Doctors Lisa Schwartz & Steve Woloshin: “Let people make health decisions based on facts rather than hype”

Mari Räsänen | syyskuu 12, 2018

Researchers and medical doctors Lisa Schwartz and Steven Woloshin give their views on medical science communication, medicine in the media and the status of the patient today. This blog series introduces science communication superstars from different fields.

Medicine is present in our lives almost daily, but how do we actually make the decision on whether to take a pill or not? We often make it based on biased information, say doctors Lisa Schwartz and Steven Woloshin. They claim medical information often poorly communicates the risks, benefits, and uncertainties of treatments.

Schwartz and Woloshin are partners both in marriage and at work at the Dartmouth Institute in New Hampshire. They have worked together for years to improve how medicine is communicated to patients, journalists and clinicians.

Schwartz and Woloshin’s mission is to guide people through the tsunami of health information they receive, sometimes from conflicting sources, and help them make educated decisions.

Possibly their best-known innovation was discovered at a surprising place: the breakfast table. Schwartz and Woloshin were inspired by the nutrition label found on every milk carton and chocolate bar. If food can be communicated so efficiently, why not pharmaceutical drugs as well? They developed the idea into something called the Drug Facts Box, an invention that replaces the long side effect lists on drug bottles with a simple table that sums up the harms and benefits of the treatment.

The box has already been endorsed by the FDA’s (American Food and Drug Administration) risk communication advisory committee (but not yet implemented by FDA). In Europe, it has been recommended to the European Commission by the UK Academy for Medical Sciences as a model for medical communication.

We met Schwartz and Woloshin at the Too Much Medicine Symposium and asked for their thoughts on medical science communication and medicine in the media.

What is the aim of your communicatory work?

Lisa Schwartz: “What we are hoping to change in medical communication is for people to get closer to the truth. A lot of what you read about medicine sounds too good to be true, or sometimes even too bad to be true. Our goal has been to give people a realistic sense of what is known and what is not known – how hopeful or worried they should be. We want to provide understandable medical information that hasn’t been influenced by other interests and that isn’t trying to sell or promote anything.”

Steven Woloshin: “We want to help people make good decisions. The stakes are high, especially when it comes to health. If people don’t have the facts, they can’t make informed decisions consistent with their values. I think the Drug Facts Box culminates our work because, in order to do it, we had to figure out what is the best way to represent data and how to talk about uncertainty in medical science.

The idea of the box is to efficiently present the harms and benefits of the same dose. We use information that does not come through the drug industry but has been independently reanalyzed by the FDA, so it’s more trustworthy. In the future, we would like the box to be in two places: available for patients to google and for doctors to easily look up new medications.”

Where does the patient stand today?

SW: “A lot of patients are overwhelmed because there is so much medical information available from so many sources. The key is to find reliable sources, and that is sometimes hard to do. It is best to look for government-funded sources that are independent of the drug industry [such as Käypä hoito in Finland]. The idea is that someone is looking at all the research evidence, not just one piece of it.

We don’t want to make people scared or cynical, but help them be a little sceptical and ask the right questions to decide if a drug or test is worth taking. That’s why it is important to give people reliable information on the pros and cons in an understandable format.”

LS: “It’s always about asking: what will this do for me and how might it hurt me? In general, your doctor is there to help you with that decision. Sometimes there is only one right answer or no time to think about alternatives, such as in an emergency. But a lot of times there are multiple choices and the patient should be engaged in that decision making.”

SW: “There is no reason why the patients can’t get the same information the doctor has, although maybe not exactly in the same form. If a doctor can understand it, they should make sure the patient understands too.”

What could journalists do better?

LS: “Sometimes the media can contribute to overmedicalization and selling diseases by not being sceptical enough. They can get excited about the benefits of a treatment and not discuss the harms so that it sounds like a quick fix for a hard problem.

One of the common distortions of health statistics in the media is talking about relative rather than absolute numbers when presenting benefits. Saying that there was a 50% reduction in something bad but not mentioning that it’s really the difference between 2% of people having a bad thing happen versus 1%. So actually the effect itself occurs very rarely.”

SW: “Another thing is how to communicate the uncertainty and limitations of studies. If studies are too small, uncontrolled or not even based on humans, sometimes it is important for the journalist to decide that maybe this is not even worth reporting on. Let people make decisions based on facts rather than hype.”

LS: “It is also always a bit dangerous to interview single patients in articles, although we do realize that it’s unrealistic to think that journalists will write stories without patients. At least you should try to have a patient who is representative of the effect and avoid miracle stories. Because even if all the facts are in the story but there is this one powerful quote, that’s all people will pay attention to. If you want to avoid selling diseases as a journalist, it’s all about asking: what is the science behind this?”

Schwartz and Woloshin’s top 3

Who to follow in science communication? Gary Schwitzer, founder of healthnewsreview.com.

A trend we should be aware of? Wellness.

LS: “There are all these things people say you need to buy to be well but often they are just opinions. Before buying anything you might want to ask whether there is any science behind it.”

What to read? Know Your Chances: Understanding Health Statistics, Lisa Schwartz & Steven Woloshin.

SW:  “We recommend our own book (warning: we may be biased!). But it’s a simple introduction to help you understand the numbers you read in the news. It also has useful tips for journalists about making health statistics easier for the readers. And it is available for free.”

Schwartz and Woloshin spoke at the Too Much Medicine Symposium in Helsinki (15–17.8.), where health professionals and journalists came together to discuss overmedication and overdiagnosis, as well as the role of health journalism in the issue.

Illustration by Janika Lähdes.

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