3. Good Science vs. Bad Science – Where can we find reliable health information?
The majority of us nowadays google health updates, news, seeking a treatment or specialists’ recommendations in relation to nutritional, natural or medical products, diseases like Covid and its treatments, advances or medical equipment. You may receive information also over social media or hear something from a family member, friend or neighbor. You may watch a youtuber or a blogger brainwashing her audience on how fantastic or how awful this experience or that. You might be a fan of homeopathy and websites advocating natural remedies.
I have a duty to tell you that all of this have never been a subject of scientific validation. What benefits somebody pose a risk to another and vice versa. Science has its extremely reliable way of testing to explore the good and bad for every one by robustly experimenting on huge numbers of people under strict neutral conditions.
The scientific progress over the past 50 years did not only embrace development and innovation of content. More importantly it comprised robust quality assurance of the methods this scientific content has been practiced and whether the outcomes are conscientiously and accurately sound. Like all other fields of professions, quality guarantee systems have been overwhelmingly of utmost importance to make sure the advances are competent with the current and future levels of human welfare. In healthcare, this concept has become even more complex due to its nature guarding the safety and wellbeing of people. If wrong estimates, personal interests and bias are allowed into Medicine, the cost would be millions of lives, no civilized community can afford such price.
In brief, what we call “Evidence Based Medicine” has a hierarchy. Single expert opinion is at the base of this hierarchy, while a consensus of such experts ranks higher.
An unpublished study which hasn’t been reviewed by a peer in the field is out of the window, better in the dustbin.
A study of a medicine in the lab with some good results, but hasn’t been tried on humans could be promising, but still not a sound scientific evidence.
A study on a huge number of patients already peer reviewed and published in a well-recognized journal mounts to a good evidence but still not the best.
If the study includes observations over a period of time is better.
A clinical trial comparing the medicine to another with neutralization of all biasing factors is stronger.
If we can blind the practitioners and the researchers, so that they do not know which medicine was tried on which patients, this ranks very high (Double blind randomized controlled trial).
When the evidence from such study outweighs similar studies as per experts’ systematic review, then we have achieved the strongest possible evidence. This is good science.
Yet, still the world is not that ideal and rosy in the field.
Certainly you cannot look for the evidence and its strength yourself. Most doctors can not as well, either because they are not trained to do it or due to the inability to follow all the new evidence. The number of medical studies published in well-recognized journal exceeds 125000 articles annually. Every 5 minutes, a new article is published in a well-recognized journal, let alone the more abundant second and third degree journals in addition to pseudoscience journals. By the time we sleep at night and wake up nest morning, 100 new articles would have been published.
Is it all good science?
Definitely not. If we are optimistic, 85% would be bad science. What is applicable to our everyday healthcare is a minority of the 15% good science.
Most of what you find in google, receive on social media, read in the news, and hear from friends and family is either bad science, pseudoscience or no science at all. We have not discussed yet the dubious funding of research by pharmaceutical companies (directly and indirectly) to twist the research serving their own interests.
Some of the study results you encounter in general media are there only, because the researchers have good connections with the media or due to their positions in authoritative bodies. Frequently, it has not anything to do with credibility of the research.
What should we do then?
Internet wise, you should only rely on a handful of trustworthy resources, which are very unlikely to be biased by financial interests, trends, ideology or unqualified administrators. Usually websites of scientific societies, patient groups and charity organizations are duly respectable in that aspect.
Practice wise, your trusted doctor is the best to consult. A doctor who listens and talks to you long enough to find out whether she is honest, clever, qualified and up to date. Whether your doctor is going to refer you or treat you himself, he will be able to follow you up and show adequate care and empathy. Doctors of this quality belong to highly specialized medical societies which review and update the strongest evidence regularly and update all members with the top guidelines and protocols.
4. March of the Virus
This chart compares the R0 of different viruses. R0 is the number of contacts contracting infection from the original case on average. So, it is a measure of the power of the virus to infect. In other words, it reflects how fast and broad the virus can spread. As you can see, the measles is the worst (Thanks to vaccination saving millions every year). The laziest is the MERS (Fortunate as well because it is very deadly with a mortality rate of 30%).
Covid 19 or in more scientific term: SARS-COV-2 stands as average. Its R0 is 2.5; each case transmits the infection to 2-3 contacts in average. It is comparable to Ebola, less infective than SARS and more infective than seasonal flu.
The main route for transmission of infection for Covid 19 (like other respiratory infections) is direct contact (less than 1.5 meters distance) with a coughing or sneezing carrier of the virus. Also, loud speaking of the infected person can spread the infection to people in close contact. The possibility of transmission is directly proportional to the duration of contact. More details on this issue will come up in later articles. Whether the transmission is airborne or not is still debatable.
An interesting story related to that has been published in “Emerging infectious diseases”, the official journal of the Chinese centers for disease control and prevention:
Mid-April 2020, a stroke patient at a local hospital in the Chinese province of Heilongjiang was diagnosed to have covid19. This was surprising, as the area was declared Covid free on the 11th of March. Two sons of the patient were found to test positive as well.
A comprehensive screening was done for all the hospital patients and staff. Twenty (20) other people tested positive, but it did not stop there. This patient has been to another hospital previous to admission to this hospital, between the 2nd and the 6th of April. When tested, 28 more people were Covid 19 positive. The stroke patient has attended a party before falling sick, specifically on the 29th of March. Swabs were done for all guests of the party. 19 were infected. Among the guests, a lady and her friend visited earlier the lady’s daughter 10 days before the party. This daughter also caught the infection.
On reviewing the information of the residents where the daughter lives, it was discovered that one of the residents returned from USA the same day the lady visited her daughter.
The traveler lives one level above the daughter. The traveler had no symptoms at all and tested negative on airport swab. This was a dilemma. To confuse the investigators more, she was found to be adhering to the quarantine rules very strictly. The team was shocked by the result of antibody testing of the traveler. The antibodies were quite high. She had it then!!!!
In spite of being asymptomatic??!! Yep
In spite of test negativity??!! Yep
Based on the fact that the traveler never mixed with her neighbor, nor her neighbor’s mother or friend, it was concluded that the transmission of infection occurred indirectly through the building lift, which was used by the traveler shortly before her neighbor’s family. From there, the virus marched steadily and heavily to invade 68 other people in an area which was covid19 free prior to this incident.