31 March 2011

Annals of crappy medical journalism part XLIV

Going to the Huffington Post for medical information is perhaps comparable to going to Vito Corleone for advice on income tax compliance.  Another prominent blogger refers to is as "that hive of scum and quackery," a lovely and accurate epithet for a media outlet which provides refuge and cover for anti-vaccationists, homeopaths and practictioners of reiki and other such pseudoscientific twaddle. I avoid the HuffPo like the plague.  But, like a moth to the flame, sometimes I can't help myself, and when a facebook friend (and former blogger) pointed to this contrarian article, my interest was piqued and I had to check it out.

Is High Blood Pressure Overtreated? Dr. Dennis Gottfried, Associate professor, University of Connecticut Medical School

First of all, I don't know Dr Gottfried, and I don't want to cast aspersions on him professionally. He might be a faith healer and snake-handler, or he might be a prominent researcher and expert in the field. I have no idea, and other than his questionable judgement in being affiliated with the HuffPo, I don't want to make any judgement on him as a physician or a scientist. 

The media and communications, part, however, is pretty aggravating. As a general-interest publication, the HuffPo is trafficked primarily by people who are, in the medical context, patients. Which means that when they consume medical news they tend to personalize it -- "How does this article relate to me?" It's also true, perhaps unfortunately, that for most news articles, many people read only the headline and the lede and maybe the final paragraph. 

So the take-home message of this article most health consumers will get is this: "Diagnosing and treating hypertension is clearly sound preventative medicine; but, as with so many areas of health care, too much of a good thing is often not good!" and this: "What these studies do show is that lowering blood pressure excessively with medications can be dangerous. The national belief that more and newer in health care always represents improvement is not only expensive, but dangerous. In medicine, too much of a good thing can be bad." Which are absolutely awful messages to send to the general public! It's a public health imperative to educate people of the importance of identifying and controlling high blood pressure, and this article sends a confusing and conflicting message to patients that maybe it's actually a bad thing to control their blood pressure!

Now it's true that the article pays lip service to the importance of controlling blood pressure for most people. But that's a nuance too easily lost, especially when it's in direct opposition to the central thesis of the article -- that too much treatment of blood pressure is bad. It's also true that the author does a nice academic-style review of some recent studies which do, in fact, support this central thesis. But there is a major qualifier which is actually pretty difficult to extract from this article: the applicability of the thesis is solely to a very small selected population of people who already have been identified as vasculopaths. That's a huge caveat, and one which absolutely needs to be clearly and prominently identified in the key parts of this article, especially since it is directed at the general public.

There is a huge difference in the way a physician and a patient read this sort of thing.  A health care provider will (hopefully) evaluate the argument and the data and consider which of the many patients he or she cares for it might be applicable to. The population in discussion is reasonably well identified in this article, and I think most doctors would be able to internalize and use this information clinically. But for general audiences, this is terrible, since most people/patients who read this (who are problby more likely to have HTN than the average reader) may not pick up on the narrow applicability of this study and draw the wrong conclusion as it relates to their own health, that taking their meds or controlling their pressure is maybe not as important as their doctor said, and maybe even harmful. This is all the more possible since the discussion of the research is pretty dense and academic. (I had to read it a couple of times to make sure I had a grip on it, and I am accustomed to reading medical literature.) People have a hard time making sense of conflicting and changing medical science, and this article, written as if for a professional audience but presented in a general publication, only exacerbates that public health challenge. As an editorial in Circulation, I'd have little argument with this piece. As an article in the "Personal Health" section of a mass-market website, it does a grave public disservice.

Take home message: know your audience and make sure your message is geared to be clear and accessible to them.


  1. "people who are, in the medical context, patients." This is so much nicer than how those same people in the power generation context are known as rate payors.

    Your rant makes me wonder if I am right to believe that drinking Scotch every day is good for you because I once heard a daily glass of red wine is good for, and since Scotch is much better than wine, a daily glass of Scotch must be awesome for one's health.

  2. I love this! As a rising med student and an aspiring medical journalist you raise a number of excellent points! I'll be sure to keep this in mind as i go forward in my career.

  3. Aw, c'mon, give HuffPo *some* credit - it can make for entertaining (albeit sometimes irritating) reading! Kind of like the National Enquirer . . . there's usually a teeny-tiny grain of truth in there somewhere, and if you're smarter than a 5th grader, it can be fun to look for....

  4. A more useful article would have been on diagnosing high blood pressure - in the UK, for example NICE has just issued provisional new guidance that ambulatory readings are better than relying on readings taken in physicians' offices (so avoiding the 'whitecoat' effect).

  5. It's all part of the movement to make us think that we have too much healthcare, we need less healthcare because we are going to get less healthcare. And we'll be better off ! Right!

  6. Crappy medical journalism, crappy science journalism, in fact journalism in general is pretty crappy in America, at least at the major outlets.


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