Bias in Health Information: Understanding the Agendas

Writers of medical advice–including columnists, insurance companies, governmental agencies, medical organizations, drug companies and even practitioners–are all biased. They always have agendas. They all choose to write about certain topics and not others. They make choices about what to include in their articles, what to leave out and how to state their cases. They’re all self-serving. They all have something to “sell,” even when there is not an immediate cash-return.

Does that mean you should throw up your hands, say the hell with it, and never read or listen to another medical message? I don’t think so, but in order to derive value from these messages, you sure as heck better understand the agendas of the people who created them. Or as the psychologists say, if you want to understand a behavior, you need to figure out what motivated it. Let’s examine some advice-givers and their biases.

What motivates health columnists? Well, how about their continued employment, the needs of their publisher-employers, and the needs of the companies the publishers wish to attract as advertisers? It’s not hard to imagine there are some subtle and not-so-subtle influences and incentives at play in framing the subject-matter and slant of the articles. Certainly, it’s hard to attract the business of potential advertisers when you have written devastating critiques of their products.

Yet don’t infer that you should ignore what the health columnists have to say. They provide a wonderful service in discussing health issues, the business of medicine and its practice. I personally enjoy reading the health columns of that great medical publication, The Wall Street Journal. In fact, I still distribute to my patients an excellent article about medication-overuse headaches that Tara Parker-Pope, one of their columnists, wrote years ago.

One of the odder chapters in the business of medicine is that certain insurance companies have positioned themselves as providers of health advice, particularly those companies paid by employers to manage their medication-benefit plans. I won’t waste the reader’s time in building a case that insurance companies have agendas and conflicts-of-interest in providing such advice. This should be self-evident.

Governmental agencies like the National Institutes of Health provide medical information which is generally reliable and useful, but influenced by the agency’s understandable needs for self-promotion and self-preservation. The same holds true for medical organizations like the American Academy of Neurology (to which I belong) and big group-practices like the Mayo Clinic and Cleveland Clinic. The advice tendered by these medical organizations in their publications and web-pages is backed by their reputations, which they zealously protect. So you can be sure that the medical content is subjected to rigorous quality-control. And fortunately, although their messages are motivated by commercial needs, the linkages are obvious and easy for the consumer to take into account.

How about individual health practitioners? Giving advice is what they do for a living, so what’s the issue? Well, in the U.S., at least, there is a genuine “medical marketplace” where competition reigns supreme. So when you need help with your health, each practitioner (including me!) would like to make the short-list of advisers whose opinions you trust and value.

Let’s move on to the drug companies. In my opinion there is no medical information that is both as pervasive and biased as that created by drug companies. And in many cases the connection between the message and the drug company’s name has been obscured or hidden, so the consumer doesn’t even know to be wary.

I have written elsewhere about the comical turn of events in the “advice” that drug companies have provided to people with headaches. For many years the makers of sinus medications invested heavily in convincing people with headaches that most of them were due to sinus disease. But now that effective and lucrative drugs for migraine exist, companies are sinking even larger sums of money into the message that those headaches weren’t due to sinus conditions after all. Instead, they’ve been due to migraine. This vignette illustrates the hazard in allowing marketing departments of drug companies to diagnose one’s headaches.

Another hazard is in allowing drug companies to write the information-sheets that doctors hand patients at the ends of office visits. Every doctor gets buried in pamphlets that sales reps from drug companies leave at their offices. For years I actually looked at these things, trying to select the 30% that might be worth retaining and passing along to my patients. After a while, 30% seemed too optimistic, so I searched for the 20% that was worth keeping, and then the 10%…well, you get the idea. The pamphlets kept getting more biased and less useful. At one time the sales reps passed out some real gems that were genuinely helpful to patients and their families. But those days are gone.