I need to preface this post by saying I’m not talking about a specific person who might be using “Dr. Google” as a handle on social media, blog site, etc. I’m using this term to reference the way that many people get their medical information, a google search that takes them to a reputable-sounding website. A recent experience I had lined up with the recent news of the “sort of appeared” “science” promoted by Fauci and others.
For example, you may do a google search on “is supplement XXX safe during pregnancy?” That will take you to a reputable-sounding medical website, which screams “NO!” If you are lucky, that website will include a scientific citation where that “fact” came from, but often it does not.
So here are a few lessons to keep in mind while searching the web for medical info.
Research may be incomplete
Let’s go with the not-so-hypothetical example I gave above. One review article made the point that supplement XXX was not to be used during pregnancy because there wasn’t enough evidence that it was beneficial even in none pregnant people. That is a matter of sample size, statistical power, study design… all kinds of things. Often such claims (“not enough evidence of benefit”) are made before larger studies are published, and lo and behold, demonstrate statsitically significant effects. But not surprisingly, these review articles are never refreshed to revisit this conclusion of “NO! NEVER!”
Safety testing may have not been done… because it is unethical in some circumstances
Clinical trials are rarely done in pregnant and other high-risk or vulnerable people. Its a question of ethics… because if you don’t know the safety profile, you might harm the baby, or young child, etc. So this raises the question, will safety profiles for such things ever be known? Probably not. But what this also means is, if you see “no safety data available”, the conclusion should not be “so don’t EVER use it” because it could potentially be safe.
Sometimes things are not well-understood… because the disease is not well understood.
An example here is autoimmunity. Scientists are still trying to figure out the pathology, biology, etc of autoimmune diseases. They are a mystery in many ways. So, understanding how a certain supplement acts in an individual with an autoimmune disease is difficult because so much of the basic science is not well understood. Also see #2.
COVID-19 is not a model for how science should be done.
I get this question a lot. “Well, in COVID, they had massive clinical trials that demonstrated that the vaccine worked!” I have never seen two different vaccine developers attack a vaccine development simultaneously and arrive at the same conclusion. There are rumors that the clinical trial phases did not happen sequentially as is the norm (Phase I and II may have been done simultaneously). The funds needed to do massive Phase III clinical trials are usually not available so quickly, and for studies to be done simultaneously. (Which by the way, the conduct of multiple trials is a good thing - replicability is important in science.) This is NOT typical. Finally, there are questions about how adverse events were assessed in those clinical trials (note that’s a peer-reviewed published paper!)
The argument during COVID of course was that the potential benefit of the vaccine could outweigh potential risks in pregnant and other vulnerable people. Of course, that assumes the vaccine did what it was supposed to do… and the outcomes were not what the public thought they were.
What is the solution then?
First, follow the rabbit trail. Often what happens is one paper cites another, which cites another… and it takes a lot of hunting to find the actual paper where the point is actually made abou the question you are asking. Yes, that takes a lot of time. But you may find at the end of that rabbit trail that the point made by that medical website is not supported by the papers as the claim…
Second, learn how to read the literature. A keen eye goes a long way. Here I’ll make a shameless plug for IPAK-edu, which has a ton of courses that teach how to understand the science and critique it.