Medical studies: Facts of the matter

* Lancet, the reputed medical journal retracted the report after serious concerns were raised about the data used in the study

* The internet has made research reports accessible to the lay reader — which can clearly be both beneficial and harmful

To believe or not believe — that is the question. Can the novel coronavirus spread from those who are infected but show no symptoms of it? Does the drug hydroxychloroquine actually help prevent and treat Covid-19? The novel coronavirus pandemic has thrown up a question that refuses to die down: Just how authentic are the studies that people are being flooded with?

Conflicting results from different medical studies not only spark controversy, but also lead to confusion and uncertainty. And not just among laypeople.

Some weeks ago, the World Health Organization (WHO) called off its trial on hydroxychloroquine after a study said it could lead to heart problems and even deaths. The study was published in Lancet . But last week the reputed medical journal retracted the report after serious concerns were raised about the data used in the study. The WHO has now resumed the trial.

Not just about the pandemic, scores of conflicting studies have kicked up controversies on a spectrum of subjects in recent times. Just when people had got used to looking at eggs as a possible source of heart disease, a 2016 study published in the American Journal of Clinical Nutrition indicated that there was nothing wrong with eating an egg a day as far as the heart was concerned. After being warned about the effects of cholesterol for years, new research pooh-poohed such concerns. Green tea was being held up as an elixir when a study claimed it could be associated with an increased risk of type 2 diabetes.

There was a time when studies were confined to medical or science journals or, at best, the science pages of newspapers. But the internet has made research reports accessible to the lay reader — which can clearly be both beneficial and harmful.

“These days, a lot of information is available in the public health domain,” agrees Nirmal Kumar Ganguly, former director general of the Indian Council of Medical Research (ICMR). Adds Shantanu Panja, consultant ENT specialist at Apollo Gleneagles Hospital, Kolkata: “Research articles in medical journals are not meant for common people as there can be finer nuances, viewpoints and caveats to it which are subject to academic discussion.”

Conflicting findings may lead to half-baked knowledge, Sutapa Bandyopadhyay Neogi, a professor at the New Delhi-based International Institute of Health Management Research, points out. “People usually agree to choose what they wish to follow,” she says.

Take the example of vitamin D. Most know that it is essential for good health. But a 2016 study published in the Journal of Clinical Outcomes Management suggested that taking high doses of vitamin D supplements could increase the risk of falls in older adults.

Rahuldeb Sarkar, a respiratory medicine consultant at the Medway Maritime Hospital, Kent, UK, believes that professionals should also be held partly responsible for the conflicting information.

“We fail to synthesise the information from various sources and then communicate to the public in a way they can understand,” he notes.

Behind most such controversies are “incomplete studies” and projection of the results without a proper follow-up, adds Rajamahendran Rajendran, consultant surgical gastroenterologist, RRM Gastro Surgical and Research Centre, Villupuram, Tamil Nadu.

However, as Amar Jesani, the editor of Indian Journal of Medical Ethics , explains, science is not faith; its basis is a rational, evidence-centric explanation. People with a scientific temperament would give space to conflicting findings, but seek advice from their physicians whom they trust, he says. Ganguly urges people to rely on academies and societies “which are not influenced by a conflict of interest”.

However, in a disease such as Covid-19, about which very little is known, information from even the most trusted bodies can be confusing. Earlier this week, the media reported a senior WHO official as saying that asymptomatic transmission of Covid-19 was rare. A day later, the official said, “I think that’s a misunderstanding to state that asymptomatic transmission globally is very rare.”

Jesani notes that the problem is not simply the reporting of conflicting findings in the media but the fact that companies with vested interests may gain out of such reports. “When people get influenced by such biased reporting, companies make a profit while people may sometimes harm themselves by using such advice without guidance.”

But a question often asked is who studies the studies. How responsible are the journals that publish them? Most reputed organisations have a system of scrutiny in place. There is a provision for people to raise concerns about a study in many top journals. On the basis of such complaints, the journal concerned issues an “expression of concern” regarding the study findings, and its authors are asked to clarify doubts. If they fail to do so, the paper is retracted.

The Royal College of Surgeons of England states that a research paper seeking to be published in a medical journal has to add something to the existing literature. These research papers go through peer review by those who are usually counted as experts in the subject. “Most journals only accept around a quarter of papers and more prestigious journals accept even fewer,” it says in a statement.

Sarkar suggests — only half in jest — that professionals such as doctors act as allegorical cooks. They should pick up the right ingredients and discard the redundant information and then present the end product for consumption by readers, he adds. And that, certainly, would be easier to digest.

Sanjeet Bagcchi is a physician and an independent writer based in Kolkata.

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