Who do you trust?

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“Don’t believe everything you hear about research, even from me.” It was a great line to end an outstanding lecture on evidence based medicine. Everyone laughed and began standing up as the lecturer called for questions. I thought he was going to get a standing ovation. But no one went to the microphone.

“Don’t believe everything you hear about research, even from me.” It was a great line to end an outstanding lecture on evidence based medicine. Everyone laughed and began standing up as the lecturer called for questions.  I thought he was going to get a standing ovation. But no one went to the microphone. Instead it seemed that everyone was running for the door.
“What’s with the furrowed brow?” my wife asked as I met up with her after the lecture. “You look confused. Was it a good lecture?”
“It was a great lecture,” I said.
“Well, what did you learn?” she asked. I had heard her grill our kids with the same question for years as they came home from school each day. Now I know why they made up stupid answers.
“I don’t know,” I said feeling cornered.
“You don’t know? I thought you were looking forward to hearing that guy speak. Isn’t he an expert?”
“Well, yeah,” I said suddenly feeling like I had raised my hand to answer a question only to have it fly away.
“Didn’t you tell me that the guy is like the guru of the latest research?”
“He is,” I said defensively. “He’s made a national reputation by telling everyone what the latest research says. But now he says you can’t trust the research.”
“That’s kind of strange. Why can’t you trust any research?”
“It’s not that you can’t trust ANY research. It’s just that you can’t trust SOME research.” I looked over my glasses and lifted my brows attempting to look professorial.
“Well, which can you trust?”
“Well, first of all, you can’t trust any research that is funded by drug companies. All they are trying to do is show that their drug works better than something that we know doesn’t work. So their studies always show that their product works. Oh, and if the study doesn’t come out right, they just don’t publish it, and go find somebody else to repeat the study until it comes out the way they want, and then they publish that one.”
“Who publishes it?” she said incredulously.
“Oh, big name journals like the New England Journal of Medicine, JAMA, Annals, they all do.”
“Oh, I don’t believe that!” she squinted and cocked her head. “You’re telling me that the big name journals publish stuff that is cooked up by the big drug companies. You think there’s a big conspiracy behind everything. Why would they do something like that. Hey,” she said slowly. “You went and watched that Michael Moore movie, Stinko, didn’t you?”
“It’s ‘Sicko’, not ‘Stinko’, and no I didn’t go see it. And it’s not like that.”
“Well, I don’t care if it’s ‘Fatso’ I don’t think the drug companies have this big conspiracy to sell everyone rat poison. They’re in the healing profession, just like you.”
“Oh, so you think that doctors decisions can’t be influenced by money? Who do you think flies around the country talking about all these drugs, huh? Doctors, that’s who. Professors at big universities who make little bitty university salaries and drive around in great big Lexus SUVs bought with grant money from big drug companies.”
“And you know all those journals that nobody ever reads? Do you know how they make so much money? Do you? Reprints! They sell reprints of all those journal articles that no one ever read to drug salesmen who come around with doughnuts and crappy ink pens and tell you how their drug is better than nothing.”
“Honey, I think you’re starting to talk a little fast and maybe you’re just a little paranoid. Have you taken your Geodon today.”
“Oh, very funny,” I said, twitching slightly.
“Well, all the studies aren’t funded by drug companies are they?”
“Actually, most of them are,” I said starting to calm down. “But the studies are supposed to be randomized control trials, you know where one person administers the therapy and another person looks to see if it worked,” I said anticipating her next question.
“So, even though they fund the studies, it not like they can influence the outcomes can they? And since there are other drug companies showing how their drugs work better, isn’t there a contest of ideas. Doesn’t the truth usually emerge? After all, you don’t just look at one study do you?”
“What are you, some sort of research statistician? I thought the only things you read were People and Ladies Home Journal.”
“That’s why I read both, so I get different viewpoints.” She had me checked. “Besides, you moron, I probably read more of your journals than you do.”
“But what if both of your viewpoints are influenced by the same third view point?” Touche! I was dueling with a master swordsman.  My next move: Retreat up the steps and leap to the chandelier to swing over my opponent.
“Then you just get more viewpoints,” she parried. “I thought there were hundreds of studies on just about everything.”
My daydream froze in mid swing. “That’s true,” I said. “And there are studies that combine the results of a whole bunch of studies. But you can’t trust those studies either.”
“Why, because the drug companies have bought out everybody?”
“No, because ‘three second graders don’t equal a sixth grader’” I said, recalling another laugh line from the speakers power point.
“Who’s the sixth grader and who’s the second grader?” my wife said to an imaginary audience while rolling her eyes.
“No,” I said trying to regain the upper hand. “It means that even the guys who are combining the studies can insert their own bias. Sometimes the guys taking a certain view point only want to make themselves look smart so they can make speeches or sell books.”
“Like the guy making the speech you just heard?”
“No, no, not him,” I said dismissively. “He’s a great guy. He’s read every piece of research that’s ever been published.”
“So you trust what he has to say, right?”
“Yeah,” I said cautiously.
“Why,” she said slowly as she moved her queen in front of my cornered king.
“Because he told me not to?” I was rescued by the buzzing of my cell phone. “Hey, Punkie, it’s great to hear your voice.” My college-aged daughter always called at the right time. “It’s Whitney,” I whispered to my wife. “Oh, sweetheart, I’m so sorry. Did you put it under cool water? You don’t want to let it keep burning deeper.
“She burned her hand on some grease,” I said covering the mouth piece. My wife looked distressed. “It’s OK, though, I’ve got her covered.” I whispered.
“No, no, no” I said, turning back to the phone, “I don’t care what your roommate says. Don’t put butter on it. You’re not cooking a turkey.”
“No, don’t break the blister. It’s nature’s Band-aid. Ok, sweetheart, I love you, too.” I closed the phone with a feeling of fatherly fulfillment.
“Is she OK?” my wife asked.
“She’ll be fine,” I said authoritatively. “You heard what I told her.”
“And where’d you learn that information?” she asked, returning to the previous discussion
for a victory lap.
“There is good research showing that butter does not help a burn and may in fact make it worse. And the little thing about ‘nature’s Band-aid’ is from my mother.”
Mark Plaster, MD, Founder/editor-in-chief of Emergency Physicians Monthly.
Dr. Plaster practices emergency medicine in Baltimore.


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