Married to Medicine

Married to Medicine

Tuesday, May 9, 2017

How To Spot Fake (Medical) News

Lots of talk these days about "fake news."  Our nation is in the midst of a collective prise de conscience and at long last, people are realizing that half the "news" they get from social media is fake - or at least, grossly misrepresented.  It's dawning on people that they might actually want to check the source.

(photo credit)
Not so, though, with medical news.  Still today if the topic is medical, all you have to do is throw the word "natural" into your URL and bam, your word ... which will undoubtedly include shocking revelations somehow unbeknownst to the people whose life work involves the study or practice of a particular subject matter ... is gold.  Why is this?  Well, presumably it's because lay people have literally no idea how to tell a legitimate medical article or study from a bogus one.  Good news:  I can help you out with that.

Let's take this article as our example (you can click on the red to open it).

At first glance, it looks pretty legitimate - right?  The website is the "Children's Medical Safety Research Institute."  Can't argue with a title like that.  It sounds like it's some sort of fancy, cutting edge collaboration of the best scientific minds around.  And I mean it has the word "safety" in it, so obviously this "institute" has only the best of intentions!

Seriously - does it get more legit-looking than this? 

But if you poke around a little on google, you'll find that all it is is a website of alleged "research" funded by a married couple, neither of whom is any sort of physician or scientist.  It closely mimics the name of the fully legit "Children's Medical Research Institute" but don't be fooled - it's not the same.  And don't miss the "click to donate" button about two-thirds of the way down the article.

But... the post is based on a real study!  See?  There's even a cool infograph!

Cool infograph

Is it?  Hmm.  Let's look closer.

Clue #1:  Even if you know nothing about determining the legitimacy of an online study, you might be tipped off by the article's claim that the study, a "pilot study of 666 homeschooled children," is the "first of its kind."  The article itself states that "Remarkably, not a single published study has ever compared vaccinated kids to unvaccinated kids to see who is healthier years after the shots."  Remarkable indeed!  D'oh!  How on Earth did we not think to do this until just now - we've been debating vaccine safety for decades and not a single scientist has thought to compare vaccinated to unvaccinated children years after their shots?!  Silly us.  In reality of course, there exists a multitude of such studies, not only out of the U.S. but out of other Western nations as well.  Here are just a few (this, this, and this)

But even if you come across a "study" whose conclusions actually do seem legitimate, you can still dig further to determine whether - or to what degree - those conclusions actually are.  And in fact, you must do so.  Because there is a lot of fake "science" out there on the internet.  Here's the link to a sting operation by NPR that found that many online "journals" will actually publish fake science for a fee.  And here's an NYT article that discusses the "world of fake academia" and why it exists.  How do you dig further?  Here are a few ways:

(1) First, google the journal that the study was published in and add the phrase "impact factor."  A journal's impact factor is the official measure of the yearly average number of citations, in other journals, to recent articles published in that journal - in other words, it's a measurement of whether or not, and at what frequency, other medical and scientific journals are citing the journal you're curious about.  The leading medical journal in the U.S., the NEJM, has an impact factor of 59.558.  Bogus journals may have a very low impact factor or, in the case of the "Journal of Translational Sciences" from the article we're examining, no impact factor at all (but be careful - the Journal of Translational *Medicine* is a legitimate journal... now do you see what they're doing?).

(2) Consider the qualifications of the authors of the study.  I usually look for studies that have at least one author who holds an M.D. plus a relevant scientific post-graduate degree (e.g., an M.D. and a Ph.D.).  If you see a study authored by multiple M.D.s. and Ph.Ds., that study is much more likely to be legitimate than a study with only a few authors whose qualifications are scant or nonexistent.  Also, if you see a Ph.D., makes sure it's a relevant one.  Remember "Dr. Laura" (Schlessinger)?  Her Ph.D. was in physiology, but most of her fans believe she actually has relevant psychological training and education.

(3) Examine not only the "conclusions" section but the actual data.  If you look closely at either of the two "studies" home birth proponents rely on to claim that home birth is just as safe as hospital birth (this one and this one), you'll see that in fact, they are relying on the sad reality that most people will only read the "conclusion" section and not actually examine the data in any meaningful way.  In fact, when the second such study was first released (by MANA, the Midwives Alliance of North America), HuffPo made the mistake of believing MANA's "conclusions" (this "study" was really just self-reported data MANA was forced to release and had tried to hide), and ended up having to completely change the title of its article covering the study.  WOW, right?

(4) Realize that as a laypeople, our examination of any single study will always lack synthesis.  Complex medical questions are not often (really - not ever) answered with a single study, and unless we get our own medical degrees and/or our own M.S.'s or Ph.D.'s, our examination of a single study is tunnel-visioned; we often don't even know how to properly be skeptical about it or even how to read its data.  So if you find yourself arriving at a conclusion different from the clear consensus of every legitimate health organization in the world (ahem... vaccines), based on your own examination of one study (or a few studies)... you've got cause for pause ;)

(5) Be sure you take a look at the title of the journal.  This one just cracks me up!  In the post examined above we have a purported study of vaccine safety supposedly published in the "Journal of Translational Science."  In fact,"translational" science or medicine has nothing at all to do with vaccine safety and a study comparing vaccinated to unvaccinated children would never appear in a so-titled journal.  Translational medicine refers to the efforts to use basic (think cellular) scientific findings to create new diagnostic tools and treatments.  Nice try, guys!  Now, let's all give a collective sigh of pity for all the people who clicked the "donate" button.  Womp womp.

That's my summary folks.  Now you, too, can spot fake medical news.

Tuesday, January 3, 2017

What You NEED to Know About Gardasil (but probably don't)

A lot of people ask me about Gardasil... it's the vaccine I'm asked about the most, by far.  But very few people are are aware of what I consider to be the most important thing about it.

Bear with me because I think giving you my personal perspective along with the facts is the best way I can share this with readers.


It was 2007, and HPV wasn't on either of our minds at all.  My husband was only 17 when I'd started dating him a decade earlier, and I was the first girl he'd ever really even kissed.  We'd then saved sex for marriage... for 5 years... and gotten married right before starting demanding graduate programs.  So by the time we were 27 we both had very long, well-established histories of pretty much no sex ever.  HPV was not anything we were concerned with.

That year, my husband finished up his academic medical training (meaning, classroom-based years) and was just starting his clinical years - the years of actually seeing patients.  As you can imagine, it's quite an education and it's a very intense time for medical students - the privilege of working with people on their most important situations is not lost on any trainee who has even half a heart.  Everything is new, the learning curve is incredibly steep, and the demands - physical, intellectual, and emotional - are sky high.

During this time, my husband saw many things that made an impression on him, and I was sometimes his sounding board.  One of the things that struck both of us as very scary... and very sad ... was something he noticed when he started his rotation in the head and neck cancer clinic.  The scene there wasn't what one might think would be, based on common knowledge.  About half of it was... about half of the patients there were the typical population of aging and elderly smokers and chewers... the sad situations he'd expected to encounter.  Very sad indeed, because oral and throat cancers are not only very deadly cancers but they bring some of the most excruciating deaths and their treatments carry horrendous and often permanent side-effects, even for survivors.  As a physician friend of mine has noted, "People with head and neck cancers have disfiguring masses in their mouths and throats, which make it hard for them to eat and speak ... I've been the last person to hear them talk before their vocal cords are removed in surgery, and it is a chilling experience."  This, again, was simply to be expected.  But what my husband hadn't expected and what struck us as almost perverse in how strange and wrong it seemed, was that the other half (half!) of the patients were early middle-aged people with no history of smoking or chewing and no histories of any other high-risk lifestyle choices either.  They were, by and large, parents - with young children.  Totally normal parents.  Parents who, along with their young families, were living out complete nightmares.

What was the cause of these truly godforsaken tragedies?  You've probably figured it out by now ... HPV.  As I sit here writing this post, a decade later, Doctors and scientists now widely consider HPV patients to be "The New Face of Head and Neck Cancer," and oncologists, who have nothing to do with administering the vaccine, are "leading the campaign to boost its use."  And here's the thing:  You don't have to have sex to get HPV in your mouth ... open-mouth kissing is currently believed to be enough, and oral sex, which younger generations don't even consider to be "real" sex, will do it for sure.  And here's the other thing:  There's no annual pap smear, or *any* test, to catch pre-cancerous cells in the mouth or throat and scrape them away.  It's tempting to tell oneself that one's children don't need the HPV vaccine because hopefully they won't be promiscuous and even if they are, they'll surely always have annual checkups (lots wrong here already, but that's outside the scope of this blog post).  But even if those things were safe to assume, they're utterly irrelevant to protecting against the risk of HPV-originating oral and throat cancers.

Most people who ask me about the HPV vaccine have no idea HPV can cause any type of cancer other than cervical.  And that's simply because all of this is so new.  Much as our knowledge base continues to grow, there hasn't even been enough time to complete any long-term studies; we can test the cancer cells themselves and see that they came from HPV, but we still don't know exactly the risk of kissing or oral sex - though I once read an article by a Harvard oncologist estimating that having three or more oral sex partners is the new risk-equivalent of long-term smoking (I read that years ago now and cannot find the link - personally I don't think any solid estimation can really be made yet, but that's the only estimation I've ever seen).  So most people making this choice for their children don't even know the half of what they're deciding about.  And as with all the other standard vaccines, there is plenty of misinformation on the internet to scare parents about alleged side-effects.  I'm not going to rehash why that is and where you should look to find legitimate information; you can read my more general vaccine post on all that (and click here or check Snopes if you've heard the debunked myth about Gardasil's "creator" Dr. Diane Harper).  But here's what I think you should consider:  Whether or not the vaccine has any real risk of side-effects, the decision not to get the vaccine absolutely has a risk of side-effects.  If you visit your local hospital, you won't find a single person occupying a bed there because he or she got the vaccine.  But you'll have only to take the elevator to the head and neck cancer clinic to find plenty of people there because they didn't get the vaccine.   

I hope for your own sake that you've never been (and will never be) close to a young family facing the loss of a mom or a dad.  My husband (now an oncologist/researcher focusing on leukemia research at The Dana-Farber Cancer Institute, a Harvard affiliate) says that these are hardest losses he sees (he doesn't do pediatric oncology... says he couldn't).  Whereas other patients weigh the pros and cons of increasingly experimental treatments and often choose to forego treatments that have almost no chance of prolonging their lives more than a few extra weeks, while also carrying brutal side-effects, parents of young children will put themselves through almost anything for even one more day before they have to say a permanent goodbye to their children. Believe me when I tell you - if there was anything you could do to prevent your child and his or her future family from facing this... you would do it in a heartbeat.  And there is.  It won't protect against all types of cancer, obviously.  But the HPV vaccine will protect against various cervical, vaginal, vulvar, penile, anal, rectal, and oropharyngeal cancers.  My kids will both be getting it as soon as they're eligible - in spite of the fairly chaste lifestyles my husband and I lived and hope they will also live.  I hope so strongly that your children will get the vaccine too.