Saturday, June 11, 2005

Checking The Validity of Medical Claims

Persons who use the Internet are likely to encounter various claims about medical topics.  Indeed, the Internet is a powerful and useful tool for obtaining medical information.  Probably anyone reading this knows, though, that there is a lot of utter nonsense out there.  Some of it is not just wrong, but dangerously wrong.  In this post, I examine one example of a medical claim (Tom Cruise's inept remarks about postpartum depression), then use the example to illustrate how to use the Internet to find valid medical information.

In a recent interview on Access Hollywood, actor Tom Cruise criticized his colleague, Brooke Shields, about her use of paroxetine to treat postpartum depression:  
Brooke Shields, with whom Tom co-starred in "Endless Love," recently wrote a book about her own bout with post-partum depression following the birth of her daughter, Rowan. She wrote about the drug treatment that helped her through it.

"Look at her life," counters Tom. "Here is a woman - and I care about Brooke Shields because I think she is incredibly talented - (but) you look at where has her career gone? It has helped her. When someone says it has helped them, it is to cope. It didn't cure anything. There is no science. There is nothing that can cure them whatsoever." [...]

Tom went on to say, "What you can do with vitamins and exercise to help a woman through that, to help someone through that, all right. She doesn't know what these drugs are and for her to promote it is irresponsible. And I wish her well in life. (But) it is irresponsible to do that."
This comment generated a lot of criticism, as illustrated here.  Obviously, people get pretty worked up about some of these topics.  People who put things on the Internet have all kinds of agendas, and it is not always obvious what their agenda is.  So how can a person figure out which claims are valid, and which are not?  Here are some tips:

1. Consider the source.  Although it sometimes is hard to verify the authenticity of a webpage, some sources clearly are authoritative.  The National Library of Medicine, National Institutes of Health, and the Centers for Disease Control and Prevention often are good starting places for medical information.  Access Hollywood is not.  Look at the credentials of the author, if possible.

Would you take medical advice from this man?

2.  Search for more information.  Search engines such as Google can find a lot of information, but they cannot verify that the sources are any good.  Googling "Tom Cruise postpartum" turns up a lot of commentary, mostly negative.  This is a clue, but is not definitive.
I ask you this, sir: Since when are you a woman? When was the last time you gave birth? When was the last time you were married to a woman who gave birth? You ranting, cult-following lunatic, the answer to those questions, in case you didn't notice, was NEVER.

I feel incredibly sorry for women who have to deal with this condition. Small-minded people without any first-hand knowledge of the situation cannot possibly offer their two cents. I hope women continue to get treatment for this and don't take some male actor's opinions to heart.
3. Search again for more information: this time, use a better search tool.  The best, by far, is Medline.  The National Library of Medicine offers free Medline searching here.  If you search for "postpartum depression" you get 1,284 hits.  If you search for "vitamins" you get 171,562 hits.  If you search for "postpartum depression vitamins" you get 4 hits.  Not a single one of those 4 contains any recommendation for treating postpartum depression with vitamins.  If you search for "postpartum depression exercise" you do a little better: there are 10 hits.  One of them, The role of alternative medicine in treating postnatal depression, was published in Complimentary Therapies in Nursing & Midwifery.  This shows that Medline does not leave out alternative sources of information.  As it happens, nurse midwives think women should exercise after childbirth, but even midwives do not seem to put any stock in using vitamins to treat postpartum depression.  

4. Evaluate specific claims: Vague statements often sound good, but can be difficult to test for validity.  Another quote from Cruise provides some material for the method of testing specific claims:
"When you talk about postpartum, you can take people today, women, and what you do is you use vitamins. There is a hormonal thing that is going on, scientifically, you can prove that. But when you talk about emotional, chemical imbalances in people, there is no science behind that. You can use vitamins to help a woman through those things."
We've already looked at the vitamin question, and found no scientific evidence to support his claims.  But it is hard to prove something by not finding contrary evidence.  However, the claim, that there is no science behind the notion of chemical imbalances, can be shown false by finding evidence of chemical imbalances.  A Medline search on the string "biological basis of depression" turns up 339 hits.  Googling "brain imaging mood disorders" turns up this:

Mr. Cruise, your mission, should you decide to accept it, is to explain how these images came about in the absence of a chemical imbalance.

In summary, it is not only possible, but actually quite easy, to find reliable information on medical topics.  Just stay away from experts who jump on sofas.

(Note: The Rest of the Story/Corpus Callosum has moved. Visit the new site here.)
E-mail a link that points to this post:

Another good source for the layman (like me, a lowly engineer) is www.medlineplus.gov. It is a search engine that goes to reliable websites that were looked at by a human who knows what they are doing.

Some folks mistake expertise in one field for competence in what at most is a marginally related field.

A big "For instance"... there are people who for some reason feel they must test themselves (or children) for mercury. THEN they decide to chelate for mercury. One of the biggest proponents is discussed by the Autism-Diva:
and these are the qualifications of the "Andy Cutler" who is referenced in that blog, from his own website:
"Andrew Cutler is a health care consultant in the Seattle area. He has a PhD in chemistry from Princeton, a BS in physics from the University of California, is a patent agent and a registered professional chemical engineer. His research has led to a number of publications in chemistry, chemical engineering and space related journals."

People are getting medical advice from a chemical engineer who THINKS he knows some biochemistry.

He is even scarier than Tom Cruise.
Your understanding is nearly as superficial as Mr. Cruise's. While the data do show that neurotransmitter concentration seem to be a function of depressed state, correlation is not causation. The full data, which do not show up in a blithe web search, also show that "fixing" the neurotransmitter levels has zero immediate effect on depression. This is in stark contrast to a true chemical imbalance disorder, such as loss of the sense of smell due to zinc deficiency, where administration of zinc fixes the problem quickly and dramatically.

In general, the therapeutic effects of antidepressants (as well as their side effects) take weeks or months to show up. That shows rather conclusively that depression involves large multi-part control systems that are slow to change. The best current guess is that it results from the absence of entire nerve cells in a part of the brain called the hippocampus, and that antidepressants trick the cells into being born more rapidly. Conversely, destroying those cells with x-rays in mice causes the mouse version of depression regardless of neurotransmitter levels.

Furthermore, Mr. Cruise is absolutely right that vitamins are an antidepressant drug. That's because of the placebo effect: if a depressed person believes that something might help them, there is a substantial chance that it will.
HCN makes good point, that sources that appear authoritative may not be. They may have a lot of information to offer, and it may be that most of it is correct, while one or two key points are wacko. The Telepath inadvertently demonstrates this principle.

A little knowledge can be dangerous!

I agree with you. And I'd like to think my post, which you linked to in yours, was as even as possible on the subject of antidepressants. They worked for me, and whether it was because of a placebo effect or a true impact on a chemical imbalance, I don't care. What matters is that I got my life back and have a wonderful, fulfilling relationship with my son. What bothers me about Cruise is that he categorically denied the effectiveness or need for these drugs. My mother, who happens to be a social worker at the Mississippi State Mental Hospital, pointed out how hard it is already for she and her colleagues to get people suffering from schizophrenia, for example, to take their medication. And after such comments as Mr. Cruise's, she worries that struggle could become even greater.
I want to know why all media sources have not entered into the education arena to provide postpartum information on the side of prevention. All of society needs to learn what is known versus what is still not researched and known.

This would be a perfect time for all of us to do some research and pass on to women what we do know about each maternal mood disorder -not just postpartum depression.

The media continues to treat the general public as if it had a grammar school education and as a result providing preventative information is avoided at all costs. Even though most studies can be altered depending upon the variables used, to share past, proven, scientific studies will help to educate the at risk factors concerning both the psychological and physiological (hormonal imbalances) aspects post childbirth. After reading, The New Mother Syndrome by Carol Dix, 1985, published with Doubleday, I found out where the initial problems began.

The whole truth and nothing but, lies with the American Psychological Association's, APA, long ago split with the American Medical Association, AMA, over their misinterpretation of these studies when first released by the AMA. The APA eventually decided to omit the very term "postpartum" from the Diagnosis Code Book, DSM, used by all doctors when properly diagnosing a patient. Without a diagnosis code, postpartum treatment for all became compromised. For the woman who wanted nothing more than to have a positive mothering experience she was left out in the cold to fight the demons alone.

The twenty years of DSM omission, from 1972 to 1992 also gave us medical students who are now the doctors of today who still do not know how to adequately help new mothers found to be in a state of depression and/or out of touch with reality like Andrea Yates.

What causes women to fail in motherhood such as Debra Gindorf, Paula-Blew Sims, and Tammy Eveans -who have been incarcerated for over twenty years at Dwight Correctional Facility in Illinois? Well, I'm ready to tell all of the world! Each one of us was failed by society not protecting us from having been abused by those entrusted to our care. The memories are so horrible they are housed in the sub-conscious and the conscious mind is not privy to that knowledge. When we have our babies our bodies remember the abuse, but our minds are in constant battle between two aspects of our psyche. Additionally I was brought up in an alcoholic home and as such took on the guilt and shame from what went on behind closed doors. Privacy issues are furthering the non-protection of children in such situations. Check out PSI's latest Conference details to learn more.

It is any wonder that women like Brooke Shields have to become their own advocate; Brooke was very lucky to find a doctor that at least knew something that could be done to relieve her depressive symptoms, and motherly fear. Most women are not so fortunate!

My two children were born in 1972 and 1977 when the window of postpartum depression/psychosis understanding was completely closed off. As a result, I suffered for three and a quarter years after giving birth to my daughter. No one medicine given to me worked to change the unconnected negative thoughts, and it was a miracle that both my daughter and I survived to work on a manuscript to share what happened and let all of society know that there is no one answer or medicine that works for every mother.

The important issue to further is to demand all media to provide "R.E.A.P. Recognition, Education, Awareness, Prevention" (Copyrighted Material, March '05)for all future generations!

My daughter has a master's in clinical psychology and is on her way this fall toward a doctorate. She and I just published our first article together with Postpartum Support International, PSI. PSI's web site is www.postpartum.net and provides continued support, education and contacts who list with them for mothers world-wide.

I have learned from my many negative experiences in life to look for the positive in every negative situation - therefore, any attention to the postpartum controversy is a welcome boost to educate those who are part of the problem. Research is desperately needed and if everyone were to write or email a letter to their legislators to request immediate passage of Bill H.R. 1940, The Melanie Blocker Stokes Postpartum Research and Care Act - all of society would be better off, including Tom Cruise and Brooke Shields.
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