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Health info - sorting the wheat from the chaff
[Posted: Mon 22/11/2010 by Niall Hunter, Editor www.irishhealth.com]
Patients are frequently being misled by “quacks”, dodgy research and journalists producing miracle cure and sinister hidden health scare stories, a leading medical health writer and doctor has said.
Dr Ben Goldacre is scourge of those who he says misuse science and medicine for selfish ends with potentially dangerous results.
He is probably best known for managing to procure online for his dead cat membership of the US nutrition organisation to which TV diet expert and recent “I’m a Celebrity" contestant Gillian McKeith belonged.
However, Dr Goldacre told irishhealth.com that while the peddling of wrong medical information, misinformation and scares through unreliable research and in the media had its funny side, it was a very serious public health problem, as it can harm patients.
“It is not just fun and games and it not just abut there being the occasional, odd, silly story. This has quite a serious impact on the public’s understanding not just on whether something is good or bad for you but also, but on the methods of evidence-based medicine, because I think the public is being misled about how do we really know if something is good for us.”
Dr Goldacre says if you look at surveys of the media, half of all science stories are medical stories.
“Those are generally stories about what is going to kill you and what is going to cure you. So there’s no doubt that the public have got a real interest in health.”
But isn’t blaming the media too much for dubious claims from research or from so-called experts not a bit like shooting the messenger? Is there not a need for better regulation of where the information originates from?
“People have to be free to come out with insane ideas if they waent to but it is the job of journalists not to be scribes and just write down what people say and then print it as if it is true."
"It is the job of journalist to hear what people have to say and then have a think about it, decide if it is true or not and go and double-check the facts.”
Dr Goldacre, who writes a column for The Guardian and wrote the bestselling book “Bad Science”, gives the MMR-autism link scare as just one example of media misinformation and scaremongering.
He rejects the contention that it was to an extent understandable that the media should hav originally given credence to what was after all, research published in a peer-reviewed journal, The Lancet.
“There are millions of doctors in the world, there are tens of millions of people with PhDs who are entitled to call themselves doctors - I would contend there is no imaginable proposition so ridiculous that I couldn’t find you one doctor somewhere in the world who is willing to defend it to the death, but that doesn’t mean that it’s true.”
“Also, obviously such stories have to fit in with the interests and agendas and concerns of the journalists.”
He points out that the media at the time ignored a wealth of reliable research elsewhere that showed the MMR vaccine was safe.
With respect to The Lancet, he said he believed it was a “slightly silly paper” for the journal to have published.
“But you have to remember this paper didn’t actually say MMR causes autism, it didn’t even speculate on that. It was accompanied by an editorial that said by the way people should be very clear that it doesn’t mean that MMR causes autism.
“Also, this was a 12 subject case series report - it was a description of only 12 children’s clinical anecdotes, and while this is not good evidence to say MMR causes autism, it is a perfectly legitimate thing to publish.”
Dr Goldacre says medical academic journals cannot go around saying “we can’t publish this weak piece of evidence in case the entire British news media gets the wrong end of the stick and creates a five-year long scare story out of it”, as that would not be reasonable.
“As a basic principle for all research I feel you should publish everything, but everybody should read everything that is published critically, and that goes for journalists, doctors and patients, if they want to.”
In Ireland recently for the annual conference of the Network of Establishing GPs in Athlone, Dr Goldacre pointed out to the meeting that while Wakefield’s study was published in 1998, the vaccine scares only really accelerated around 2001-2 when then Prime Minister Tony Blair refused to confirm whether his infant son would be getting the MMR vaccine.
Dr Goldacre, in his book, also says drug companies frequently suppress trial data that is not favourable to their products.
He agrees that it would be impossible for anyone - the media, doctors - trying to assess this information to know that this selective use of data had happened.
“ If a drug rep spins a doctor a line they can ignore it and go and double check what they say against the real evidence published in the medical literature. When an advert or company brochure is misleading you can double-check the claims.
“But if they poison the well, when unflattering evidence that a drug doesn’t work, for example, is not published and nobody ever has access to it, then there is no way that anybody can know."
Dr Goldacre says this happens frequently.
He is also critical of what he feels is a too close relationship between some doctors and the pharma industry.
Asked it pharmaceutical industry funding for research and other medical activities was not an economic reality, he said you have to be realistic in the modern age, in that when Governments fail to fund research, but research obviously must be done, the pharma industry will sponsor research.
“I think when that happens you just have to be cautious to ensure you have a regulatory framework that stops people from behaving badly, that stops people from hiding data.”
“The relationship between doctors and the pharmaceutical industry is problematic but I think it is something that is getting better. It’s important not to be shrill about it and choose your targets. I think pharma companies sponsoring medical education and producing the materials for it is unacceptable; I think pharma companies paying for people to go on nice golfing trips is also pretty out of order.
"Pharma companies sponsoring research is always going to happen and is arguably appropriate, I don’t have a very strong view on it, but I think it is something that has to be properly regulated. All data from comparative research conducted in human subjects should be published within one year of completion, and people who fail to do this should face criminal charges because patients can suffer as a result."
Ben Goldacre believes the “real tragedy” here is that not all “Big Pharma” is not necessarily “Bad Pharma” - quite the opposite in fact.
“It’s an extraordinary puzzle - how an industry which does so much good and produces all of these fantastic life-saving products has managed to torpedo its own reputation to the point where it is almost accepted knowledge that ‘drug companies are dodgy’. This is almost a reflex reaction if you ask the average person on the street.”
“To me that’s what drives a lot of the popularity of “quackery” and other things like vaccine scares.”
Dr Goldacre says doctors should be far more proactive in ”going hammer and tongs” in publicly refuting false and misleading health claims that make their way into the media.
As an example of tabloid newspaper health coverage, he pointed out that in the UK, the Daily Mail newspaper mounted a major campaign against a cervical cancer vaccine for children , while supporting the exact opposite in its Irish edition after Mary Harney had postponed the HPV vaccination scheme.
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