Fake Medical News: When is Fake Really Fake?

By Ajay K. Singh, MBBS, FRCP, MBA
August 24, 2017

The use of the term “fake news” by President Trump and others raises the issue of whether medical news about disease and/or its treatment can be faked. Robert McNutt, in a provocative article in the Health Care Blog, asks the question: How Can I Tell if Medical News is Fake or Not?

Dr. McNutt recommends asking three questions in evaluating medical news:

  1. Is the item being reported measurable?
  2. What additional human traits or actions may cloud or confound the relationship between the item being studied and the outcome being touted?
  3. How was the study done?

McNutt uses the example of the purported health benefits of coffee. In a blog piece about one year ago, one of my Harvard colleagues, Dr. Sanjiv Chopra, wrote the following about the benefits of coffee drinking:

The facts are indisputable; coffee appears to offer a great variety of benefits, including substantial protection against liver cirrhosis, type 2 diabetes, heart disease, Parkinson’s disease, cognitive decline and dementia, gall stones, tooth decay and a host of common cancers, including prostate, colon, endometrial, and skin cancer. There also is a lower rate of suicide among coffee drinkers.”

Since I am not an expert on this, I will refrain from opining on the merits of coffee drinking, although I am very skeptical that the facts are “indisputable.” In McNutt’s example, he interrogates the benefit of coffee drinking using the three stated questions. More generally, he then states:

Observational comparison studies, rather than randomized studies, are nearly always fake, as observational studies cannot prove an independent contribution of the item being studied to the outcome of interest. In other words, if they happen to be true, we can’t prove it. Hence, they are fake.”

Of course, Dr. McNutt must realize that his statement goes too far. While confounding is an important issue in any association study, it is manifestly wrong to state that results from these studies are fake. Observational studies have limitations, but so do randomized trials.

Observational studies do not prove causation, but they can provide valuable data that, when examined by sophisticated statistical methods, might mimic randomized trials. Take the example of postmenopausal hormone therapy and coronary heart disease. Hernan and colleagues conceptualize observational data as a sequence of non-randomized trials to demonstrate the ability to arrive at conclusions that mimic those from a randomized trial on postmenopausal hormone therapy.

The early epidemiologic science around the association between smoking and lung cancer underscores the powerful impact that observational data can have in reducing the burden of disease and saving lives. Writing in Tobacco Control, Robert Proctor states:

“Scholars started noting the parallel rise in cigarette consumption and lung cancer, and by the 1930s had begun to investigate this relationship using the methods of case-control epidemiology. Franz Hermann Müller at Cologne Hospital in 1939 published the first such study, comparing 86 lung cancer ‘cases’ and a similar number of cancer-free controls. Müller was able to show that people with lung cancer were far more likely than non-cancer controls to have smoked, a fact confirmed by Eberhard Schairer and Eric Schöniger at the University of Jena in an even more ambitious study from 1943. These German results were subsequently verified and amplified by UK and American scholars: in 1950 alone, five separate epidemiological studies were published, including papers by Ernst Wynder and Evarts Graham in the USA and Richard Doll and A Bradford Hill in England. All confirmed this growing suspicion, that smokers of cigarettes were far more likely to contract lung cancer than non-smokers. Further confirmation came shortly thereafter from a series of prospective ‘cohort’ studies, conducted to eliminate the possibility of recall bias. The theory here was that by following two separate and initially healthy groups over time, one smoking and one non-smoking, matched by age, sex, occupation and other relevant traits, you could find out whether smoking was a factor in the genesis of lung disease. The results were unequivocal: Doll and Hill in 1954 concluded that smokers of 35 or more cigarettes per day increased their odds of dying from lung cancer by a factor of 40. Hammond and Horn, working with the American Cancer Society on another large cohort study, concluded that same year that the link had been proven ‘beyond a reasonable doubt’.

And, there are many other examples in the arena of public health and delivery science.

Dr. McNutt’s summary condemnation of the value of epidemiologic research, however well meaning, demonstrates a fundamental lack of understanding of the value of this science. Indeed, epidemiologic studies done well not only provide the foundation to develop hypotheses that can be tested in randomized trials, but have in themselves had tremendous impact on public health.

Ajay Singh, MBBS, FRCP headshotDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

Dr. Singh teaches the online CME course: Developing Essential Skills in Clinical Research

*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.

 

 

Embracing Social Media in Academic Medicine

[The first in a three-part series exploring the use of social media by medical professionals seeking greater academic impact.]

By Kristina Dzara, Ph.D., M.M.Sc.
July 12, 2017

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature.

Sample Altmetrics Score Depiction
Sample Altmetrics score

Academic medicine is harnessing the power of social media for networking, professional development, education, and dissemination of information.1 An ever-growing cadre of individuals and organizations in healthcare have Twitter, Facebook, and Instagram accounts, e-newsletters, podcasts and blogs.1-3 In fact, Twitter is the social media of choice for academic medicine.3,4 Although there is debate about professionalism and social media—as well as a concern that we spend too much time using social media without concrete evidence of educational and academic worth—social media has a strong foothold in our community of practice.3,5-7

The journal article remains the gold standard for dissemination of scholarly work. Yet, the publication process continues to be disrupted by new models of publication—prime examples are open access e-journals such as MedEdPortal and MedEdWorld. These advances are symbiotic with social media, especially Twitter. A number of journals have started including author Twitter handles in their publications and encourage tweets about new articles. Several offer a link providing free access to a limited number of readers, to be used for social media dissemination.

Blogs are multipurpose and can allow for the rapid spread of information.2 Blogs are colloquially written, and authors can write without the time and resources required to construct a full-length research article. Blogging can also help authors explore areas of early professional interest to increase familiarity with the topic. Certainly, the content and quality of blogs vary, but studies are being conducted to offer objective, scientific evidence of quality.8 Moreover, some journals, such as Health Affairs and the British Medical Journal, have blogs and encourage participation.

Although traditional journal-based citation metrics such as the impact factor and h-index  remain the standard, researchers are embracing new alternative metrics including usage (views, downloads, clicks), mentions (blog, media coverage), citations (Scopus, Web of Science, Pubmed), and number of tweets and Facebook likes for their own articles to supplement journal impact factors.4,9,10 These and other alternatives, such as the Altmetric Attention Score, are becoming more commonly used in academic medicine.4,9,10 Altmetrics are social-media based, have both a numeric score and a visual depiction of reach, and can objectively measure the impact of articles, webinars, educational videos, and blogs in real time.4,9,10 Although there is some concern that Altmetric scores can be gamed or manipulated, overall they can be utilized as an additional measure which can be triangulated with traditional metrics to gain a more comprehensive portrait of impact.4,5,9,10

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature. We know that our millennial learners and colleagues have embraced social media, and that the technology which allows us to engage worldwide is expanding by the day. If information truly is power, social media offers us more than we could have ever previously imagined.


Already using Twitter? Be sure to follow HMS Global Academy @AcademyHMS.


References:

  1. Chisolm MS. Social Media in Medicine: The Volume that Twitter Built. Int Rev Psychiatry. 2015; 27(2):83-84.
  2. Khadpe J, Joshi N. How to Utilize Blogs for Residency Education. Journal of Graduate Medical Education. 2016; 8(4):605-606.
  3. Gallo T. Twitter is Trending in Academic Medicine. 2017. https://goo.gl/grJz1w.
  4. Chisholm MS. Altmetrics for Medical Educators. Acad Psychiatry. 2016.
  5. Wise J. Promoting Research on Social Media Has Little Impact. BMJ. 2014; 349:g7016.
  6. Choo EK, Ranney ML, Chan TM, et al. Twitter as a Tool for Communication and Knowledge Exchange in Academic Medicine: A Guide for Skeptics and Novices. Med Teach. 2015; 37(5):411-416.
  7. Kesselheim JC, Batra M, Belmonte F, Boland KA, McGregor RS. New Professionalism Challenge in Medical Training: An Exploration of Social Networking. J Grad Med Educ. 2014; 6(1):100-105.
  8. Chan T, Trueger NS, Roland D, Thoma B. Evidence-based Medicine in the Era of Social Media: Scholarly Engagement Through Participation and Online Interaction. Cjem. 2017:1-6.
  9. Handel MJ. Article-level Metrics-It’s Not Just About Citations. J Exp Biol. 2014; 217(Pt 24):4271-4272.
  10. Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article’s Academic and Societal Impact. Aesthet Surg J. 2014; 34(7):1123-1126.

Kristina Dzara_100x125Kristina Dzara, Ph.D., M.M.Sc. (@KristinaDzara) is a medical educator and researcher with 5+ years of experience in academic medicine. A recent graduate of the Harvard Medical School Master’s in Medical Education program and a Harvard Macy scholar, Kristina’s areas of professional interest include evaluation and assessment, faculty development, and social media in medical education.

*OPINIONS EXPRESSED BY OUR GUEST AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.

If President Trump Cuts NIH Funding, We All Lose

Photo caption: Youngmi Ji, Ph.D., research fellow, conducts research in the NIAMS Cartilage Biology and Orthopaedics Branch. The lab’s research focuses on understanding specific orthopaedic pathologies to better facilitate clinical translation of lab results to medical therapies.

By Ajay K. Singh, MBBS, FRCP, MBA
March 21, 2017

Adrienne Lafrance writing in the Atlantic:

“The work of a scientist is often unglamorous. Behind every headline-making, cork-popping, blockbuster discovery, there are many lifetimes of work. And that work is often mundane. We’re talking drips-of-solution-into-a-Petri-dish mundane, maintaining-a-database mundane. Usually, nothing happens.”

Lafrance continues: “Scientific discovery costs money—quite a lot of it over time—and requires dogged commitment from the people devoted to advancing their fields. Now, the funding uncertainty that has chipped away at the nation’s scientific efforts for more than a decade is poised to get worse.”

The recent budget proposed by the Trump administration, if passed, will cut the NIH budget by nearly 20%. This will most certainly affect both intra- and extramural NIH funding. Since about 80% of NIH’s funding is extramural, the impact on research institutions around the country will be devastating. Still, even more demoralizing is the potential effect on individual researchers. The figure below shows that the success rate for NIH funding is currently less than 20%. If the Trump budget plan prevails, the funding rate will plummet even further. Promising research will not get done.

NIH Funding graph

If this cut was not bad enough, the Trump budget seeks to shut down the NIH’s Fogarty International Center. While the budget of the Fogarty Center is relatively small  (≈69 million dollars), it’s mission is important at a time of emerging global infectious threats: funding training programs in global health and supporting global projects that include research into HIV/AIDS, Ebola, and Zika.

In a statement introducing the budget, Mick Mulvaney the director of the Office of Management and Budget, says “I am proud to introduce the ‘America First’ budget.”

Cutting funding for the NIH is not placing America First.

If American science loses, the country loses. Slashing NIH funding destabilizes science all over the country – institutions will lose precious support from indirect funding, and investigators will not receive direct funding for promising projects, which will likely be terminated in the thousands. Crucial infrastructure will be dismantled. And, young people aiming for a career in bench or clinical science, will have their dreams dashed.

The cut in funding will destabilize science and everything science stands for at a very critical juncture. It will take our eyes off the prize – of curing disease and relieving human suffering. And, it will send a message to the rest of the world, that America is readying itself to give up as the world’s leader in science.

This is not enhancing America’s security. This is not putting “America First.”

[NIH photo credit:
National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health]

Ajay Singh, MBBS, FRCPDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.