Friday, February 21, 2014
Medicine Is Not So Simple
Headline News: A new study suggests that men who stand on their heads at least once a week have fewer heart attacks. This fictional headline is not unlike many breaking stories we see daily on line, in print or on TV. Someone does a study and the news releases the results no matter how wacky or unreliable. Doctors and hospitals must be more careful in reaching conclusions and making recommendations. The human body is complex and variable, and correlation does not prove causation.
Here is a real example. The FDA advisory committee “voted 16-9 that the available data don't support a conclusion that naproxen has a lower risk of cardiac problems compared with the other NSAIDs.” There may be some evidence and some excellent studies, but they are not yet definitive enough to convince the expert panel. This is, in fact, contrary to a headline that came out about a week before this clarification was published.
Another recent example comes from a Johns Hopkins bulletin. After describing studies showing an association between daily coffee consumption and a reduction in some risks related to prostate cancer, they go on to warn: “there is still not enough information to recommend that anyone start drinking coffee solely for its potential anti-cancer benefits...[because] all the studies…are observational, and these research efforts do not prove any clear cause-and-effect relationship between coffee consumption and prostate cancer protection.” Again, they need clear evidence of cause and effect, from several well-designed studies.
Likewise studies of meditation find that it can be effective in reducing stress and anxiety, but the question of positive emotional benefits is still unanswered. “Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.” Clinicians must know this to counsel clients appropriately.
In my fictional news story of the head standing, those who do may also practice yoga. Yoga may lead to better circulation, which may reduce heart attacks. Yoga may lead to practicing meditation to reduce stress, which may reduce heart attacks. It may just be that overweight men are less inclined to stand on their heads, so the head-standers are in better physical condition, which reduces heart attacks. Researchers may have studied, measured and compared the wrong things – as could also be the case in the coffee example.
These types of studies are happening all the time and the news media do not necessarily handle the information responsibly, preferring a big splash on the front page to the more careful approach taken by medical experts. As a result we are faced with conflicting opinions about the relative effectiveness of mammograms, PSA tests and many other items of health news. It’s important to keep in mind that medical science is more precise and careful than what a neighbor or relative reports, what the TV doctor recommends or what the latest breaking headline study suggests. This understanding helps separate the real from the hoped-for, the effective remedy from the placebo, and the tested medicine from the prescription by popular opinion.