A dose of our own medicine

A report this week struck right at the heart of what we do. Yes. it was another analysis of the world's medical journalism.

There was a conflict of interest but we did not hold back. We reported the story.

Like most such analyses, it concluded that most medical journalism in the mainstream media is flawed. That's no surprise. But the study, from Alberta, Canada, did make some interesting points.

It suggests four kinds of basic information that should be included:

• the number of patients;
• the methods used;
• the doseage;
• conflicts of interest.

Tania Bubela, who conducted the research, seemed to want to make the case that reporting is biased against alternative therapy. So I think that was why dose was important in her mind - as it is less standard in, say, herbal medicine than in mainstream.

Methods is an interesting challenge. Yes we always try and report the methods used. Frankly its tedious for the writer and the reader. The problem is that the "gold standard" is the randomised control trial. This means that neither the doctor nor the patient knows whether they are receiving the real pill or a fake - known as a placebo. As we saw in the case of acupuncture, creating a placebo can be problematic. It's okay with pills but with other therapies, how do you fake them?

There are other statistical methods, mainly involving the analysis of populations. These will tend to tell you about the impact of diet and lifestyle. They are rarely conclusive on their own but taken together, over the years, they can be pretty convincing. It was that kind of analysis that proved that smoking causes lung cancer - it took a long time.

And that's where numbers come into it. Yes, we would always report the number of people in a trial. It's very important. If percentage differences between a treatment working and not working are close, you want to see large numbers - thousands. If they are overwhelming smaller numbers, say hundreds, will do. The trouble is we still live in a world where some people have done statistics (and hence standard deviation etc) at school and others have not. Increasingly the younger generation, certainly in Britain, will have at least a smattering of statistics.

Finally there's conficts of interest. I touched on this in a recent posting. Frankly it's not always easy to know. But yes there are some stories which are disseminated actively by commercial interests. We are more cautious of these than others, perhaps. And we see sourcing as important. If we report a therapy, the report will generally come from a journal or a conference, possibly via a university. We will identify that source in detail. That's not usual in the mainstream media.

Is acupuncture harmful?

There's a curious story we've written which may appear on this site quite soon. It is about acupuncture and reports a Chinese study of the impact of acupuncture on fertility treatment.

The researchers in Hong Kong set out to be scientific in their research and used standard medical research techniques. And that causes the problem.

The research compared fake acupuncture with real acupuncture. In fake acupuncture, treatment is given with fake needles which retract when pressed against the skin. This was meant to be the same as the use of a placebo in drugs trial. A placebo is a dummy pill meant to make the patient think they might be receiving treatment. So the psychological impact of receiving treatment is taken into account.

So if a drug works, patients taking the real drug fare better than those taking the placebo. If a drug is harmful, patients fare worse on the real thing. And if a drug is totally ineffective, both placebo and drug are about the same.

What Dr Ernest Ng and his colleagues concluded was that women who received fake acupuncture were more likely to get pregnant than those receiving the real thing. The women were received IVF treatment and 55 per cent of those in the first group were successful - compared with 45 per cent of those getting fake acupuncture.

What can be concluded from this? Almost certainly that acupuncture for fertility treatment does not work. But does fake acupuncture work? And is real acupuncture actually harmful, as you might conclude?

And how on earth do you write the story?

It would be a great deal easier if acupuncture had been compared with nothing. You could then conclude that acupuncture wasm harmful. But it is also possible that fake treatment is beneficial. It involved applying gentle pressure to acupuncture points - and maybe that is better than inserting a needle when a woman is trying to get pregnant.

It's been said that journalism is the first draft of history. Our story reads:
Pretend acupuncture may help boost fertility - and is better than the real thing, according to new findings.
That was not our first draft and it is just about tenable. The researchers certainly believed that the placebo effect was genuine - that fake treatment had helped to stimulate the women in some way.

It's also possible that real acupuncture was harmful to these women.

And it is even possible the whole thing is a statistical freak. The research involved just 370 women - and that is not a great deal when you are seeking a statistically robust result.

An advertising policy

If you go to our page on services and policies, you will find our policy on accepting advertising is "currently under review". It's said that for ten years - as that has been the case for ten years. The Englemed site became largely a showcase for potential clients and we drifted away from our original idea of providing a news site for the public.

Now that's changed following a major revamp. And, after some consideration and research, we even have an advertising policy - which you can see reflected on the site!

We hope the site is now more useable and that it contains useful information.

The problem we had with advertising was not to compromise the independence of our news service. We are almost unique in that we do not draw from the main news agency sources that feed all media, papers, TV and web - mainly Reuters and the Press Association. You can see that today in our very different take on the story about statins and heart disease.

If we provide a service to another website there's a good chance they may be taking pharmaceutical sponsorship or relying on selling health products. When we agree a contract we negotiate carefully so they can reassure their users the news service is unbiassed. When there's been pharmaceutical sponsorship our experience has varied - but at the very least it tends to mean some restriction on what is published. One approach is simply to agree not to report about any marketed drugs. It means the news is about other issues, lifestyle, causes etc. That's fine - but we get unhappy if we come under constant pressure to identify, say, a particular cause when there may not be medical consensus about it.

On this site we think you need to be sure we won't hold back from reporting good or bad news about a treatment. So we don't want to be reliant on pharmaceutical sponsorship - even if it were possible (and there are legal issues involved too). Nor do we want to promote herbal remedies, vitamins, dietary supplements or alternative therapies. The news about these treatments tends to be mixed and you need to be sure you are getting it fairly. They may crop up on google ads which appear on blogs. That's fine - their appearance is largely out of our control although we can and will block a repeat advertiser who is clearly disreputable.

We have for some time promoted a limited range of books from reputable organisations and authors. And thanks to the wonders of affiliate schemes, we can now promote other relevant material to our visitors. We've always had a strong family focus. This is a feature we did on pregnancy issues some time ago. And our redesign gives fresh emphasis to this.

So if you're having a baby, there's maternity wear. There's toddler and baby safety devices. And there are those hard to find gifts for all the family and special occasions. There's even a garden centre! We think this is the right kind of ethical advertising for this site - so readers can be assured they are getting real news!