Wednesday, June 6, 2012

And The Study Showed What?

Virtually not a day goes by that headlines don't blare the results of some new medical studies.  Just today, two studies caught my attention. One showed that even low-dose aspirin is associated with a significant increased rate of bleeding episodes and another showed that ginseng improved fatigue in cancer patients.

As with all studies, these two demanded closer attention to understand if they were even reliable. They were both pretty good studies but not easily applicable to the layperson. They require further consideration based on personal circumstances.  Today, I want to educate you about any study you may come across.  There are seven questions to ask yourself whenever you see a medical related study. I will present each question with some thoughts.

Was it a study in the laboratory, in animals, or in people?

As far as I am concerned, the only studies that truly matter involve people. That's the only way to know for sure how it will affect most people.

Does the study include enough people like you?

If you are an Asian-American and the study was done in African-Americans, it may not be relevant to you. Likewise, if you are Okinawan and the study was done with Ashkenazi Jews. The most relevant studies for you are the ones done in your ethnic group, age group, gender, economic and social level, health state, and disease state. Notwithstanding, studies done in any humans can be expected to have some relevance to all humans.

Was it a randomized controlled clinical trial involving thousands of people?

These are the gold standard studies and can be best relied upon. They are also very expensive to do, so you don't see them often enough.

Where was the research done?

Better research facilities typically do better research. For example, a study done at a top medical school or large hospital system, may have greater resources to perform complicated experiments or have deeper experience with the subject matter. The best studies involve multiple, quality institutions working together.

If a new treatment was being tested, were there side effects?

Authors report results because of an intended consequence. For example, statins lower cholesterol. But they also increase your risk for diabetes. When results are reported, they often play down side effects but these side effects may be highly problematic for you personally. Therefore, don't just focus on what the main thrust of the study was, but also review what side effects it caused.  Sometimes the cure can be worse than the disease. 

Who paid for the research?

This is a big one. Who controls the results? Is there a conflict of interest? For example, is the Cattle Rancher's Association paying for a study to show the health benefits of meat? If so, do they have final say on withholding negative results? Can they repeat the experiment ten times and report the one time it worked in their favor?  Federal government studies, like the National Institutes of Health, or a large foundation not supported or beholden to industry, are the most reliable sources of funding. With new drugs, it's a different story. Clearly, the study is paid for by the pharmaceutical company and they stand to benefit from positive results. However, the results are reviewed by the FDA and there can be a fair amount of reliance that the process has undergone the necessary scrutiny. Notwithstanding, it is an imperfect process that sometimes goes awry. 

Who is reporting the results?

The source of the news about the study may be the most important fact to consider. News media can often distort study results for a certain newsworthy angle. Never rely solely on one source of news regarding a study. Also, be careful of interpretations of studies. Know who is interpreting it and what dog they have in the fight.

Ultimately, the best approach to understanding the significance of any study is to share it with your doctor and to figure out together if it applies to you. I always say, an educated patient is my favorite kind.

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