Evaluating Medical Information And Literature
The internet has provided us with so much information. You can find unending resources for any topic including health topics. But how to do you know that you can trust what you are reading? What information should you be looking at? How to you identify facts versus opinions? Today we will talk about medical literature, scientific information versus opinion. We will also explore the plethora of health information available and how to evaluate it.
We are all exposed to large amounts of medical information through newspapers, online articles, googles searches, and social media. But what should you be looking for to make sure the information is trustworthy? And why is this important?
Not all medical information is created equally. The best medical information is information based on scientific evidence. Opinions and anecdotes are NOT scientific evidence.
The best scientific evidence will be based on empirical research or secondary research. Empirical research involves conducting an experiment. An experiment is a specific step of the scientific process. In this step, a carefully planned procedure helps answer a question, makes a discovery, or describes an unexplained process. In an experiment, researchers will
- Observe a problem or phenomena
- Ask a question related to their observation
- Make hypothesis
- Make predictions
- Test the predictions
- Interpret results
- Ask new questions
- Plan next steps if needed
The best empirical studies will control for bias. Unbiased science is when science or experiments are not affected by outside factors, prejudices, beliefs, or favoritism. This means it is as fair as possible and doesn’t support one particular group or outcome. Unbiased studies use systematically designed research and use population level datasets (meaning groups that are similar to the population). Randomized controlled trials, RTCs, are the gold standard of unbiased studies.
RCTs evaluate the effectiveness of a medical intervention using randomized participants and blinding to reduce bias. In a randomized blinded study, a participant is randomly placed in a group. That person and the researchers or technicians are blinded to which treatment that person is receiving.
Secondary research is when researchers look at analyze lots of experiments to put together a summary of findings from those studies.
Both types of research can be presented as a scientific paper. The paper will include
- An abstract (or summary of the paper)
- An introduction with background information, definitions, knowledge gaps
- A statement of purpose
- A hypothesis
- Materials and methods which are details of how the study was done
- Results including any statistics and findings
- A Discussion which provides analysis of the results and compares the results to the hypothesis and a conclusion based on those results
- o It may also include information from other studies
- A list of limitations of their study
- Suggestions for future studies
- Reference lists of all the studies that have been cited in the paper
Science is NOT finite. We are learning all the time. We continue to accumulate data and look for new data. When we find new data we update or adjust conclusions, interpretations, and recommendations. This is NOT deception. It indicates science is working, we are learning, and we have new information.
QUALITY SOURCES FOR INFORMATION
Scientific articles are published in medical journals. Before being published, they are peer reviewed. This means other experts in that scientific field look at the work to make sure it is done thoroughly, correctly, and the results are valid. This helps maintain the integrity of the experiment and science. Once an article is peer-reviewed it is published in a credible journal. Credible journals will check for peer-review as well as ensure the highest quality studies are presented. To make sure you are looking in a credible journal, the journal should be included on Web of Science of PubMed. All credible journals will require authors to state any conflicts of interest including university affiliations and any financial interests. They must state who they are working for and who is paying for the study including if it is funded by a pharmaceutical company.
Scientific papers and articles are the best place to find quality information. But most people do not have access to medical journals. Usually, we come across this information when referenced in tv or print media, social media, or forwarded links. If you can, try to find the original study to confirm that the article interpreted the information correctly and did not cherry pick information. This isn’t always available, but most journals make abstracts free to view if you search via PubMed or Web of Science.
Reading news articles, social media posts, memes, or watching unverified videos can help you find information, but it shouldn’t replace reading original research. If you are reading this type of information source, it should be critically evaluated. Articles we find on social media and in some online news sources are not written to give out information but to generate clicks and revenue. Sometimes they present information that is not accurate, well organized, or given in context. Websites must also be explored for credibility. Here is a list of credible websites to look for medical articles or health information:
Healthy Children is a parent friendly site for the most up-to-date pediatric health information.
American Academy of Pediatrics
The AAP is a nonpartisan group that advocates for children’s well-being and funds research.
The National Institutes of Health
The NIH is the medical research agency for the United States.
Center for Disease Control and Prevention
The CDC website provides accurate and up-to-date information on healthy living, diseases, and conditions.
Medline Plus is a division of the U.S. National Library of Medicine. It is the world’s largest collection of health information.
The WHO site has up-to-date science-based health information.
Health finder is a source of medical information provided by the US Department of Health and Human Services.
National Center for Complementary and Integrative Health
A division of NIH, the NCCIH conducts and supports research on complementary health products and practices.
We must also look at who is providing the information in these sources and what is their expertise or authority on the subject. We get into trouble when seeking information from False Authorities. A False Authority is not actually an expert in a subject but will claim expertise. They do not add credibility to an argument. To avoid using False Authorities you must be able to recognize them as well as verify your source and their credentials. There are 4 types of false authority.
- Irrelevant Credentials
- This is when a person uses their educational degree to exert expertise, but the degree is not in the field they are discussing. For example, using someone who has a PhD in English speaking about how mRNA vaccines work. They may have a PhD and be called Doctor. but they do not have a PhD in Immunology or Cellular Biology.
- Dubious Credentials
- This is when a person claims medical expertise but doesn’t have the correct training to exert expertise. Often naturopaths and chiropractors will claim expertise but lack the schooling or science background to back up their claims.
- Insufficient Credentials
- o This is when a person has expertise but not in the field they are discussing. For example, an orthopedist who is giving advice about a dermatological condition.
- No Credentials
- This is when a celebrity or influencer is believed just because they are famous or when a layperson is disputing data because of their opinion.
ONLINE HEALTH INFORMATION
In addition to scientific studies, we often look for health information online. And there is no lack of resources or information! Over 80% of people get their health information from online sources. There are 700,000 searches for health information done every minute! One favorite source is Google, aka Dr. Google!
It is very easy to google a condition and self-diagnose or treat yourself. Dr. Google is the term used for people who get their medical information from google. Over 35% of people use Dr. Google to diagnose a condition in themselves or a friend or family member instead of seeking medical care.
How is Dr. Google helpful? Dr. Google can lead you to symptom checkers. Symptom checkers are not there to provide a diagnosis but to help guide if you need immediate medical care of can wait for an evaluation. It can help you recognize more serious symptoms. It can also help you make the most of an appointment with your primary care provider. It may help you organize your thoughts, questions, and symptoms. It may help you know things you should mention that you may not have believed to be related or thought to have included.
How can Dr. Google hurt you? Dr. Google should never be used instead of a formal evaluation by your primary care provider. Dr. Google can cause cyberchondria. Cyberchondria is when a person has increased anxiety due to web searches about their health. Often a web search leads to self-diagnosis. These diagnoses can be incorrect and can lead to unnecessary worry. That extra worry may result in trying incorrect treatments at home or may cause you to demand unnecessary medical care or extra testing based on those worries. The unnecessary worries can also create a nocebo effect. This is the opposite of the placebo effect (a positive effect from anticipating that effect). A nocebo effect is when you have negative effects or symptoms from anticipating that effect.
Dr. Google also erodes trust in your primary care provider and care team. Should Dr. Google erode trust in your team? Absolutely not! Dr. Google can help identify diagnoses but isn’t as good as actual health care providers. A study found Dr. Google identified the correct diagnosis 34% of the time, but providers are correct 72% of time! When looking at the top 3 diagnoses, Dr. Google only got the real diagnosis in the top 3 list 50% of the time whereas providers had the diagnosis in the top 3 84% of the time. This study did not let providers use exams, labs, or other testing to determine a diagnosis. They had the same information (the history and list of symptoms) that were provided to Dr. Google. A human professional with proper training is always the best place to seek a diagnosis or evaluation.
It is not surprising that Dr. Google has a hard time diagnosis with accuracy. There are many causes to just a few symptoms. For example, abdominal pain can be the result of dysfunction of 6 different organ systems and can result in over 20 different diagnoses! That’s a lot of options to choose from!
Dr. Google isn’t bad, you just need to make sure you know how you got the information and how you will use it. It should be used as a starting point and not an official diagnosis or treatment plan. When you bring information that you have found online to your provider, via Google or elsewhere, make sure you know who runs the site you found the information on, if it is promoting a product, when it was written, where the information came from, and why the site is in existence. This can help weed out inappropriate or false medical information.
Often articles and social media are providing opinions. Opinions are NOT fact and are NOT information. A fact is information that is provable, observable, and measurable. A fact can be supported by data and evidence or objective observations. Facts do not differ based on feelings. Indisputable facts are based on the current best evidence.
Opinions are personal views, beliefs, or judgements. These are NOT founded on proof, cannot be supported with data or evidence. They are subjective observations that are influences by belief, culture, and experience. They differ among people and are disputable.
Sometimes it is easy to tell fact versus opinion. Sometimes it is harder. BUT JUST BECAUSE YOU DO NOT ACCEPT SOMETHING, DOESN’T NEGATE IT BEING A FACT.
When looking at information from authorities or in media, we must use critical thinking to evaluate this information. We’ve learned to look for true expertise and to look at the quality of the data. We also must learn how to think about potential biases or incorrect reasoning that people may use when presenting arguments.
We want to look for any logical fallacies. Logical fallacies are common errors in reasoning. These errors lead to incorrect conclusions or correct inclusions but with arguments that do not actually support that conclusion. Knowing the common types of fallacies will help you identify them.
- Post Hoc Ergo
- In this fallacy, you assume that because one thing happened before another, it was the cause. Correlation does not equal causation. This is a frequent fallacy used in the anti-vaccine movement. Because autism is diagnosed around 15-18 months and the MMR vaccine is given around the same time, the anti-vax movement claims the MMR vaccine must be causing autism. This has been proven to be untrue (read more about that below).
- Appeal to Nature
- This fallacy claims just because it is natural that it is good or better than artificial or alternative. We see this argument a lot with vaccines. People claim getting immunity from the disease is better than from a vaccine when the vaccine often provides better or equivalent immunity without the suffering from the disease or consequences of the disease
- Appeal to Authority
- This fallacy is related to false authority or believing someone’s’ position of authority makes their argument more valid. Remember not all credentials makes someone an expert. And an expert in the field should only speak to their expertise and should not include any biases. An example of this logical fallacy is when a celebrity advertises that a cereal is the best breakfast choice.
- Red Herring
- A red herring argument diverts attention from the discussion by focusing on an issue that SEEMS relevant but isn’t. It is used to confuse or distract. This is seen when you say you aren’t hungry anymore, but your parent insists you eat because there are starving children elsewhere. Starving children in other countries have no relation to your own hunger cues.
- Appeal to Emotion
- This fallacy uses arguments that evoke feelings of compassion, pity, or fear to win over an audience. They do not use legitimate evidence. One example is animal shelter advertisements, instead of talking about what your donation will go towards and how it will help, it plays sad songs and shows sad pictures of puppies! The end result (donation of time or resources) is the same, but they used emotional appeal instead of facts and information to make their argument.
- Arguments from Ignorance
- This fallacy claims something must be true just because it hasn’t been proven false. One example is someone insisting Big Foot exists because you can’t prove they do not.
CWe must also look for cognitive dissonance when information especially when provided to us via social media. This may be easier to see with personal relationships such as friends or family members. Cognitive dissonance is when a person’s beliefs and behaviors do not align. A person who suffers from cognitive dissonance will suffer from confirmation bias. This means they will ONLY expose themselves to information that aligns with their belief. They will avoid any conflicting information. They may rationalize their actions or choices. They may behave in a way they would normally criticize. They may refuse to talk about certain topics knowing they can’t back up their argument. One example of someone who would suffer from cognitive dissonance, is a person who believes strongly in climate change but refuses to believe the science behind vaccines. Or a person who is willing to get Botox, an actual toxin and biological weapon, but won’t get a vaccine because they believe them to be “toxic”. They cherry pick which information to believe based on their personal belief system.
Cognitive dissonance is hard to overcome and very challenging to fight as the person will most likely ignore your information or rationalize it away. They may also fall to the boomerang effect. The boomerang effect is when a person is more likely to believe false information when presented with facts that prove their belief untrue.
This week we discussed looking at medical and health literature for accuracy, evidence-based science, and credibility. We have discussed using health literature in a productive manner and avoiding the pitfalls of using information online. We have also learned about facts versus opinions. Next week we will learn about misinformation and disinformation, as well as look at an example of disinformation and its effect.
Children’s Health Care of Newburyport, Massachusetts and Haverhill, Massachusetts is a pediatric healthcare practice providing care for families across the North Shore, Merrimack Valley, southern New Hampshire, and the Seacoast regions. The Children’s Health Care team includes pediatricians and pediatric nurse practitioners who provide comprehensive pediatric health care for children, including newborns, toddlers, school aged children, adolescents, and young adults. Our child-centered and family-focused approach covers preventative and urgent care, immunizations, and specialist referrals. Our services include an on-site pediatric nutritionist, special needs care coordinator, and social workers. We also have walk-in appointments available at all of our locations for acute sick visits. Please visit chcmass.com where you will find information about our pediatric doctors, nurse practitioners, as well as our hours and services.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.