Headlines declare wine is good for your health. So is a small bit of dark chocolate. Then, they say it's not. One day coffee is bad for you and the next it's good. We're bombarded with health messages daily from companies selling things, advocacy groups promoting their agendas and journalists trying to sift through it all. Who are you to believe? Unless you have a degree in epidemiology, it's very difficult to discern the valuable information from all the garbage. In his new book, "The Healthy Skeptic," journalist Robert Davis gives readers some quick tips to become better consumers of health care information.
"A healthy skeptic carefully and critically evaluates each piece of advice taking into account not only its source but the science behind it," Davis writes. Davis has 20 years' experience as a health and medical journalist, as well as a Ph.D. and M.P.H. in health policy and public health. He teaches at Emory's school of public health. In the book, Davis uses common examples of over-hyping that upon inspection often prove incomplete or even misleading, such as misguided dieting advice and the total prevention promises of lowering cholesterol and wearing sunscreen. He also offers several examples of how overzealous health promoters have led consumers astray, such as Oprah's on-air full body CT-Scan; Katie Couric's promotion of colonoscopies before the recommended age of 50; and the unproven but nearly messianic messages about cancer screening.
Davis gives health promoters the benefit of the doubt that their errors result from having to snag consumers' attention while competing with thousands of messages bombarding them daily. "To convey complex scientific information in this environment, health promoters may resort to oversimplifying or sensationalizing," Davis writes "They may not necessarily lie to us, but like anyone else trying to sell something, they don't always give us the full truth, either. Instead, what we may get, even from individuals and organizations with the most altruistic of motives, is hype, half-truths and spin." Davis offers eight questions to help readers assess the science behind a health message before drawing conclusions. I doubt the average consumer will apply his evaluation techniques, but certainly anyone who buys the book would find them helpful. And this should be required reading for health and medical journalists.
The Healthy Skeptic's eight key questions:
What kind of study is behind the research? Is it a gold standard randomized clinical trial or is it an observational population study? The latter can only show strong associations and never definitively prove a risk or benefit.
How big is the effect shown in the study? The larger the effect the more believable it is.
Could the findings be a fluke? In other words, is it statistically significant?
Who was studied? Do the study subjects closely resemble the population for which the the conclusions are being extrapolated?
Is there a good explanation? Is there a believable biological explanation for the study's findings?
Who paid for the research? Could the funding source have influenced the researchers, either consciously or subconsciously?
Was it peer reviewed? Did it appear in a respected journal that required other scientists to critique it first?
How does it square with other studies? Individual studies are pieces of a larger puzzle and the entire puzzle must be examined before conclusions can be drawn.
This post originally published August 15, 2008 by Sally Arnquist on The Health Care Blog.
August 15, 2008
August 27, 2007
100,000 Lives
A report from the Commonwealth Fund compares the quality of care in various countries. The United States didn't do well. The table at left summarizes the findings.
Yet another report highlights the lack of preventive care in the United States. Following is an article from Reuters which details several often-overlooked services:
NEW YORK (Reuters Health) Aug 07 - More than 100,000 lives could be saved in the US each year, if use of just five preventive services were increased, according to study findings released Tuesday by the Partnership for Prevention. The report also indicates that there is a major racial gap in the use of preventive services. In particular, African Americans, Hispanic Americans, and Asian Americans are less likely to use such services than whites. Key findings from the study, which was funded by the Centers for Disease Control and Prevention and other groups, include:
--If the percentage of adults taking aspirin daily to stave off heart disease were to increase to 90%, roughly 45,000 lives would be saved annually. At present, aspirin usage in eligible adults is under 50%.
--If the percentage of smokers who were advised by a healthcare professional to quit and then offered assistance were to increase from the current 28% to 90%, an estimated 42,000 lives would be saved each year.
--If the percentage of adults age 50 and older who are up to date with recommended colorectal cancer screening were to increase from the current 50% to 90%, roughly 14,000 lives would be saved each year.
--If the percentage of adults who receive influenza vaccination rose from 37% to 90% annually, an additional 12,000 lives would be saved each year.
--If the percentage of women screened for breast cancer in the past 2 years increased from 67% to 90%, an extra 4000 lives would be saved annually.
In addition, the report indicates that 30,000 cases of pelvic inflammatory disease could be avoided each year if the percentage of sexually active young women who are screened for chlamydial infection rose from 40% to 90%.
Some of the racial differences identified include:
--Hispanics are 55% less likely to receive smoking cessation assistance than whites.
--Asians are 40% less likely to use aspirin to prevent heart disease than whites.
--African Americans have higher cancer screening rates for breast and colorectal cancer than Hispanics and Asians, but increased screening in African Americans could lead to bigger gains because they have higher mortality due to these malignancies.
Posted by Scott W. Yates, MD, MBA, MS, FACP
NEW YORK (Reuters Health) Aug 07 - More than 100,000 lives could be saved in the US each year, if use of just five preventive services were increased, according to study findings released Tuesday by the Partnership for Prevention. The report also indicates that there is a major racial gap in the use of preventive services. In particular, African Americans, Hispanic Americans, and Asian Americans are less likely to use such services than whites. Key findings from the study, which was funded by the Centers for Disease Control and Prevention and other groups, include:
--If the percentage of adults taking aspirin daily to stave off heart disease were to increase to 90%, roughly 45,000 lives would be saved annually. At present, aspirin usage in eligible adults is under 50%.
--If the percentage of smokers who were advised by a healthcare professional to quit and then offered assistance were to increase from the current 28% to 90%, an estimated 42,000 lives would be saved each year.
--If the percentage of adults age 50 and older who are up to date with recommended colorectal cancer screening were to increase from the current 50% to 90%, roughly 14,000 lives would be saved each year.
--If the percentage of adults who receive influenza vaccination rose from 37% to 90% annually, an additional 12,000 lives would be saved each year.
--If the percentage of women screened for breast cancer in the past 2 years increased from 67% to 90%, an extra 4000 lives would be saved annually.
In addition, the report indicates that 30,000 cases of pelvic inflammatory disease could be avoided each year if the percentage of sexually active young women who are screened for chlamydial infection rose from 40% to 90%.
Some of the racial differences identified include:
--Hispanics are 55% less likely to receive smoking cessation assistance than whites.
--Asians are 40% less likely to use aspirin to prevent heart disease than whites.
--African Americans have higher cancer screening rates for breast and colorectal cancer than Hispanics and Asians, but increased screening in African Americans could lead to bigger gains because they have higher mortality due to these malignancies.
Posted by Scott W. Yates, MD, MBA, MS, FACP
August 20, 2007
Concierge Medicine
Your doctor has your cell phone number. Here, you'll have his. Wait an hour for your doctor? Never here; our patients do not wait. The President has 24/7 access to his personal physician. Now, you can too.
Never wait to see your doctor again. Your personal physician is reachable by cell phone any time day or night. Even responds promptly to e-mail. And you can arrange to have your physician come to your home or office. You’ll have 24/7 access. We’ve created a different kind of medical practice that puts you in charge of the doctor-patient relationship. For more information, see our website at www.my24-7md.com
See http://www.my24-7md.com/ for additional information.
Scott W. Yates, MD, MBA, MS, FACP
Center for Executive Medicine
Never wait to see your doctor again. Your personal physician is reachable by cell phone any time day or night. Even responds promptly to e-mail. And you can arrange to have your physician come to your home or office. You’ll have 24/7 access. We’ve created a different kind of medical practice that puts you in charge of the doctor-patient relationship. For more information, see our website at www.my24-7md.com
See http://www.my24-7md.com/ for additional information.
Scott W. Yates, MD, MBA, MS, FACP
Center for Executive Medicine
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