Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence, proven facts powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Kevin Geddings:
0:16
So we're going to spend a little bit of time talking about a really interesting and very useful website, the MedEvidence website. Dr. Michael Koren is here with me and of course, he heads up the show with ENCORE Docs and also helps us get good health care information and medical research information. Dr. Koren, give us the website, the actual address, and then we're going to start talking about it in a little more detail.
Dr. Michael Koren:
0:39
Okay, yeah, thank you, Kevin. It's called MedEvidence. com and it's a platform that we established several years ago to help people understand how to evaluate medical products, services, tests and claims in an objective way and also from the standpoint of somebody who's involved with clinical research, which is the way we actually put things to the test. So we like to call it the truth behind the data, and I'm happy to explore that with you, because there are actually some principles that one should use to understand health claims as well as possible and then ultimately make good decisions for you and your family.
Kevin Geddings:
1:20
Yeah, Dr. Koren. Obviously there's justa flurry of health care information that comes flying at us. It seems like every day there's a little snippet either in the news or on our Facebook feed that says that here's the latest research on Alzheimer's or the effectiveness of statins or whether or not the COVID vaccine latest variation works.
Dr. Michael Koren:
1:39
How do we?
Kevin Geddings:
1:40
How do we use MedEvidence to help us make better sense of all this health care information that kind of blows at us out of a fire hose.
Dr. Michael Koren:
1:48
Yeah, and keep in mind that when you Google something, you're going to get information back that's based on somebody trying to sell you something, and that's fine. I have no objection to capitalism. I'm a capitalist. I think you are too as well, Kevin, but ultimately, people need to get to the truth. And how do you do that? So, again, our bias is only that we believe in evidence-based medicine, we believe that medical claims should be backed up by some scientific information, and we are part of the process for generating that scientific information. So that's what I do day to day. So, when I think about how to advise patients and family members and friends, it comes down to understanding certain elements that will help you think through these things in a much better way, and I like to say that there are three big categories. One, understand how to look at risks versus benefits. Two, understand who you are and how that's relevant to medical decision making. And then, finally, understand issues around value and convenience. And then the fourth thing is that once you've gone through those three major elements of decision making, then you have to know what dose to pick, and the devil is in the details. So we'll get to that and we're going to break down each one, right? So let's start with the concept of risk versus benefit. So, Kevin, what do people usually ask me when they come to my office? Rhetorical question they ask me is something good or bad for me, right? And that's not a great way to think about the world, because everything could be good or everything could be bad. There's nothing intrinsic about things that are either good or bad. It depends on their context. So, for example, is water good for you? Well, we all need water to live, and water and being hydrated is important. But you can drown in water and you can literally kill yourself with water. People have actually drank so much water that they die from water intoxication. So water isn't good or bad. Water is something that has a benefit and a risk and, depending upon what your question is, what your circumstances are, you can assess that risk versus benefit. Obviously, in the doses that we usually use for water, the risk is extremely low, but it doesn't mean it's zero. And actually, when you get into management disease, the amount of fluid in one's body becomes very, very important in terms of how well they'll live their lives. And, of course, this concept of risk versus benefit carries through in virtually every decision we make in medicine. So some of the common ones. I think you and I have talked about this should I take an aspirin a day? Is aspirin good or bad? Well, aspirin is neither good or bad, but aspirin is something that, if used correctly, can reduce your risk for heart artery disease. If used incorrectly, it could increase your risk of having a gastrointestinal bleed, and so we can go into why, in certain circumstances, something should be considered to be high risk and something that should be considered to be low risk.
Kevin Geddings:
4:57
Does that resonate? Yeah, I think I guess I would ask and back up a little bit. When somebody first goes to Dr. Google and they research whether or not it makes sense to take a statin because they've been told their cholesterol is elevated, and they see all these results and depending on how they typed in the search, it could come up with all kinds of stuff, what would you recommend for we laymen out here? I mean, how do we handle that? How do we handle all that stuff that's appearing on our Google search results? What should be step one, as we really look at that, understanding the whole risk reward notion that you just explained?
Dr. Michael Koren:
5:32
Right. You should look at the information based on that risk reward mentality. So, for example, if you're looking at statins and you're just looking up their side effect profile, well, you're going to find lots of reports about side effects, right. On the other hand, if you look at statins and you say what are all the potential benefits? You'll say that they save lives, they reduce strokes, they reduce heart attacks. There's no question about that. And you get more into the risk versus benefit when you start to look at the clinical research elements and you also look at the consistency of all the scientific data. So, if you have heart artery disease or if you've had a stroke, there's nothing that ever has said that, on average, stentons will be bad for you. Obviously, somebody could have an individual side effect, but as a population and you're at that high risk category of having had previous heart disease there's nothing out there that says that stentons are a problem. And there's nothing out there that says getting your LDL cholesterol down to as low as possible is a bad thing. So some people have said in the past oh, you need a certain amount of cholesterol to live Well, that's really not exactly true, and the reason it's not true is because your body is very, very capable of making cholesterol from basic ingredients. So every cell in the body is able to produce cholesterol for its own needs, which are multiple. Cholesterol is a very, very important part of cellular functions but because of that, every cell in your body except your eyelashes, interestingly enough can make cholesterol. And the stuff in your circulation, the stuff that we measure is the extra stuff your body's trying to get rid of, and the stentons help your body get rid of that. So again, getting back to your question is look at the clinical trial evidence or look at a resource like MedEvidence that breaks this down, not from anecdotes or stories, but looking at more global pictures, and then fit yourself into that global picture. Is it relevant to you? So, for example, if you're a 22 year old woman who is a vegetarian and you get a report that your cholesterol is a little bit high, don't freak out. Chances are that that may be "good cholesterol. Quote unquote, meaning that the cholesterol your body is trying to get rid of is in a favorable package called HDL and that person shouldn't be on a statin number one, because they probably don't need it and number two statins can cause birth defects. So if you're a 20 year old woman and you may get pregnant or you may want a baby. You don't want to be on a statin. So, again, this is the concept of one looking at risk, benefits, and then start putting it into step two, which is who you are.
Kevin Geddings:
8:17
And it would seem that Dr. Koren all of us, I guess is layman consumers of health care. We want absolutes right. We want absolute answers. You know that say, okay, this is good, this is bad, this will work 100%, this won't, and that's really totally seems like it's unrealistic to ever look at any health information in that way.
Dr. Michael Koren:
8:38
You're absolutely right, Kevin, is that if you look at anything absolutely, you'll be absolutely wrong. So with that concept let's take a break and in our next session let's talk more about who you are and why that's so important.
Narrator:
8:52
Thanks for joining the MedEvidence podcast. To learn more, head over to medevidence. com or subscribe to our podcast on your favorite podcast platform.
