Every patient should know his maneuver
How to search for medical information on the Internet
Dmitry Solovyov, MednovostiFinding information about treatment on forums is one of the favorite activities of patients.
This affects both doctors who are forced to explain why colds cannot be treated with antibiotics, and patients who harm themselves and others in this way. How do you learn to distinguish reliable data from unverified and potentially dangerous ones? Is it worth trusting Wikipedia and how to assess the safety of a drug prescribed by a doctor? MedNovosti explains how to properly search for medical information on the Internet.
What is evidence-based medicineTo date, there are two different approaches in medicine, and one of them is gradually replacing the other.
For centuries, the main "engine" of medical science has been the achievements of individual scientists. At the same time, the opinion of one professor on any issue could be radically different from the opinion of his colleague from another university. Each of them taught medical students in their own way, and so medical schools were formed.
The situation began to change in the second half of the XX century. With the development of medical science, it became clear that the main source of reliable data is large international studies, and their use is the best way to prove the effectiveness and uselessness of a particular treatment method. This approach has been called "evidence-based medicine." It implies that only those methods that have been recognized as effective and safe according to research results are used in diagnosis and treatment. Based on scientific data, constantly updated recommendations for doctors are formed, where preferred diagnostic and therapy schemes are given. Contrary to popular misconception, evidence-based medicine does not exclude a doctor's personal opinion from the process of choosing treatment. It only says that if there is reliable data from large-scale studies on any issue, it will be optimal to use them.
Evidence-based medicine appeared in developed Western countries and was finally formed at the end of the XX century. For various reasons, the position of evidence-based medicine in Russia is not yet as strong as in Europe and the USA, so the bulk of Russian-language information about medicine is still based on outdated data. And if you need to understand the issue thoroughly, then, most likely, you cannot do without reading English-language articles.
It should be clarified that this instruction is not a call for self-medication at all: only a qualified specialist can correctly diagnose and prescribe treatment. But many patients have a need to learn more about their disease and the prescribed treatment than the doctor has time to tell them during the reception. This instruction is written for such "curious" patients.
Where to look for information about the diseaseA person who wants to learn more about the symptoms that disturb him, about the diagnosed disease or about the method of treatment prescribed by a doctor, can first turn to the encyclopedia sites.
Unfortunately, only the website adheres to the principles of evidence-based medicine in Russian Medspecial.ru . But much more information can be found in English (those who do not know it can use a machine translation system, for example, built into the Google Chrome browser: not bad, but better than nothing – VM). Among the most reputable sites: NHS.uk , Medscape, MedlinePlus, UpToDate. Some of them are focused only on patients (NHS.uk , MedlinePlus), others have sections with basic information in the public domain and more detailed information available by subscription (sometimes paid). Do not be surprised if you fail to detect vegetative vascular dystonia, osteochondrosis of the spine, dyscirculatory encephalopathy, etc. Such diseases are diagnosed only on the territory of the former Soviet Union. In the West, the symptoms corresponding to them may indicate a variety of pathologies.
In addition to encyclopedias, there are also recommendations for doctors. This information is regularly updated by specialized medical communities. Unfortunately, high-quality recommendations are more common in English, but in some cases they are also available in Russian (usually translated works). Thus, the website of the Russian Society of Cardiology published recommendations for the treatment of arterial hypertension, coronary heart disease, arrhythmias, and for the prevention of heart diseases. International recommendations for the treatment of bronchial asthma and chronic obstructive pulmonary disease are available in Russian, there are recommendations for the treatment of diabetes mellitus on the website of the Endocrinological Research Center, and recommendations for the treatment of bladder and prostate cancer on the portal of the Russian Society of Oncourologists. Many of the sections of these recommendations may be difficult to understand, but, for example, the sections on prevention are very useful, especially for patients.
If we are talking about a rare disease, then perhaps the best way to get the latest and reliable information about diagnosis, treatment, etc. is to study the articles on the website of the relevant patient organization. More trust, of course, in international associations.
As for Wikipedia, experts do not advise using it as the main source of materials about medicine. According to statistics, up to 9 out of 10 medical articles in the English version of Wikipedia contain inaccuracies and errors. And there is little chance that the situation is better in the Russian version.
How to evaluate the quality of a scientific articleThere are several reasons why a patient may be interested in scientific articles written, it would seem, only for doctors.
For example, the doctor prescribed treatment, which, according to the articles on the above sites, is not recommended. There is always some possibility that the doctor was not mistaken, but simply uses the data of a fresh study that has not yet managed to get into the recommendations. Or, for example, a person with a heart condition read in the media that "British scientists have found that two cups of coffee a day reduce the risk of heart attack by 90 percent." Is this really the case? Have the journalists misrepresented? To understand this, it is necessary to independently check the quality of the studies of interest.
Find an articleFinding a summary of a scientific article, knowing its authors and title, is usually not difficult.
To do this, you can use the GoogleScholar service or one of its specialized medical analogues (for example, PubMed). The vast majority of current medical articles are published in English, and a brief description of the study and its results are given in the Abstract section. Often the full text of an article costs quite a lot of money, so sites like sci-hub.org .
Evaluate the quality of the studyResearch can be organized in different ways.
It is believed that the most reliable results are in a double-blind placebo-controlled study. This means that such a study included, as a rule, several thousand people randomly distributed into two groups: one received treatment, the effectiveness of which had to be checked, and the second group did not receive or received treatment related to the "gold standard". The trick of such studies is that until they are completed, neither the patients themselves nor their doctors know which group they were assigned to, and whether they received the tested treatment method or a placebo. This allows you to achieve the highest reliability of the results. (A lot of useful information can be found on the Russian portal of clinical research CRA-Club – VM.)In accordance with the criteria of evidence–based medicine , such studies have the highest level of evidence - A.
Smaller–scale - level of evidence B and C, and the conclusion of a group of reputable experts – the lowest level D.
So, by what criteria should the study be evaluated?
– Who was it conducted on? It makes sense for patients to pay attention only to those studies that have been conducted on humans. Cell cultures, mice, rats, rabbits, dogs, monkeys have their own characteristics, and very often drugs that worked on an animal model turn out to be ineffective or even dangerous when used in humans.
– Is there a control group? If there is no group of people in the study who took a placebo or a drug that is currently the "gold standard", then there is no need to talk about the reliability of the results. Improvement in the condition of patients may be associated in this case with a natural recovery or fluctuation in the manifestations of symptoms.
– How many people took part in the study? In the USA, the drug will not be registered if the drug has not passed a study involving several thousand people. The number of participants is an important criterion that excludes the influence of extraneous factors on the result. For example, it could happen that there are more smokers in one group and fewer in the other. Then the effect of the pressure-lowering drug will be different. With a large sample, all these differences are erased.
– How many scientists conducted this study? There is much more trust in multicenter research: when not one surgeon operated in some specific way, but several surgeons around the world tried a new technology. This eliminates the risk of falsification of the result and stereotypical mistakes of the doctor.
– How authoritative is the journal in which the study was published? The status of scientific journals is expressed using the impact factor. This indicator, based on the citation of journal articles, changes every year, and its latest value can be found, for example, on the website citefactor.org (the leader of 2014 is The New England Journal of Medicine with a score of 54.42, but even an impact factor of more than 10 is already considered high). A journal without an impact factor should not be considered as a source.
But scientific articles are not only based on the scientists' own work with patients. Meta-analysis provides the most complete picture in evidence-based medicine. This is a study that evaluates the results of various works on the topic. The most authoritative source of meta–analyses is the Cochrane Library, created and maintained by the community of the same name. In it you can find an analysis of many studies on a variety of topics.
When studying scientific articles, it is better not to limit yourself to a brief content ("abstract"). For example, it states that "drug N increases the risk of heart attack by 50 percent." And it may give the impression that this medicine is very dangerous and should not be taken in any case. However, when reading the full text of the article, it may turn out that drug N increases the risk of heart attack from 2 cases per 100,000 patients to 3 cases per 100,000 patients. And at the same time, in more than half of them, it effectively fights another serious disease, improves the quality and life expectancy. Therefore, for a more complete understanding of the problem, it is important to read not texts in the media, not press releases, not abstracts, but the full texts of articles and evaluate them according to the specified criteria.
How to test a medicine for efficacy and safetySo, the doctor prescribed medications.
How to understand that these drugs have proven efficacy and safety?
Medicine or dietary supplementFirst of all, it is necessary to check whether these funds do not belong to biologically active additives.
You can find out this in the Register of Medicines. Dietary supplements are rarely effective, so it is important to check with your doctor why he made such an appointment or try to find out in the ways described above. If we are talking about a medicine, then the most reliable and complete instructions for it can be found in the State Register. (A beautiful and constantly updated graphical interactive database about dietary supplements – in the true meaning of the word, and not any motherwort-plus and alcoholic tinctures of hawthorn, which in Russia are issued for biologically active additives – is posted on the portal informationisbeautiful.net . There is also a detailed description of the analysis methodology and instructions for use, an opportunity to make sure on the basis of which scientific publications the presented conclusions are made, etc. – VM.)Efficiency and safety check
There are several groups of drugs that are not used practically anywhere except in the countries of the former Soviet Union.
These are immunomodulators, nootropics, hepatoprotectors, many antiviral drugs, etc. (A list of useless medicines and many other useful information can be found on the Citofarm – VM portal.) Such medicines have not been able to prove their effectiveness and safety in serious studies, but in Russia this is not an obstacle to the registration of the drug. This feature of the legislation is also connected with the fact that drugs that have "failed" research in the West come to our market. Therefore, the best way to check whether the effectiveness and safety of a drug has been proven is to check with the FDA (US Food and Drug Administration) database. FDA control is an unspoken standard for checking medicines all over the world: the requirements of this organization are among the strictest. Since drugs may have different names in different countries, you need to enter the name of the active substance in the search bar (it is in the instructions) in English.
Are the prescribed medications compatibleSometimes it happens that different doctors prescribe drugs to a patient, without taking into account the prescriptions of their colleagues.
Therefore, it is better for the patient to clarify whether the medications that he needs to take are compatible. It is also worth knowing whether it is possible to drink alcohol when taking these drugs. Unfortunately, the relevant proven services are available only in English. This is, in particular, Medscape, WebMD.com or Drugs.com . These sites have smartphone apps of the same name. In addition, the Epocrates application is popular.
Why understand medicine yourself if there are doctorsThere is a lot of reliable medical information on the Internet that needs to be learned to separate from outdated data and near-scientific rumors.
One of the best ways to do this is to check the information found for compliance with the principles of evidence–based medicine.
Most likely, it is rather pointless to study a meta-analysis on the incidence of SARS in order to recover from seasonal flu (although for a person interested in science, the idea is not so bad). However, when it comes to more serious diseases, a lot depends on understanding the need for treatment, knowledge of possible side effects, risks and benefits of various therapies. In this case, the patient can familiarize himself with the recommendations – at least in order to feel more confident during the next visit to the doctor. And when it comes to making important decisions, for example, about consent to surgery, sometimes it will be useful to read a couple of scientific articles.
"Understanding that a patient can ask the most unexpected question helps the doctor to be in good shape, makes him maintain knowledge about ongoing clinical trials and new methods of treatment, as well as why some drugs are ineffective in a particular situation, etc., – says doctor Vladimir Bogin, medical director of the charity movement "Together against cancer." – In addition, doctors are also people, so when a patient shakes the doctor once again and says: "Wait, you did such and such an analysis for me, but you didn't do such and such," it's even useful. I think that a patient who knows his medical history and asks questions is a patient who has a better chance of receiving more qualified medical care. An educated patient may not always be comfortable for a doctor and requires more of his time, but it's definitely good."
We thank Anton Vladimirovich Rodionov, cardiologist, Associate Professor of the Department of Faculty Therapy No. 1 of the Medical Faculty of the I. M. Sechenov First Moscow State Medical University, and the MasterCard press service for their help in preparing the material.
Portal "Eternal youth" http://vechnayamolodost.ru21.10.2014