The problem with medical advice columns
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7214.928 (Published 02 October 1999) Cite this as: BMJ 1999;319:928
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EDITOR-In her recent review discussing the problems of medical advice
in the media McPherson gives an example of such problems in her own
article (1). She criticizes Dr Mark Porter's comment that radiotherapy 'is
an effective form of treatment in breast cancer and tends to be fairly
well tolerated by most patients'. This statement, although simplistic, is
not misleading as is suggested in the article. McPherson's own comments,
however, are inaccurate. Radiotherapy does not 'stop' local recurrence,
though it does significantly reduce the recurrence rate. It is also stated
that local radiotherapy does not stop the spread of breast cancer or
affect mortality. In fact, recent randomised trials have shown in pre- and
postmenopausal women with high-risk breast cancer that both local
recurrence and overall survival are improved by radiotherapy in addition
to surgery and systemic treatment (2,3,4).
With the rapid increase in published medical information it is
impossible for any one doctor to keep up to date in all areas of medicine.
In medical advice columns, as in all areas of life there will be both good
and bad advice and both patients and doctors should be aware of this.
1. McPherson A. The problem with medical advice columns. BMJ
1999;319:928.
2. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer
M, Gadeberg CC, Mouridsen HT, Jensen M-B, Zedeler K. Postoperative
radiotherapy in high-risk premenopausal women with breast cancer who
receive adjuvant chemotherapy. N Engl J Med 1997;337:949-55.
3. Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE,
Wilson KS, Knowling MA, Coppin CML, Paradis M, Coldman AJ, Olivotto IA.
Adjuvant radiotherapy and chemotherapy in node-positive premenopausal
women with breast cancer. N Engl J Med 1997;337:956-62.
4. Overgaard M, Jensen M-B, Overgaard J, Hansen PS, Rose C, Andersson M,
Kamby C, Kjaer M, Gadeburg CC, Rasmussen BB, Blichert-Toft M, Mouridsen
HT. Postoperative radiotherapy in high-risk postmenopausal breast-cancer
patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group
DGCG 82c randomised trial. Lancet 1999;353:1641-8.
Competing interests: No competing interests
Statutory/voluntary warning?
Dr Julian Adlard's general point at the bottom of his response is
quite fair. Perhaps there should be some sort of 'warning' at the bottom
of all published medical articles (both in ordinary newspapers and in
professional journals) such as the one below? After all, unit trusts
can't claim "2000% growth in two years!" without having some quite wordy
statutory warnings underneath which say that this figure should not be
relied upon for the future. Although potentially unpopular, if such a
warning were made a statutory requirement then it may go some way to
alleviating the pressure many doctors feel from patients, and the growing
number of lawsuits. After all, the statutory label "Always consult your
doctor" on some medicines has been around for several years now.
"Although published in good faith, the information contained in this
article should not be relied solely upon for decisions about any
individual's health. We recommend that any reproduction of this article,
or excerpts thereof, also include this warning."
Competing interests: No competing interests