Understanding Medical Research

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
00:02 --> 00:04comes from AstraZeneca, dedicated
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00:10 --> 00:13More information at astrazeneca-us.com.
00:13 --> 00:15Welcome to Yale Cancer Answers with
00:15 --> 00:18your host doctor Anees Chagpar.
00:18 --> 00:19Yale Cancer Answers features the
00:19 --> 00:22latest information on cancer care by
00:22 --> 00:23welcoming oncologists and specialists
00:23 --> 00:26who are on the forefront of the
00:26 --> 00:28battle to fight cancer. This week,
00:28 --> 00:29it's a conversation about understanding
00:29 --> 00:32medical research with Doctor Perry Wilson.
00:32 --> 00:34Doctor Wilson is the course director of
00:34 --> 00:36Interpretation of the medical literature
00:36 --> 00:38at the Yale School of Medicine,
00:38 --> 00:40where Doctor Chagpar is a
00:40 --> 00:41professor of surgical oncology.
00:42 --> 00:45Perry, maybe we can start off by you
00:45 --> 00:48telling us a little bit about yourself
00:48 --> 00:50and what it is that you do.
00:50 --> 00:52I'm a physician,
00:52 --> 00:54and I specialize in internal
00:54 --> 00:55medicine and nephrology,
00:55 --> 00:56which is kidney diseases.
00:56 --> 00:59But most of my time is spent
00:59 --> 01:00doing clinical research.
01:00 --> 01:02So my lab does clinical trials.
01:02 --> 01:05We use a lot of what people
01:05 --> 01:07might call big data approaches.
01:07 --> 01:09Getting data and analysis into
01:09 --> 01:10the electronic health record,
01:10 --> 01:14but I think one of my real passions has been
01:14 --> 01:15trying to explain medical
01:15 --> 01:17research to everyone.
01:17 --> 01:19It's something that I love to do.
01:19 --> 01:21I love medical research.
01:21 --> 01:23I think it's
01:23 --> 01:24transformed humanity over the
01:24 --> 01:27past century and I want to share
01:27 --> 01:28that enthusiasm with people.
01:28 --> 01:30And so I've been, on my
01:30 --> 01:33off hours, writing columns
01:33 --> 01:35about new medical studies trying
01:35 --> 01:38to get people as excited as I am
01:38 --> 01:40about the medical research process.
01:41 --> 01:43And that's such a great
01:43 --> 01:45thing to kick off with because,
01:45 --> 01:47especially this year,
01:47 --> 01:50there's been a lot of
01:50 --> 01:50misinformation,
01:50 --> 01:52a lot of ambiguity,
01:52 --> 01:55a lot of trepidation on the part of
01:55 --> 01:57the general public about medical research,
01:57 --> 02:00so maybe you can start off by talking
02:00 --> 02:04to us a little bit about how that
02:04 --> 02:05misinformation gets propagated
02:05 --> 02:08and what we can do about it.
02:08 --> 02:10Sure, Covid has really turned
02:10 --> 02:13up the level of medical misinformation.
02:13 --> 02:15It's always been out there.
02:15 --> 02:18It's even before the Internet there were
02:18 --> 02:20people coming through
02:20 --> 02:22with their patent medicines and
02:22 --> 02:25tonics and trying to force
02:25 --> 02:27something in a vial on an unsuspecting
02:27 --> 02:30population that will always be there.
02:30 --> 02:32There will always be people trying to
02:32 --> 02:35make a buck from fake information,
02:35 --> 02:37but as the Internet exploded and access
02:37 --> 02:40to information became more available
02:40 --> 02:42as social media exploded and the sharing
02:42 --> 02:43of information became
02:43 --> 02:45exponentially easier and then now with covid,
02:45 --> 02:48it was really this perfect storm of medical
02:48 --> 02:50information that we were
02:50 --> 02:51all hit with.
02:51 --> 02:53It was the first time I can remember
02:53 --> 02:54where literally everyone was
02:54 --> 02:56searching for the same thing on line
02:56 --> 02:58when it comes to medical studies.
02:58 --> 02:59So before covid,
02:59 --> 03:01you had people that were
03:01 --> 03:03looking for the latest diet that
03:03 --> 03:05would help them lose a few pounds.
03:05 --> 03:06And then
03:06 --> 03:08of course you had people who might
03:08 --> 03:10have had a new diagnosis like a
03:10 --> 03:12new cancer diagnosis for example,
03:12 --> 03:13and they're searching that.
03:13 --> 03:14And there's misinformation in
03:14 --> 03:15all those spaces,
03:15 --> 03:18but all of a sudden 2020 comes and every
03:18 --> 03:20single person is searching for any
03:20 --> 03:22information they can find about covid.
03:22 --> 03:24And in that environment you are
03:24 --> 03:27going to get a lot of misinformation
03:27 --> 03:29out there. And that's exactly what happened.
03:29 --> 03:31But you know, Perry,
03:31 --> 03:33it's really interesting because for
03:33 --> 03:35many people they think the Internet
03:35 --> 03:37was really the boon of information
03:37 --> 03:39sharing and a great way for people
03:39 --> 03:41to get high quality information and
03:41 --> 03:43disseminate it across a large population.
03:43 --> 03:46So I think one of the key issues is how do
03:46 --> 03:49people distinguish from good information
03:49 --> 03:51factual information versus misinformation.
03:51 --> 03:53Both of them seem to be
03:53 --> 03:55apparent on the Internet,
03:55 --> 03:58but sometimes it's hard to tell them apart.
03:58 --> 03:59Yeah, absolutely.
03:59 --> 04:00And this is
04:00 --> 04:02one of the double edged
04:02 --> 04:04swords of our information age.
04:04 --> 04:07So one thing I always remind
04:07 --> 04:10people is that there is such a thing
04:10 --> 04:13as a bad medical study. There is
04:13 --> 04:15good data and bad data.
04:15 --> 04:18There are good studies and bad studies,
04:18 --> 04:20and when access to that information
04:20 --> 04:22is so readily available so unfiltered
04:22 --> 04:24or sometimes just filtered through
04:24 --> 04:27the sort of biases of whoever's on
04:27 --> 04:29your social media feed, it
04:29 --> 04:31has become really easy to
04:31 --> 04:32find information that confirms
04:32 --> 04:34your previously held beliefs,
04:34 --> 04:37and if there is one thing I sort
04:37 --> 04:39of caution people against when they
04:39 --> 04:42go looking for information is,
04:42 --> 04:43do it with an open mind.
04:43 --> 04:46Don't try to find things that confirm
04:46 --> 04:48what you already believe to be true,
04:48 --> 04:49because maybe that worked back in
04:49 --> 04:51the day when you went into the
04:51 --> 04:53encyclopedia and everything was
04:53 --> 04:55sort of nicely laid out and had
04:55 --> 04:57been vetted by an editorial board
04:57 --> 04:58and things like that.
04:58 --> 05:01But the problem with social media is
05:01 --> 05:03similar beliefs cluster together. The
05:03 --> 05:05social media algorithms on Twitter
05:05 --> 05:07and Facebook and Instagram and all of
05:07 --> 05:10the social media companies work the same way.
05:10 --> 05:12They are designed to maximize engagement,
05:12 --> 05:14which is eyeballs on the screen,
05:14 --> 05:15clicks, likes,
05:15 --> 05:16retweets etc.
05:16 --> 05:17In that environment,
05:17 --> 05:19things that are nuanced that are
05:19 --> 05:22subtle that don't sort of confirm
05:22 --> 05:24what people want to be true don't
05:24 --> 05:26get a lot of engagement,
05:26 --> 05:28and those things that are more
05:28 --> 05:30exciting and dramatic,
05:30 --> 05:32we've got a cure for covid in
05:32 --> 05:34our medicine chest right now.
05:34 --> 05:37It gets a ton of engagement and one
05:37 --> 05:39of the things that we used to be
05:39 --> 05:41able to do as humans was trust
05:41 --> 05:44what we perceive as the majority opinion
05:44 --> 05:46when a lot of people share an opinion,
05:46 --> 05:49we would go around in our social lives
05:49 --> 05:51and say, oh that's probably true.
05:51 --> 05:53Most people sort of think this,
05:53 --> 05:55and I've heard this from a number
05:55 --> 05:57of people in social media,
05:57 --> 05:59now it's possible to go down a rabbit
05:59 --> 06:01hole of misinformation where every
06:01 --> 06:04voice you see every link you click is
06:04 --> 06:05reinforcing the false information.
06:05 --> 06:08And what you then get is this
06:08 --> 06:09erroneous perception that there's
06:09 --> 06:12this wealth of data out there
06:12 --> 06:13that's supporting your belief,
06:13 --> 06:16when in fact it's all this
06:16 --> 06:18self perpetuating engagement,
06:18 --> 06:21and you've got to be able to
06:21 --> 06:22get out of there.
06:22 --> 06:25The easiest way is right off the bat,
06:25 --> 06:27be honest with yourself.
06:27 --> 06:30Ask yourself what you want to be true,
06:30 --> 06:33and recognize that if you find data
06:33 --> 06:36that supports what you want to be true,
06:36 --> 06:38you even have to be extra
06:38 --> 06:40skeptical about that type of
06:40 --> 06:43data.
06:43 --> 06:46I just finished reading Adam Grant's book,
06:46 --> 06:48Think Again, which for if anybody is
06:48 --> 06:52a big fan of Adam Grant or enjoys
06:52 --> 06:54reading organizational psychologists,
06:54 --> 06:55I highly recommend it.
06:55 --> 06:58But it's exactly to your point about
06:58 --> 07:01rethinking your biases.
07:01 --> 07:03But you know Perry,
07:03 --> 07:04it's really difficult, right?
07:04 --> 07:07Because if you are looking for something,
07:07 --> 07:09something appears to be true,
07:09 --> 07:12it fits with your gut,
07:12 --> 07:14you're more likely to
07:14 --> 07:15think that that's right,
07:15 --> 07:17so are there any objective ways
07:17 --> 07:18for example,
07:18 --> 07:21if patients or the people
07:21 --> 07:24who are listening to our show today,
07:24 --> 07:25they may have just been
07:25 --> 07:26diagnosed with cancer,
07:26 --> 07:29or they may be looking for other
07:29 --> 07:31medical information and it's
07:31 --> 07:33so easy to go to the Internet.
07:33 --> 07:35Information at our fingertips.
07:35 --> 07:38Are there any ways that you can
07:38 --> 07:39really distinguish, intangible ways,
07:39 --> 07:43Igood information versus garbage?
07:45 --> 07:47There certainly are and it
07:47 --> 07:49does take a
07:49 --> 07:52little bit of work and
07:52 --> 07:54it's the hardest thing in the
07:54 --> 07:56world to disregard information
07:56 --> 07:58that feels right to you.
07:58 --> 08:01That speaks to you in that way because
08:01 --> 08:04that is a very human thing that we all do.
08:04 --> 08:07But I can
08:07 --> 08:09give you a couple of tips.
08:09 --> 08:11So number one,
08:11 --> 08:12is that biologic plausibility
08:12 --> 08:14is only the start of
08:14 --> 08:16medical research, not the end,
08:16 --> 08:18and what I mean by biologic
08:18 --> 08:19plausibility is when something is
08:19 --> 08:21stated that makes sense biologically.
08:23 --> 08:25To give you an example,
08:25 --> 08:28if I told you that if
08:28 --> 08:31I wrapped my necktie around my head, it would
08:31 --> 08:34help the arthritis in my knees,
08:34 --> 08:35that's not biologically plausible.
08:35 --> 08:37There's no real reason to
08:37 --> 08:39think that that should work,
08:39 --> 08:41so we don't pay much attention to that.
08:41 --> 08:44But there are lots of examples
08:44 --> 08:45of things that seem
08:45 --> 08:47biologically plausible, for example,
08:47 --> 08:49we know that as you age,
08:49 --> 08:51there's more oxidative stress in your
08:51 --> 08:54body and that oxidative stress might
08:54 --> 08:56lead to some of the symptoms of aging
08:56 --> 08:58like arthritis and stuff.
08:58 --> 09:00We also have a chemical called
09:00 --> 09:03vitamin E which is an antioxidant,
09:03 --> 09:05and well reported as an antioxidant.
09:05 --> 09:06It's biologically plausible,
09:06 --> 09:08then that vitamin E would be
09:08 --> 09:10good at helping against aging.
09:10 --> 09:12Maybe might prevent heart
09:12 --> 09:14attacks and things like that.
09:14 --> 09:16Now a lot of people stop there.
09:16 --> 09:18They say, oh that's biologically plausible.
09:18 --> 09:20Oxidation is bad,
09:20 --> 09:21antioxidant is good, vitamin E
09:21 --> 09:23is cheap, it's at my drugstore.
09:23 --> 09:24There's very limited side effects.
09:24 --> 09:25You know this is great.
09:25 --> 09:27It helps to confirm a belief that
09:27 --> 09:30many of us want to be true that we
09:30 --> 09:32can take charge of our lives without
09:32 --> 09:34paying pharmaceutical companies and
09:34 --> 09:35without having side effects.
09:35 --> 09:38So there's a lot going for vitamin E,
09:38 --> 09:39but let me tell you what
09:39 --> 09:41happened with Vitamin E.
09:41 --> 09:42They did a randomized trial of vitamin
09:42 --> 09:45E and people who are at risk of heart
09:45 --> 09:47disease and actually found not only
09:47 --> 09:48was there no difference in
09:48 --> 09:50the rate of heart attacks,
09:50 --> 09:51the people taking vitamin
09:51 --> 09:53E compared to placebo,
09:53 --> 09:54but the people taking vitamin E
09:54 --> 09:56had more heart failure.
09:56 --> 09:58Statistically more heart failure than
09:58 --> 10:00those taking placebo and again and again
10:00 --> 10:01in medicine
10:01 --> 10:02we see biologic plausibility,
10:02 --> 10:04and actual efficacy getting untied.
10:04 --> 10:06So what I tell people is that
10:06 --> 10:08biologically plausible thing that you
10:08 --> 10:10read about, like oh this is interesting,
10:10 --> 10:12it works in cell culture,
10:12 --> 10:14the mice seem to respond to this
10:14 --> 10:17and it all sort of makes sense
10:17 --> 10:19with how we understand the world,
10:19 --> 10:21that's great, but that's only the beginning.
10:21 --> 10:23You really want to see that randomized trial,
10:23 --> 10:24not because
10:24 --> 10:26I'm the kind of guy who
10:27 --> 10:29I'm just following the rules and
10:29 --> 10:31everything needs a randomized trial,
10:31 --> 10:32it's because we've been burned
10:32 --> 10:33so many times before,
10:33 --> 10:36and I think that's what people don't realize.
10:36 --> 10:37It's not like jumping
10:37 --> 10:38through an arbitrary hoop.
10:38 --> 10:40We've been wrong a lot when it
10:40 --> 10:41comes to biologic plausibility,
10:41 --> 10:43so I really do tell people
10:43 --> 10:44we want a randomized trial.
10:44 --> 10:47And if you want to be really sure you're not
10:47 --> 10:49swallowing some patent medicine,
10:49 --> 10:52you want to see a replication of that study.
10:52 --> 10:54You want to see more than one study
10:54 --> 10:56showing the same thing and ideally
10:56 --> 10:58studies done by different people.
10:58 --> 11:00You know different groups across the country
11:00 --> 11:02or in different countries in the world.
11:02 --> 11:04That's how you build an evidence base.
11:04 --> 11:05And of course,
11:05 --> 11:07that's what doctors jobs are, right?
11:07 --> 11:09So one of the easiest things you
11:09 --> 11:11can do if you have a trusted
11:11 --> 11:12healthcare provider in your life,
11:12 --> 11:16it is our job to be doing this and
11:16 --> 11:17ask them. Talk to them.
11:17 --> 11:20We're often excited to talk to you
11:20 --> 11:22about what's real and what's not,
11:22 --> 11:23and again,
11:23 --> 11:25just hear it with an
11:25 --> 11:27open mind.
11:27 --> 11:30In terms of the information of looking
11:30 --> 11:32for randomized control trials,
11:32 --> 11:33especially that are all
11:33 --> 11:35going in the same direction,
11:35 --> 11:38because we've all seen randomized
11:38 --> 11:40control trials that then are disproven
11:40 --> 11:43by other randomized control trials.
11:43 --> 11:44But you know, Perry,
11:44 --> 11:46it's so difficult for the general
11:46 --> 11:48public to actually access good
11:48 --> 11:49randomized control trials.
11:49 --> 11:52They're not really going to pubMed and
11:52 --> 11:54searching the medical literature and
11:54 --> 11:57looking at things with a critical eye.
11:57 --> 12:00And in terms of talking to their doctor,
12:00 --> 12:03that's certainly a great way to start.
12:03 --> 12:05But there are also quote doctors
12:05 --> 12:07who you can find on line who
12:07 --> 12:08are spewing misinformation.
12:08 --> 12:12So how do you kind of get around that?
12:13 --> 12:16You've got to be careful,
12:16 --> 12:18really anything that comes from social media,
12:18 --> 12:20whether it's YouTube or Twitter.
12:20 --> 12:22And hey, I'm on Twitter,
12:22 --> 12:24but you do have to be careful
12:24 --> 12:26because of the echo chamber effect.
12:26 --> 12:29Someone can sort of wear the mantle of
12:29 --> 12:31authority on social media based on sort
12:31 --> 12:34of the number of followers and stuff
12:34 --> 12:36that they have and that might make what
12:36 --> 12:38they're saying seem more believable,
12:38 --> 12:40when in fact it's not.
12:40 --> 12:43And so you know, social media is fun.
12:43 --> 12:44And interesting and a great
12:44 --> 12:46place to share pictures.
12:46 --> 12:47It's not where I recommend
12:47 --> 12:49people do their research
12:49 --> 12:50for medical questions.
12:50 --> 12:51There are some absolutely wonderful
12:51 --> 12:53medical reporters out there.
12:53 --> 12:54So if you don't want to read the
12:56 --> 12:58primary literature and
12:58 --> 13:01pick up your copy of the New
13:01 --> 13:02England Journal Medicine,
13:02 --> 13:03there's some great science and
13:03 --> 13:05medicine reporters out there.
13:05 --> 13:07You want to look for reporters
13:07 --> 13:08that that's their beat.
13:08 --> 13:10Because of the slow death
13:10 --> 13:13of the newspaper industry in America
13:13 --> 13:15you get a lot of times the
13:15 --> 13:17science and health, and
13:17 --> 13:18even sports reporters are all
13:18 --> 13:20the same person in some outlets.
13:20 --> 13:22So you want to look for someone whose
13:22 --> 13:24job is to write about health and medicine.
13:24 --> 13:26They are often very well trained
13:26 --> 13:27and are good nuanced
13:27 --> 13:29and if you're
13:29 --> 13:30reading about a new drug,
13:30 --> 13:32a new treatment, you want to read
13:32 --> 13:34from a couple of different people.
13:38 --> 13:39There's some great writing,
13:39 --> 13:40for example, in the Atlantic,
13:40 --> 13:42the science section of the New York
13:42 --> 13:44Times has always been very strong.
13:44 --> 13:47Do they get it right 100% of the time?
13:47 --> 13:47No,
13:47 --> 13:50but that's why you look for other articles.
13:50 --> 13:51That being said,
13:51 --> 13:53it is not impossible for laypeople to
13:53 --> 13:56go into the real medical literature and
13:56 --> 13:58in fact I have a course
13:58 --> 14:00online here at Yale,
14:00 --> 14:01which is free called
14:01 --> 14:02Understanding Medical Research:
14:02 --> 14:04Your Facebook friend is wrong.
14:04 --> 14:06It's on the Coursera platform you
14:06 --> 14:08can search for it and basically
14:08 --> 14:10it is an online course of 15
14:10 --> 14:13minute lectures that you can watch
14:13 --> 14:14over your lunch break
14:14 --> 14:16where I teach you how to find a
14:16 --> 14:18actual medical article,
14:18 --> 14:21go to pub Med and how to find it,
14:21 --> 14:22how to read it,
14:22 --> 14:24and how to interpret the results.
14:24 --> 14:25So if any of the listeners
14:25 --> 14:28really want to get deep into this,
14:28 --> 14:30really want to take that next step
14:30 --> 14:31to understanding medical research.
14:31 --> 14:32it's accessible you don't need
14:32 --> 14:33a degree in chemistry.
14:33 --> 14:35You don't need to remember calculus,
14:35 --> 14:37you just need some logical thinking skills,
14:37 --> 14:40and intuition so a little pitch for that course. It's free.
14:40 --> 14:42And it's so
14:42 --> 14:43important for people really to
14:43 --> 14:46do your own research and be
14:46 --> 14:48vigilant about it so that you're not
14:48 --> 14:50taking other people's word for it.
14:50 --> 14:52You're going to the source and
14:52 --> 14:53knowing how to interpret that.
14:53 --> 14:55We're going to take a short
14:55 --> 14:57break for a medical minute,
14:57 --> 14:58but please stay tuned to learn
14:58 --> 15:00more about understanding medical
15:00 --> 15:01research with my guest Doctor
15:01 --> 15:02Perry Wilson.
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15:51 --> 15:55You're listening to Connecticut Public Radio.
15:56 --> 15:58Welcome back to Yale Cancer Answers.
15:58 --> 16:00This is doctor Anees Chagpar
16:00 --> 16:03and I'm joined tonight by my guest
16:03 --> 16:05doctor Perry Wilson and we're talking about
16:05 --> 16:07understanding medical research.
16:07 --> 16:10Perry, before the break
16:10 --> 16:13we were talking about how much misinformation
16:13 --> 16:16really is out there on the Internet,
16:16 --> 16:18whether it's about covid or whether
16:18 --> 16:20it's about cancer or whether
16:20 --> 16:22it's about any topic really,
16:22 --> 16:24whether it's medical or not.
16:24 --> 16:26There is just so much misinformation
16:26 --> 16:28that's propagated out there.
16:28 --> 16:31So let's talk a little bit about some
16:31 --> 16:35of the ways that we can mitigate that.
16:35 --> 16:38You know, aside from being vigilant
16:38 --> 16:39consumers of medical research,
16:39 --> 16:42what else can be done to really
16:42 --> 16:45kind of tamp down on all of the
16:45 --> 16:48misinformation that's out there?
16:50 --> 16:52This is a really hard problem
16:52 --> 16:56that it's clear a lot of the social
16:56 --> 16:58media companies are struggling with.
16:58 --> 17:01As you know you see Facebook and Twitter
17:01 --> 17:03for example, imposing essentially
17:03 --> 17:05fact checking on some tweets,
17:05 --> 17:07particularly surrounding hot button issues.
17:07 --> 17:09For example, vaccination
17:09 --> 17:11where they're literally
17:11 --> 17:14blocking tweets, blocking posts that are
17:14 --> 17:16construed by some of their
17:16 --> 17:19moderators to be potentially anti VAX,
17:19 --> 17:20for example this does
17:20 --> 17:21strike some people as
17:21 --> 17:23heavy handed.
17:23 --> 17:24There are certainly concerns about
17:24 --> 17:26is this going to have a chilling
17:26 --> 17:28effect on speech?
17:28 --> 17:30On the other side, people say that
17:30 --> 17:32these are private companies that
17:32 --> 17:35can do whatever they want
17:35 --> 17:36within the confines of their own platform.
17:37 --> 17:39It strikes me though,
17:39 --> 17:41that it's a bit of whack-a-mole
17:41 --> 17:43and that these efforts
17:43 --> 17:44are reactive rather than proactive.
17:44 --> 17:48What can we do to be more proactive?
17:48 --> 17:50One of the things I've
17:50 --> 17:52seen that's a little clever
17:52 --> 17:54is Twitter has been generating a little
17:54 --> 17:56pop up when you retweet an article
17:56 --> 17:58if it notes that you haven't
17:58 --> 18:00actually read the article.
18:04 --> 18:06That's a whole other topic, right?
18:06 --> 18:08Like how it knows
18:08 --> 18:10whether you've opened the other
18:10 --> 18:12you didn't look at the article,
18:12 --> 18:14but I think what it's doing is
18:14 --> 18:16the article will have a tweet with a link
18:20 --> 18:22and it knows if you've clicked that
18:22 --> 18:24link 'cause it's within Twitter.
18:24 --> 18:27If you haven't and you click retweet,
18:27 --> 18:29it's been saying, hey,
18:29 --> 18:32do you want to maybe read this
18:32 --> 18:33article before you retweet it?
18:34 --> 18:36That is an interesting strategy because
18:36 --> 18:39it takes the emotion slightly down.
18:39 --> 18:41There's a tendency for people
18:41 --> 18:43to share and retweet things that
18:43 --> 18:44are emotionally activating.
18:44 --> 18:46Whether they make you angry
18:46 --> 18:48or make you happy.
18:48 --> 18:50Whether it's a mama cat
18:50 --> 18:51cuddling with baby kittens,
18:51 --> 18:54or whether it's someone saying
18:54 --> 18:56something terrible and caught on tape.
18:56 --> 18:58Both of those strong reactions
18:58 --> 19:00elicit a lot of engagement and
19:00 --> 19:02trying to remove that a little bit,
19:02 --> 19:04giving people a little extra time to say, wait
19:04 --> 19:07do you really want to put this out there?
19:07 --> 19:09Do you want to share this?
19:09 --> 19:11Might help a little bit.
19:13 --> 19:15My hope lies a lot with
19:15 --> 19:16the younger generations.
19:16 --> 19:16Honestly,
19:16 --> 19:18who are growing up in this
19:18 --> 19:19environment and in my opinion,
19:19 --> 19:22are actually quite a bit more savvy.
19:22 --> 19:24I agree with you.
19:24 --> 19:26I think that even our patients who come in,
19:26 --> 19:30many times the older
19:30 --> 19:32generation sometimes will have heard
19:32 --> 19:35things like sugar feeds cancer or
19:35 --> 19:39it can stop all cancer and some of our
19:39 --> 19:41younger patients or patients families,
19:41 --> 19:44it's remarkable they will have gone
19:44 --> 19:47to the literature and be quizzing
19:47 --> 19:50you on the latest study that was
19:50 --> 19:53published in the New England Journal
19:53 --> 19:56or what just came out at ASCO.
19:56 --> 19:59So it really does behoove us to
19:59 --> 20:03be wary of what's out there now.
20:03 --> 20:06Are there certain places where
20:06 --> 20:09people should go to kind of look
20:09 --> 20:11at the literature if they don't go
20:11 --> 20:14to pubMed directly and again,
20:14 --> 20:17your course will tell them how they can
20:17 --> 20:19actually go to the primary literature,
20:19 --> 20:21but are there certain websites
20:21 --> 20:24that you think are
20:24 --> 20:26generally pretty reliable versus
20:26 --> 20:29kind of taking the latest weird
20:29 --> 20:31theory that's out there?
20:31 --> 20:33As I mentioned,
20:33 --> 20:35some of the large news organizations
20:35 --> 20:37that have dedicated science
20:37 --> 20:39writers are a great tool,
20:39 --> 20:42but if you really want dedicated sites,
20:42 --> 20:44there's a couple of good sites,
20:44 --> 20:46Medscape.com, andfFull disclosure,
20:46 --> 20:49I have a weekly column on medscape.com
20:49 --> 20:52but Medscape.com is a medical news website.
20:52 --> 20:55It's an offshoot of WebMD which
20:55 --> 20:57actually does a very nice job.
20:57 --> 20:59They have dedicated reporters covering
20:59 --> 21:01the latest medical studies,
21:01 --> 21:02which is quite good, stat.com,
21:02 --> 21:05which is another medical news focused
21:05 --> 21:07website is quite good and
21:07 --> 21:10as you're exploring there
21:10 --> 21:12are other sites as well.
21:12 --> 21:15And when you're exploring a site,
21:15 --> 21:18I think one of the real hints as
21:18 --> 21:20you're reading through as a reader to
21:20 --> 21:23know about the quality here is
21:23 --> 21:26look for emotion in the writing and if
21:26 --> 21:30there is too much be worried.
21:30 --> 21:32Real medical reading is often not
21:32 --> 21:33the most exciting thing.
21:33 --> 21:35This is not Hemingway.
21:35 --> 21:37This is reporting on often nuanced
21:37 --> 21:40medical studies and drugs that have
21:40 --> 21:43some benefit but some risks.
21:43 --> 21:46And if your reporting is expressive of that,
21:46 --> 21:49then it's good reporting, latest
21:49 --> 21:51breakthrough, Miracle Cure, New Silver Bullet.
21:51 --> 21:54The end of blank diseases in sight.
21:54 --> 21:56These highly emotional headlines are
21:56 --> 21:59a good red flag that you're not on a
21:59 --> 22:02site that's taking this very seriously.
22:02 --> 22:05I mean it goes back to the old
22:05 --> 22:08adage of if it sounds too good to be true,
22:08 --> 22:11it likely is, and so I'll add to your list.
22:11 --> 22:15I think that there are some
22:15 --> 22:16good professional organizations
22:16 --> 22:19that people can turn to.
22:19 --> 22:23ASCO has some websites that are dedicated
22:23 --> 22:24to patient information, cancer.net,
22:24 --> 22:28for example, the American Cancer Society.
22:28 --> 22:31Cancer.org has some great information
22:31 --> 22:35and there are a variety of associations
22:35 --> 22:39for whatever cancer my ail you,
22:39 --> 22:43whether it's breast cancer or leukemia
22:43 --> 22:47or colon and rectal cancer.
22:47 --> 22:48Go to the
22:48 --> 22:50organizations that are really
22:50 --> 22:52doing the research into this,
22:52 --> 22:54because very often they will
22:54 --> 22:57publish that data and a good hint
22:57 --> 22:59is to look for the footnotes,
22:59 --> 23:02because very often they will lead you
23:02 --> 23:05to the studies and to the literature
23:05 --> 23:07that they're citing in making the
23:07 --> 23:10claim that they they have so and so.
23:10 --> 23:13We have some of that data for
23:13 --> 23:16cancer, and I think that
23:16 --> 23:18because cancer has been around
23:18 --> 23:20for a long time,
23:20 --> 23:23a lot of the misinformation now I think it's
23:23 --> 23:26starting to die down. There still are some
23:26 --> 23:29old wives tales out there like
23:29 --> 23:31sugar feeds cancer or tumeric
23:31 --> 23:32will cure all cancers.
23:32 --> 23:34PS for our listeners,
23:34 --> 23:38neither of those two statements are true.
23:38 --> 23:39But for novel diseases,
23:39 --> 23:42things like Covid, it's a lot harder.
23:42 --> 23:44I think for people,
23:44 --> 23:46especially initially to weed
23:46 --> 23:48out some of that misinformation.
23:48 --> 23:50So what are some of the misinformation
23:50 --> 23:53hot buttons that you found
23:53 --> 23:55out there that are propagated
23:55 --> 23:57that you'd like to dispel?
23:57 --> 23:58Oh my
23:58 --> 24:00gosh, Covid has really given
24:00 --> 24:03those of us who like to correct
24:03 --> 24:05the record in Medicine a lot to do.
24:05 --> 24:08It's been a full time job in Covid
24:08 --> 24:11and I think in part it gets back to
24:11 --> 24:14that idea of motivated reasoning.
24:14 --> 24:15We all hate this pandemic.
24:15 --> 24:18Every single one of us wants
24:18 --> 24:20nothing more than for it to be over,
24:20 --> 24:23and if there were some simple cure
24:23 --> 24:25that was cheap and effective and
24:25 --> 24:27worked 100% of the time oh my gosh,
24:27 --> 24:28it would be amazing.
24:28 --> 24:31We all want that and so you
24:31 --> 24:33had this proliferation of data
24:33 --> 24:34coming out early in Covid
24:34 --> 24:37and I think that's sort of prototypical.
24:37 --> 24:39One was the study surrounding
24:39 --> 24:39Hydroxychloroquine which
24:39 --> 24:41is an anti-malarial drug
24:41 --> 24:42that's also used for lupus,
24:42 --> 24:44which is an autoimmune disease.
24:44 --> 24:46An old drug that with a lot of
24:46 --> 24:48experience with and the truth is
24:48 --> 24:50relatively safe as some drugs go,
24:50 --> 24:52although there can be risks of cardiac
24:52 --> 24:54arrhythmias in people who take it,
24:54 --> 24:55but it's not
24:55 --> 24:58the most toxic drug in the world,
24:58 --> 25:00and some early studies,
25:00 --> 25:0110-20 people suggested that maybe
25:01 --> 25:03they get a little better faster now.
25:03 --> 25:05Skip ahead and I'll tell you that large
25:05 --> 25:07clinical trials have been done
25:07 --> 25:09now I think we're at 9 or 10 large
25:09 --> 25:11clinical trials of hydroxychloroquine.
25:11 --> 25:13All of them negative.
25:14 --> 25:16That's fairly well confirmed,
25:16 --> 25:18but initially there was this
25:18 --> 25:19huge enthusiasm surrounding it.
25:19 --> 25:22And to the point where you know
25:22 --> 25:23people were stockpiling the
25:23 --> 25:25stuff people were taking it,
25:25 --> 25:29and I think it fed what we wanted to believe,
25:29 --> 25:32which was that there was a solution.
25:32 --> 25:35And unfortunately the truth
25:35 --> 25:37it's rare that things work that well.
25:37 --> 25:38It's just unlikely that no
25:38 --> 25:40matter what comes down the pipe,
25:40 --> 25:42the cure is going to be something
25:42 --> 25:44in your medicine cabinet that
25:44 --> 25:46just doesn't happen very often.
25:46 --> 25:48The exception being maybe
25:48 --> 25:49like scurvy and vitamin C,
25:49 --> 25:52and even that took a randomized trial
25:52 --> 25:54to figure out back on the high seas.
25:54 --> 25:57So that was certainly a big one.
25:58 --> 25:59What's more concerning,
25:59 --> 26:02I think even then the medication stuff
26:02 --> 26:04is the vaccination issues in covid,
26:04 --> 26:05so these are new vaccines.
26:05 --> 26:08A lot of vaccine hesitancy at baseline
26:08 --> 26:10kind of brought up to a degree by
26:10 --> 26:12the fact that there are some new
26:12 --> 26:14technologies in these vaccines,
26:14 --> 26:15like MRNA technology,
26:15 --> 26:17which I will point out,
26:17 --> 26:19is new in the sense that we've never
26:19 --> 26:21done it broadscale treatment with it,
26:21 --> 26:22but is not new.
26:22 --> 26:24It's actually been in clinical
26:24 --> 26:26use for more than a decade now,
26:26 --> 26:28but still new stuff for people,
26:28 --> 26:30and we're seeing a lot of misinformation
26:30 --> 26:32about what is in the vaccine,
26:32 --> 26:34how the trials were done.
26:34 --> 26:36I was reading on social media that
26:36 --> 26:39people were saying that the trials
26:39 --> 26:41were inoculating their volunteers with
26:41 --> 26:43Covid when they walked through the door,
26:43 --> 26:45which is a trial design
26:45 --> 26:46that is quite controversial
26:46 --> 26:49and is not what happened in these
26:49 --> 26:51large clinical trials.
26:51 --> 26:54And the problem of course with this
26:54 --> 26:56misinformation is that this really does hurt
26:56 --> 26:58our ability to end this pandemic, because
26:58 --> 27:01the vaccines are the best tools we have.
27:03 --> 27:05There's lots of misinformation
27:05 --> 27:07around masks as well.
27:07 --> 27:09You still see posts saying that
27:09 --> 27:11masks reduce your blood oxygen content
27:11 --> 27:12or increase the carbon dioxide content.
27:12 --> 27:13You're a surgeon.
27:13 --> 27:15My wife is a surgeon.
27:15 --> 27:17She is wearing a mask for
27:17 --> 27:188 hours a day, every day,
27:18 --> 27:21and her oxygen level is perfectly fine.
27:21 --> 27:22She doesn't get lung disease or
27:22 --> 27:24infections that's still out there,
27:24 --> 27:25and it really does
27:25 --> 27:26hurt our ability
27:26 --> 27:28to end the pandemic faster.
27:28 --> 27:29We're kind of shooting ourselves
27:29 --> 27:31in the foot with this stuff.
27:32 --> 27:33The other big
27:33 --> 27:34piece of misinformation, I
27:34 --> 27:36was watching the news the other
27:36 --> 27:38day and they were saying that
27:38 --> 27:4233% of Americans that
27:42 --> 27:45were surveyed in this one poll
27:45 --> 27:49felt that Covid was not real.
27:49 --> 27:51And you kind of shake your head and
27:51 --> 27:53you say we're now over half a million
27:53 --> 27:55people dead in this country of a
27:55 --> 27:57disease that you think is not real.
28:01 --> 28:02And for people, including myself,
28:02 --> 28:04and I'm sure you as well have cared for
28:04 --> 28:06these patients in the hospital that
28:06 --> 28:08it's particularly painful to hear that.
28:08 --> 28:10And of course, some of us have
28:10 --> 28:12lost loved ones to the disease.
28:12 --> 28:14But you know, again
28:14 --> 28:16I'm trying to do my best to
28:16 --> 28:17understand where this comes from,
28:17 --> 28:19and I do think it comes
28:19 --> 28:21from a place of desire.
28:21 --> 28:23Why do people believe that it's not real?
28:24 --> 28:26Because they don't want it to be real,
28:26 --> 28:28and if we just ask people,
28:28 --> 28:29be aware of your motivations
28:29 --> 28:32and be skeptical of data that only
28:32 --> 28:34confirms what you want to be true,
28:34 --> 28:36people will be in good shape.
28:37 --> 28:39Doctor Perry Wilson is the course
28:39 --> 28:41director of Interpretation of the medical
28:41 --> 28:43literature at the Yale School of Medicine.
28:43 --> 28:45If you have questions,
28:45 --> 28:46the address is canceranswers@yale.edu
28:46 --> 28:48and past editions of the program
28:48 --> 28:50are available in audio and written
28:50 --> 28:52form at yalecancercenter.org.
28:52 --> 28:54We hope you'll join us next week to
28:54 --> 28:57learn more about the fight against
28:57 --> 29:00cancer here on Connecticut Public Radio.

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April 25, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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