Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, April 19, for an hour-long chat about filtering through pseudoscience on the Internet, with the Tribune's health reporter Trine Tsouderos and panelist Robert Goldberg.
The Internet has become a major source of medical information for millions of us as we wonder what might be causing our headache, what to do about our child's hyperactivity, whether we should be worried about that mole or not, whether homebirth is safer than hospital birth. We Google cures for cancer, silver bullet weight loss strategies, treatments for autism and risks associated with vaccines.
Are we better informed? Or are we bathing in a tub of bad information and even undermining our own health? Join journalists Trine Tsouderos and Robert Goldberg for an hour-long discussion of the Internet as a source of medical information and misinformation. We'll be discussing how to avoid slipping in puddles of pseudoscience and instead, how to become an astute consumer of online medical information. In a national PEW Study, find out what type of health advice people ages 18 and up are most likely to look for online and who is most likely to look for health advice online.
Journalist Robert Goldberg is the author of "Tabloid Medicine: How the Internet Is Being Used to Hijack Medical Science for Fear and Profit." Co-host of the blog www.drugwonks.com, Goldberg's work has appeared in the Wall Street Journal and Los Angeles Times. He is also vice president of the non-profit Center for Medicine in the Public Interest.
If you would like to submit a question in advance, please e-mail Trine Tsouderos at ttsouderos@tribune.com.
Thank you for joining our chat today. Please feel free to submit your questions. We will start at noon.
Tuesday April 19, 2011 11:54 Chicago Tribune
12:00
Trine Tsouderos:
Thanks so much for joining us for this chat. The topic is so important in this modern day. We are totally bombarded with health information on the Internet and much of it is totally bogus. Dr. Robert Goldberg is an expert on this topic - he wrote an excellent book called Tabloid Medicine: How the Internet Is Being Used to Hijack Medical Science For Fear and Profit. Okay, welcome Robert, and welcome readers. Let's go!
Tuesday April 19, 2011 12:00 Trine Tsouderos
12:00
Trine Tsouderos:
Dr. Goldberg, what do you think of the quality of information on the internet, when it comes to medical information?
Tuesday April 19, 2011 12:00 Trine Tsouderos
12:02
robert goldberg:
A great question to start off the discussion. It depends on where you go for information. Scientific discussions require confirming evidence and providing a context...most information on the web does not include either.
Tuesday April 19, 2011 12:02 robert goldberg
12:02
[Comment From Todd PlacherTodd Placher: ]
Is there a good way to determine if a study is better than another say for example if one is using a double blind standard and the other isn't.
Tuesday April 19, 2011 12:02 Todd Placher
12:03
robert goldberg:
On a scale to 1-10 I would give the information a 5 because the majority of stuff is so poor but a few sources are great
Tuesday April 19, 2011 12:03 robert goldberg
12:05
robert goldberg:
hi Todd, Randomized clinical trials are often considered the gold standard. In many cases they are if they are just looking at how one factor affects an outcome. At the same time studies that capture lots of factors and follow them over time can be just as reliable. I think the worst type of research is the meta analysis because you can cherry pick the studies you want to get the outcome you want. And we are seeing more of these because they get headlines
Tuesday April 19, 2011 12:05 robert goldberg
12:06
Trine Tsouderos:
The other really important part is to remember that studies can't be considered alone - we need to think about whether they have been replicated by other independent teams of researchers. One study - even a well designed RCT in a respected journal by researchers at a prestigious institution - means less if it hasn't been replicated.
Tuesday April 19, 2011 12:06 Trine Tsouderos
12:06
[Comment From anneanne: ]
Most people wouldn't understand how to read/interpret research studies -- I think the typical consumer would prefer to have the info distilled to an understandable level, e.g. "what does this mean to me?" -- then, of course, there is the issue of how to determine if whoever does that "distilling" is credible.
Tuesday April 19, 2011 12:06 anne
12:09
robert goldberg:
Great question for two reasons. First as Trine notes, you have to look at the context and whether a study has been replicated. Second, as the slew of studies claiming diet drinks, sitting around or limited exercise are linked to heart attacks 'show', failing to look at other health factors skews the conclusion. I am less concerned about who is distilling than whether researchers are doing studies that can be replicated and take into account a variety of factors including biological risk
Tuesday April 19, 2011 12:09 robert goldberg
12:09
Trine Tsouderos:
Hi Anne. That is so true. It is very difficult for a lay person to determine whether a study is good, or what it means. Even specialists in one field may have difficulty really understanding a study in another field. So we depend on people to interpret it for us. Ideally, you want the true experts distilling it for you. Dr. Vincent Racaniello at virology.ws is a good example. A respected virologist with a knack for explaining complex topics to laypeople.
Tuesday April 19, 2011 12:09 Trine Tsouderos
12:11
robert goldberg:
I would avoid Gary Schweitzer... he is a amateur (read, not a scientist) who seeks to undermine the credibility of studies regarding the value of medical innovation without applying Trine's rules. Opinion is more subjective than science. :)
Tuesday April 19, 2011 12:11 robert goldberg
12:11
Trine Tsouderos:
In my reporting on alternative treatments for autism, I was always struck by the wide chasm between what folks peddling dubious treatments said certain papers meant, and what the researchers who actually wrote the papers said they meant. There was often a massive difference. And yet, for a regular person, like me or most folks, that would be hard to determine.
Tuesday April 19, 2011 12:11 Trine Tsouderos
12:11
[Comment From Dan JDan J: ]
Glad to see this issue addressed here. Science-based medicine is *real* medicine. (Currently being treated for Hodgkins Lymphoma)
Tuesday April 19, 2011 12:11 Dan J
12:12
[Comment From Todd PlacherTodd Placher: ]
What if the information on the internet is coming from a respected science journal or medical journal? If an article is citing one is that better?
Tuesday April 19, 2011 12:12 Todd Placher
12:14
Trine Tsouderos:
Well, certainly some journals are better than others. Medical Hypotheses is not a place I look for solid medical studies. Science is. JAMA is. That said, studies in the most respected journals can be wrong, and often are. John Ioannides at Tufts has studied this phenomenon, looking at old studies in respected journals and seeing how many turned out to be right. The percentage was strikingly low. So you can't trust studies in isolation in good journals. You have to be skeptical, and think about what the body of work on that question points to.
Tuesday April 19, 2011 12:14 Trine Tsouderos
12:14
robert goldberg:
There are certainly some journals that are regarded as "leading" because lots of people follow them or because the media deems them leading. But remember that it was the British Medical Journal -- a 'leading" medical journal -- the published Wakefield's fraudulent connection between vaccines and autism.
Tuesday April 19, 2011 12:14 robert goldberg
12:14
Trine Tsouderos:
That is a great point. Wakefield's terrible study was published in a very respectable journal. And it was just terrible.
Tuesday April 19, 2011 12:14 Trine Tsouderos
12:15
robert goldberg:
And I would also refer to a great article in Commentarymagazine.com, "The Worst Study Ever" that discusses the biased approach to rating health care systems carried out by the World health Organization, the one that claims the US is 37th in overall health.
Tuesday April 19, 2011 12:15 robert goldberg
12:16
[Comment From anneanne: ]
So are there guidelines for how to decide what resources are credible on the internet?
Tuesday April 19, 2011 12:16 anne
12:18
Trine Tsouderos:
I think it is worth remembering always that scientific knowledge is hard won - it is gathered so slowly. One study adds to what we know about a particular question, but one study rarely answers that question alone. So whenever you see a study, it's worth looking for others and to keep looking and reading. Ask yourself, what, in total, do we really know about this?
Tuesday April 19, 2011 12:18 Trine Tsouderos
12:18
robert goldberg:
Yes.. and they can all be found in my new book (of course!).. Seriously, my rules of the info superhighway are:
1. If someone is selling something and claiming science supports it, don't buy either. 2. A single study with a small sample is to be avoided 3. If the study claims an association instead of biological cause and effect, it is less reliable, especially if the cause and effect is not replicated by other studies
Tuesday April 19, 2011 12:18 robert goldberg
12:19
[Comment From DragonblazeDragonblaze: ]
Hi Robert, do you think the "quack miranda" warning - "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease." - is effective? I know I don't rely on any advice from any site that displays this, but do we know how many people pay any attention to it?
Tuesday April 19, 2011 12:19 Dragonblaze
12:21
Trine Tsouderos:
I love it when a site displays that warning and then goes on to make claims about how their product IS intended to diagnose, treat, cure and/or prevent disease, often a lot of them. That's always great.
Tuesday April 19, 2011 12:21 Trine Tsouderos
12:21
robert goldberg:
I think it does have an educational effect.. but hope is a dangerous thing. Because most of the products that require that label claim they are 'natural, safe and effective' in the absence of any other information to the contrary people will buy alternative products.
Tuesday April 19, 2011 12:21 robert goldberg
12:22
Trine Tsouderos:
I do think it's useful in that it makes it clear that the products are not FDA-approved.
Tuesday April 19, 2011 12:22 Trine Tsouderos
12:24
robert goldberg:
I would also add that there is a booming industry -- funded by government -- for producing studies that claim a cheaper treatment is better than a newer one. It's called comparative effectiveness research. Yet there is no research showing whether such older treatments are actually more effective. It's merely a literature review with an opinion. These studes ALSO have a quack miranda warning by the way..
Tuesday April 19, 2011 12:24 robert goldberg
12:24
[Comment From KatieKatie: ]
How important is the knowing the funding source in evaluating a research study? Seems like studies sponsored by drug/alt med manufacturers should be more suspect than ones that are funded by NIH, etc.
Tuesday April 19, 2011 12:24 Katie
12:25
Trine Tsouderos:
A great question, and a timely one. There have been recent scandals about conflicts of interest not being disclosed in studies published in big respectable medical journals.
Tuesday April 19, 2011 12:25 Trine Tsouderos
12:27
robert goldberg:
It has almost no difference. First, to claim that funding affects conclusions would be to suggest that every discovery that has lead to vaccines, chemotherapy, heart treatments supported by "industry" really don't work. Was Pasteur's fermentation research a fraud because it was funded by the French beer and wine industry.
Second, funding is different that conflicts. Most of the most unreliable -- and deadly -- research came from people that had an ideological or cultural bias. Wakefield is the best example of that.
Tuesday April 19, 2011 12:27 robert goldberg
12:27
[Comment From MichelleMichelle: ]
How can we deal with the "Dr. Google" problem, where people seem to think that spending three minutes Googling something makes them an expert on the subject? I'd say it's a serious issue for our health care system when doctors have to spend 45 minutes going through 100 pages a patient printed off the web, trying to explain that the information may not be credible, or isn't even relevant to their condition.
Tuesday April 19, 2011 12:27 Michelle
12:30
Trine Tsouderos:
Oh, what a terrific topic. Right now, in the world of CFS, there are several non-scientists CFS patients who are attempting to "school" career retrovirologists on how to do their experiments, on what is wrong with their technique. Their PhDs are from Google U, of course. What hubris. This is becoming more common. It's great to learn about another field, but no amount of studying at Google U turns a layperson into a real expert.
Tuesday April 19, 2011 12:30 Trine Tsouderos
12:30
robert goldberg:
Great point. It's the reason that people have stopped immunizing their kids, stopped getting treated for depression, etc. And sadly a whole new body of research claiming certain treatments are not only ineffective but dangerous as well based on cherry picking of studies are easy to digest and spread on the net. In the absence of no knowlege, information warning danger is likely to be accepted.
Tuesday April 19, 2011 12:30 robert goldberg
12:32
Trine Tsouderos:
I was at a conference a few years ago and someone introduced me to the "world expert on vaccine studies." She was described as such to me several times. I was excited to meet this person. I met her and it turned out she was a Spanish teacher with no training in epidemiology at all. But others considered her an expert because, well, who knows why? But she had managed to spread a lot of misinformation about vaccines and autism. She had done harm because of this Google U phenomenon.
Tuesday April 19, 2011 12:32 Trine Tsouderos
12:32
[Comment From GuestGuest: ]
Can you give some advice on reducing confirmation bias as a reader? My sense is that many of us are drawn to articles that reinforce what we think we already know... or that give us answers we in some way expect. Suggestions on how to think critically, when facing a completely unfamiliar field?
Tuesday April 19, 2011 12:32 Guest
12:34
Trine Tsouderos:
This is a challenge I face every day as a journalist. I know I know so little about extremely complex fields, and yet I need to figure them out. A real challenge for anybody delving into something new in medicine.
Tuesday April 19, 2011 12:34 Trine Tsouderos
12:34
Trine Tsouderos:
And when I say "figure them out," I don't mean I actually become an expert. Not even close. But I need to get my arms around what is going on, as best as I can. And that is difficult.
Tuesday April 19, 2011 12:34 Trine Tsouderos
12:35
robert goldberg:
Confirmation bias is hard to avoid and even worse, researchers and advocates use studies to sway opinion and behavior based on a desire to avoid risk. But science is the collective process of testing hypotheses and holding experience up to scrutiny. And it is - or should be -- increasingly a process of establishing what are the factors and biological mechanisms that cause disease. We are healthier and live longer because of that collective enterprise. I am afraid the internet fragments and does an end around that process.
Tuesday April 19, 2011 12:35 robert goldberg
12:36
[Comment From KatieKatie: ]
What about the credibility some people give to unpublished data (provided at informal meetings or by 3rd parties)? Or researchers who claim their data is being suppressed because it challenges existing paradigms? That stuff can take on a life of its own and become powerful.
Tuesday April 19, 2011 12:36 Katie
12:37
Trine Tsouderos:
Oh it does! A good example right now is the XMRV/CFS debate.
Tuesday April 19, 2011 12:37 Trine Tsouderos
12:39
robert goldberg:
"Unpublished data" usually means unfit to present to the rest of the world because the sample size is small, the design is experimental or the conclusions are so significant that they really have to be a statistical fluke... All the 'unpublished data' claiming a link between suicidal behavior and antidepressants AND that antidepressants are no better than placebo (so a drug no better than placebo is actually powerful?) was stuff that was really unreliable. But it did become a weapon in the hands of people who had an axe to grind.
Tuesday April 19, 2011 12:39 robert goldberg
12:39
[Comment From MatthewMatthew: ]
One common element I've noticed in many online scams is an appeal to anti-establishment or anti-intellectual attitudes. Mis-characterizations of studies are often accompanied by statements questioning the integrity or wisdom of academia or the government, which seem to play into real fears or doubts in the population. Are there efforts in the scientific community to change these attitudes or counter this mistrust?
Tuesday April 19, 2011 12:39 Matthew
12:41
Trine Tsouderos:
This is so true. Big Pharma and Big Government are often cast as villains by dubious medicine practitioners. And of course, there have been scandals involving Big Pharma and Big Govt, which gives even the wildest conspiracies fuel.
Tuesday April 19, 2011 12:41 Trine Tsouderos
12:42
robert goldberg:
Great observation. I happen to think you are right, that much of the tabloid medicine movement is part of a larger effort to tear down institutions and defend the "oppressed." Aaron Wildvasky, a political scientist noted that there is nothing more effective in attacking science or technology than claiming it causes cancer. He was speaking about environmentalism but it also applies to efforts to attack medical technology.
Tuesday April 19, 2011 12:42 robert goldberg
12:42
Trine Tsouderos:
No better example of this is conspiracy described by some who say vaccines cause autism. There has be a way to explain away the studies, which found no evidence of a link, right?
Tuesday April 19, 2011 12:42 Trine Tsouderos
12:43
[Comment From erv goldbergerv goldberg: ]
autism is a classic example of the harmful effects of pseudoscience. Unfortunately, it was played to the hilt by a so-called medical expert.
Tuesday April 19, 2011 12:43 erv goldberg
12:45
Trine Tsouderos:
So many folks selling so many treatments to parents with children with autism, based on junk science, with no proven benefits and in some cases, known risks. In others, unknown risks. And yet, docs selling these dubious treatments often accompany their sales pitches for them with lots of scientific papers. Trying to sort them out is an enormous challenge. A full-time job, really. But when you do, the whole of it winds up to be junk. We wrote about this in a series that won national awards: www.chicagotribune.com/autism
Tuesday April 19, 2011 12:45 Trine Tsouderos
12:46
robert goldberg:
More than that (and great last name by the way) the so-called medical experts the media ran to for comment also validated it by not speaking plainly about the lousy quality of the data. I would add that when someone like Steve Nissen, a cardiologist at the Cleveland Clinic, claimed a diabetes drug was "another 9-11" he was doing as much damage as Wakefield did. Fewer people are taking oral diabetes drugs and the bar for new drugs is higher than ever.
Tuesday April 19, 2011 12:46 robert goldberg
12:48
Trine Tsouderos:
And then you have folks like Dr. Mehmet Oz, who has had a tremendous career as a cardiac surgeon. And yet now he is selling his audience on faith healers and folks who claim they can talk to the dead. He has a website that is jumbled with evidence-based information and stuff that is absolutely not based in science. How to sort it out? Is he for evidence-based medicine or not? I would say it seems not. But yet he is out there as a credible source of info.
Tuesday April 19, 2011 12:48 Trine Tsouderos
12:48
[Comment From Gregory ZiomekGregory Ziomek: ]
This question goes back to the mention of the work by Ioannides. What can the scientific community do to address the fact that we often make incorrect conclusions? Just more replication?
Tuesday April 19, 2011 12:48 Gregory Ziomek
12:50
Trine Tsouderos:
I think it is not a failing of the medical community that studies often turn out to be wrong. It's the way science works, it is self-correcting over time. Scientists know that. It's the media who get it wrong and tout one study in isolation as an answer to a medical question when it never is. Never. We should not write about single studies that say, oh, coffee will give you cancer. Because tomorrow, it is entirely possible another study will say it is protective. Over time we will figure it out. It doesn't mean scientists are stupid and can never get it right. it means science is hard, and that we need to be patient and wait for knowledge to develop over time.
Tuesday April 19, 2011 12:50 Trine Tsouderos
12:51
robert goldberg:
You mean" Why Most Published Research Findings Are False." That paper makes two important conclusions: combining lots of small, unreliable studies will produce a very big literature view that is hugely unreliable. Second, that bias is not just financial, it is intellectual, political, cultural and personal. Most scientific fraud is committed by people who want to advance their careers. And much good research is ignored because it does not fit the status quo. The paper is a great reminder about how the collective intellect of science -- over time and place -- is the only sure path to progress.
Tuesday April 19, 2011 12:51 robert goldberg
12:52
Trine Tsouderos:
A great example, not to tout XMRV-CFS again, is that patients with CFS are taking HIV antiretroviral drugs right now based on one study published in Science that associated CFS with the retrovirus XMRV. Many other teams have failed to replicate that original study, and yet, there are patients looking at that one study, deciding it has to be right, and actually taking potent drugs with serious side effects because of it.
Tuesday April 19, 2011 12:52 Trine Tsouderos
12:52
[Comment From KrisKris: ]
So the internet is a confusion of good and bad information and hope. Would you conclude that as a layperson, you should find a few trusted experts on your subject and ignore all the other claims and exciting "breakthroughs"?
Tuesday April 19, 2011 12:52 Kris
12:53
Trine Tsouderos:
Hi Kris. I think that is a great strategy.
Tuesday April 19, 2011 12:53 Trine Tsouderos
12:55
robert goldberg:
The internet is a tool, not a magic wand. It is being used by people using pseudo-science to push an agenda to a greater extent than scientists who could weigh in with useful and more scientific information.. That's the real problem. The go-to people are few and far between and they are often ignored because of the narrative that financial ties to industry means the experts are corrupt or unreliable. We need more courageous voices like Paul Offit
Tuesday April 19, 2011 12:55 robert goldberg
12:55
[Comment From erv goldbergerv goldberg: ]
With respect to media getting it wrong; that's often because scientists are unwilling or unable to communicate with reporters.
Tuesday April 19, 2011 12:55 erv goldberg
12:57
robert goldberg:
Yes, I agree. I saw a comment in an article about online health that underscores your concern: "The patients are already on the Web.. they are waiting for scientists and doctors to join them." The web can be a great tool for holding the media and pseudoscientists to account.
Tuesday April 19, 2011 12:57 robert goldberg
12:58
Trine Tsouderos:
I can't talk about any other reporters' expeirences, but in my experience, scientists have been happy to talk to me. They return my calls. They email back. They are happy to fact-check and they have been patient about explaining often technical information to me. I do think it is a massive challenge for a scientist to explain his enormously complicated field to a layperson like a journalist. Some have been burned before, misquoted, etc. So perhaps occasionally they simplify too much. But my experience has been very good. It's our fault in the media for getting it wrong, I think.
Tuesday April 19, 2011 12:58 Trine Tsouderos
12:58
[Comment From erv goldbergerv goldberg: ]
Sick people become desperate and look everywhere for answers. The M.D.'s need to do a better job communicating with their patients; or spending more time with them.
Tuesday April 19, 2011 12:58 erv goldberg
1:01
Trine Tsouderos:
Desperation is a powerful emotion. And now we have so many places - on the Internet - designed, really, to attract desperate people. Promising cures and hope based on junk science. And for a price.
Tuesday April 19, 2011 1:01 Trine Tsouderos
1:01
robert goldberg:
Unfortunately it is not always possible for doctors to spend as much time as they would like.. and increasingly health insurers are trying to "script" doctors to lay out options in ways that often put the risks of treatment first. It is incumbent upon more doctors and scientists to reach out via the Web and good reporters like Trine to make sure that when people use the Web, the doctors are already there.
Tuesday April 19, 2011 1:01 robert goldberg
1:03
Trine Tsouderos:
Gosh thank you so much Robert!! You are so sweet. Well, sadly, I think we have run out of time, and what a great chat! Thank you so much for all of your fantastic questions. And thank you especially to Robert, who took time out from his trip to Israel to be with us! Join us next week for a chat with my talented colleague, Deb Shelton: April 26 at noon CT about children's developmental skills.
Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, April 19, for an hour-long chat about filtering through pseudoscience on the Internet, with the Tribune's health reporter Trine Tsouderos and panelist Robert Goldberg.
Journalist Robert Goldberg is the author of "Tabloid Medicine: How the Internet Is Being Used to Hijack Medical Science for Fear and Profit." Co-host of the blog 
