Just before leaving office at the end of his second term, President Dwight Eisenhower gave a speech in which he famously warned of the “military-industrial complex.” By this he meant that having large military budgets year after year was creating a powerful class of business interests who viewed the American military not simply as an institution vital to national security, but rather as a source of their own financial profits, and would hence forever exert pressure on the US government to increase military spending, regardless of whether it was otherwise appropriate to do so. This critique – which was shocking at the time – in retrospect seems rather obvious. Most observers of the US government now agree that there is an important interplay between the congress, the military, and the armaments industry, and the idea of a “military-industrial complex” is widely taken for granted.
Sadly, I see many parallels to the military-industrial complex in America’s modern medical system. Such as the way that pharmaceutical companies give generous donations to congressional members, who then pass legislation that is favorable to those companies. Or how the regulators of the pharmaceutical industry often obtain plum jobs with the pharmaceutical companies once they leave government, thus giving them an incentive while in office to “play nice” with them. Or how a small cadre of doctors sit atop the leadership at places like the NIH, controlling where grant money for research will go, thus creating an environment in which research that counters those doctors’ preferred ideas or theories is much less likely to receive funding.
But I want to talk about one such “complex” that particularly irks me, which I hereby will call the “academic-media complex.”
You have perhaps heard the mantra in academia of “publish or perish,” meaning that University professors, scientists at academic institutions, doctors who hold faculty positions at medical schools, and the like, have to constantly publish research in order to justify their positions. This of course creates a lot of pressure on academics to publish as much research as they possibly can. Which leads, frankly, to a lot of very low-quality research being published. And I mean a lot.
You have perhaps also heard the phrase about the media that “if it bleeds, it leads,” meaning that newspapers and television shows love to prominently feature sensational stories. This is because the media has an incentive to gain the most viewers/readers/subscribers it can, not necessarily to parse out the complex nuances of truth. Hence, a lot of the low-quality research mentioned above, coming as it often does to sensational conclusions, gets heavily publicized in the media.
Hopefully you can appreciate the problem here. Incentives in both academia and in the corporate media lead to a lot of bad research getting done, and then getting covered in the news. The winners in this scenario are the academic institutions and researchers who get to publish a lot of high attention research, and the media institutions who profit from the resultant sales, views, or clicks when that research creates fear or confusion. On the flip side, the losers in this arrangement are the American people, who are frequently given a dizzying and misleading stream of bad information about how to stay healthy.
It would be impossible to cover all of the examples of this phenomenon. I am not exaggerating when I say that I see several examples of this every single week. But to make my point I’ll review just two examples today.
“Eating Just One Slice of Bacon a day linked to higher risk of colon cancer, says study” proclaimed a headline published on CNN in 2019. The article touted a review of a health database in the UK that found that those patients who reported eating more red meat had a 20% higher risk of developing colon cancer. It would take me several entire blog posts to do justice to how uselessly poor the study in question was, so I’ll just highlight a few key points.
For one, this was an epidemiologic study, not a clinical trial, and hence can only show an association between two variables. Such a study cannot determine that red meat CAUSES cancer, only that there seems to be an association between the two. But in science, we have a mantra that “association does not equal causation.” For example, ice cream sales and drownings are also associated, but for the obvious reason that people both eat more ice cream and swim more in the summer, not because they have anything to do with each other.
Secondly, the food consumption of the participants was not measured by the researchers but rather was gathered by administering a food questionnaire to the patients about their diet, a tactic that is known to be wildly unreliable (how likely are you to be able to report everything you ate during the last month with any serious precision?)
Third of all, this study can’t account for “healthy user bias,” which essentially means the fact that – since everybody has been told for the past fifty years that red meat is bad for them – the people who eat less red meat also tend to be the people who are more health conscious, and hence more likely to exercise, to not smoke, to wear their seat belts, and to engage in lots of other behaviors that might lead to better health.
Leaving all of the above aside and assuming for a moment that the study’s conclusions are in fact accurate, what does it mean to have a 20% higher risk for colon cancer? That sounds terrifying. But not so much in fact. It would simply mean that your lifetime risk of developing colon cancer would increase from 4% to 4.8% (0.8% being 20% of 4%). That’s not a good thing, but it’s a heck of a lot less sensational than what most people would be led to believe by the headline.
Another example is “Fish oil supplements may raise risk of stroke, heart issues, study suggests.” This study made huge headlines when it was published recently. Again it was an epidemiologic study that analyzed a database and tried to link the consumption of fish oil supplements with various health outcomes. While the headlines touted that the supplements appeared to be linked to an increased risk for a type of heart arrhythmia called atrial fibrillation or stroke, they left out some other important details:
The increased risks of Atrial Fibrillation (13%) and first time stroke (5%) are, again, statistically misleading. A 5% increased risk for a stroke doesn’t mean a 5% risk of a stroke. It means that if your risk of having a stroke this year is 1%, it would increase to 1.05%, which is fairly meaningless
While an increased risk for atrial fibrillation and stroke were noted in the study – and touted in the headlines – so were a DECREASED risk for heart attack, congestive heart failure, and cardiovascular death. So even if the increased risk for AFib and stroke are real, the study still suggests that, overall, fish oil is beneficial, not harmful.
Finally, the study found that taking fish oil seemed to increase the risk for developing Atrial Fibrillation and for having a first time stroke. But it also found that once a person has had atrial fibrillation or a first time stroke, they did BETTER if they took fish oil. Specifically, it found that people who have atrial fibrillation and take fish oil have fewer further cardiovascular events than people with atrial fibrillation who don’t take fish oil, and that people who have had a stroke and take fish oil are LESS likely to have a subsequent second stroke than those who have had a stroke but don’t take fish oil. In other words, it suggests that taking fish oil can lead to a first stroke, but prevent a second stroke. Does that make any sense to you? Me neither. Results like this strongly suggest that the researchers are picking up on statistical noise, rather than on any true clinically meaningful finding.
I could go on, but I’ll stop here so as to avoid making this post overly lengthy and tedious. The point I’m making here is not that red meat is relatively harmless or that fish oil is good for you (I happen to believe both of those things are probably true, but that’s a much more complex topic for another time), but rather that most of the newspaper articles you’ve ever read about medical research would be better used to make spitballs than to actually guide you on how to live a healthier life.
