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Front Page » August 30, 2012 » Focus » What about those studies....
Published 695 days ago

What about those studies....


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By RICHARD SHAW
Sun Advocate publisher

Discerning the difference between the truth, half-truths and what we don't know for Sure

Each day the general populace of the United States is bombarded with the results of medical and health studies concerning some aspect of their well being. It seems one day the studies tell us one thing, and on another they tell us the opposite.

It is a problem for everyone because it sets us up for thinking we know something that may not be the truth.

Now maybe the word truth is a little strong here. In science truths can change as new discoveries are made. Beliefs people had about medical care even a century ago are completely different now. How we view the world of biology changes every year.

And sometimes the most reputable sources for a scientific study seems to be in juxtaposition to another study by just as reputable a source.

While I have observed this problem for years, it really came to a head last week when I visited my doctor. I was in for my biannual checkup to see how my heart and cholesterol are doing. For the past few years I have also asked my physician to have a PSA (prostate-specific antigen) done. The men in my family have had a history of prostrate problems, so I want to keep tabs on what is going on.

But the test that I have been taking for years to monitor my health is now very much in question. Some recent studies have shown the test to not be that reliable. In fact some feel that the test could actually be harmful by pointing men toward treatments that could be far worse for one's health than living with the cancer that could occur there.

Today medical experts seem just as willing to let you have your cake and eat it too when it comes to PSA screening. It's because PSA screening, once thought to be the where-all, show-all test for finding out if a man has prostate cancer, is no longer a sure thing. In fact, apparently, it never was.

Most urologists, based on what their association (the American Association of Urologists) says, still think it is a valuable tool. But the evidence from a number of studies shows something different.

I know this is a rather personal thing to discuss, but then good story tellers use their personal experiences to tell good stories. So talking about this may be embarrassing for some, but for me it is just part of my life experience. Making it up close, and personal makes it real.

As we looked at my numbers they had gone up over the past three years. Based on what I have read that could be because I am getting older, my prostrate is just sending out more or I could have cancer. To me it was that simplistic. But nothing is ever as simple as you think it is.

My doctor asked me if I had seen the recent studies and he admitted in some ways general physicians are just as confused because their sources, much more technical and specific are saying much of the same thing we, the general public, are hearing.

"We really don't have a simple way to detect prostate cancer," he said. "Biopsy or autopsy are the only sure way to find out." Then he smiled and we both laughed nervous laughs.

Neither sounded good to me. My numbers aren't that high so he and I are going to watch what is going on more closely, now every six months.

But this raised the question in my mind again about studies and scientific trials. What can we believe and why should we believe it.

I have come to the point when I see studies come out in the media that I am neither alarmed by nor am I complacent about. I have found that before I even start to wonder about what a studies results mean, I need to know some details about that particular study.

First we need to get the nomenclature correct. People interchange the words medical trials, studies, and other words. They all mean different things and also have various other words attached to them such as research, clinical, cohort, panel, etc.

What we want to do here is take a general view. You see something in the media and you should ask yourself "How does this affect me?"

If you think it is important then you should dig for answers. You could ask your doctor, but that takes time during an exam or checkup and to be honest, you may not ask the right questions if you already don't have some good information on which to base your questions.

So in the news story, you'll often find a review of who was studied. Make sure those participants fit your circumstances. Their gender, overall health, age and other physical characteristics are every bit as pertinent as what is being studied. Ask yourself if you match the group.

Once this is done, and you find that you would fit into the group if you were in the study yourself, credibility of the study becomes the question. That is the next step to take in evaluation.

This is a very important point. Not all news outlets are as credible as others. A television report will never tell you as much as a good magazine or newspaper report. Unless it is in a news magazine show, they just don't have the time to look at in depth. You need to make that determination, because getting to the original source of the report takes time, and you don't want to invest your time in something that was skimmed off the top of a wire report or a reporter's whim.

While not everyone thinks about it, we all inherently know that not all media outlets are as credible as others. The same is true of medical and research journals. Most strive to be scientific, but some are just not as good as others.

Examples of good ones (and you will hear these often recited in news stories on how credible news outlets are) the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM). This doesn't mean these are the only ones that are valuable, but they are at the top of the list.

Once you do this, you can move on to look at the information available. The study report itself or at least a summary is often available on the internet. If you can get the information on the original you can often get access through a local library, even if they don't carry that particular journal or source.

Once this is done, then one needs to look at the credibility and objectivity of those who did the study or trial. In these days of full of conspiracy theories it is often helpful to have a good dose of common sense with a big pinch of mistrust.

Money, money, money. One must watch the money trail when looking at any kind of research. Scientific study itself, when conducted properly, is as pure as anything man has ever devised. But it can be tainted by green stuff. In this case objectives to find what is wanted can be set before the study is begun.

While not useless, studies that are funded by companies, clinics or others who could profit from the results should be suspect, particularly if the results are dramatic and show little downside.

Look for results from independent researchers or labs. Government entities and public universities usually are very reliable. However, do remember in this day and age even public universities are profiting from patents and things they have developed in many fields. And if there is private money involved, good researchers will reveal that to those studying their results.

Objectivity is what you are after. Biased opinions are not good for your health.

Next look at how the study was done. There are three important aspects that anyone looking for a good study should review.

•How large was the group of people studied. If it was 10 people studied over a year, not a very good study regardless of their circumstances. If it was thousands looked and evaluated over 10 years, those are good numbers.

•That brings up the second important point. The length of the study. Depending on what is being studied the time that it took to do the study should be long enough to give some good, reliable information. Some studies would not need to be lengthy. Others, particularly concerning chronic diseases (such as cancer or heart disease) need time to blossom.

•Is the study the confirmation of another study or is it a ground breaker? Confirmation of another reliable study would be something that could hold a lot of water. It if was a first time study on something, regardless of length or group, there may still be some questions to be answered. In the past there have been studies of groups of people or therapies that despite all the other things being equal, show different results. Replication of results by another researcher is important.

Also don't county on replication. There have been many studies on large groups of people over long periods of time that show different things. The PSA tests referred to earlier in this article is a good example of what can happen.

All this is good news and good information. However, don't miss out on talking to your doctor too. You are an individual and your doctor knows about you. Even with all the research you may have done, and information you may have gathered only having a conversation with your physician should lead to lifestyle changes, particularly when it comes to drug regimens.

Studies are good to follow, but remember every individual is different, and that can be the key to good health.

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