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How do you know which health research claims to trust?

Science and health claims

Will statins prevent heart attacks or are they harmful? Should we avoid eating fat or carbs? Will binge-watching TV kill us?

We face so many confusing health messages in the media, and trying to make decisions and understand how good the evidence behind these claims can be daunting. When it comes to research studies, there’s a real range in quality and it’s hard to sort the good from the bad.

Confusing health messages

The media play a vital role in communicating science – without it, we wouldn’t hear about most health research. But sometimes media reports misrepresent what the research shows.

Although there is plenty of good science journalism, the conflict between scientists’ slow, (hopefully) careful research and critical thinking and journalists’ need for fast exciting stories can result in some confusing health messages for consumers. While the media provide a useful service, what if we didn’t need to rely solely on the media to weigh up what a research study can and can’t tell us?

Which? readers don’t need to be persuaded of the value of considering evidence for their own decision making. Yet critical appraisal – the process of assessing the quality and usefulness of a research study – is (unfortunately) not common sense.

Research papers can be dense and inaccessible to newcomers and without a guide to navigate through the paper, reading research can be frustrating. It’s something that only some researchers and medics have been trained to do, and even those with training may find the skills difficult to maintain. So what if we could find out for ourselves what research papers mean?

Understanding the science

Some scientific journals are trying to do their bit by offering Plain English summaries of research, and thanks to the Open Access movement in academic publishing, more and more research papers are freely available online.

But the more research that becomes available, the clearer it becomes that simply accessing research is only half the battle; the tricky part is to understand it.

That’s why the new Understanding Health Research tool has been designed. This new tool aims to help more people wade through the research. It’s been created is for those with no science background and professional evidence users alike, so they can weigh up the quality of research papers for themselves and reach their own conclusions.

Now we don’t need to take anybody else’s word for it. It may not be a replacement for the advice of healthcare providers, or organisations who review quality of research for us like NHS Behind the headlines, but it is one more tool to help people think critically and engage with health research.

This is a guest contribution from Chris Patterson, Research Assistant MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow. All views expressed here are Chris’s own and not necessarily those shared by Which?.

Comments
Profile photo of wavechange
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Thanks for this Convo, Chris. I suggest that anyone who is interested in looking at scientific literature should start by looking at scientific reviews in peer reviewed journals rather than individual research papers. The authors of a good review should have looked at the most important papers, summarising the state of knowledge and where uncertainties remain. The authors should have explored the evidence for different theories or hypotheses. Not all reviews are published in open access journals, unfortunately.

One of my main concerns is misuse of science. One way in which this is done is to choose only those research papers that support an argument, conveniently disregarding others. This bias may be difficult for the non-specialist to spot.

Profile photo of malcolm r
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I agree with wavechange’s reservations. Any scientific papers I believe need a real understanding of the topic for their significance, impartiality, validity to be properly understood and critically assessed . We used at least two experts to vet submitted papers and even from eminent authors the work often raised questions. There is pressure to get work published particularly from academic institutions; not every topic and theory researched will provide the hoped for advance.

Self diagnosis in medical matters is, I think, particularly worrying; you see this when people trawl the internet and worry themselves about what they find. Used sensibly it can give appropriate questions to ask your doctor or consultant, but you sometimes see it arouses mild irritation.

Important medical issues should be properly vetted by a panel of real experts. The “press” does not have this capability; they prefer to hype something up for impact, not to objectively inform the public. I’d be very wary of lay people’s interpretations of specialist work.

Profile photo of John Ward
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Pardon my pedantry, but in the further interests of plain English, could we have the headline title of this Conversation replaced by “How do you know which health research claims to trust?” ? This will remove any ambiguity of meaning. Thank you.

Profile photo of Ian
Member

Niggling, isn’t it?

Profile photo of Patrick Taylor
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I agree. I am sure that Which? will wish to correct it speedily.

Profile photo of Lauren Deitz
Member

Morning John, that change has been made. Thanks

Profile photo of John Ward
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Thank you. I am at peace now. I can get on with my life . . . and I might even go out when it stops raining.

Profile photo of Ian
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Depends what’s in the rain…

Profile photo of Patrick Taylor
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For the University world
theconversation.com/from-medical-treatment-to-diet-and-lifestyle-choice-how-to-spot-unreliable-health-research-63572
Noting the longer line length that article is nearly 100% bigger.

However the important lesson for me is that Which? does not provide a white-list of useful resource sites so trying to recall the name of this site in 5 months time will not be solved by a quick look in an index.
Bookmarking on this computer does not help much if one uses several or are using a friends/library computer.

Profile photo of Lauren Deitz
Member

That’s an interesting suggestion @dieseltaylor, I’ll share it with the wider team. My tip is to use a Google account to store these things, you can then log into the account and it pulls up all of your saved bookmarks

Profile photo of Patrick Taylor
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It is a thought but it does suggest that you should allow Google to have information that they may subsequently use for targeted adverts. In any event on my primary computer I have 27 categories for sorted book marks and roughly 200 in the unsorted bookmarks box currently.
These include a category for Frauds on the Elderly, WW2 research with 47 links …….

Whilst Google may be a help for individuals I would prefer to say that go to Which? and they have a list of respectable sites where you can go for information on x. Kudos to Which? and a potential new member.

The problem for most people is a plethora of sites without any way of establishing a quality/reliability factor. This problem is unlikely to be resolved other than by a white-list approach.

If Which? does not see this as an opportunity to occupy an important niche then I do wonder if some other organisation of repute will take the role. You might consider how helpful it is to recommend Wikipedia – and then include the possible drawbacks to its articles.

Similarly Revoo is not perfect but commonly used. Or even Google and its propensities on how it organises information. And how to maximise searches. Sense about Science would deserve a mention. TheConversations for deeper thoughts ….

Profile photo of Ian
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Critical thinking is a faculty that usually requires teaching. I would argue that anyone with a Science, Engineering or Technology background at University will certainly possess it, and just about anyone with a higher degree will, in some part. But we’re re-treading old ground, here. The problem is not the research per se, although a worryingly large amount is both commissioned and subsequently embargoed by the big pharmaceutical companies, it is the near Scientific illiteracy of the average journalist, whose ability to distinguish between probability and magic seems utterly unattainable.

Research consensus and Peer reviewing are the two touchstones for validation of any research, yet all too often these same illiterate hacks grab a sentence they can barely comprehend and publish it as a confirmed fact, and often as a headline. Comics like the DFM usually just make it up, anyway, so what’s the answer? Is misinformation more dangerous than no information?

This is tricky, because the nature of high level research is poorly understood, often, sadly, by the researchers themselves, so even Plain English summaries are likely to be confusing or – worse – inaccurate. People want simple, straightforward guidelines, not reams of carefully qualified statistical results. If I want a new ‘Fridge, I don’t look for the papers the designers worked on to create the perfect chiller: I go to Which? and find the best buy and trust their research and testing has been thorough.

In health terms that’s what everyone wants, but there’s a problem: never has the truism ‘One size doesn’t fit all’ been more applicable than in the case of human health. Simply put, we’re complicated and different. Our sexual reproductive methodology ensures that, and although doting aunts might like to believe little Freddie has his mother’s eyes, they’re just as likely to be those of a Denisovan, or Neanderthal. albeit a few generations back (although, to be fair, in the case of the Neanderthal there’s a growing body of evidence that suggests their descendants still live on, a fact which attendance at any Premier league game would seem to confirm).

Neither can we trust the Government, itself riddled Scientific illiterates and if not, ‘yes’ men, who don’t wish to displease their political masters, and whose guidelines regarding fruit and veg intake were seemingly plucked out of thin air. So what’s the answer?

We managed to stop a lot of folk dying from cancers through the smoking ban. I never thought it would happen, but happen it did, but on that occasion everyone in the scientific world was speaking with a single voice. So if we can achieve it with a known carcinogen could we achieve it with foods? Perhaps – once we understand exactly how different foods affect us, but we’re a very long way from that. When the makers of some of the most important drugs don’t fully understand their mechanisms, only their consequences, and while research generally continues to be beholden to vested interests as much as it currently is, I seriously doubt any amount of plain English will save the day.

Dollop of Bovine extract saturated butterfat in your coffee, sir?

Profile photo of Ian
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If ever there was an example of badly (actually fraudulently) done research it’s the paper by Andrew Wakefield on the effects of the MMR vaccination. He was exposed, eventually, by the efforts of a doggedly determined journalist – Brian Deare – but not before incalculable damage had been done. In that case even the big TV companies were effectively complicit in spreading the lies, but how would they know his work was fraudulent?

Although he was struck off and banned from medicine in the UK he’s now in the ever-gullible USA spreading his disinformation to a much less discerning market.

Profile photo of Beryl
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Any drug, whether medically prescribed or not can cause adverse side effects. You only have to read the leaflet that accompanies the pack to witness the number of side effects that can present, some quite serious, which to me indicates the uniqueness of each and everyone of us.

Science does not always get it right however, despite intensive trials using control groups. For example, at this time of the year I tend to suffer the effects of hay fever, so about 4 years ago I took a well known proprietary over the counter anti-histamine which caused me to have an irregular heartbeat. I was rushed to A&E who informed me it was very unlikely the antihistamine could be responsible as did my GP during the follow up treatment. However, recent online research on this particular drug now includes ‘”irregular heartbeat” as one of its side effects. This info was definitely not contained in the original leaflet as I always check before taking any new medication. My heart, I am pleased to say, has worked normally since and I have regular health checks to make sure it continues to do so.

I agree there is a lot of conflicting information online as research is often in its very early stages and inconclusive. It’s best to stay with NHS online or NICE for anyone concerned about ones general health, unless of course you are interested and well informed enough as some of the Convo regulars seem to be, its best left to science who presumably are suitably qualified to carry out their research, although some of it controversial, but that is an entirely different topic so will leave it there.

Profile photo of Patrick Taylor
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Perhaps we need to add that drugs tend to be tried out on men as they do not have such extreme monthly cycles so there may be effect variables. And that in fact ethnicity can also be a factor in drug efficacy.
e.g. ” Race has been reported to contribute to variability in dosing
requirements for warfarin in anticoagulation, with African
Americans requiring higher doses and Asians requiring lower
doses than whites.”

One thing I do find disconcerting is that physical size/weight seem not to affect dosing levels which for something like a headache pill is diffused through the body. Not that I have investigated further as generally I take very few pills per year.

Profile photo of Sophie Gilbert
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Beryl, I was listening to Inside Health on Radio 4 yesterday and the Yellow Card app was mentioned again in the programme. We are all of us, ie not necessarily with medical and related backgrounds, strongly encouraged to download it and flag up any side effects that any drugs may give us. I think they mentioned that you can do this through the web as well. I would do this now with the antihistamine you mention. I would listen to the podcast to find out more and also see what it says in the website.

In the same programme, to illustrate the difficulty we are all facing when wondering what evidence to trust, an oncologist was interviewed and he said that it is possible sometimes to get as many different opinions on how to treat a cancer case as you ask oncologists. Like Ian says, one size doesn’t fit all, and professionals won’t always agree what size will fit you.

My GP has recommended Patient.co.uk as a website to find info from. I also ask her what she thinks. I also wonder what questions I would ask if I had to make a difficult decision about treatment. One that comes to mind, not scientific, is, how would you advise your mother/sister/wife/daughter to proceed?

Profile photo of wavechange
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The Yellow Card scheme for reporting problems with drugs is here: https://yellowcard.mhra.gov.uk

For years, Yellow Cards have been included in the British National Formulary, a concise compendium of guidance on the use of drugs used by GPs and hospital doctors. Initially the Yellow Card was for professional use but the general public can report concerns about suspected problems.

About 20 years ago I reported a problem with a drug and the advice in BNF was updated appropriately, though I suspect that there may have been other similar reports. It’s vital that patients do provide feedback and let their GP know about suspected problems.

Profile photo of malcolm r
Member

Sophie, regarding your last point I would suggest that having decided, and exhausted, the questions to ask of their doctor or consultant they could discuss the options with family but, in the end, should be left to make their own decision.

A good example might be a transplant, where there are significant risks for either having, or not having, one. Only the patient really knows the effect their condition is having on their quality of life and what risk they are prepared to take. The family will have emotive issues to deal with which can cloud their judgement.

Profile photo of Beryl
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Thanks Sophie and Wavechange, that’s very useful info to know. Antihistamine as I understand it is a particular type of hormone and it does now state “irregular heartbeat” as a side effect, although rare. I am convinced that, although I made it abundantly clear at the time I take thyroxine, another hormone which controls ones metabolism, there was an adverse interaction with the two, although this was categorically denied at the time.

I can only assume my particular case was reported by both the hospital and my GP to the Yellow Card which hopefully contributed to the addition of this side effect along with others. I would be interested to know whether my assumptions are correct.

I am very reluctant to risk taking another antihistamine and I am suffering at the moment. I will certainly log onto the yellow card and report my case to them. It’s amazing what Which?Convo can deliver 🙂

Profile photo of Beryl
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PS Lauren I had to log in again and my usual avatar has again disappeared. I am using the new password which is very strong and long and impossible to remember so have to look it up each time I log in. The problem is intermittent if that helps to solve it.

Profile photo of wavechange
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Irregular heartbeat is a possible side effect of antihistamines. I had this many years ago when taking the non-sedating antihistamine loratadine (Clarityn).

I had not realised that the BNF is now available online, and now no registration is needed to view it: http://www.evidence.nhs.uk/formulary/bnf/current/

I’m glad to hear that you have reported a problem, Beryl. With the large number of prescription and over the counter drugs available, there is a lot of potential for interactions.

Profile photo of Patrick Taylor
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Curiously for Which? Conversations I use a very weak password as it has no value other than I>D>. Often I log in the once without using the password and that covers all posts to Conversations for the day with my username.

The Members Forum is a valued one and that password is much more robust.

Member
Beryl says:
11 August 2016

Bingo Wavechange! It was the same antihistamine I took containing loratadine (Clarityn). Thanks for the link. I would advise anyone taking thyroxine to check with their GP before taking this drug.

Profile photo of Lauren Deitz
Member

Thanks for the update Beryl, I’ll take a look

Profile photo of Sophie Gilbert
Member

Thanks, malcolm, you’re right. I wasn’t clear in what I said. I meant that, faced with several options explained to me by a doctor regarding treatment for myself and really not knowing what on earth I should go for, I would ask the doctor what s/he would advise her relative to do. Not necessarily expecting a straight forward answer of course.

Profile photo of Ian
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Thanks for that Link, Wave; I wasn’t aware it was now open to all. Very useful.

Member

If the research is published by someone that is trying to sell you something then be wary.

Profile photo of duncan lucas
Member

According to the Medical Daily ( quoting the Journal of the National Cancer Institute ) young people have a lot in common with those born in 1890,s in relation to colon/rectal cancer . It has doubled in two decades – studies of half a Million people between 1974 and 2013 /born around 1990 show double for colon cancer and quadruple for rectal cancer . Stop eating chemical food /fast food .