Many of us, armed with good intentions to educate ourselves about good health practices, turn to health sites on the internet, magazines and other media forms for answers. It is all too easy to end up adrift in this vast sea of content.
Having embarked on our navigation, not much time passes before encountering the ubiquitous daily news scoops that invariably begin with “A new study shows …”. Rather than shedding light on a public health concern, such stories are more likely to leave you as much in the dark as you were previously.
How can we differentiate credible health information from the silver-bullet gimmicks peddled by profit-driven hacks? How can we hone in on health info that is relevant to our individual circumstances and needs?
- Be sceptical
- Don’t always rely on the health experts
- Evaluate the evidence and know how to apply it to you and your situation
Smart Health Choices
Smart Health Choices, co-authored by Professor Les Irwig and Judy Irwig, Lyndal Trevana and Melissa Sweet, was written in the interest of helping consumers as well as practitioners to develop skills to assess health advice so as to improve the quality of their care. The book is available as a free download here.
Whether we are simply wanting to lead a healthier life, or perhaps struggling to come to terms with an illness, annoying symptoms, injury or a diagnoses we don’t agree with, the book is intended as a handy guide to making sense of any health assessment we may receive. It helps you to recognise what counts as sound evidence and to identify and reject flimsier advice which is likely to be harmful.
Smart Health Choices promotes the idea of people being proactive participants in their own health care, in partnership with their healthcare professionals – this includes physicians, naturopaths, dentists, counsellors. The book emphasises the importance of moving away from the old paradigm of uncritically assenting to whatever medical treatments the “heath experts” dispense to us.
Apart from seeking out reliable health information, Irwig and co. also encourage us to think about our own preferences in working out whether a particular medical treatment is right for us, in terms of potential risks and benefits.
Five questions in your health choice toolkit
The book’s message boils down to a basic toolkit of five questions to address in making better health choices. In the following order, they are:
- What will happen if I wait and watch?
- What are my test or treatment options?
- What are the benefits and harms of these options?
- What do the benefits and harms weigh up for “my health”?
- Do I have enough information to make a choice?
No —–> Get the necessary information and back to the relevant question
Yes —-> Put the best option into action
What are randomised controlled trials?
In terms of evaluating advice presented in published research and other media, the book argues that you can’t go past randomised controlled trials (RCTs) as far as settling on a solid basis for evidence.
RCTs involve randomly allocating patients to either the active treatment or a comparison (control) group. This provides the all-important comparison since knowing that a medical treatment leads to a 50 per cent recovery rate is not much help if you don’t know how this compares with alternative treatments or not treatment at all.
Randomly allocating patients to the comparison group aims to reduce the chance of such biases occurring. It means that the groups start out with an equal chance of event occurring during the study, whether disease recurrence, side effects from treatment or symptom relief. In other words, it increases the likelihood that any differences in outcome between the groups are caused by the test or treatment and not other factors.
Features of a good randomised controlled trial:
- A control group receiving the best existing treatment (or placebo if there is no treatment)
- Randomly allocated people to the intervention and control groups
- Keeps practitioners and study participants unaware as to who is in which group
- Follows up on everyone who was randomized to the various groups at the start of the trial
Once you understand the basis of a randomised controlled trial and why it provides superior evidence as to the effectiveness of a treatment, the next step is to know where to look for RCT findings.
Links to systematic reviews of RCTs
The Cochrane Collaboration is an international movement of thousands of professionals and consumers who produce a regularly updated electronic library of the best available evidence about the effects of interventions. It contains thousands of systematic reviews on a wide range of health treatment options. The abstracts or summaries of the reviews are available globally free of charge.
Informed Health Online originated from the Cochrane Collaboration and is now funded by the German government. It contains plain language summaries of many systematic reviews from the Cochrane Library.
The authors of the book recommend seeking out systematic reviews of RCTs – that is, reviews that identify all the RCTs on a particular topic, pooling all the results into a large analysis and assessing whether there is variability in effects in different sorts of patients.
If you find a review that does not have these specific features, it is unlikely to be a systematic and thus more reliable review of the trialed results.