The Secret Lair

Both at Balticon and in an upcoming episode of The Secret Lair podcast, I talk a bit about how people without medical training can, and should, read the medical literature. This is particularly important, as the main way the lay public finds out about new medical studies is through media reports, which are often oversimplified, sensationalized, or just plain wrong. Anyone can track down and read a journal article, especially once you know all the important things to look for – including who paid for the study, any conflicts of interest the authors may have, and the like – although there are a few potential barriers that someone without medical training may face. These include familiarity with the science behind common medical concepts, as well as a basic understanding of statistics.

Really, these barriers shouldn’t exist.

A perennial topic of conversation among scientists and educators is the need to revamp our educational system to be relevant to modern life. This is not just about the content of what we are teaching the young members of our society, but also about the paradigm of our entire educational system. We need to identify new cornerstones of modern life, and adapt to formally teach those things universally; instead of merely making policies on how schools handle smartphone use and social media online, we should be educating everyone on how mobile phone technology works and social ethics of online interactions, for example. In this regard, I feel strongly that science education needs to be refocused, in part, on medical topics that have the potential to affect everyone during the course of their lives, no matter what their interests are or their potential career will be.

Dr. RW discussed this a bit last year, and brainstormed a list of medical learning objectives that would allow a layperson to approach and discuss the medical literature. He was inspired by a document addressing science education for ministers, and his list was designed with science journalists in mind, but I contend that all of these are things that everyone should know. What follows is his original list, with some editorial comments of my own in parentheses:

• Outline the scientific method.

• Explain the hazards of examining scientific questions in the arena of public debate. (This is so critical to many things, especially with the current dialogue about the US healthcare system.)

• Explain how the 1918 influenza pandemic was fundamentally different from the 1957, 1968 and 2009 pandemics. (This is key, especially as there are some who think that just because the 2009 pandemic didn’t cause a massive death toll, that it was somehow not an actual pandemic.)

• Define and distinguish: epidemic, pandemic, endemic.

• Define and distinguish: sensitivity, specificity, positive predictive value, negative predictive value. (These are basic statistical terms that aren’t hard to understand mathematically, but are the absolute cornerstone of discussing how well any medical test works.)

• Define and distinguish: enzyme, catalyst, protein.

• Define and distinguish: antigen, antibody.

• Define and distinguish: DNA, RNA.

• Define and distinguish: axiom, postulate, hypothesis, theory, fact. (Also huge, especially as the word theory is very often misused and misunderstood.)

• Define evidence based medicine.

• Explain why consideration of biologic plausibility is important in the evaluation of health claims and why evidence based medicine often fails when biologic plausibility is not taken into account.

• Define and distinguish: bacteria, fungus, virus. (This would seem a bit obvious, but the number of times I’ve seen these terms mixed up in the lay press is a bit disturbing.)

• Explain why scientific progress does not lend itself to sound bite reporting or “news of the day” journalism.

• Describe Medicare’s prospective payment system and the financial conflict of interest it causes. (Noone should publicly express their opinion on the state of healthcare in the US without understanding this first.)

• Define and distinguish: humoral immunity, cell mediated immunity, innate immunity, acquired immunity. (“The immune system” is not just one thing, and is not a simple thing. Anyone who claims they have a treatment that can “boost” the immune system needs to explain specifically what part is being affected, and how – most true examples of a part of the immune system working more vigorously are harmful or fatal to the person involved.)

• Define and distinguish: carbohydrate, protein, fat, vitamin, mineral. (Especially vitamins, which have specific physiological roles in the body, and do not magically give you energy.)

• Define and distinguish: heart failure, shock, heart attack, angina. (Common terms for common conditions, that many people don’t understand what they specifically mean about what’s going on it the body.)

• Define: relative risk reduction, absolute risk reduction, number needed to treat. (More basic statistical terms that are key to knowing how medical studies talk about things like a risk factor causing a disease, or how a well medication works.)

• Explain the difference between clinical significance and statistical significance in clinical trial results. (This is also huge, namely because sometimes statistics say there is a difference between things that are studied, but it doesn’t change much in terms of the health of patients.)

• Define and distinguish: accountable health organization, health maintenance organization, preferred provider organization, patient centered medical home, integrated delivery system. (Buzzwords for healthcare reform that everyone should have a basic handle on.)

• Define and distinguish, in the context of health care: quality, patient safety, performance.

• Describe Mendalian genetics and explain why common inherited conditions do not follow simple Mendalian patterns.

• Define and distinguish: meta-analysis, systematic review, expert review. (These are different ways to look at groups of studies, and are the common basis for lay press medical reporting.)

• Distinguish between a left ventricular assist device (LVAD) and an artificial heart.

• Distinguish between pacemaker, implantable defibrillator and cardiac resynchronization device.

Each of the terms and concepts above are things that I contend everyone should know. I’ll be going through some of these learning objectives in future columns or episodes of The Secret Lair. How did you fair with the list above?

Thanks to Dr. RW for his original post!

Tags: Balticon, Conditions and Diseases, Education, Evidence-based medicine, Health, Immune system, John Cmar, Medicine, Pandemic

This entry was posted on Thursday, July 7th, 2011 at 12:30 pm and is filed under Science. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.