If you’ve ever tuned in to “The Dr. Oz Show,” you’ve probably heard the popular medical expert touting the benefits of a particular product, citing scientific gold-standard randomized controlled trials (RCTs) as evidence for its claim. But how many of us are skeptical because we think RCTs automatically translate into factual endorsement?
In his recent statement on CBS’ “60 Minutes,” Dr. Mehmet Oz admitted to not always fact-checking the products he profiled on his TV show. Perhaps the problem is not necessarily the products, but rather, our current understanding of evidence-gathering and what “a study” really entails. In fact, as medical professionals and enthusiasts, we’ve been talking and debating about health and disease, good and bad, for decades.
Our current way of thinking about evidence and endorsement is binaristic — that is, it’s either black or white. But that’s only how we choose to view this type of information, not necessarily a true representation of reality. At the forefront of this cognitive process is our reliance on the scientific method, which ideally elucidates one optimal solution to our scientific problem. In our opinion, alternative perspectives and nuances should be welcomed to this conversation, because society needs to understand the often-contradictory nature of study results in health and wellness.
Every medical or health field has organizations that assess the strength of evidence for treating or diagnosing various conditions. The “gold standard” is the RCT, in which participants are assigned by chance (randomly) to one of several groups to determine the effect of an intervention, such as a treatment or drug, against a condition. Dr. Oz emphasized his use of RCTs as a basis of evidence for his shows. Does this truly translate, then, to effective methods for everyday consumption? Let’s eConsult!
The truth is that RCTs do not necessarily equate with true effectiveness. Let’s return to our hypothetical example above: participants may have pre-existing conditions or medication use prior to the trial, thereby muddying baseline comparisons. In addition, RCTs may also be prone to imprecision or “noise.” For instance, if our RCT for a new antidepressant medication is run during the holidays, some participants’ improved mood may be due to, say, holiday cheer rather than the medication. This would falsely inflate our estimate of the medication’s effectiveness according to the RCT results. Lastly, RCTs rigidly adhere to “exposed” and “not exposed” customers — a clinical trial participant’s entire health care “lifestyle” in the study is by design rigorously curtailed. In other words, these results are not always actionable to everyday situations.
What about secondary sources to support the health claim? There are other study designs in addition to RCTs, such as cross-sectional cohort studies, where we can look at broad associations and patterns of how exposures and conditions relate to one another without necessarily stressing causation. Epidemiologists (public health experts who research the causes and effects of health and disease) often design studies this way to gain broad insight into populations.
The differences between RCTs and cross-sectional cohort studies ultimately helps us elucidate that scientific evidence is not black and white. In other words, health care is full of gray areas, which can ultimately be informative to us as providers, patients, and as human beings. Rather than being skeptical about the use of “all-natural” supplements a la Dr. Oz, we should be thoughtful about incorporating these nuances into our understanding of health and disease. In fact, decades of research have shown that people who focus on prevention (rather than just treatment) have better long-term health outcomes. And part of prevention is incorporating evidence-based insights into personal “lifestyle” and group habits that can create a community sense of both wellness and health.
Though the oversimplification and misapplication of scientific evidence in everyday applications has often led to sensationalized popular media misinterpretations, which in turn has affected the very credibility of medical professionals, let us instead embrace the nuances and complexity of evidence-based knowledge in health and wellness.
The views and opinions expressed in this article are solely those of the authors and do not necessarily reflect those of ConnMED, ConnHealth, or their employees.
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