Critical thinking about health information - A challenge for professionals and consumers

Does your doctor often have the same take on things as the news? Perhaps it’s because a surprising amount of continuing medical education for doctors is written by the same people who bring us the news.

One of the leading providers of health information is WebMD. It also supplies financial technology and health information applications for large employers, the pharmaceutical industry, health plans and financial institutions. The WebMD Health Network reaches over 30 million online visitors a month through sites it owns and operates, which include WebMD Health, Medscape, MedicineNet, e-Medicine, e-Medicine Health, RxList and theheart.org.

Medscape, LLC offers accredited CME free to physicians, as well as continuing education credits free to nurses. WebMD offers and syndicates selected health news and information to consumers through its website and through contracted employer and insurer personal health managers.

This is the health news and information we most hear.

WebMD, WebMD Health, Medscape and e-Medicine are trademarks of Emdeon Corporation or its subsidiaries. Emdeon, a corporation with an over $3.8 billion market capitalization, says its mission is to “transform both the financial and clinical aspects of healthcare delivery.”

WebMD also provides personal health records to more than 90 large employers, pharmaceutical companies and health plans (Aetna, Cigna and Wellpoint). Information from insurer billing records, clinical laboratories and pharmacy benefit managers is entered automatically, along with any information employees volunteer about their health and lifestyle habits in health assessment questionnaires. WebMD was also awarded a government contract last summer in efforts to develop personal health records for the Centers for Medicare & Medicaid Services using its claims data. These personal health records are being used to identify and target people to receive alerts about certain health factors and reminders of screening and interventions, as well as measure compliance.

WebMD also has a Weight Loss Clinic and its obesity reference material is offered in collaboration with The Cleveland Clinic. The Cleveland Clinic Bariatric and Metabolic Institute, in addition to providing bariatric surgeries, has been a leader in promoting the obesity epidemic and the costs of obesity. You may have heard it hosted the Obesity Congress — Leading Clinicians and Industry to Explore Solutions to Emerging Obesity Epidemic — this past October featuring bariatric and weight loss interests. The keynote speech was given by former U.S. Surgeon General Richard H. Carmona, M.D., MPH, who called obesity “public enemy number one.”

Clearly, the information WebMD Health Networks provides has a significant influence throughout the healthcare system. Ideally, it is careful, unbiased and helpful for consumers and medical professionals and leads them to make the soundest health and clinical decisions. Let’s look at a couple of recent medical studies and compare the study results to the information WebMD provided to the public and the information Medscape gave healthcare providers.

Transfats and ovulatory infertility

As you’ll remember in a close look at this Harvard study, it found that the more total fat women ate, the less likely they were to have problems conceiving and that each quintele of higher fat intake was associated with an improved ability to conceive. Not only that, but the type of fat made no difference. Saturated, monounsaturated, total polyunsaturated, omega-3 and omega-6 fatty acids were not associated with ovulatory infertility. Only an untenable association was found between transfats and ovulatory factors, only one of numerous factors in a couple’s infertility.

The WebMD review for the public, “Study Shows Latest Nutrition Bad Guy Can More Than Double Infertility Risk,” was released on January 12th. The Medscape article course for doctors, “Trans Fatty Acid Intake Increases Risk for Ovulatory Infertility,” came out ten days later.

For CME credit, doctors were given these Pearls for Practice to learn from this study:

* “Ovulatory function can be adversely affected by intake of trans unsaturated fatty acids, by the down-regulation of PPAR-gamma expression, which is associated with a greater risk for insulin resistance, type 2 diabetes, and increased inflammatory markers.” [However, this study was only looking for correlations and didn’t conduct any research into such speculations.]

* “Consuming trans unsaturated fatty acids instead of carbohydrates, monounsaturated fatty acids, or n-6 polyunsaturated fatty acids is associated with a greater risk for ovulatory infertility.” [However, not explained, the relative risk they found was so untenable it couldn’t be separated from random chance or statistic error.]

Red meat and breast cancer

You may remember, that this Nurses Health Study was unable to find any measurable correlation between red meat intake and premenopausal breast cancers. After doing a secondary statistical analysis the only thing they could find was an untenable correlation between the highest red meat consumption and hormone receptor positive breast cancers, except not all red meat, only if it wasn’t eaten in a sandwich or as hotdogs and bacon. The relative risk associated with red meat was in reality so insignificant, even if it wasn’t a statistic error or random chance finding, that it would account for a difference in actual risk of only 0.15% over twelve years.

The WebMD article for consumers was titled “Red Meat May Up Breast Cancer Risk” and told women that “Eating more than one serving of red meat every day may double her risk of developing some forms of breast cancer.” Medscape provided CME to doctors and CE for nurses with a review article titled “Red Meat Intake Increases Risk for Breast Cancer in Premenopausal Women.”

Its Pearl for Practice was: “Red meat intake is strongly associated with ER+/PR+ breast cancer during 12 years of follow-up.”

Obesity and prostate cancer death

As was reviewed here, this study in a journal of the American Cancer Society found no association between the men’s body mass index or the men’s change in weight and their overall risk for prostate cancer. In fact, the obese men had about 10% lower overall incidence of prostate cancers and the risk steadily dropped as BMIs increased. And the men who gained 10 pounds had a 20% lower risk for the most deadly, metastatic forms of cancer, with the men gaining 20 pounds having a lower risk than the men who hadn’t gained an ounce.

In contrast, WebMD told consumers “Weight Loss Cuts Prostate Cancer Risk.” And Medscape reported to healthcare professionals that “Men who lose weight may be less likely to get aggressive prostate cancer, while obesity may increase a man's risk....Men who lose weight may reduce their risk of prostate cancer.”

This exercise isn’t to imply a conspiracy theory, but to highlight how important it is for all of us to look critically at all health information we hear in the news or online, regardless of the source. Even when it is accredited for our continued medical education, provided by our employer or health plan, or referenced by governmental health agencies.

© 2007 Sandy Szwarc