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THE PUBLIC's HEALTH Medical Breakthroughs Should Be Read With a Critical Eye

Posted on: Monday, 20 June 2005, 15:00 CDT

As you're pouring your morning coffee, you see a TV report or read a headline heralding a major medical breakthrough. What do you make of it?

Not all that long ago, research results appeared only in professional medical journals seen by physicians, not their patients. Today, with expanded media coverage of medicine, patients often learn about research findings when their doctors do.

The media have become the primary source of health information for consumers. In the late 1970s, I was a budding journalist and decided to get a graduate degree in public health. I still recall a perplexed faculty member asking why a journalist would want to study public health. Health reporters were that rare.

Doctors say that the increase in health reporting has made patients savvier but also more likely to arrive in their office waving a newspaper or Internet story that has given them unrealistic expectations or overblown concerns.

So how can you be a more sophisticated reader of research results?

It's not surprising that media reports can confuse or mislead consumers. Researchers and their sponsors can have financial and other incentives to package their results to hook reporters, and reporters understand that the most dramatic results get the best coverage.

Reporters typically have short deadlines and insufficient air time or print space to explain complicated studies. The most dramatic finding often becomes the memorable headline (by the way, not written by the reporter). The fine points can land late in the story where fewer readers go.

But even when reporters go the distance and the best ones do consumers have taken on a role for which few are trained. To personalize the media report to your own circumstances and values, you and your doctor have to dig more deeply. Here are a few questions to ask about research reports.

Is the study reputable?

Publication in a respected journal is an important threshold. A randomized controlled trial is considered the gold standard. In such a trial, subjects are typically randomly assigned to either a treatment or placebo group, and researchers look for differences across groups. Other types of clinical trials and research can also advance understanding.

Who were the research subjects?

Were people like you studied? First, make sure they are indeed people and not laboratory animals. Look at characteristics such as age, gender, ethnicity and health status. Historically, research involved mostly white males, but as more ethnic minorities and women have been included, important differences have surfaced. For example, a recent study of the lung cancer drug Iressa was not found to be effective overall, but it was effective in Asians and non- smokers. Aspirin has been shown to prevent a first heart attack in men but not in women younger than 65.

One growing concern is that elderly patients the fastest growing segment of the population and the ones taking the most drugs are typically excluded from trials because their multiple conditions and drugs make it harder to isolate the effects of the therapy being tested.

Do the results make a practical difference?

When differences in outcome are seen say 20% of the therapy group improved but only15% of the placebo group statisticians run tests to make sure the difference isn't due to chance. If it is unlikely to be chance, the difference is called "statistically significant."

That makes headlines but it may not be big news for you.

An improvement of a couple of points on a dementia scale may be a statistically significant change but not make a noticeable difference in your aging parent's life. A drug may extend the life of terminal cancer patients by a couple of months but those may be months without much quality. Bottom line: Statistical significance may not mean clinical significance.

A report that a helpful drug you take doubles or even triples your chance of getting cancer or some other dreaded condition sounds scary. Or news that you can halve your chance of getting an illness seems exciting. But before you panic or celebrate, look beyond this relative risk to the base numbers that can tell you your absolute risk.

The doubling or tripling could mean that your chances have actually gone only from 1 in 10,000 to 2 or 3 in 10,000. That doesn't sound so bad. And keep in mind that one study rarely proves the case; knowledge builds with repeated findings.

These tips should get you started. And one last reminder: The therapy you pursue may have as much to do with your personal values and your doctor's as the science in these studies.

Renie Schapiro has taught at the Yale School of Epidemiology and Public Health and at University of Wisconsin Medical School. She can be reached at renieschapiro@hotmail.com.

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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