A blog post on blog posts: Fact, fiction, and friction

A blog by definition is a regularly updated website or web page, typically one run by an individual or group, and is written in an informal or conversational style. As with any conversation, there is usually a blend of fact and opinion. In the case of a blog on medical topics, frequently the opinions are those of experts, and it is not uncommon for such opinions to lead to healthy debate.

Fake news or skewed views?

We make many decisions on the basis of research studies, and this is particularly the case in medicine. The non-medical media often does a good job of sensationalizing research in ways that are at times excessive. A new drug or device is labeled a breakthrough treatment on the front page of the newspaper, when in fact the supporting evidence of effectiveness was modest at best and only relevant for a small subset of patients with the least prominent form of the disease. A commonly consumed food is labeled a risk factor for cancer in humans, when in fact the study involved only rats with two million times the exposure a human would have in a lifetime. As you can tell, it can be a rat race in more ways than one.

When not caring for patients, physicians spend countless hours reading journals to learn about new therapeutic options and trends in medicine. Physicians in particular must read with a critical eye. It is often not difficult to manipulate study parameters or statistics in order to demonstrate a particular finding in a study. For example, let's say there is a study evaluating a medication to prevent headaches, and the results suggest no significant reduction in the number of headache days per month. If you modify the units to reduced number of headache hours per month, it could look like there was a noticeable improvement. There are many factors that actually weaken the link between the medication and this perceived improvement. For example, if subjects in the study started taking prescription pain medication to stop the headache after it started, and experienced shorter duration headaches, this could make it appear that the study drug was effective at reducing the hours of headache per month. As such, it is very important to really understand the nuances of a study before jumping to conclusions about conclusions. It is in this regard that I often think of the store Syms and their old slogan, "An educated consumer is our best customer."

Physicians' opinions are shaped by research (what is written in textbooks and scientific journals) and by clinical experience. Clinical experience is the sum total of everything that patients tell their physician over the years and decades of experience and practice. Years of caring for patients yields rich information about treatments that work well and for whom they might work well. In taking care of headache patients, I have learned over the years that a key to headache relief includes paying careful attention to addressing non-pain symptoms (vomiting can be more of a problem than the pain of the headache), triggers (no patient leaves my office without spending some time talking about sleep problems because they are so common), and the non-medication treatments they've tried. Although a recent blog post I wrote on acupuncture may have seemed a bit skewed, I do not regularly advise patients not to try acupuncture. Different patients respond differently to different therapies.

Clinical experience: That's what she said…

In my clinical experience, the overwhelming majority of my patients have indicated no long-term migraine benefit from acupuncture treatment. Yet some of those very same patients have indicated that acupuncture was effective for treating other conditions. I am glad that my acupuncture piece sparked some healthy debate. My intention was not to slander acupuncture, but rather to share the feedback from thousands of patients I've worked with over the years, as well as discuss some of the weaknesses in a study that looked at the long-term benefit of acupuncture for the treatment of migraine. That being said, I hope my acupuncture colleagues can accept this olive branch if they found my piece offensive, and understand that behind the subheadings (referred to as "snarky"), clinical experience was driving the content, not a personal vendetta for a treatment that may be effective for some patients with certain diagnoses. I would also point out that the inconsistent effectiveness of many treatments I employ has been written about extensively in the medical literature.

When considering what constitutes an "effective" therapy, I fondly recall one patient who came to see me for treatment of her headaches. She had seen numerous neurologists and pain specialists with limited benefit, as many treatments with significant research backing their efficacy just didn't work for her. After introducing myself, she said, "Dr. Mathew, I know you are the doctor who is finally going to fix me." In reply, I said, "Young lady, I am not a veterinarian, and as such, I do not fix people." After a chuckle, a discussion of her history, and a physical examination, we outlined a treatment plan that involved lifestyle modifications and some complementary/alternative treatments, which she found beneficial. Although not a veterinarian, I was able to effectively treat her dog-gone headaches, and she was no longer barking up the wrong tree.