From the desk of the EMD: Fake news!
No this column is not a piece on the war between President Trump and the media about “fake news.” My guess is that if I gave you my thoughts on the issue, half of the allergy community would praise me and the other half would demand that our President, Stephen Tilles, MD, FACAAI, fire me immediately. I love my position as EMD of the College, so I’m not going there.
But all the fuss about “fake news” got me to thinking: is there fake news in medicine, and especially in allergy/immunology? We would hope that everything published in our newsletters, AllergyWatch, and Annals are true. Then I came across an article from STAT news – whose byline is “reporting from the frontiers of health and medicine.” “In age of alternative facts, a college course on calling out scientific crap” by Usha Lee McFarling, delves into a course being taught at the University of Washington entitled “Calling bullshit in the age of big data.” The professors teaching the course, Carl Bergstrom, a biologist, and Jevin West, from the University of Washington’s Information School, wanted to teach about the inflated claims, manipulated algorithms and twisted interpretations of scientific research in the press and in scientific papers themselves. They state the aim of this course is to teach you how to think critically about the data and models that constitute evidence in the social and natural sciences. Nothing could be more important in synthesizing the allergy literature today.
So, when I was conducting Journal Club for the allergy fellows at the University of Tennessee, I attempted to help them to interpret if the science behind an article was valid. The most important part of any scientific article is the soundness of the methods. The rest is fluff. To be honest, even in prestigious journals like the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA), retractions have been made related to misinformation in the articles. It was in Lancet that the article linking autism to MMR vaccines was published and finally retracted 12 years later, after much damage had already been done. Last year an article in PLoS ONE from 2012 entitled "Iron supplementation decreases severity of allergic inflammation in murine lung" was retracted due to discrepancies in the data.
Probably the biggest area of “fake news” in allergy is related to the press coverage of food allergy. I don’t have to tell you that this is today’s hot topic. Probably one of the biggest stories that turned out not to be true was a few years ago, when a Canadian teenager died after kissing her boyfriend who had peanut butter on toast NINE hours earlier. It turned out that she did not die from peanut anaphylaxis, but from an asthma attack, which progressed at a party she was attending at the time. This “kiss of death” from peanut led to widespread panic in parents of children with peanut allergy.
And what in the world is going on with gluten intolerance or allergy? Does everyone in America now suffer with evils of gluten proteins? Can you still buy a product at the grocery store that has gluten in it? Do a Google search on diseases linked to gluten sensitivity and you come up with osteoporosis, irritable bowel disease, inflammatory bowel disease, anemia, cancer, fatigue, canker sores, rheumatoid arthritis, lupus, multiple sclerosis, anxiety, depression, schizophrenia, dementia, migraines, epilepsy, neuropathy, and autism. I’m not saying gluten sensitivity doesn’t exist – of course it does. But not in the numbers suffering and with all these conditions that are reported in “fake news.”
One last point. In scientific articles, we live and die by the p value. If the results in the publication show a p value of less than 0.05, then by all means it is medical fact. In general, for any drug to be approved by the FDA, the study must show statistical significance with an appropriate p value. We must remember that even if a journal article is statistically significant, that it does not make it necessarily clinically relevant. We all have seen medications approved by the FDA which had little or no success in the care of our patients.
So be on the lookout for “fake news” in allergy. You need to be a credible source in providing accurate information to your patients. The College is here to help with our newsletters and publications, along with our posts on social media. You can follow me on Twitter @wheezemd. Hopefully President Trump won’t label my Twitter account as “fake news.”