Researching on the Internet? What can you rely on?
Our patients often tell us “I’ve done my research”, and we notice that the quality of that research varies considerably from person to person.
There is a vast amount of information on the internet. Some of it is brilliant, some is untrue and manipulative, and there’s a whole spectrum in between. How can an intelligent person know what to believe if it’s not their area of expertise? If you’d like to make sure your research is based on reliable information, this Health Post is for you.
For a start, AI will only give you a skimmed version of the most commonly available information on the subject, and the first hits from a google search are usually sales pitches!
People on YouTube and other influencers have their own agendas, which usually focus around how to sell you something or have you become a follower. And they like to make it sound sexy or urgent or scary. Real research is rather dry, but very interesting if it is a topic you want to know more about.
Nothing can tell us the 100%-undeniable, will-never-change truth: that probably isn’t even known yet, and maybe never will be. In the meanwhile we do our best with the most robust information we can find, which means looking to the scientific evidence, as we SHINE doctors do.
The two most common sources for this are Pubmed and Google scholar. The information they publish is peer-reviewed, which means that colleagues in the same field as the author have read it over and agree with it.
There is a hierarchy of scientific evidence, according to the quality and dependability of that research. This helps us know how much confidence we can have in its results. It’s a little long, but we encourage you to use it as reference when you are looking into medical questions.
Here’s how that hierarchy works, so you can check out the robustness of the information you have accessed:
1) Systematic reviews and meta-analyses are considered to reflect the best degree of evidence. They combine data from several high-quality research papers to offer broad insights. The results are considered strong enough to be applied to people in general. Careful assessment of the quality of individual research is required when performing systematic reviews, to retain their credibility.
2) Randomized controlled trials RCTs
Most trials included in meta-analyses are RCTs.
Randomized means that who gets the treatment and who gets a placebo is randomly assigned.
Controlled means placebo-controlled. This tells us that some of the group get the treatment, and some get a sham medication. The placebo effect is well known: if someone thinks they are getting a treatment, they may improve because of that belief, not because of the treatment. This can happen in 20 - 30% of people! Trials need to take this into account to find out how much difference the actual treatment makes. Of course we need to remember that 20-30% of those taking the medication will experience a placebo effect too. The control group balances that out.
3) Cohort and case–controlled studies
Cohort studies track groups over time to evaluate results, whereas case–controlled studies compare people with and without a disease. These observational studies provide significant insights but are less reliable than RCTs owing to potential variables.
Prospective cohort studies track people continuously, enabling more reliable data gathering while minimizing recall bias. Retrospective studies examine historical data, relying on people’s memories, so they produce less reliable information.
4) Case series and case reports include information on individual or group instances, and often apply to rare illnesses or therapies. While beneficial for developing hypotheses, they can’t be generalized and they have intrinsic limitations. However they often offer preliminary findings that later develop into well-structured cohort studies and RCTs.
5) Expert opinion and anecdotal evidence are at the bottom of the hierarchy and rely on personal experience or isolated observations. While perceptive, they are the least trustworthy because they are more subjective and prone to human bias, and they lack standardization or control. They may give insights in exploring new treatments or uncommon illnesses, when data are limited.
The gold standard for trials is that they are double-blind, randomized, placebo controlled, cross-over and multi-centred. This is what those terms mean:
Blinded means the patient isn’t told what they are getting: the medicine or the placebo.
Double-blind means that neither the patient nor the researcher giving the treatment knows whether the patient is getting the real deal or the placebo. This way there’s no chance of accidentally subtly communicating to the patient which they are taking.
Randomized means that those who get the medication and those who get the placebo, are randomly assigned.
Cross-over means that the treatment group and the placebo group swap over after a while: those who were getting the treatment get the placebo and vice versa.
Multi-centered means the trial was run from more than one location.
The date of the research is also relevant - was it the latest information, or something that was published 20 years ago? Has it been superseded by better research results since? Or is that older research so well supported that it is still reliable?
If you really want to understand more deeply, it’s preferable to read the paper itself. This is how we gather our information to write these Health Posts. And so of course you can trust SHINE Health Posts. We delve deeply into health topics, so the information we provide is current and reliable.
To learn more about reliability of health research see:
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