Conflicting Headlines Create Mistrust

Can you trust today’s health headlines? People are fed up with all the contradictory information they get from news media and even health professionals.
For decades women were told that hormone replacement therapy (HRT) would protect them from all kinds of problems associated with aging. Heart disease, the number one killer of women, was near the top of the list. Then, in 2002, a large study showed that HRT actually increased the risk for heart disease, strokes and breast cancer.
The diabetes drug Avandia lowered blood sugar beautifully. Doctors prescribed it frequently, until the FDA restricted its sale after studies showed that the drug increased the risk of heart disease, the primary killer of people with diabetes.
Calcium supplements were supposed to prevent broken bones. But last year a study suggested that excess calcium might increase the risk for heart attacks (BMJ online, July 29, 2010).
In the biggest reversal yet, the value of statin-type cholesterol-lowering drugs to prevent heart attacks in healthy people has been questioned. The analysis comes from the Cochrane Collaboration, a worldwide network of experts in evidence-based medicine. They reviewed 14 studies that had more than 30,000 participants altogether. What they found was “limited evidence” that statins would extend or improve life in people without clear signs of heart disease (Cochrane Reviews, online, Jan. 19, 2011).
This study came on the heels of an earlier analysis of 11 trials involving a total of over 60,000 people (Archives of Internal Medicine, June 28, 2010). The conclusion was that healthy people with no symptoms don’t get obvious benefit from taking statins, even if their cholesterol is elevated.
With so many contradictory messages, it is no wonder that patients get frustrated and cynical. They may stop taking medications that they think cause them side effects, especially if there is a hefty co-pay for the drug.
Doctors and pharmacists get frustrated too. When patients stop taking their medicine or don’t pick up their refills, the term that health professionals use is noncompliance. It basically translates to patient misbehavior.
This mutual frustration is rooted partly in the way in which clinical trials are conducted and partly in the way they are reported. The FDA often approves medications based on how well they affect risk factors such as blood sugar, blood pressure or cholesterol levels. The assumption has been that changing such numbers from “bad” to “good” will improve health and prolong life.
These surrogate markers, however, don’t tell the whole story. The Avandia diabetes disappointment demonstrated that lowering blood sugar doesn’t necessarily result in better survival. The same thing may be true when statins are prescribed to otherwise healthy people.
There is little room for subtlety in headlines or 30-second sound bites. Media reports tend to either hype benefits or exaggerate dangers. That’s why patients feel betrayed and physicians are dismayed.
If patients are to trust the prescriptions they receive, those must be based on conclusive evidence that won’t be overturned by the next clinical trial or meta-analysis. As challenging as that may be, it’s essential to reestablish confidence in modern medicine.