CHECK YOUR SOURCES

u.s. PreVentiVe serVices task force CHECK YOUR SOURCES

By David Blodgett, MD, MPH

SWUPHD Director and Health Officer

It is bewildering to consider the onslaught of information that we are exposed to in today’s world. As more is understood about any given topic, it becomes even clearer that there is much that we do not know. It’s also exciting to live in a time when vast amounts of information are available and readily accessible to almost anyone. The internet in particular has opened these doors so that all may learn the secrets of the ages. However, not all sources of information are equal. The modern day miracle of the internet has a downside. With very little investment in experience, education, forethought or finances, anyone can represent themselves as an expert on any issue. What people used to say about the news is now said about the internet; the joke now goes, “I found it online, so it must be true!” Even people who seem to have legitimate credentials, such as celebrity doctors, are often maintaining large financial operations and can be influenced by paid advertisers and product endorsements. We can be easily manipulated by emotion and criticism, therefore a well-based online article may not be able to compete with the frequently anonymous tirades that follow it. A study published in the Journal of Computer-Mediated Communication (Feb-

ruary 2013) found that inflammatory statements made in online comment sections can influence readers on the topic more than the article itself! The difficulty of navigating the information superhighway is compounded by the complexity of some issues. The media tends to explain issues in one-liners and sound-bites and we tend to welcome oversimplified explanations. This is the path to misunderstanding, division, inconsistency, and often downright bad information. Nowhere is this more apparent than in politics, but a close second would have to be the medical world. You don’t have to look far to see examples of this every day: coconut oil is bad for you/coconut oil is healthy. Whole wheat is nutritious/whole wheat is poisonous. Do statins (medications for high cholesterol) help or hinder? “Use this one weird trick to (insert whatever health problem is being exploited)”.

Who can you trust? There are several organizations that have been set up to specifically avoid the effects of politics and money on medical and public health decision making. These groups become the most credible simply because their charge is to examine and interpret all of the scientific data instead of advancing an agenda. Often their recommendations are controversial because they are made outside of the political and social environment. Among the best of these organizations is the United States Preventive Services Task Force (USPSTF). Here’s a description from their website: “Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Task Force members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Their recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.” The USPSTF serves as a watchdog over health practices and helps protect against harm that may arise from over-testing and over-promising. Their recommendations can be found online at uspreventiveservicestaskforce.org. Here you will find evidence-based evaluations of many popular preventive screenings and medical interventions, gathered from thorough investigations and reviews of medical literature. The USPSTF makes recommendations on the following basis:

Grades A & B: Recommended for everyone

Grade C: Recommended only for selected individuals

Grade D: Not recommended

Grade I: Insufficient evidence to recommend either way

These recommendations are supported by extensive research and documentation of the process the task force used to arrive at their conclusion. Some of the recommendations of the task force may surprise you. For example, screening for prostate cancer using a prostate specific antigen (PSA) test received a D grade (not recommended) in 2012 after the task force found that studies on prostate screening could not find any benefits as far as men saved from dying of prostate cancer. That grade was upgraded to a C in 2018 after ongoing research showed that “screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men.” The test is still only recommended for select individuals based on family history, race, and other risk factors, since “many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.” PSAs are still not recommended for men aged 70 and older. Other preventive tests and interventions that don’t make the cut: • Screening for carotid artery stenosis: D • Ovarian cancer screening for most women: D • Testicular cancer screening: D • Combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women: D The USPSTF caused some controversy when it found that the best use of mammograms for women at average risk is at ages 50-74, then every other year (grade B). The American Cancer society had

continued on next page...

'check your sources' continued...

recommended mammograms every year after age 40, but has since increased the age to 45 with alternating annual tests starting at age 55. Here are some recommended tests and interventions from the task force: •Colonoscopies for everyone ages 50-75: A •Folic acid supplements for women of childbearing age: A •Screening for gestational diabetes in pregnant women after second trimester: B •Blood pressure screening for all adults: A The USPSTF has also released an app called ePSS that will display all of the recommended screenings for you, based on your age and risk factors. The app will also leave out screenings that have been shown to be unnecessary or potentially harmful, based on the data you enter. The USPSTF serves as a trusted resource that does all the heavy lifting to provide reliable information on which to base your health decisions. Scan this QR code on your device to download the ePSS app:

iPhone

Android

How to be a healthy skeptic

Ask yourself these basic questions when evaluating information you find online or anywhere else, especially when it affects your health: •Does the claim fall in line with what you know about the world and common sense? •Is the claim advocating an extreme regimen, behavior, or quantity of something?

“Moderation in all things” is more than a nice phrase, and “more is better” has its limits. •Is this an effort to sell you something or does someone’s livelihood benefit from the decision you make about the claim? Look for indications of a “paid advertisement”. •Is the source a lone expert? In general, sources that are supported by recognizable groups of authorities in an area of expertise are more reliable than a single individual. This guideline is not foolproof, but larger professional organizations often have a process in place that helps weed out bad information. •Are there any underlying agendas? Sources that do not have a financial or political stake in the issue are more credible. The role of governmental organizations (such as the Centers for Disease Control & Prevention or your local health department) should be to put science ahead of politics, so that the public benefits from accurate, unbiased information.