Learning to look at the evidence (2)

Yet, to make things even more confusing for the layperson, there do exist doctors who take advantage. Some peddle unproven therapies against COVID-19. There are also persons masquerading as medical professionals and spreading false information and COVID-19 conspiracy theories. Filipinos continue to fall prey to such manipulations, praising these individuals as proclaimers of unpopular truths, underdogs going up against the greedy medical community/big pharma/evil government agencies. Given these factors, what can guide the lay person in dissecting truth and fiction? To begin with, the reader must seek facts, whether or not they confirm or support previous convictions. In the pursuit of evidence-based medicine (EBM), we can’t pick and choose stories to support our claims without quality evidence. We also cannot believe everything proclaimed to be true by popular personalities, which is a practice called “eminence-based” medicine. While prominent medical professionals may have knowledge on scientific matters, their opinions are not valid unless based on sound evidence. Without evidence, all is hearsay, speculation, anecdotes.

Also, when one comes across posts on proposed treatments or COVID-19 prevention, it is useful to see what health authorities have to say. If one has lost trust in local agencies — an understandable situation — international health authorities can provide further information, unburdened by confusion from local politics. A search through Google Scholar, the most lay-friendly search engine for scientific articles, can also point one in a better direction. One may also use PubMed, the search engine for the bibliographic databases of MEDLINE, or the Medical Literature Analysis and Retrieval System. In looking through such databases, one should keep in mind the hierarchy of evidence discussed in last week’s column: that large scale, systematically done trials are powerful, and reports about individual patients or small numbers are less so. I am not writing this to make EBM scholars out of our readers, since any such quick guide would be incomplete. However I wish to show avenues for information gathering when the reader can no longer decide whom to trust among social media networks and news outlets. I am also illustrating how medical professionals themselves often go about verifying claims about supposed treatments. The reader must also keep in mind that sometimes the evidence to support or refute claims simply does not yet exist. The past year and a half has been a moment of vast scientific inquiry, and information continues to evolve. For instance, the pandemic started a worldwide practice of “overzealous cleaning,” like households wiping down their groceries. More recent advisories suggest that the risk of surface transmission is really minuscule, and that the scientific basis for aggressive surface cleaning is very slim. What we know about the virus continues to grow. What continues to be supported by evidence is advice repeated by medical professionals from the beginning: that we should wear masks appropriately; that we should avoid crowded areas; that taking off masks to eat in office pantries and in restaurants is a common source of transmission; that physical distance is our friend; that timely contact tracing with quarantine works.

Moreover, the reader must remember that the practice of medicine is a matter of calculating risk versus benefit. No drug is absolutely free of adverse effects, in every population, at any given time. However, the strong call for vaccination among medical communities exists because the vaccines have been proven safe and effective in the vast majority of their indicated populations, and because the risk of contracting severe COVID-19 continues to be a threat much heavier and riskier than known adverse effects in the appropriately selected patients.

All of this confusion about truth and science underscores a failure on the part of government to deliver information that is free from mixed messaging, straightforward and supported by the best available scientific evidence. It should not really be the job of the lay public, especially those struggling with literacy and access to health information, to dive through PubMed to figure things out on their own. It should be part of our government’s crisis response to consistently and clearly relay evidence-based policies. It is also part of its responsibility to strengthen public trust in its agencies, such that this trust is not so easily swayed by every snake oil peddler with a Facebook following. The erosion of public trust is more evident than ever, and it will take a long time to recover.

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