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...

ATTN: Edmonton, Feb 3, 2016 Picard Lecture: Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

Gilbert Welch (img used without permission,  Beacon Broadside )

Gilbert Welch (img used without permission, Beacon Broadside)

I just learned of this event in Edmonton, on Feb 3rd. Don't miss it!

Welch is a persuasive champion of 'less is more' in medicine, and his talks are inspiring, dynamic, and necessary. If you can't attend, check out his latest book, Less Medicine, More Health. RSVP details below. - J.


From The University of Alberta (original post):

"Many doctors are worried about the problems caused by too much medical care. A recent survey suggested that nearly one-half said their patients received too much medical care. But it is hard to communicate the nuances – that medical care can do a lot of good in selected settings, but can also do harm in others – during a 10-15 minute clinic visit.

Doctors like to blame lawyers for the problem of too much medical care. But ask yourself this: Would the problem of overuse disappear if the lawyers disappeared? Economists like to blame economics. But the recipe of adding fee for service to third-party payment to cook up too much medical care would not work without strong underlying beliefs about the value of the product. The general public harbors assumptions about medical care that encourage overuse.

I’m not blaming the public; many of these assumptions flow directly from information provided to them – be it from the news media, talk shows, advertising, PR campaigns, disease advocacy groups, public service announcements or doctors themselves.

Regardless of their source, these assumptions lead individuals to have an excessively optimistic view of medical care. That leads them to seek – some would say to demand, others to accept – too much care.

February 3, 2016
12:00
McLennan Ross Hall (Rm 231/237), Law Centre (111 - 89 Ave)
University of Alberta - Edmonton, AB

Please RSVP here.

Dr. Welch is a general internist and professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research in the Geisel School of Medicine. He is also a professor of Public Policy at Dartmouth College and a professor of Business Administration at the Amos Tuck School.

For the 25 years he has been practicing medicine, Dr. Welch has been asking hard questions about his profession. His arguments are frequently counter-intuitive, even heretical, yet have regularly appeared in the country's most prestigious medical journals — Annals of Internal Medicine, Journal of the American Medical Association, the New England Journal of Medicine and the Journal of the National Cancer Institute — as well as in op-eds in the Los Angeles Times and the New York Times. His most recent book is Less Medicine, More Health – 7 Assumptions that Drive Too Much Medical Care.

Dr. Welch is very much part of the “Dartmouth School” that questions the assumption that more medical care is always better. His research has focused on the assumption as it relates to diagnosis: that the best strategy to keep people healthy is early diagnosis – and the earlier the better. He has delineated the side-effects of this strategy: physicians test too often, treat too aggressively and tell too many people that they are sick. Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer."

How can you have an overdiagnosis of cancer? Either it's there, or it's not.

"How can you have an overdiagnosis of #cancer?  Either it's there, or it's not." – @susila55

[click to expand]

Rates of new diagnosis and death for five types of cancer in the US, 1975-2005. Adapted from Welch and Black, in Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012; 344:e3502

In response to tweets about a potential for overdiagnosis in thyroid cancer cases, a twitter user, Susan Burke Mangano (@susila55), asked this question.

There have been many articles lately on overdiagnosis of almost all kinds of cancer. Our twitter discussion was mainly around thyroid cancer (with Dr Gilbert Welch leading in publications eg. Current Thyroid Cancer Trends in the United States).

Whether breast or prostate, thyroid or renal, the conclusions are generally the same: we are diagnosing more and more cancer, but it is not affecting mortality rates.

How? What?

"There is an ongoing epidemic of thyroid cancer in the United States. The epidemiology of the increased incidence, however, suggests that it is not an epidemic of disease but rather an epidemic of diagnosis." – Welch et al.

I'm not going to explain it here myself since it has already been done well in many places, the most straightforward of which is this video/article combo, by the Wall Street Journal.

I highly recommend you take a look.

Read Some Cancer Experts See 'Overdiagnosis,' Question Emphasis on Early Detection in the Wall Street Journal.

 

* As they have just locked this article (you need a WSJ subscription or institutional access eg. university library account), I will include a few pertinent quotes here:

 

While it's clear that early-stage cancers are more treatable than late-stage ones, some leading cancer experts say that zealous screening and advanced diagnostic tools are finding ever-smaller abnormalities in prostate, breast, thyroid and other tissues. Many are being labeled cancer or precancer and treated aggressively, even though they may never have caused harm . . .
"We're not finding enough of the really lethal cancers, and we're finding too many of the slow-moving ones that probably don't need to be found," says Laura Esserman, a breast-cancer surgeon at the University of California, San Francisco. . . .
"Unfortunately, when patients hear the word cancer, most assume they have a disease that will progress, metastasize and cause death," the group wrote in the journal Lancet Oncology in May. "Many physicians think so as well, and act or advise their patients accordingly." . . .
Overdiagnosis--the detection of tumors that aren't likely to cause harm--is now a hot topic in other cancers as well. A growing volume of studies estimate that as many as 30% of invasive breast cancers, 18% of lung cancers and 90% of papillary thyroid cancers may not pose a lethal threat. . . .
"Everyone says they'd be willing to be overtreated if it means not dying--but that's a big fallacy," says Dr. Esserman. "By treating 1,000 people who have low-risk disease, we're not going to save the one person with aggressive disease." . . .
Says Dr. Esserman: "We need to start testing some of these ideas, rather than just fighting over them. People are afraid to do less. We want to figure out how to do less safely."
- Melinda Beck, WSJ