Doctors behind the headlines

April 6th, 2007 by Ben Goldacre in bad science, media, references | 10 Comments »

Another BMJ column, forgot to post this when it came out recently, it’s a bit doctory mind…

Ben Goldacre
BMJ 2007;334:613 (24 March)
doi:10.1136/bmj.39160.566285.47
Observations – Media watch

With real evidence, we are all better placed to communicate the truth behind the news

Few things can make a doctor’s heart sink more in clinic than a patient brandishing a newspaper clipping. Alongside the best efforts to empower patients, misleading information conveyed with hyperbole is paradoxically disempowering; and it’s fair to say that the media don’t have an absolutely brilliant track record in faithfully reporting medical news.

But time and thought has gone into this act. The article has been read, and understood, it has been cut out and stored, and then remembered; before the appointment it has been reread, folded up, and brought in to you. This is a piece of paper that deserves to be taken seriously.

Only those who have never met the full range of people in their community will ever claim that the public are stupid: in most doctors’ experience, people are almost universally sharp witted. Where they are misled, someone has worked hard at the job.

The bigger examples, such as MMR, are clear enough. They’re also less dangerous, because with issues of wide concern, doctors know what to read. It’s the unexpected smaller stories that pose the greater risk: the daily dribble of claims that a new drug is being withheld, despite miraculous benefits, or that a drug has dramatic side effects; or the nonsensical lifestyle claims, founded on schoolboy errors of epidemiology. The Daily Mail, in particular, has an ongoing project to divide all the inanimate objects in the world into the ones that either cause, or cure, cancer.

So what to do with the clipping? We all want people to take an interest in their own health, and we all want to work collaboratively with our patients towards an optimum health outcome. As I see it, there are three options. None of them is satisfactory.

One is to skim read the clipping, and unless it reports something that you already know to be true, dismiss it out of hand, explaining—perhaps sternly, and over your half moon spectacles—that the newspapers are full of “lies.” The second option might make you more popular, at least in the short term: you could take the article, and faithfully negotiate a treatment programme, based on the truth of every word. Nobody, after all, likes conflict.

Both these options are unacceptable. But the third option is the toughest of them all: take the article, in good faith, and try to get to the bottom of the real medical evidence behind the story. Few doctors have the resources and patience to seek out even the published academic literature behind every news story; but even if they tried, many media stories—especially the dramatic and misleading ones—are based on unpublished research, conference presentations, briefings by “mavericks,” or press releases, all of which are tricky primary sources to track down, and which are rarely amenable to basic critical appraisal.

One service does solve this problem, with heroic and admirable patience: Hitting the Headlines is a part of the NHS National Electronic Library for Health (www.nelh.nhs.uk). It has funding for only a handful of stories a month, but already it has amassed an impressive collection. Australia and America are developing their own systems.

Hitting the Headlines can often give you the all-important true negative, when it shows that there is no more than an industry press release to go on. But it also finds and summarises the published research behind genuine stories. It offered a valuable quick link to—and précis of—the study behind newspaper articles suggesting that patients taking SSRIs have a twofold increased risk of fractures, for example. Given the media’s history of hyperbole, that’s the kind of news story you might easily have brushed off, unless you had come across the prospective cohort study yourself.

Among the mass of duff stories, the recent flattery of exemestane, similarly and surprisingly, was based on a published randomised controlled trial; although it’s also useful to know that the Telegraph article overstated its benefits by a factor of 10 (Daily Telegraph 2007 Feb 13:13). Its coruscating headline—”Thousands are denied life-saving breast cancer drug”—feels even more censorious in that light (especially since it had already been approved by NICE, and the new study was the first time that it had been shown to reduce the death rate more than tamoxifen alone).

But beyond mere firefighting, this service has a more important role. As doctors, or nurses, or anyone working in health, we don’t provide information for just our patients; we are all situated in communities, and in our lives outside of work we are in a unique position to communicate. When people have been scared or misled—about MMR, or chemotherapy, or anything—they will look to us, and a leaflet, a poster, or a website, is of little help. Everybody misconstrues things in ways that are unique to them, and people can be disabused only on a one to one level. With real evidence, we are all better placed to communicate the truth behind the news.

Ben Goldacre, doctor and writer, London

ben@badscience.net

NELH has moved, here is the best link for the Hitting the Headlines archive:

www.library.nhs.uk/rss/newsAndRssArchive.aspx?storyCategory=0

I should add that – excellent though it is – a service like this is only valuable as a “go-to” resource if it covers all the questions you are likely to be asked about in a clinical setting; sadly at the moment it only does a couple of stories a week, so it’s interesting, and readable, but it’s still short of being a resource that could be routinely used to address a patient query.


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10 Responses



  1. Dave A said,

    April 8, 2007 at 9:40 am

    Don’t get me wrong, I think NeLH Behind the Headlines is fab – I use it an awful lot myself, but…….

    There’s another organisation that helps advise people about the reality behind what they read in the papers, or TV or radio for that matter. I only know because I work for them (hides behind desk to avoid sudden barrage of flak) – NHS Direct.

    I know we mainly get bad press in the media, and even then the nurses get all the attention, but health info staff like myself answer people’s weird, wonderful & sometimes mundane questions about health, including putting them straight about things like miracle cures peddled by the Daily Mail, drugs being banned or discontinued by the NHS, health scares like the MMR debate, Alder Hey & organ retention policies and pretty much anything else you can think of.

    Now, technically, we’re only available to patients, not health professionals – although anecdotally, it seems an awful lot of GP’s etc. send patients to us for more information following diagnosis, or before making decisions about treatment.

    Unfortunately, we’re a bit short of health info staff at the moment, so waiting times for the health info side of our service are longer than we’d like, unless its something urgent. But we’re an option for anyone that wants to call us.

  2. Formermedicalperson said,

    April 8, 2007 at 11:22 am

    Relax, JohnD. The Bulletin article is indeed entertaining and informative but I’ll bet you an EEG monitor to a chloroform-soaked handfkerchief that it’s a spoof, though possibly based on a real patient. The first give-away was the reference to an alarm for ‘inattentive’ anaesthetists. I suppose such alarms exist (I did my bit of anaesthetics in the low-tech sixties) but jocular references to our little human weknesses are not on now.

    One technique with the victims of bad journalism (apart from encouraging them to sue the journalist concerned) is to invite them to test their assumtions. I recall a patient who was convinced she had become allergic to various foods, including sugar. She agreed to swallow a naso-gastric tube and we spent a pleasant and instructive day monitoring her reaction to the alleged poisons injected blind and randomly down the tube. She eventually conceded that she was mistaken and – I hope – lived happily ever after.

  3. evidencebasedeating said,

    April 8, 2007 at 3:53 pm

    we’ve taken to issuing a direct contact number in the hospital promotion material for GPs. They can ring we dietitians directly (on an office number not issued to patients) and if lucky, we’ll be in the office to deal with the query directly. If not, they leave a contact number and we ring them back within a session. Its worked quite well for the 6 or 7 queries we’ve had so far. GPs seem to appreciate it…. subjectively, of course.

  4. coracle said,

    April 9, 2007 at 9:25 pm

    Dave A, Phones or OES? I’m an OES guy!

  5. Dr Aust said,

    April 10, 2007 at 9:03 pm

    Enjoyed the Anaesthetics Bulletin spoof case, JohnD.
    (Definitely a made-up case as they do say at the end that
    “Mr Lionel Smith, Professor Audrey Smith, Sonya and Dr Marcus Le Grand do not relate, in part or in whole, to any known person, living or dead.”)

    The authors do a nice job of exemplifying the difficulties for Drs of balancing accuracy and honesty with need to reassure, and the way that the people on both sides of the Dr-patient dialogue are influential in what gets conveyed / understood. I suspect they might have written this in part as a “discussion piece” for use in teaching.

  6. coracle said,

    April 10, 2007 at 9:50 pm

    ooooh, nice redesign!

    Wasn’t sure where to put that comment!

  7. Dave A said,

    April 14, 2007 at 10:30 am

    Hi Coracle,
    I’m a researcher at EMID – so very much phones. Contact me on ravenshead42@gmail.com if you want to carry on the gossip – I can’t imagine Ben would be too chuffed for us to use this forum as an NHSD chat room!

  8. Ben Goldacre said,

    April 14, 2007 at 1:01 pm

    i think it’s great that people research symptoms themselves, you might find that the reasons gps find it difficult is not because they object to that in principle – it is to be welcomed – but because people are presented with a lot of factually inaccurate and emotionally laden material in the media and on the internet which is very misleading. i’m not sure that saying you just don’t like doctors very much is very helpful, i’m sorry you were teaching them if that’s the case.

  9. Dr Aust said,

    April 16, 2007 at 8:41 pm

    I caught sight of one of my former medical students in “Hospital Doctor” the other day – he was giving the NHS the bodyswerve and heading off to rural Queensland, crafty sod.

    Medical students can be a bit annoying (like any bunch of 18 yr olds) but they are virtually all bright, motivated, engaged, interested etc etc. A lot more fun to teach than most students, in my experience.

    One of the other things that occasionally meeting ex-students n years on teaches you is that their 18 yr old self is not a terribly reliable indicator of what they will be like at 23, let alone 28. Same as for anyone, really. So it behoves us crusty middle-aged academics to cut them some slack.

    Like I say, provided students are basically interested, the rest can be acquired/learnt/ taught. The thing that I do find depressing about a significant number of the students in some bioscience degree courses I teach is that they seem to lack basic curiosity about what they are supposed to be studying.

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