I don't think that I'm alone amongst doctors in feeling a shiver run down my spine when a patient produces a crumpled newspaper clipping from their pocket. To me this is an immediate indicator that the consultation is about to get more tricky. It means that either an unusual treatment or investigation is about to be requested or a standard treatment is about to be challenged.
Despite my personal dread of this moment it is quite right that patients question us and quite right that they challenge us. If I was in the patient's position I'm sure I would be researching my options and I think it likely that I would be attending my GP with newspaper clippings and internet print outs. My issue is really with the inconsistency and irresponsibility with which health stories are generally covered in the media and the subsequent poor quality of the articles that people bring to their doctors. The problem is that far more regard is given to the emotive impact a story will have than the scientific merit behind it.
Statins are a perennial hot topic and are a good example of what I mean. Here is a selection of headlines from the Daily Mail over the last two years; 'Wonder drugs and lifestyle changes cut toll of strokes by 40%', 'Why Everyone over 50 needs to be taking statins', 'popular statin 'may raise the danger of diabetes'', 'Four million patients on statins don't need them'. If I was a Daily Mail reader taking statins, and there are plenty of them, I would probably be feeling a little confused.
Essentially this is what happens when you give equal weight and importance to every emerging study or expert opinion. The standard advice that your doctor will give you is that which is included in the NICE guidelines; anyone with a greater than 10% risk of having a heart attack or a stroke within the next ten years should take a statin. This advice is based on the cumulative evidence from hundreds of trials carried out over decades. Not all of these trials will necessarily agree with the final outcome of the guideline. Individual trials vary according to their size, their duration and how well they are constructed and carried out. Even a well constructed trial can produce spurious results due to random variation and thus its findings may be completely at odds with the guidelines. That is why it is so important to aggregate all the results before coming to a conclusion.
I don't want to get bogged down in the debate over statins because, in this instance, they are just a convenient example, I could have chosen the debate over taking aspirin, or over diet and exercise, or over screening for different cancers. Even for people trained in statistics and the evaluation of scientific studies there is rarely enough detail within an article to enable them to make a judgement about the quality of the evidence presented. In any case, it shouldn't be expected of the public to trawl through all the evidence, surely that responsibility lies with the journalists writing the stories. However, whether the story is based on the opinion of a single maverick expert, or on the outcome of a painstaking analysis of hundreds of trials, the font size of the banner headline is usually the same.
People are influenced by what the papers say and the decisions they make based on the information they are given are important. Swinging wildly for or against any particular treatment or intervention in order to sell more papers is quite damaging and quite reckless. Patients need to be informed and they need to be empowered to make decisions about their own treatment and their own health, but they need to be given good information and balanced information, not merely the information that will spark the strongest response.