Doctoring Knowledge


“I’ve read that…”

“Did you hear about…”

“So and so (publication) said this…”

These days, medical information is like Kudzu in the Smoky mountains.  But just a few years ago, or so it seems, researching a medical topic took personal initiative and a not inconsequential time commitment.  Now, on an elevator at work with a smartphone, or at the kitchen table with a laptop (but surely not in a car while driving), one can find medical information almost instantaneously.

Questions can be answered.

How long will that poison ivy rash last? Is it even poison ivy?

Why do I have that pain down the side of my leg?

What are the side effects (or the benefits) of my new medicine? 

Should I get vaccinated? (Tread carefully here.) 

Is my doctor any good?  (Well, we still have a ways to go on this one.)

Yes, the widespread and easily accessed availability of ‘instant-knowledge’ is a good thing.  It would be hard to imagine life without it.

However, such a wealth of information requires more from the reader–a critical eye.  Not necessarily a cynical view, just a watchful one.  Watchful not only for the accuracy of the information, but also for the amount of inherent bias, applicability to the real-world, or perhaps cost implications to both the individual and society.

And such criticality isn’t just required for the usual sources of misinformation, like those for-profit websites which try to sell you things, but also for the interpretation of studies from mainstream medical journals.  For instance, just this week in the preeminent NEJM, a study was published touting the benefits of a new blood thinning drug for lower-leg blood clots. The accompanying editorial opinion—which usually agrees with the study’s conclusions—dissented.   Sure, the new (and expensive) drug was effective, but the editorial pointed out that the disease was too benign to justify the too small benefit of the costly therapy.  In reading only the headline all that would have been learned was that the drug was more effective.  But the whole story is important; as it always has been.  (A concise assessment of the specifics on this particular trial are here.)

If you are interested in a comprehensive understanding of how bias may affect the outcome of scientific trials, read DrRich’s most recent piece on the inevitability of bias in clinical research. It’s a real eye-opener. DrRich is a retired electrophysiologist, professor and keen observer of obviousness.  He speaks freely, with a refreshing candor, and a just a hint of one of my favorite vehicles of communication–sarcasm.

For the medically-inclined journal clubbers, check out Yale Medical School professor, Dr Harlan Krumholz’s discussion of how two simultaneously published studies in two different leading journals (with some of the same authors on both papers) came up with two different spins on the same data. The specifics here are complex, and well..quite specific to interventional cardiology, but the larger point is that the same data was spun in two different ways, by some of the same authors. If the authors are confused, than surely will be the reader. Again, gathering useful medical information is not straightforward.

In our present deluge of daily reports on matters health, independent reviews of mainstream medical reporting clearly has an important role in helping consumers (patients) understand the whole story. For a great source of independent expert reviews of medical journalism, read Gary Schwitzers,

Need yet another place (an information “home”) to hear unbiased viewpoints, unfiltered, often raucous opinions, and real-world vignettes on your chosen topic of interest?  Look no further than the increasingly populated medical blogosphere. Useful information doesn’t have to be accompanied by a 100-reference bibliography, or written by twenty different authors.  Those motivated souls who dare hit the ‘publish post’ button often offer important practicality and realism. (See disclaimer)

To be truly informed in the current information-morass, it has never been more important to read past the headline.

And to consider not just the staid voices from the ivory tower, but also the boisterous hollering from the rathskeller–where the bloggers hang.


Disclaimer: The author has an inherent bias in promoting the medical blogosphere, as he is part of it. Though (at the moment) he has no financial interests in this website, he does have a site-meter, and an ego.

One reply on “Informed”

Since I developed the arrhythmia, I've read many doctor blogs and learned many things. Yours has been particularly instructive and helpful in understanding the language of the erratic heart. I recently learned that shingles does not cross the mid-line from the Happy Hospitalist, which is good to know. However, I'm still looking for that elusive piece of information on how to ride faster without doing intervals, which I don't enjoy. Keep up the excellent work.

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