Reading between the lines - critically appraising the press

This year, I have been introduced to "critically appraising", a vital skill which enables you to look at a research article, pick out its strengths and weaknesses and decide how relevant and reliable it is.  At first, I admit I was sceptical - how can I, a third year pharmacy student, possibly criticise a piece of published research?  However, I now realise how important it is to be able to do this well.  When carefully read, an article can throw up many questions for the reader - for example, does the fact the research team is funded by the manufacturers of the new treatment mean the results could be biased? Is the method reproducible?  Does this result contradict with the results of similar trials?  The answers to these (and many other!) questions allow the quality of the research to be assessed, and help the reader decide if it can be trusted or if it is relevant to their area of interest.  It's something I had been doing unconsciously on a basic level, but since being introduced to it I have realised how important it is to do this well with all articles.  This blog will look at critically appraising health related newspaper articles, and why this is important.

As future/qualified health professionals, we are unlikely to look for information in newspapers.  However, the general public is likely to get a lot of their health related updates from the press, especially when newspapers report on "scary" conditions like cancer or diabetes.  Large, front page headlines mean that most people will catch sight of them, and may wonder whether the research being reported on is relevant to them.   If we are asked, it is up to us to get the scientific message from such articles and translate them to our patient.

We've all seen and heard the headlines - for example, how a vitamin supplement has been shown to increase the chances of getting pregnant, how a certain food can increase cancer risk, and no doubt those that have worked in community pharmacy in particular have been asked for advise relating to something seen in a magazine or newspaper.  In such cases, the article needs briefly critically appraising - it may say the study is to be published in a medical journal, but don't let that put you off!  Consider the bias - does the article and research refer to a specific manufacturer who would benefit from good results?  Did this company fund the research?   Does the article appear to advertise the product at all, for example with pictures?  This may seem cynical, but bias is important to consider as researchers involved with the manufacturer may present the results to look better than independent researchers would.  Next, consider the trial - how many people were involved?  Was there a control group?  What conditions did the participants need to fulfil? Were the participants even human, or is the research still in such early stages that animals are being used? Do the results come from in-vitro lab tests and not in-vivo human body tests? If it is a small trial, the results may not be representative of the population, and if the research hasn't even got to human trials yet there is still a long way to go - it may not even end up being manufactured or recommended.   Look at any method details – does it seem fair and thorough?  Does it look like something is missing from the results?  Could the results be read in a different way?  Make sure you read the whole article to get as much information as possible, and if possible/necessary try to get hold of the original research article and appraise this too.  This is just a brief idea of things that should be considered when reading an article – many more may come to light as it is read.

Then decide how to advise the patient – depending on the article, different depths of appraisal may be necessary.  For example, unless there is a specific reason why the patient shouldn't take a vitamin tablet it is unlikely to harm them and so they may want to take it even if there is very little evidence for it working.  However, wanting to cut something out of their diet to decrease their cancer risk may require more counselling, as the evidence may not be that robust and the patient still needs to make sure they are still getting all the necessary components from their food.  They would also need to know any proven risks associated with cutting a certain food out.  Another example is that they may want to know why they haven't been offered latest "wonder drug" for their condition, and this may require more in-depth research, explanation and reasoning.  All in all, don't just read the headlines and scan the article - read between the lines and gain a good understanding of it, to help your patients make informed decisions.