Which Medical Myths Are You Falling Victim To?
By: Zachary Walston
Tags: Healthcare, Misinformation, Fitness, Advice, Health

Which Medical Myths Are You Falling Victim To?

Photo by aisvri on Unsplash

Who is to blame for the rampant presence of medical misinformation?

It’s hard to place blame for the spreading of misinformation or the burden of stopping it at the feet of a single group of people. This pandemic is a case study in how people determine source credibility and tease out misinformation.

It’s been painful to watch.

Much of the focus is on the struggle to transfer valid information from credible experts to the general population, as well it should be, but let’s not forget about the importance of trained professionals holding each other accountable.

It often doesn’t happen, as I experienced as a physical therapy student on my first internship.

Staying silent

“Falsehood flies, and the truth comes limping after it,” Jonathan Swift

It is an odd feeling when you see a mentor recognize a mistake you made but choose to remain silent. I have experienced this on multiple occasions, but one that particularly sticks out is from my first long-term clinical rotation.

I finished administering soft tissue mobilization (PT-speak for a deep-tissue massage) to a patient’s low back. Typically, the next step would be to administer exercise, but I had wrapped up the manual portion of the session too quickly. At the clinic, the expectation was to provide patients 30 minutes of manual therapy followed by 30 minutes of exercise. While this was not a hard rule, it was one I was not going to question as a student — more on this later.

Needing to fill the time with a meaningful treatment before exercise, I examined my sparse clinical toolbox. Empty. So, I went to the modality I most commonly witnessed in the clinic: combo therapy.

Combo therapy is the combination of electrical stimulation and ultrasound in a single application. Wherever the ultrasound head is placed on the muscle within the borders of the applied electrode pads, the muscle contracts. The technique was more common in the 1980s and 90s and started falling out of favor as the research routinely failed to support its efficacy.

Outdated treatments are hard to eradicate.

As soon as I started the treatment, I looked up and saw the owner of the clinic starring at the device with a perplexed expression. It was evident he was wondering what the hell I was doing. As the owner and a practicing PT, he was aware of the treatments being administered in his clinic. While he condoned the use of combo therapy, it was clear he questioned my decision to use it at that moment.

Even for someone who believes in the efficacy of combo, it is difficult to rationalize its usage immediately following soft tissue therapy. The goals are similar. But he didn’t say anything. Instead, he gave a halfhearted shrug and returned to his patient.

Despite the lack of words, the message was clear — sort of. Don’t do that again, right? Why weren’t explicit words spoken? Better yet, why did I continue with the treatment?

We are often blind to contradictory information

Theory-induced blindness, coined by Nobel Laureate and author Daniel Kahneman, is a phenomenon in which someone vehemently defends a current theory they possess, searching for any reasoning to reinforce it, regardless of the theory’s applicability or appropriateness for the situation.

Does anything come to mind for you? Take a few minutes to ponder this. Things you are blind to won’t readily pop in your head.

Theory-induced blindness pairs well with confirmation bias, the tendency to support any information that supports our current beliefs and refute any information that contradicts them.

My experience as a student highlights how misinformation can sustain within the field of experts and credible sources. In healthcare, we have many myths that perpetuate, in part due to these logical fallacies.

Here are some examples of those myths I have been working to stamp out (I am not the only one, thankfully):

This is not a comprehensive list. If you encompass the fitness industry, including misinformation (and disinformation) spread by trainers and fitness gurus, the list grows. These issues and myths are spread to and by trained and untrained individuals.

Yes, clinicians are a common source of misinformation. By failing to challenge our own beliefs and each other, we continue providing suboptimal treatment and education.

Changing is hard.

The clinic I did my rotation in used a treatment that was the “gold standard” at one point. Physicians recommended it, colleagues used it, and patients requested it. It’s easier to dismiss new research and fall back on personal experience.

What change have you been resistant to?

Be wary of the outcome bias trap — the ‘ends justify the means’ bias. In healthcare, clinicians often fall back on the “it works” excuse for continuing a treatment.

I had a lot of good outcomes with patients who received combo therapy and mediocre education — I was a student after all. How do low-value treatments lead to good outcomes?

Two things: natural history and the placebo effect.

Most pain resolves on its own without any intervention. I was once told by a colleague we often simply entertain patients while their body gets them better. Crude and oversimplified but with a hint of truth.

“If a cold is treated energetically it will get well in seven days, while if left to itself it will get well in a week.” — WA Hopkins

Research is designed to tease out as many unknown variables as possible and to determine if an intervention was the cause of the effect. If placebo, which is driven by expectations, is the primary driver of an outcome, it doesn’t mean the outcome isn’t real. Pain relief is real regardless of the source, but pain is often only one piece of the treatment puzzle.

So, how do we change the status quo?

The best thing we can all do to stamp out misinformation is to ask more questions.

Questions to ask anyone providing you treatment or health education

“Seek first to understand, then to be understood.”― Stephen R. Covey

When it comes to our health, opinions are strong and difficult to change. The same is true for professional identity — making it difficult to stamp out medical myths and misinformation. No one likes being wrong.

So don’t focus on being right or wrong. Science is always changing. If my clinical practice is not changing every year, I am a lazy provider who is on the path to providing ineffective and suboptimal treatment.

Instead, focus on asking questions to learn more information to make an informed choice.

1. What are the risks or side effects?

There are two things you want to know here. First, what are the risks and side effects? Second, what are the odds of them occurring? The second question has two different answers — the relative and the absolute risk.

The relative risk is used by marketers to scare or impress you. For example, ‘treatment X’ will reduce your risk of sustaining an injury by 50%. Sounds great, until you find out the absolute risk of sustaining an injury in that event is 0.5% and it was reduced to 0.25%. What if the absolute risk for side effects was 2%. Is the risk worth the benefit? It may depend on the severity of the risk.

Unfortunately, the relative and absolute risks are often interchanged and framed to maximize or minimize the intended outcome. For example, a treatment will have a 50% improvement in symptoms (relative) but only a 0.5% risk for a negative side effect (absolute). In most cases, percentages of the risks are omitted.

You want to know the absolute and relative risk (relative to you, not a patient population that differs) for both risks and benefits.

This information is available for all drugs and most treatments as they are determined during research studies. Get objective numbers, as subjective are heavily biased.

2. How does the treatment work?

The goal here is to tease out the placebo effect.

Determine if the provider is using updated research or only falling back on personal experience. While having 20 years of experience with a specific technique is impressive and means they are likely proficient with the technique, it may not be the best available option.

The best surgeon in the world at performing open rotator cuff repairs (splitting the deltoid open) will always fall short of residents performing arthroscopic repairs. Experience can only take you so far.

3. What are the alternatives?

Always get a second opinion. Everyone is blinded by personal bias and limited perspective. Our training, mentors, environment (i.e. clinicians who use combo therapy), and past patients shape how we treat. Providers often answer what they would do in your situation.

You want to know you, with your history, circumstances, and goals, should do.

Ask your provider or source of information what the alternative treatments are. You want all of the options on the table. All of their proposed effects, risks, costs, and timelines. Some providers only provide options they feel comfortable with (such as a surgical technique) but it may not be the best option (e.g. posterior vs. anterior approach to a total hip replacement)

Providers don’t wake up in the morning thinking, “today I am going to give crappy care.” They want to help people, but that doesn’t mean they don’t sometimes provide ineffective treatments.

Tackling health misinformation requires a team effort. It requires more questions on each side of the treatment table.

It requires scientific curiosity and the willingness to be wrong.