How to survive the medical misinformation mess

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision‐making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision‐making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders.

[1]  Kim Walsh-Childers,et al.  One Step Forward, One Step Back: Changes in News Coverage of Medical Interventions , 2018, Health communication.

[2]  S. Brownlee,et al.  Addressing overuse and underuse around the world , 2017, The Lancet.

[3]  S. Brownlee,et al.  Evidence for overuse of medical services around the world , 2017, The Lancet.

[4]  G. Guyatt,et al.  Evidence for underuse of effective medical services around the world , 2017, The Lancet.

[5]  France Légaré,et al.  Decision aids for people facing health treatment or screening decisions. , 2017, The Cochrane database of systematic reviews.

[6]  Gary Schwitzer,et al.  Pollution of health news , 2017, British Medical Journal.

[7]  John P. A. Ioannidis,et al.  A manifesto for reproducible science , 2017, Nature Human Behaviour.

[8]  Chris Del Mar,et al.  Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review , 2017, JAMA internal medicine.

[9]  E. Frangou,et al.  Impact of a web-based tool (WebCONSORT) to improve the reporting of randomised trials: results of a randomised controlled trial , 2016, BMC Medicine.

[10]  John P A Ioannidis,et al.  The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. , 2016, The Milbank quarterly.

[11]  I. Tannock,et al.  Bias in reporting of randomised clinical trials in oncology. , 2016, European journal of cancer.

[12]  Wolfgang Greiner,et al.  Barriers and Strategies in Guideline Implementation—A Scoping Review , 2016, Healthcare.

[13]  John P. A. Ioannidis,et al.  Why Most Clinical Research Is Not Useful , 2016, PLoS medicine.

[14]  Amy B Smith,et al.  A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine. , 2016, The Journal of emergency medicine.

[15]  Gabriele Meyer,et al.  Effectiveness of training in evidence-based medicine skills for healthcare professionals: a systematic review , 2016, BMC Medical Education.

[16]  Karen R. Sepucha,et al.  Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital. , 2016, Health affairs.

[17]  G. Schwitzer.  How can journalists do a better job reporting on the principles of shared decision making , 2016 .

[18]  G. Schwitzer.  Trying to Drink from a Fire Hose: Too Much of the Wrong Kind of Health Care News. , 2015, Trends in pharmacological sciences.

[19]  T. Greenhalgh,et al.  Six ‘biases’ against patients and carers in evidence-based medicine , 2015, BMC Medicine.

[20]  John P. A. Ioannidis,et al.  How to Make More Published Research True , 2014, PLoS medicine.

[21]  G. Schwitzer.  A guide to reading health care news stories. , 2014, JAMA internal medicine.

[22]  M. Clarke,et al.  What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews , 2014, PloS one.

[23]  Angela Buchholz,et al.  Basing information on comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence: a quality dimension of the International Patient Decision Aid Standards , 2013, BMC Medical Informatics and Decision Making.

[24]  Glyn Elwyn,et al.  “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice , 2013, BMC Medical Informatics and Decision Making.

[25]  John P A Ioannidis,et al.  Ensuring the integrity of clinical practice guidelines: a tool for protecting patients , 2013, BMJ : British Medical Journal.

[26]  P. Yong,et al.  The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary , 2013 .

[27]  T. Shaneyfelt,et al.  In Guidelines We Cannot Trust: Comment on “Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards” , 2012 .

[28]  P. Mackowiak,et al.  Failure of clinical practice guidelines to meet institute of medicine standards: Two more decades of little, if any, progress. , 2012, Archives of internal medicine.

[29]  Glyn Elwyn,et al.  Stop the silent misdiagnosis: patients’ preferences matter , 2012, BMJ : British Medical Journal.

[30]  R. Thomson,et al.  Shared Decision Making: A Model for Clinical Practice , 2012, Journal of General Internal Medicine.

[31]  Ability of an information mastery curriculum to improve residents' skills and attitudes. , 2012, Family medicine.

[32]  T. Shaneyfelt.  In guidelines we cannot trust. , 2012, Archives of internal medicine.

[33]  T. Horsley,et al.  Teaching critical appraisal skills in healthcare settings. , 2011, The Cochrane database of systematic reviews.

[34]  K. Grimmer-Somers,et al.  Complex interventions required to comprehensively educate allied health practitioners on evidence-based practice , 2011, Advances in medical education and practice.

[35]  Ruth Gilbert,et al.  Evidence based medicine and the medical curriculum , 2008, BMJ : British Medical Journal.

[36]  D. Altman,et al.  Chapter 8: Assessing risk of bias in included studies , 2008 .

[37]  D. Altman,et al.  Assessing Risk of Bias in Included Studies , 2008 .

[38]  E. Veitch,et al.  False Hopes, Unwarranted Fears: The Trouble with Medical News Stories , 2008, PLoS medicine.

[39]  G. Flores-Mateo,et al.  Evidence based practice in postgraduate healthcare education: A systematic review , 2007, BMC Health Services Research.

[40]  L. G. Cleland,et al.  Selective COX-2 Inhibitors, Eicosanoid Synthesis and Clinical Outcomes: A Case Study of System Failure , 2007, Lipids.

[41]  MPH Somnath Saha MD,et al.  Journal reading habits of internists , 2007, Journal of General Internal Medicine.

[42]  B. Moulton,et al.  Rethinking Informed Consent: The Case for Shared Medical Decision-Making , 2006, American Journal of Law & Medicine.

[43]  P. Glasziou.  The EBM journal selection process: how to find the 1 in 400 valid and highly relevant new research articles , 2006, Evidence-based medicine.

[44]  Gregory Makoul,et al.  An integrative model of shared decision making in medical encounters. , 2006, Patient education and counseling.

[45]  Stephan D. Fihn,et al.  How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision Making in the Outpatient Setting , 1997, Journal of General Internal Medicine.

[46]  Faye Flintoff.  Time to get back to basics. , 2006, Nursing New Zealand.

[47]  J. Ioannidis.  Why Most Published Research Findings Are False , 2005, PLoS medicine.

[48]  B. Reeves,et al.  Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378] , 2004, BMC medical education.

[49]  Arri Coomarasamy,et al.  What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review , 2004, BMJ : British Medical Journal.

[50]  K. A. McKibbon,et al.  What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals? , 2004, BMC medicine.

[51]  R. McLeod,et al.  Teaching practicing surgeons critical appraisal skills with an Internet-based journal club: A randomized, controlled trial. , 2004, Surgery.

[52]  E. McGlynn,et al.  Profiling the quality of care in twelve communities: results from the CQI study. , 2004, Health affairs.

[53]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[54]  Richard Thomson,et al.  The importance of patient preferences in treatment decisions—challenges for doctors , 2003, BMJ : British Medical Journal.

[55]  R. Thomson,et al.  Decision aids for people facing health treatment or screening decisions. , 2003, The Cochrane database of systematic reviews.

[56]  T. Greenhalgh,et al.  Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine , 2002, BMJ : British Medical Journal.

[57]  J. Skinner,et al.  The Efficiency of Medicare , 2001 .

[58]  T Fahey,et al.  Shared decision making in hypertension: the impact of patient preferences on treatment choice. , 2001, Family practice.

[59]  W. Levinson,et al.  Informed decision making in outpatient practice: time to get back to basics. , 1999, JAMA.

[60]  Molla S. Donaldson,et al.  National Roundtable On Health Care Quality , 1999 .

[61]  M. Chassin,et al.  The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. , 1998, JAMA.

[62]  E. DeLong,et al.  Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial. , 1988, JAMA.