How do you know? Fact, fiction, alternative truth?

Humanity has explored many ways of knowing, from trusting deities and their 'earthly conduits,' to seeking out experts, to looking for evidence and statistics, to believing what one feels is 'right.' I am fascinated by epistemology (the investigation of how we know things, of what distinguishes justified belief from opinion) and the psychology of choice, but I am even more interested in what we can do to promote critical thinking.

 

How do you raise children to question the statements that they hear?

How do you inspire patients to develop their health literacy and explore how probabilities are presented to them?

How do you convince policy-makers to consider value rather than throughput in their decision-making?

Can we convince health 'experts' to include effectiveness, the risks, and costs of various interventions when they write guidelines?

Apparently the heat from climate change has fried our leader's critical-thinking brain centres, and we now find ourselves awkwardly in an era of supposed "alternative facts." We know that fighting firmly held personal beliefs (even if we consider them lies and delusions) with facts is not effective; however, if you a reading this then you are already probably a bit skeptical, and you can explore the resources below to help with your own decision-making.

 

HERE ARE A HANDFUL OF PUBLICLY-AVAILABLE TOOLS TO HELP:

 

1) A book: Know Your Chances - Woloshin, Schwartz, Welch - FREE Online via PubMed

Every day we are bombarded by television ads, public service announcements, and media reports warning of dire risks to our health and offering solutions to help us lower those risks. But many of these messages are incomplete, misleading, or exaggerated, leaving the average person misinformed and confused. Know Your Chances is a lively, accessible, and carefully researched book that can help consumers sort through this daily barrage by teaching them how to interpret the numbers behind the messages. . . The book's easy-to-understand charts will help ordinary people put their health concerns into perspective.This short, reader-friendly volume will foster communication between patients and doctors and provide the basic critical-thinking skills necessary for navigating today's confusing health landscape.

[some other books about overtesting, overtreatment, and being skeptical in medicine are listed HERE]


2) A video: How to spot fake news

This video highlights the need to be skeptical and question headlines on social media or on other sites; it's sometimes hard to tell if a story is fake. If something seems shocking or strange, it's a good idea to ask around and do a bit of google-sleuthing. Checking the date, the source, and asking a skeptical friend can help you figure it out.
 

3) A website: Testing Treatments Interactive

The TTi site contains learning resources to help people recognise and understand Key Concepts, and how use them to evaluate treatment claims. These are categorized by concept, target learning group (kids, undergraduate students, etc), and the format (videos, websites, cartoons, etc). The book is also free and available in audio, PDF, or HTML format.

4) A guide: 12 Questions to Ask: How to Evaluate Health Information on the Internet

The National Institutes of Health has put together a great tool to help patients and caregivers check the reliability if information from the internet. These 12 straightforward questions can help you decide if what you are reading is useful - or useless.

Do you have other tips for getting to the truth? 

Source: https://www.amazon.ca/Know-Your-Chances-Un...

Is it worth it? The role of Health Technology Assessment (HTA) and using evidence with patients

"These are my people," I thought to myself on the long plane ride West, destined for home to a verdant explosion of nature after three days in snowy Ottawa. Maybe it was the season, but I think it was more the people around me that reignited my enthusiasm for change in health care.

In April, I was invited to Ottawa to be a part of the Canadian Agency for Drugs and Technologies in Health (CADTH) symposium closing plenary on the subject of Health Technology Assessment (HTA), a term that I had (embarrassingly!) not really heard of until receiving that invitation.

Despite feeling woefully out of place as a mere clinician, surrounded by successful policy analysts, clever researchers, health economists, and seasoned advocates, I had an incredible time. As I milled about taking in various presentations and getting my feet wet as part of a panel on Disinvestment, I found myself suddenly realize: everyone around me "gets" it.

What a gift: when you are asked to share your passion, say whatever you want to say, and know that the people listening are listening and nodding "yes" to some of the things that fall out of your mouth?

As I think more and more about how I can have a positive impact on the health and well-being of people, I think about the role of HTA in policy change, and about how evidence belongs to everyone. Being a bit camera-phobic I was reluctant to highlight this 8 minute video, but it was an honour that I do not wish to squander and I hope that some of what I said resonates with you too.

The 2017 CADTH Symposium is Apr 23-25, with the theme "Measuring Value in Theory and the Real World." If you are a student or patient group representative, you may be eligible for a travel scholarship. Check it out!

No strong proof that flossing your teeth has medical benefit

This is the third in a series of "no evidence" posts I've made recently, with the first two being "No evidence that N95 respirators are better than surgical masks" and "No benefit to locked mental health wards."

Today's serves as another example of where something seemed like a good idea but... "sURpriSe!!!!" maybe it isn't. 

Certainly, the evidence is lacking to support the bullying that goes on in dental chairs around the world.
"Are you flossing?"
"Yes....."
"Are you sure?"
"Uhhh....." *guilty face*

Personally, as a reluctant flosser, and as a person who questioned the risk/benefit return of having wisdom teeth extracted, I feel a little bit vindicated here. I was always curious 1) if I asked the dentist to guess whether I was flossing or not, could they tell? and 2) Does flossing really do anything useful?

I can't lie to my dentist... how could they do their job if I did? So when asked "have you been flossing?" I usually tell them "no" or "yah but just for 2 months" if I had been doing so, in a phase of thinking I should probably try to stick with flossing. 

Last time I was feeling contemplative in between wafts of chemical smells and *wizzzzzzzes* of the drill in the neighbouring stall, I told my dentist and hygenist that if they could show me solid evidence of benefit of flossing, then I would do it. The hygienist listed a bunch of benefits and I went home to check it out. All the PubMedding in the world didn't find anything to back up her statements. Since they couldn't produce a strong reason for me to do it, so I decided to stop.

Flossing is not fun, it creates waste, and I can think of better things to do with 5 minutes a day. In fact, with those 5 minutes today, I can bring you this article in The Journal of Clinical Peridontology, which found:

The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extent.

The paper did find that  inter-dental brushes (IDBs) are effective in removing plaque. These brushes I have tried and they look like little pipe-cleaners that you shove between your teeth. It feels about as good as it sounds!!! Ow.

I may wait for the randomized controlled trial (RCT) proving that those angry little bristles decrease caries (cavities) before attempting their use again, as "plaque removal" is but a surrogate marker for other things.

Further to the lack of advancement of evidence-based practice in dentistry, one periodontist. Dr Ghilzon, when interviewed by the CBC said:

I would say if you know how to floss I would continue just in case it does make a difference

When the CBC talked to Matthew J. Messina, a dentist and spokesman for the U.S. dental association, they pressed him. He acknowledged weak evidence, but he blamed research participants who didn't floss correctly.

It seems Dentistry is eons behing medicine in terms of evidence gathering let alone application. Whether employing patient-blaming, citing anecdotes, or declining to accept the value of evidence, Dentistry is set to follow Medicine in suffering the same "just in case" approach that dooms patients to overtesting and overtreating and promotes ignorance of the harms of intervention.  

See the original CBC article here.

Source: http://www.cbc.ca/beta/news/health/dental-...

BMJ Blogs: Six proposals for EBM’s future

Dr Paul Glasziou is a Professor of Evidence-Based Medicine at Bond University in Australia. He speaks and writes mainly about the translation of health research into clinical practice.

His latest contribution to the BMJ Blog is a look at the future of evidence-based medicine (EBM). As its era fades into another, it becomes apparent that there is still a huge gap between what research tells us and what doctors and patients wind up doing.

Sometimes the known evidence is biased, of poor quality, or doesn't actually have any relevance for our patient. Sometimes, we have strong evidence about what is clinically 'correct' but we have forgotten to remember that each patient is an individual, with unique goals and life circumstances. Sometimes, we get so caught up in chasing the potential benefits of something that we fail to realize it could be causing more harm than good.

Read Dr Glaszious' Six Proposals for EBM's future, as he tackles these tough issues and helps to guide us back to a place where research improves care.

Source: http://blogs.bmj.com/ce/2015/03/27/six-pro...

CONFERENCE: ISDM/ISEHC2015: Bringing Evidence-Based Practice and Shared Decision-Making Together

What could be better than a conference combining evidence-based practice (EBM) and shared decision making (SDM)!? 

A conference combining EBM and SDM... in Australia!!

That's right, July 19-22, the University of Sydney will be hosting the joint international shared decision-making (ISDM) and International Society for Evidence Based Health Care (ISEHC) conference.

Drs Paul Glasziou (@PaulGlasziou) and Lyndal Trevena (@LyndalTrevena) host, with keynote speeches from Drs Victor Montori (@VMontori), Alexandra Barratt (U of Sydney, organizing committee of Preventing Overdiagnosis), and Sharon Strauss (U of Toronto).

Submit an abstract today! Early bird registration will open soon, and close April 17, 2015. Check out the website and subscribe to their email list so you know as soon as registration opens.

 

Find out about other conferences and events on the subject of Overdiagnosis, the application of evidence and shared decision-making, and Less is More in Medicine.

7 Themes from Preventing Overdiagnosis #PODC2014

In September I was lucky enough to attend the Preventing Overdiagnosis conference in Oxford, UK. I learned about new resources and people that I could connect with, changed some of my beliefs, and generated even more questions for myself/the health care system.

In my reflection, 7 major themes emerged:

  1. Nomenclature

    • under-use is as much an issue as over-use
      • like food, we want our medicine neither over- nor under-cooked [David Haslam]
    • how do we define the problem? what terms are being used to describe this/similar issues? [see glossary for some] can we create a common term?
    • causes of overdiagnosis are on a spectrum
      • good intentions -- wishful thinking -- vested interests [Stacy Carter]
         
  2. Cognitive/Labeling Biases = Problematic

    • flawed thinking: doing something better than nothing, "more is better"
      • the more resources exist, the more they are used
    • actions motivated by fear (of death, illness, uncertainty)
    • labeling bias
      • is there any other way we can see patients besides by labeling them with diagnoses? [William House, Andrew Morrice]
      • creating a "WAR ON CANCER" galvanizes people, breeds an ideology and creates fundamentalists
         
  3. It Is about conversations, not certainties

    • mostly grey areas, no blanket rule for everyone; evidence, guidelines, recommendations must be interpreted for each patient
    • pathology is a continuum, never/rarely yes or no
    • "correct" is not always effective

    • use existing skepticism/understanding to inform others

      • eg. people have begun to understand the harms of the overuse of antibiotics; parlay that into other areas
         

  4. Individuals vs. populations

    • for Patient X to not have a stroke, 76 other people have to be on statins
    • it is not possible to know at an individual level if something is overdiagnosis
    • evidence often does not apply to the person sitting in front of you
       
  5. Health Care delivery is flawed

    • changing the way we delivery primary care might be the heart of the solution
    • "consumer"-driven Predictive, Preventive, Personalized, Participatory (P4) medicine is scary & narcissistic [Henrik Vogt]
    • neo-paternalism may have a role
    • industry is scary
      • for-profit medicine is the biggest enemy of "Less is More Medicine"
      • this drives the medicalization of normal life, which makes us sicker!
    • the technology for genetic-based medicine is a long way off from being helpful
       
  6. Screening fails in ways we never imagined

    • patients equate screening with access to care [Laura Batstra]
    • "why is screening exempt from the ethical responsibilities to do no harm?" [Alexander Barratt]
    • preventative medicine has disappointing outcomes [Linn Getz]
       
  7. Evidence is lacking

    • it's not just a lack of quantity or quality
    • do we really need clinical trials to prove the obvious? can't we just do the right, ethical thing? [Dan Mayer]

Did you take away the same points as I did? Something completely different?

I'm already looking forward to the conference next year, in Bethesda, USA.