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.
Dr. Michael Koren:
0:16
Hello, I'm Dr Michael Koren and I'm the host for this MedEvidence podcast, and I'm delighted to have Dr. John Rowda, who's an ophthalmologist and a long-standing colleague in clinical research, and he and I have been having this great conversation about critical thinking. We talked a lot about critical thinking research, clinical trial results with regard to COVID-19 and masks, and now I kind of want to move on to just sort of general areas where we seek out medical information and how we use critical thinking to make good decisions. So I know, John, you're very passionate about this, and why don't you share with us some of your insights in this area?
Dr. John Rowda:
0:54
Well, some of the inspiration behind this is that doctors or articles often quote doctors are saying don't search the internet, you're just going to get bad information, and so nobody's going to not search the internet. Everybody's going to Google it and look up their information, and what we're hoping to do is give you some guidelines on how to find quality information.
Dr. John Rowda:
1:19
And another inspiration I've just read in Canada they've started a high school course in critical thinking where the kids are given a fact or a quote and they're supposed to search the internet finding good information, and they're graded on the source of their information and the quality and breadth of their search, which I think is a terrific idea for all of us to learn how to do this.
Dr. John Rowda:
1:43
We're all biased and there's two basic ways I see of doing this. You can ask a fair, unbiased question on the internet, because if you throw a bias in your question then the answers are going to be biased. Worse is if you have, if you're well, pick a number to irritate both sides. If you're a far left wing or far right wing and that's what your majority or half of your searches have been the last two months you can ask a very unbiased question, but the computer has your history and it's going to lead you to a far right or a far left answer. So you could try an unbiased question. But another way is to, in any area, find yourself a source, hopefully multiple, that have good, hopefully unbiased, answers and information that is based on good research. I think that may be another way for people to find the best information.
Dr. Michael Koren:
2:42
Now, this is a biased answer, but the MedEvidence podcast is an example of what we consider Where's the best.
Dr. Michael Koren:
2:49
Well, there you go. Well again, what we do that's unique, I believe, on the internet is that we explore things. We don't tell people what to do. We're not trying to sell you anything. What we are trying to do is explore all sides of the question, and you usually kind of get to the answer in a circle. You kind of move in slowly but surely and then you figure out the answer, and sometimes you can't put your finger on that one spot, but you have a general sense for what's right and what's wrong, and so that's the purpose of this. So rarely we'll tell people that they should do this or they should do that, but we like to tell people this is how you explore something and this is how you understand whether or not it's not right for you.
Dr. John Rowda:
3:31
I agree. We're the starting point and point you in a direction and hopefully teach you how we think is the best way to find the best information.
Dr. Michael Koren:
3:40
And we like to use the slogan. The truth behind the data says. We all know we generate data as clinical research professionals and data can be interpreted in different ways and the truth is never straight line. The truth is zigzags, the truth is elusive, but if you keep on looking, you keep on searching, you will eventually find it.
Dr. John Rowda:
4:01
An example I thought of while Mike was speaking is a friend was telling me about a broadcast where they had a family doctor from another country and he was talking about his 42 patients and his research results. Well, you can't do research on your own patients. It's not possible. The ideas weren't set up beforehand. It's just totally unscientific. Mike could probably talk a few days about how to do research, but I can tell you there was no research being done in this doctor's office and people listening to him as handing out the truth was just totally misled.
Dr. Michael Koren:
4:39
Right. Yeah, there are selection biases and these type of things. Observational research is usually a starting point, but not as powerful as a randomized clinical trial, and really one of the main things that we do as scientists is we try very, very hard to reduce ourselves from being biased, and it's not always easy, and it's just human nature to want to be proven right. But what we do in clinical research is we ask a hypothesis objectively and we let the answer box of a clinical trial decide what's right and what's wrong. So, John, tell us a few more stories. You and I were talking offhand. You had a number of very, very interesting stories about some of your searching on the Internet and things that came up in discussion in different searches and how you'd structure them. So give us a little bit more insight into that.
Dr. John Rowda:
5:29
Well, I was following the COVID numbers. There's several sites Johns Hopkins, new York Times do it. The Florida Health Department. Interestingly to me in the Health Department the one that jumped out you don't have to be a research scientist to understand these numbers.
Dr. John Rowda:
5:43
In the fall, I believe it was 2020, there was no vaccine for children at that time Nobody under 18, it hadn't been researched. Mike hadn't done the research yet, and so the mandate at that time was the kids in school wear a mask and they social distance and they cut down. I think the number of kids that were in classrooms at the time and where I followed was Citrus County and Jacksonville, Florida, Duval County and the first three weeks of the years with the mask and social distancing trying to do everything. There was about 30, some kids sick in Citrus County at first and Jacksonville was 40, some kids. A year later the mask was removed. The children were told not to wear a mask and it was the public sentiment was that they were not worthwhile.
Dr. John Rowda:
6:35
Citrus County the first three weeks again the year before is 30 some. The next year, the first three weeks, it was over 800 children sick. There was no statistics on how many were hospitalized or how seriously or if they had long term COVID. I did not see that. But that number, those two numbers alone, you don't have to be a bio statistician to understand there's a difference. Were well in Duval County went from 40 to 900 kids sick the first three weeks. Oddly, Citrus County Duval County, Citrus is far smaller but they had both counties had three staff members die from contracting COVID from the kids. So those are numbers that just jump out at you. That again the mask works and it was also social distancing, hand washing.
Dr. John Rowda:
7:22
I think there was a sanitizer at the door of every classroom, so it wasn't one thing. You layer these protections.
Dr. Michael Koren:
7:29
And again, as the clinical researcher, I would point out that the numbers are compelling but it's not proof, so that's why you have to do a randomized trial. So these were not randomized trials and of course, it could be coincidence that the activity of the disease in the community was a lot less and then just coincident with the changing in the mask rules, that it became more severe. So we want to be fair to say that when you have these observations, they should generate a hypothesis and, as we talked about in a previous section with regard to masks, there are randomized clinical trials that show that masks have some positive impact, that N95 masks work better than paper masks, but that no masking protocol in of itself is going to be perfect. So again, the truth is always buried in the details and related to your perspective to some degree. But I want to get back to some other things.
Dr. Michael Koren:
8:24
Just general advice for people. So you mentioned when we started. Depending on how you ask the question, is coffee good for you? Is coffee bad for you? So I like coffee, so should I be worried? How many cups of coffee should I have? Should I cut out of my life? Give me the scoop, and how do I learn more about that?
Dr. John Rowda:
8:42
Well, the same thing. You can ask the same questions about chocolate, so that people usually like both of those things and they can look them up. And the truth is the reason they're on the TV every month a study is because the answers keep changing and usually the basis is the dose. People who have one or two cups of coffee a day seem to do well and oftentimes in some studies, and you realize, each question, as Mike mentioned, is usually one question. It's not answering all health, it's usually one health problem and sometimes one or two cups of coffee a day improve some people in some studies.
Dr. John Rowda:
9:20
Now, if you've had, you know, I don't know five stents in your coronaries, probably any coffee might be a problem. You don't want to. You probably don't want to. Well, if you did study those people probably would be a problem, but the vast majority of us one or two cups of coffee is probably not a problem. If you brew yourself a strong pot and then drink the whole pot, you're probably going to have symptoms. So it's dose-related basically, and in your own health, if you're an outlier, have significant health risks, then you have to be careful. If you're a bad diabetic, chocolate is probably bad for you, but most people, especially dark chocolate. I'm told by my wife that is good for you right.
Dr. Michael Koren:
9:59
So you bring up something really interesting. And this gets into critical thinking skills. So one of the ways of understanding problems is to look at the extremes. So with all these things such as coffee or chocolate or whether or not everybody should take an aspirin, you look at the extremes. And if we all would agree that if somebody drank, you know, 50 cups of coffee a day, they would get caffeine poisoning and that's well-established in clinical medicine. But then you look at the people who never touch coffee at all. Are they living longer? Are they living better? We don't have any data for that. So at both extremes we see that a large amount of coffee is not good and zero coffee is probably not great, because we don't have any data to suggest that over the course of, you know now, thousands of years. So that extreme analysis is part of critical thinking.
Dr. Michael Koren:
10:49
The other part of critical thinking is internal inconsistencies. So if somebody says, well, diet coax, two diet coaxes is horrible for you, but two cups of coffee is fine, well, you know that may be an internal inconsistency, because probably the product in both of them that makes the product desirable is the caffeine. And so we always encourage people to use these type of critical thinking skills to look for internal inconsistencies. So John's an ophthalmologist, so I'm going to ask him a couple of quick questions in closing that again get into these same sorts of things. So I guess when I was growing up my parents would tell me to not stare too much at a piece of paper because it's going to hurt my eyes. That's like one of these myths out there, or maybe not. So how would I have known if my parents would give me good advice or bad advice?
Dr. John Rowda:
11:44
That's actually a controversy right now with the pandemic. The kids are at home and people and kids staring at their screens, their phone, their tablet, their laptop, even in the classroom. Some of this stuff is on PowerPoint. I guess they look across the room. But the point is these kids are watching too close, too close, and there's an epidemic of myopia, nearsightedness from the muscle strain of keep looking closer and closer. Actually, it seems to be a stimulus for the eyeball to grow, which becomes nearsighted, meaning you can see well up close, but you can't see in the distance. And actually one editorial that seems unbelievable to me was one of the solutions was to force your kids to go outside and play for 45 minutes a day, and I don't know about Mike, but when I was a kid, our parents had to force us to come inside.
Dr. Michael Koren:
12:40
Yeah, absolutely, isn't that crazy? That's crazy. So the other one and I'll end with this question mark sunglasses and protecting your eyes against cataracts and things of that nature. So that is one of these practical things, and should I be wearing sunglasses all the time? Should I wear indoors to protect my eyes against cataracts? Give us a little insight and what the data is showing for that.
Dr. John Rowda:
13:02
Yeah, I'll give you some population studies. Oddly, you realize, people in England, Great Britain it's a very cloudy area with people with blue eyes which tend to be more prone to problems. Well, the population of Australia are those people, that's, who mostly migrated there, and the incidence of cataract is not much different in the two populations where you have a very sunny desert type climate and there's not much difference. But oddly, the lower eyelid, because it's very thin, very fine and it's angled, is highly prone to skin cancer and so it may lower your risk a little bit of cataract slightly to wear sunglasses, but maybe for the to prevent ocular skin cancers, maybe even inside the eye. The eye is prone to melanomas and blue-eyed people tend to be prone to more skin cancer or eye cancers. So polarized sunglasses I always think are the best.
Dr. Michael Koren:
14:06
So, based on your advice, John, I probably should be wearing sunglasses now. Wouldn't it be nice if they just showed up?
Dr. John Rowda:
14:13
You make them look good.
Dr. Michael Koren:
14:16
The things you can do with video. Thank you everybody. Thank you for watching, Thank you for listening and wear your sunglasses and wear your mask when appropriate. We appreciate your attention.
