Some guidelines on thinking critically about treatments and their efficacy.
Making sense of health claims can be tough these days. We are besieged by conflicting information. The media, well-meaning friends, salespeople and health practitioners all have differing advice for us. It seems as if everyone knows someone who has had a dramatic response to some new special treatment.
What’s a concerned health consumer to do? Here are some basic guidelines to help you think critically when investigating whether or not a treatment may be beneficial for you.
The most basic and common form of health information is the testimonial. Someone swears that treatment X worked miracles for them. Is that really enough to go on? Testimonials may seem convincing at first, especially when delivered with enthusiasm and conviction, or if you know the person. Remember, though, that many acute medical conditions such as sore throats, sniffles and general muscle aches and pains get better spontaneously; and many chronic conditions such as arthritis and depression have a natural fluctuation of symptoms over time. If you really want to take testimonials about a chronic medical condition seriously, it’s best to observe for yourself how the people are doing for several months after you first talked to them. Effects may fade if the treatment wasn’t truly helpful and perceived benefits were actually due to natural symptom variability.
When my patients are interested in a new treatment I know little about, I usually suggest they look beyond the testimonials for sound research that demonstrates benefits. Based on the responses I get from some hard-core alternative-medicine consumers, I get the impression they regard “research” as a dirty word. Good quality research can help you decide whether or not a treatment may be helpful, and sincere practitioners generally welcome the chance to put their treatments to the test. His Holiness the Dalai Lama seems to concur, as he encouraged objective investigation into traditional Tibetan medicine at the First International Congress on Tibetan Medicine.
If you decide to examine health research reported through news or advertising, be alert for what research critics call surrogate outcomes. Surrogate outcomes are measured physiological changes in the body (for example, cholesterol levels) as opposed to outcomes that measure the occurrence of the actual disease (for example, heart attacks). Scientific studies can sound very convincing when they show surrogate outcomes such as reduction in cholesterol or improvement in immune function. Do not assume, however, that these changes mean that the treatment can prevent or cure a disease such as heart disease or the common cold. A physiological change may be significant enough to be measured in an experiment, but may not be sufficiently powerful in the long run to improve your health. It is far better to use the occurrence of the disease in question as the final outcome for the study.
A classic example of unhelpful surrogate outcomes is hormone replacement therapy (HRT). Early HRT research showed significant improvements in cholesterol profiles, and well-meaning doctors advised postmenopausal women to use HRT to prevent heart disease and other medical conditions. When further research looked at heart attacks as an outcome, HRT was not shown to have a significant effect. HRT is no longer generally recommended solely for heart disease prevention.
Sometimes the media seems to take a perverse delight in telling us that things we thought were good for us are bad and vice versa. And it’s not just the tabloids. Reputable media also present stories such as “Vitamin C causes arthritis” and “Smoking prevents Parkinson’s disease.” Shocking headlines undoubtedly sell well but are often completely out of step with the majority of the related research. Health research on a particular subject will indicate trends toward one conclusion, but as research progresses and more studies are done, there will almost always be a few conflicting studies.
For instance, a recent scientific review of the benefits of eating cruciferous vegetables (such as cabbage, broccoli or Brussels sprouts) in protecting against colon cancer examined twelve existing studies. Eight showed a benefit, three showed no benefit and one actually showed increased risk. (Imagine: “Killer sprouts on rampage of death!”) The overall message here is still that eating cruciferous vegetables is healthy. Be wary of sensationalistic health news.
Although reviewing good quality research is always useful, it’s also possible that a forward-thinking health practitioner may be ahead of his or her time. Such a practitioner may give valuable health advice before research catches up and proves him or her right. I was born in the 1950’s, and my mother’s doctor forbade her to drink alcohol or smoke during her pregnancy. Incredibly, he also gave her a booklet on yoga-like exercises, complete with breath training! I probably owe this progressive doc a few brain cells, as this was uncommon advice back then. If you are seeing someone that you think is an avant garde practitioner, consider that they should still be able to explain in reasonably simple terms why their advice is suitable for you and welcome any questions or concerns you may have. If they seem rushed, irritated or defensive, or the treatment costs a small fortune, consider these as possible warning signs.
There are also longstanding traditional medical practices that have not been scrutinized by Western-style research, but which could be “proven” in the future to be effective. One can make an argument in favor of continuing with a traditional treatment that seems consistently effective, provided it is safe and affordable. The stakes get much higher, however, if you have a critical medical condition and are forgoing research-backed lifesaving treatment. I then urgently recommend that patients ensure that they are well informed about their decisions.
It’s best to be vigilant in our search for good quality health information. Health and media are billion-dollar industries with powerful interests that can shape the information that comes to both consumers and practitioners. And there will always be the occasional snake-oil salesman looking for gullible or desperate consumers. Practitioners such as these offer questionable treatments whose most common side effect is an empty wallet. Bottom line? Instant and easy miracle cures are, unfortunately, extremely rare.
My approach with patients is usually to suggest sensible, effective and safe lifestyle changes whenever possible-exercise, sleep and quitting smoking-before looking to more interventional treatments. In making safe and effective health choices, we have several defense strategies at our disposal: question testimonials and practitioners, search for good quality research, understand the context of some sensationalistic media reporting, and be wary of expensive treatments and cagey or slick health gurus. We can practice intelligent discrimination while still keeping an open mind for truly valuable but unproven treatments. Just be careful not to be so open-minded that your brains fall out.