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Out of Hours

Fakery and science

Saul Miller
British Journal of General Practice 2017; 67 (657): 180. DOI: https://doi.org/10.3399/bjgp17X690365
Saul Miller
Wooler, Northumberland.
Roles: GP
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Fake news — deliberately misleading information — is a hot topic in the media.1 Despite the irony in this, there seems good reason for concern. The Pope’s endorsement of Donald Trump was apparently the most read item of news on Facebook in the 3 months leading up to the US Presidential Election.2 Of course, neither the Pope nor even Denzel Washington did endorse the man who surprised many by winning.3 But an important question was raised: how much are we being duped?

A few months ago, the Independent newspaper published its own analysis of fake health news on social media sites. It said: ‘Of the 20 most-shared articles on Facebook in 2016 with the word “cancer” in the headline, more than half report claims discredited by doctors and health authorities or — in the case of the year’s top story — directly by the source cited in the article. ’4

It isn’t my go-to source for health information, but Facebook does have about 1.86 billion ‘monthly active’ users worldwide.5 So stories on it have a massive potential circulation. By contrast, though exact figures are not available, this journal is sent to over 50 000 clinicians and researchers each month; how many of them are ‘monthly active’ is unknown.

Taking refuge in the scientific press would seem much safer even so. After all, peer review of the quality of the science presented comes as standard, or at least the facts are checked.

But then you look at a cross-sectional study of drug trials and you see that having a financial tie to the manufacturer of a study drug is an independent predictor of positive study outcome.6 That raises your eyebrows, doesn’t it? Surely it at least makes you wonder how something so non-scientific as cash payments can cause a measurable effect on the science?

Look next at a recently published study that describes itself as a ‘meta-epidemiological survey’.7 Weird as that sounds, it is a review of scientific claims based on subgroup analyses. Out of 64 randomised controlled trials reviewed, 117 claims were made in all. Of these, only 46 were supported by their own data and most of those had other reasons for doubt, such as lack of randomisation in the subgroups. Only five had at least one subsequent corroboration attempt, and none of those had a positive outcome.

Let me repeat that: of 117 scientific claims analysed, most were not supported by their own data and none was backed up by later research. What if this stuff was translated into guidelines?

It is harder to find the smoking gun this time but the GOLD COPD guidelines8 are curious. Their first iteration, in 2001, introduced a new diagnostic threshold for COPD that resulted in its apparent prevalence rising from 13% to 22%.9 A staggering change, by anyone’s standards, and without any evidence that all those extra patients would benefit from the diagnosis or its medication. Is it just coincidence that GOLD is funded by ‘unrestricted educational grants’ from a raft of companies that benefit from COPD-related sales?

Centralised science policymaking surely magnifies any risks from wrong turns, manipulations, and fakery. Globalisation means the exposed population might even exceed Facebook’s numbers.

Imagine, for example, if it turned out that saturated fat was not a villain after all.10–11 Imagine if it turned out that, during all those years of blaming saturated fat for heart disease and obesity, the real culprit was being promoted as a healthier option.12

And imagine if the source was neither Facebook nor the Easter Bunny.

  • © British Journal of General Practice 2017

REFERENCES

  1. 1.↵
    (Dec 30, 2016) BBC News, Fake news in 2016: what it is, what it wasn’t, how to help. http://www.bbc.co.uk/news/world-38168792 (accessed 6 Mar 2017).
  2. 2.↵
    1. Harford T
    (Mar 1, 2017) Financial Times, Hard truths about fake news. https://www.ft.com/content/3316daa2-fd44-11e6-96f8-3700c5664d30 (accessed 6 Mar 2017).
  3. 3.↵
    (Nov 15, 2016) BBC News, Denzel Washington hit by Facebook fake news story on Trump. http://www.bbc.co.uk/news/election-us-2016-3798730615.11.16 (accessed 6 Mar 2017).
  4. 4.↵
    1. Forster K
    (Jan 7, 2017) Independent, Revealed: how dangerous fake health news conquered Facebook. http://www.independent.co.uk/life-style/health-and-families/health-news/fake-news-health-facebook-cruel-damaging-social-media-mike-adams-natural-health-ranger-conspiracy-a7498201.html (accessed 6 Mar 2017).
  5. 5.↵
    1. Statista
    Number of monthly active Facebook users worldwide as of 4th quarter 2016 (in millions). https://www.statista.com/statistics/264810/number-of-monthly-active-facebook-users-worldwide/ (accessed 6 Mar 2017).
  6. 6.↵
    1. Rosa A,
    2. Woodbridge A,
    3. Abraham A,
    4. et al.
    (2017) Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study. BMJ 356:i6770.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Wallach JD,
    2. Sullivan PG,
    3. Trepanowski JF,
    4. et al.
    (Feb 13, 2017) Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials. JAMA Intern Med doi:10.1001/jamainternmed.2016.9125.
    OpenUrlCrossRef
  8. 8.↵
    1. Global Initiative for Chronic Obstructive Lung Disease
    GOLD 2017 Global strategy for the diagnosis, management and prevention of COPD, http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/ (accessed 6 Mar 2017).
  9. 9.↵
    1. Miller MR,
    2. Levy ML
    (2015) Chronic obstructive pulmonary disease: missed diagnosis versus misdiagnosis. BMJ 351:h3021.
    OpenUrlFREE Full Text
  10. 10.↵
    1. de Souza RJ,
    2. Mente A,
    3. Maroleanu A,
    4. et al.
    (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 351:h3978.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Ramsden CE,
    2. Zamora D,
    3. Majchrzak-Hong S,
    4. et al.
    (2016) Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 353:i1246.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Leslie I
    (Apr 7, 2016) Guardian, The sugar conspiracy. https://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin (accessed 6 Mar 2017).
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British Journal of General Practice: 67 (657)
British Journal of General Practice
Vol. 67, Issue 657
April 2017
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Saul Miller
British Journal of General Practice 2017; 67 (657): 180. DOI: 10.3399/bjgp17X690365

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