"I did the research." The obvious rarely ever is so ... this is a bit of a read so please bear with me ...
As a clinician we want our patients to be responsible for their health. I never regard my patients who show up with info regarding their health care with any negativity. Please take accountability for your health. What injects confusion is when the information is considered of higher value than expert medical advisement. THIS IS THE SAME FOR ANY FIELD.
"What do you do when the experts disagree?" One of my mentors would challenge this question during my formative years - which I think some might say are still happening (at least I hope - does learning end?)
The danger is not knowing when in good faith you are receiving bad information. It may look sciency but it is based on a poorly constructed study, or just plain old "hip-shooting." These can be very convincing, however they lead good intending people to terrible consequences. I have more than I can count treated people who followed the advice of "natural medicine experts" who presented in liver failure or worse because of "natural" supplements.
Do not misunderstand me. I recommend natural remedies and lifestyle disciplines to people initially for many health issues and have a list of natural medicine providers I trust greatly - that I use myself! But when it comes to expert medical opinion and what qualifies as better information, I suggest tipping the hat to those who are LIABLE for their counsel. Your PCP and specialist teams have standards of care we must keep that if we can be held accountable to. Google has no such liability. If it did, it would shut down all medical advice columns.
Before I get ahead of myself, let me explain the reason why I am diving into these waters. I have quite a few patients who have benefited on GLP-1s such as Wegovy, OZEMPIC, Zepbound, and Mounjaro. It has been a greatly appreciated medicine for those who have failed natural and lifestyle measures and more conservative med therapies. The glycemic control and weight loss have significantly decreased other issues (we call co-morbitites) as well.
A recent published study suggested that these meds are connected to an increase in Non Arteric Anterior Ischemic Neuropathy (NAIOM). The study conducted by Hathaway et al was published in JAMA (Journal of the American Medical Association), a very respected medical journal. The original paper can be read at the following link:
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255/#google_vignette
The findings of the research in this paper suggested that GLP-1s are associated with NAION. This is very problematic. If someone were to read this study and interpret the results, they might (and did) incite panic regarding this medication. This is widely repeated online including law firms invitations - a major problem in medicine right now driving the costs - another topic.
So did you read the article I posted? The entire article? Did you know what you were reading? Do you understand what confidence intervals are? Do you know how to determine the power of a study? Do you know how to determine which level of the evidence hierarchy this study is? In the peer review, do you know who any of those people are? Yet the results of this study, which is pretty recent, are being ran with and as you may know, no news travels like false news.
A couple of things you may or may not know about research (there is MUCH more):
1. Research NEVER proves anything. It only describes the findings and tries to interpret the results.
2. Good research is repeatable. The method has to be intricately described so that peers can recreate the study exactly as it was done and the results should be the same.
3. Research is always topic specific. Unexpected results that seem to suggest new association or results against what was expected do not translate as cause and effect no matter how likely. They will likely lead to more research specific to the new information but they are not to be used for cause and effect because the controls in place were not for them, there could be bias.
4. Research is a language to itself. Those, like myself, who use it as a standard have to take very difficult classes to be qualified to properly interpret what is being presented and what it means.
So JAMA is not making a false claim, it is merely publishing the findings of a research group. The research group did not claim that GLP-1s cause NAIOIN, they merely found a connection. The news media and lawyers added the twist of cause and effect which would understandably be seen as cause and effect but no such claim was made by the researchers.
As is always done in medicine research, this study was evaluated by another group of researchers. Their study can be found here: https://www.ajo.com/action/showFullText?pii=S0002939425000947
They found that Hathaway et al's study participants were from a clinic with patients who had significant diseases not found frequently in the typical patient population so were possibly subject to a selection bias (I will explain). They had a much larger participant population and also referred to another similar study who both found NO association w NAION, in fact, if you review the study quite the opposite. It seems that GPL-1s in healthy people may help prevent NAION. More studies would have to be conducted to consider that. But clearly, AJO's study found that GLP-1s are not associated with NAION and that the study published by JAMA is inferior to the study published by AJO likely because of bias (I am simplifying).
But HOW WOULD YOU KNOW THAT? Well intended patients get in trouble with this and it can turn into mistrust of the medical system and frustration with treatment. It can also lead to avoidable treatment delay that can worsen symptoms and lead to a catalyst of negative health effects. All because of misunderstanding the point or and misinterpreting the results of very necessary research.
This is common for medicine and research. JAMA was not wrong for publishing Hathawy's findings. A study by a respected group was done and they published their findings raising concern. This necessitated more studies to be done that were very reassuring against the concern. No one is offended. This is research and vital to our process of medicine. Yet many will read the paraphrased versions of entities with clear bias and mistrust and fear form.
So HOW DO WE FIX IT? Well let's have the conversation! Talk to your providers about what you are finding and listen to their advice. We stay up on this stuff (most of us). Did you know we have to have 200 hours of continuing learning every 2 years? Unlike what is propagated by so many media personalities
- medicine does not prosper by keeping people sick, actually quite the opposite
- medical school does not teach pushing pills and procedures. That is absolutely absurd and offensive. We press natural lifestyle modification always first. But keep in mind, laughter is the best medicine until you break your arm ...
- nature doesn't make pills. They don't grow on trees. It takes chemicals to hold them together. Did you know thats many of the meds we use are derived from natural substances?
Your medical providers are much more invested in your health than GOOGLE. Our friends are well-meaning but they can get us in a lot of trouble because a lot of what we call research is really valuing only what we find that supports what we want to be true.
Consider the following sources for failures of logic and lets have that conversation. What do you need to talk to your provider about?
Also consider my friends, this applies to every study of life, including faith - oh the trouble we can get into. Here are some resources on research and bias:
Critical Thinking Tools - Failures in Logic
I hope this helps, that's all for now
Thanks for reading,
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