by Margaret Wahl

Illustrations by Cindy Yakovich Guare

More than ever before, the average person is bombarded with information about medicine and science. Several times a day, television, radio and Web stories raise hopes about scientific "breakthroughs" or warn of hidden but growing dangers. Newspapers and magazines add to the cacophony.

Some readers and viewers react with hope or panic at every report, but most throw up their hands, sigh, and proclaim that since they cant process it all, theyll just ignore most of it.

So, whats a consumer to do? Use common sense, try to put the new announcement in context, check the source of the report and, oh yes, try to keep a sense of humor.

Here are some thoughts to keep in mind as the media bombard us with 2004s breakthroughs and warnings.

WHO SAYS SO?

"Scientists report an alarming increase in rickets and other diseases resulting from lack of sun exposure," reads the headline of a Web-based news item.

The concerned reader thinks about whether he knows anyone whos developed rickets, a bone-deforming disease common in the United States early in the 20th century, before vitamin D (which needs sunlight to work properly) was added to dairy products. Has he seen many bow-legged children lately? Is all that sunblock he puts on his 4-year-old at the pool impairing her bone growth?

But as he scrolls to the end of the item, the astute reader gains a new perspective on this piece of "news." It was placed on the Web by a company that makes tanning beds, which have come in for harsh criticism by doctors concerned about skin cancer.

The company wants to "balance" that cancer scare by raising what may be false concerns about underexposure to sunlight.

There may be some truth in the companys statements (that would require a great deal more digging on the readers part to determine). But theres no doubt that the company stands to gain financially from a reduction in consumers fears about overexposure to sunlight, and this potential gain calls into question the reliability of the "news."

Although no source of news is 100 percent reliable, news that comes from an academic institution, the National Institutes of Health, the U.S. Food and Drug Administration or a nonprofit organization is generally more trustworthy than news from a for-profit company.

That having been said, what pharmaceutical companies can tell consumers about a drug is regulated by the FDA. Although product advertisements may be mostly "spin," the official "prescribing information" thats found in either the package insert you get from a pharmacy or that you can see on the companys Web site can generally be trusted.

HOW DO THEY KNOW?

"Sixty-three percent of viewers surveyed believe they have had a personal encounter with a devil," says the crawl across the television screen while viewers are treated to a program on exorcism.

Before the viewer concludes that nearly two-thirds of U.S. citizens have a psychiatric condition or, depending on her own beliefs, that there must be a lot more evil afoot than shed thought, it would be wise for her to consider just how those people in TV land arrived at the 63 percent figure.

Assuming the survey is real, when and how was it posted? Most likely it was asked during a program about devils and exorcism, like the one the viewer is now watching. That already skews the pool of potential respondents to the "survey." Rather than being a random sample of the U.S. population, the respondents come from those who are already watching a TV show about exorcism and choose to answer an on-air question.

That audience, especially those who stick with the program more than a few minutes, are almost certainly more likely than the average person to believe that devils exist and therefore to explain some of their own experiences as being related to devils.

What question was asked? You cant really tell from the statistical result, but it was probably something like, "Do you believe you have ever had an encounter with a devil?"

Most people who dont believe there are such things as devils probably wouldnt answer such a question, because the question presumes a belief in devils.

And, if you believe devils exist but dont think youve ever met one, would you bother to get up from your favorite chair to call the television network and report that? Maybe, but youd probably be more likely to call the network to report that yes, you really do think that guy in the funny suit at your cousins wedding was a devil.

So, if we look more closely at the 63 percent of people who reported devil encounters, what part of the U.S. population might that really represent? Theres no way to know, but common sense tells us its undoubtedly far less than 63 percent.

CAUSE OR COINCIDENCE?

"Look at the correlation between the decline in fat consumption and the increase in carbohydrate consumption," proclaims a very popular diet book. "The pendulum began to swing toward fat restriction in 1975," continues the 2002 edition, "and for the next 20 years, Americans began to gain weight at an alarming rate."

Lets give the author the benefit of the doubt, and say we believe that Americans gained weight at an "alarming rate" between 1975 and 1995 compared with their rate of gain in previous 20-year periods.

The question that the careful reader now has to ask is, What caused the weight gain? The author says hes only reporting a correlation, but hes clearly implying that a single dietary change has caused the problem, and that his book has the solution.

The question to ask is, Could the true causes of the increasing rate of weight gain in the last part of the 20th century be something other than what the author suggests?

Well, yes. For one thing, the composition of the U.S. population by age changed considerably between 1975 and 1995. In 1975, the "baby boomers," the large group born between 1946 and 1964, were between 11 and 29 years old. In 1995, they ranged from 31 to 49.

Its well known that weight gain is in general a phenomenon of the middle years, not of youth or old age, so it makes sense that the average weight of the population would have risen in the targeted decades.

One could also safely say that people expended less energy during that same period. These were the decades when the microchip replaced manual and electrical systems, robbing office workers of even the scant caloric expenditure of pounding a typewriter and television viewers of even the small amount of exercise needed to get up and change the channel.

So, although changes in the relative amounts of fat and carbohydrates in our diets may have coincided with weight gain in recent years, its hard to say they caused it. And its even harder to say they caused it alone.

Similarly, if we read that the risk of Alzheimers disease is increased by having a poor education, we cant necessarily conclude as some reporters have that going to college will ward off the condition.

It could be that people with certain brain characteristics are likely to obtain more education in the first place and that their different brains are what protects them from Alzheimers, rather than the education itself.

Its also true that people who went beyond high school, especially before World War II, were better off economically than those who left school early, and that many health-related benefits are associated with a higher socioeconomic status. It could be these factors, rather than education itself, that leads to less brain degeneration in old age.

SLIPPERY STATS

Certain terms used in reporting the news should be red flags to the astute reader or viewer, because they can be used to muddy as much as to clear the waters surrounding a particular point.

Fastest Growing

One of these terms is "fastest growing." Borrowed from advertising copy, this term crops up in reports of news about medicine, psychology and cultural trends.

Of course, "fastest growing" could mean the number of people with a particular condition admitted to U.S. hospitals went from 10 to 20, an increase of 100 percent, compared to increases for another condition from 10,000 to 12,000, an increase of only 20 percent. The condition may be the fastest growing reason for hospital admissions, but there are still very few people who have it.

Three Times Faster

By now, statements that product X "relieves symptoms three times faster" are so common most people dont even hear them. Usually, theyre part of an ad, but such statements are creeping into news copy these days.

The question to ask is, Faster than what?

Average

340 divided by 10 = 34 — Who's average?

Another tricky term is "average." If a drug company says the "average" patient in a pilot study was able to reduce his daily prednisone dosage by 34 milligrams when he added a new medication, a reader might be encouraged. The prednisone-using patient, weary of side effects, may approach his doctor in anticipation of considerably reducing his prednisone dose.

The truth may be that no one in the study actually reduced his prednisone dosage by 34 milligrams. (In fact, the tablets come in 5-milligram units.) The 34 milligrams could be the arithmetic average of the dosage reduction of the 10 people in the study, six of whom experienced a 15-milligram or smaller dosage reduction.

Although its not easy to do, the best way to interpret results like these is to obtain the actual data, which if the study is real are generally published in a medical journal. You can usually get a copy of any medical journal article through the library of a medical school or through PubMed at www.ncbi.nlm.nih.gov/PubMed.

DISTORTED DRAWINGS

Lets suppose that two people who were taking 60 milligrams of prednisone a day were able to change their dose to 45 milligrams a day, a reduction of 15 milligrams.

On a graph, a reduction of 15 milligrams can appear very large if the graph is designed that way. And the line connecting the starting dose and the ending dose can either look like an Olympic ski slope or a gentle sledding hill, depending on whether the first and second points are placed close together or far apart

TIME TRAVELING

Many reports seek to compare whats happening now with what happened a long time ago or what might happen in the future. But this is tricky.

Been There, Done That

Suppose were told that women with myasthenia gravis were more likely to give birth by Caesarean in the 1990s than they were in the 1970s. We cant necessarily conclude that anything about MG-associated pregnancy itself has changed.

The number of surgeries is more likely related to better ability to detect a distressed fetus during labor and a lower threshold for performing a Caesarean in the 1990s than in the 1970s.

If studies in the 1980s say the drug gentamicin wasnt helpful in Duchenne muscular dystrophy, one has to ask what kinds of patients were in the trial.

We now know that gentamicin, if it helps in DMD, is likely to be effective only in cases where theres a specific type of mutation in the dystrophin gene. Since this connection wasnt understood until recently, investigators in the 1980s wouldnt have specifically looked for it.

At This Rate...

Sometimes, media reports try to predict the future based on whats happening now. This type of prediction, or "extrapolation," can be useful, but it can also fail to predict other changes that may alter an upward or downward trend.

For instance, statistics showed a terrifying increase in AIDS cases in the United States in the early 1990s, with dire predictions in the media of unprecedented numbers of infections and deaths. In reality, because of better methods for both prevention and treatment, U.S. deaths from AIDS leveled off during 1994 and 1995 and then began to decline.

HE SAID, SHE SAID

Too often, an editors desire to see a "balanced" presentation of information, or even to spice up an article by emphasizing conflicting viewpoints rather than consensus, results in a confusing mix of claims and counterclaims about a finding, says Lynne Friedmann, a freelance journalist based in Solana Beach, Calif., who edits the publication of the National Association of Science Writers.

She notes that its important to ask yourself whether the person expressing the opposing view seems to have been selected at the last minute to do just that or whether he or she really is a qualified expert on the subject.

CONTEXT

Shannon Brownlee, a senior fellow at the nonprofit public policy institute the New America Foundation, searched the Internet for the words "breakthrough" and "medicine" and came up with 939 articles for June 2003 alone.

"With all those breakthroughs," Brownlee concluded in an Aug. 3, 2003, article in the Washington Post, "youd think nobody would have to die of cancer anymore and we should all be running marathons into our eighties."

Friedmann says the word "breakthrough" is a red flag for her. A true breakthrough, she notes, is usually built on some earlier work.

So, if you havent heard anything about the subject before, Friedmann suggests looking for a context, or background, for the finding, even if thats limited to doing an Internet search.

"I think this is a value that the Web can provide," she notes. "Thats where stories have links to earlier information and where you can find out what terms mean. The Web is giving us a lot of information, but its also providing us with the means for getting the information that will help us sift through these stories."

For touted breakthroughs and "miracles" that have to do with neuromuscular diseases, its a good idea to check MDAs publications and Web site to see if theres any history for the claim.

COMMON SENSE

A nutritional supplement companys promise that its "natural" product can "detoxify" whatever else youre ingesting and that medical science has for some reason failed to recognize (or has suppressed) this fact just isnt believable. If the product were that great, someone would have made a tidy profit from selling it long ago, and everyone would have heard about it.

Does something sound too good to be true? As the old saying goes, then it probably is. Fortunately, the same principle can be applied to reports that challenge our beliefs by sounding too awful.