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Wednesday Sep 16, 2015

Medicine, Media and the Need for a Physician's Perspective

"I don’t like taking medicine unless I really have to."

That is the most common complaint I hear from my patient Sandra whenever I talk with her about why she should be taking a statin or why it's important to get an annual flu vaccination. Unfortunately, she bristles at discussions about quality of life and mortality.

But a conversation I had with her at this time last year was different. Sandra was eager to learn more about an immunization and medication she thought she really needed. This patient, who had rejected recommended preventive care that could protect her from far more prevalent diseases, was worried about Ebola.

My visit with Sandra was during the peak of the Ebola scare. After the first case was reported in the United States last fall, parents pulled their children from schools(www.wapt.com), politicians called for a ban on travelers(www.dallasnews.com) from West African nations, and health experts had to put down fears that Ebola would become airborne(www.washingtontimes.com).

Although more than 28,000 cases resulting in more than 11,000 deaths have been reported in Guinea, Liberia and Sierra Leone, Ebola has not made much of an impact on public health in the United States. According to the CDC(www.cdc.gov) there were four cases and one death in this country last year.

In stark comparison, heart disease is the No. 1 cause of death(www.cdc.gov) in the United States, claiming more than 600,000 lives each year. But, no, Sandra won't take a statin. And although more than one-third of Americans are obese, many patients don't want to talk about diet and exercise. Diabetes, by the way, kills more than 75,000 Americans per year.

Influenza and pneumonia (nearly 57,000 annual deaths) pose much bigger, immediate threats to U.S. public health than Ebola, yet some Americans were panicked by the incessant news coverage generated by a handful of Ebola cases being treated in the United States. Sandra had heard about an experimental Ebola vaccine on the news, but she didn’t understand its indications or the fact that it was still in trials.

The intersection of medicine and the media is a peculiar place. What the media considers newsworthy -- interesting, impactful, timely or novel -- often has little or nothing to do with scientific validity and reliability.

Mainstream news outlets frequently tout new treatment modalities and new drugs long before we know their true potential. News outlets also love stories (and ratings) related to "looming" health threats, even if the threat isn't particularly great. The urgency of Ebola was easier to convey than the long-term, more significant threat of heart disease. And news about a pill being developed to prevent Alzheimer’s (someday) or a cutting-edge therapy for cancer will always beat out common-sense recommendations about exercising to prevent obesity.

In reality, newer medical treatments and technologies do not necessarily translate to better medical care or health outcomes. In fact, they are often ineffective or come with higher costs. What is new should not trump what is true. Yet the health information disseminated to the public isn't always helpful.

Medical statistics and information can easily be misunderstood by the average person. Ideally, health care news should be dominated by systematic reviews of multiple high-quality randomized controlled trials; however, this is limited by a number of factors, including a paucity of resources to execute these trials. Consequently, media outlets often cover the results of observational studies or presentations from academic meetings, although many of these abstracts will never be published in a peer-reviewed medical journal. It's no surprise such cursory information can be misinterpreted.

The good news is more media outlets are starting to rely on physicians to convey health news. Physicians are consistently rated favorably by the public(www.gallup.com) in surveys regarding honesty and ethical standards. As members of a profession that has earned the public trust, physicians can work with the media to deliver important health messages. Family physicians, in particular, are in a unique position: We have both the most intimate and the most global perspectives when it comes to the health of our patients. We are able to interpret research without distorting its impact and articulate this information to the general public. Finally, given the broad scope of our capabilities, we can comment on topics ranging from antibiotic overuse to sleep hygiene.

Social media is another venue that allows physicians to potentially reach an audience that extends far beyond the exam room. Physicians can recommend evidence-based guidelines, provide commentary on journal articles and dispel misinformation.

Of course, the best way to combat medical misinformation is to have a trusting relationship with your patients. I explained to Sandra what I knew about Ebola and eased her fears about transmission. I also engaged her in a goal-oriented discussion about statins and the influenza vaccine. Although she didn’t change her mind that time, I took comfort in the fact that she always comes back to see me. And she’s no longer worried about Ebola.

Natasha Bhuyan, M.D., is a family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 11:24AM Sep 16, 2015 by Natasha Bhuyan, M.D.

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