Bias in Health Information:
Understanding the Agendas

Gary E Cordingley, MD, PhD
All health information and advice is biased, including mine. That
doesn't mean it's worthless. But in order to judge the message and
its applicability, you need to understand the underlying agenda.
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.

So when it comes to medical advice, consider the source.

(C) 2005 by Gary Cordingley