Who can I trust?

It is necessary to read the recommendations of medical communities

Polina Shilo, Post-science

Due to the pandemic caused by the coronavirus, there has been a surge in interest in medical information. Many articles, posts and newsletters have appeared in the public field not only about COVID-19, but also about other diseases, their treatment and prevention. How not to get lost in this information flow, news from which sources should be trusted and how not to be fooled by those who do not have a medical education? PostNauka asked these questions to the program director of the Higher School of Oncology, oncologist-chemotherapist Polina Shilo.

– Where and how to look for reliable sources of medical information? Is it possible to believe publications on popular science sites and in Is it the media or should we only take academic research seriously?

– All scientific fields work according to the same principles, and the results of any research, even if all possible errors are excluded, can be obtained by chance. For this reason, you can find a scientific article to confirm any position. But if you are not a scientist, do not have the appropriate background, do not deal with a profile narrow problem and are not aware of absolutely all publications that have come out on this topic, then it is very difficult to assess the quality of one particular article in isolation.

Therefore, in order to get more or less reliable knowledge, it is necessary to read the recommendations of scientific communities. It may be quite difficult for a non-doctor to understand them, but this is the only way out: experts have already read everything published on a given topic for you and have written recommendations based, among other things, on their experience. Practitioners read academic articles when they do not have enough information from clinical recommendations or treatment protocols. In the primary sources, you can find research results and specific information: on which patients were tested, how many of them were there, what they wanted to show during the study.

– How can you understand whether you have a high-quality medical resource in front of you? Can you give examples of such resources?

– In principle, you can trust popular science publications that have not previously been caught publishing outright nonsense. However, it is impossible to designate the only, the best and universal medical collection. 

As a rule, medical resources are divided by diseases. High-quality clinical recommendations can be found, for example, in a respected European, American or Russian community. So, in the field of oncology, there is the European Society for Medical Oncology (ESMO), the American Cancer Society (American Cancer Society), and each of them issues its own recommendations, which differ slightly. This is due, among other things, to the different economic situation in Europe and the United States: if money is not particularly considered in American recommendations, then everything is a little more conservative in European ones. But in the most important points, the recommendations of both societies still converge.

It is necessary to look for similar communities by region (for example, Europe, USA) and disease (medical field) and their clinical recommendations, because they have the greatest weight. WHO has joined in solving problems with the coronavirus and has issued its own guidelines, but there are usually no global recommendations for the treatment of other diseases: they are divided into communities. By the way, despite the stereotypes, domestic recommendations may well be good – for example, in oncology they are now practically not lagging behind either American or European and are updated annually. But if there is an opportunity, it is better to read medical publications in English – at least because this information may be more recent, because most of the articles are still published in this language.

It is important to understand that PubMed, with all its advantages, is an aggregator, and there is enough unreliable information. The main sources for finding medical information on coronavirus are CDC, FDA, WHO. There is also an UpToDate that summarizes a huge amount of information. If we talk about specialized data – for example, about the management of patients with oncological diseases in conditions of coronavirus – we need to look for recommendations on the website of the professional oncological community.

– What are the criteria for a quality article on medical topics?

– Dear authors conducting qualitative research are interested in having their article seen by the maximum number of people, so they will try to publish it in a good publication. Therefore, it is possible to evaluate the impact factor of the journal, that is, the citation index. If it is high, it means that the publication values its reputation and will not miss outright nonsense.

The article should also describe a sufficient number of patients and cases. It is important to pay attention to the design of the study. If it is carried out on 3, 10 or even 30 people, then this is very small, and the credibility of such an article will be less than that written on the basis of a study conducted on 600 patients.

Finally, the results of the study of the effectiveness of treatment should be obtained by randomized clinical trials (except in situations where it is impossible to conduct them). This is how scientists get the best evidence, it is the gold standard of research aimed at finding the right treatment. If the title or description of the article refers to randomization, then this gives the text a great advantage, since it means that the study conducted is not observational, but experimental.

Randomized controlled clinical trials.

The word "randomized" (from the English. random – "random") means a random distribution of subjects into experimental and control groups. This is necessary so that everything is as unbiased as possible and so that we can understand that a specific drug works in the experimental group, and not something else. 

If the study is controlled, it means that there was a control group in it, the results in which were compared with the results in the experimental group (or comparison group). The main functionality of randomized clinical trials and their main role is to find the right treatment for patients. This is a study to prove that treatment A is better than treatment B, drug 1 is better than drug 2.

How does a randomized controlled clinical trial usually proceed? Imagine that you need to test the effectiveness of some experimental drug compared to standard treatment. The control in such a study can be active or placebo – the latter is being used less and less now: after all, if it were necessary to evaluate the effectiveness of an experimental drug for the treatment of metastatic breast cancer using a placebo-controlled study, then some women would be treated with an experimental drug, and some would be left untreated altogether. This cannot be done, because there is an effective standard treatment. Therefore, experimental treatment is compared with standard treatment. 

The researchers try to make the groups of subjects as similar and comparable as possible: for example, approximately equally men and women of approximately the same age and with similar concomitant diseases. Then in the course of the study it will be clear that in this case it is the experimental drug that works, and not an accident associated, for example, with age. So, if the average age in one group is 60 years, and in the other – 35, then it is logical to assume that with any actions in the first group, the effect will be worse than in the second. Randomization is just needed so that the groups are comparable. The more times you flip a coin, the more heads and tails will be equal to each other. The same principle is used here: the more patients, the cleaner this procedure is.

Unfortunately, there are not as many randomized controlled trials as we would like, and there are a number of reasons for this. Randomized controlled trials have their drawbacks. They relate to the specifics of conducting tests: it's long and expensive. In addition, there are cases when conducting such a test is simply unethical. For example, it would be nice to conduct clinical studies and understand how to treat such a complication of chemotherapy as the release of a chemotherapy drug into the surrounding tissues during its intravenous administration. But it cannot be carried out, because then people would have to be specially injected with the drug directly into the tissues, and this is again an unethical intervention that will cause harm to the patient.

There are situations in which a randomized trial is not applicable and is not necessary. For example, if the task is to find out the prevalence of diabetes in In St. Petersburg, then a study is simply being conducted, for example, a cross-sectional: they give out questionnaires or look at hospitals.

– What impact did the coronavirus pandemic have on the situation with the reliability of medical information?

– Now, during the pandemic, the problem is that even in the academic world, that is, in the world of published clinical studies, difficult moments arise. The fact is that, in fact, doctors who deal with COVID-19 conduct research and try to make clinical recommendations from scratch, while studying diseases is usually years of hard work. Now we need to understand how to treat a completely new disease, literally in a few months. It's a really difficult task.

Therefore, recently even very respected organizations have been trapped when they published not very well-verified information. At the same time, it was still the best at a particular time. 

The reason is that it is simply impossible to accumulate so much knowledge in such a short period of time and react so quickly. Even doctors are not very clear what to do, not to mention everyone else.

You have read the favorites from the broadcast with the program director of the Higher School of Oncology, oncologist-chemotherapist Polina Shilo. You can watch the entire recording here.

About the author: Polina Shilo is an oncologist-chemotherapist, program director of the Higher School of Oncology.

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