally, I think the task force is right to raise concern. A lot of the hype was from the press and other non-medical people, and that hype is coming back to haunt us. I won’t change the way I practice at this point, but I really hope we can do better for women.
I hope this was helpful.
Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!