TV Doctors, The Internet, and Medical Information: How Evidence Based Medicine Can Help Me Make Medical Decisions.

by Steven D. Blatt, MD

Dr. Oz Investigates: Arsenic in Apple Juice

Bachmann (Presidential Candidate Michele Bachmann) claims HPV vaccine might cause ‘mental retardation

It seems that every day there is a new medical claim in the news. Dr. Mehmet Oz shared with his television audience his concerns about apple juice concentrate, 60% of which comes from China. Dr. Oz found that apple juice in this country contains higher levels of the poison arsenic than is considered safe. The US Food and Drug Administration called this claim “irresponsible”.

Congresswoman Bachmann claimed that HPV vaccine is dangerous and could lead to mental retardation. The American Academy of Pediatrics characterized these statements as false. For the record, I am a member of the AAP and completely agree with my pediatric colleagues. More than 35 million doses of HPV vaccine have been administered. There is no data that has ever suggested it causes developmental delays or mental retardation.

How does a parent or a patient determine who is correct? How do we figure out who to believe? Where should we get our medical information? Dr. Oz seems like a nice guy and a pretty smart doctor. In fact, I’ve occasionally seen a few minutes of his show and he seems like a smart doctor to me. His advice seems to help a lot of people. Shouldn’t I believe him?

I don’t know how TV personalities, even TV personalities who are doctors, decide how to interpret medical information. How about a Congresswoman or a Senator? They must have access to good medical information. Their medical information should be right also. Or should I believe my nurse and pharmacist and doctor? They’re medical people. They should have the best information, shouldn’t they?

People approach medical decision making differently. There are cultural influences, family traditions, economic considerations, and a set of beliefs that we all have about ourselves and the world we live in. Many of us look to others for information to help us make these decisions. How should we manage the information that we encounter from TV shows, the internet, our family and friends, our doctors….this website?

“Evidence Based Medicine” or “EBM” is the concept that we should base medical practice and medical decision making on the available medical evidence. Oftentimes, the evidence is incomplete or contradictory. All too often, the “evidence” seems to change. For example, 20 years ago, the evidence suggested that children with possible ear infections should be aggressively treated with antibiotics. Since then, we have learned that most ear infections resolve on their own and overuse of antibiotics leads to resistant germs, such as MRSA. Now the evidence suggests we use antibiotics only for those more severe ear infections. So, if the evidence is going to change or is incomplete, what should a parent or a patient do? Should one even bother reading about new medical information if there’s a good chance it will be incorrect or eventually turn out to be wrong?

After reading the literature, you, the patient or parent, either believes exercise is a healthy endeavor, or you don’t. After hearing someone speak on TV, you believe that lowering the bad cholesterol is good for your health or don’t. After gathering information, you believe you should get that vaccine or you should take that vitamin or supplement or this medicine will help you or this treatment is safe, or you don’t. In other words, you learn what you can and then you have to decide what to do with the information. One way or the other, we all have to make decisions.

Here are my recommendations for handling the medical information that is available to us:

  • Recognize that there are a lot of decisions to be made; not making a decision on medical treatment is a decision.
  • For many things in medicine, we never know the answer to “What is the best thing to do?” Recognize that even with incomplete information we may still have to make a decision.
  • Read about medical topics from sources that are reliable. Reliable websites include:
    • Medical Organizations: American Academy of Pediatrics, American Academy Family Practitioners, American Medical Association, American Congress of Obstetricians and Gynecologists. These websites often end with “.org”
    • CDC, FDA, Department of Health. These websites often end with “.gov”
    • Medical schools such as Upstate Medical University. These websites often end with “.edu”
    • The Upstate Family Resource Center (FRC) at the Golisano Children’s Hospital is staffed by medical librarians who can assist you in your search of health information for children and adults. You can reach the FRC by phone 315.464.4410 or by email frc@upstate.edu. This service is free and confidential.
  • Use your common sense and instinct. If something doesn’t seem right, keep looking for more information. Does it make sense to you that apple juice has arsenic or that a vaccine makes teenagers mentally retarded? If not, look for more information.
  • Look for hidden agendas. Is something being said or written for shock value, to raise ratings, win a vote, or to push an agenda? If so, then there’s a good chance the information isn’t valid.
  • Discuss your thoughts with people in your life who you trust and who have given you good advice in the past.
  • Discuss what you read or what you hear with a trusted health care professional. Bring the article in question to your doctor and discuss it in detail.

The internet is a great source of information, but interpret it wisely.

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