Three surveys show gaps in doctors knowledge
by Maryann Napoli
Life & Health Library
Regulating Vitamins and Herbs
Tell your doctor about any vitamins or herbal medicines you are taking. That advice has been around for years, but only recently has anyone thought to survey physician knowledge about the regulation and oversight of these over-the-counter products, known as dietary supplements.
The survey was conducted by Bismal H. Ashar and colleagues at the Johns Hopkins University School of Medicine and published last May in Archives of Internal Medicine. They designed a short online test that physicians could take to assess their knowledge of supplement regulation. The 335 physicians who volunteered to take the test last year were primarily medical residents.
About a third of the physicians were unaware that makers of dietary supplements are not required to prove safety or effectiveness before their products go on the market or that the FDA has no role in regulating their quality. And 60% did not know that adverse reactions to supplements should be reported to the FDA.
Ashar and colleagues suggest that this low level of knowledge among physicians could explain why the adverse event reporting for dietary supplements is low. Consumers as well as physicians can make adverse reaction reports about drugs and dietary supplements directly to the FDA MedWatch database (see previous page).
Over-the-counter vitamins and herbal products are a multi-billion-dollar industry in the U.S. Seventythree percent of Americans take dietary supplements, according to another survey conducted in 2002 by the FDA, and 4% of them experienced an adverse reaction that they believed might be related to supplement use.
Understanding Medical Statistics
We all hope our doctors read medical journals regularly. That is, after all, where the latest research results are published. But those findings are usually conveyed to us by doctors and drug ads ("Cuts your risk of heart attack by 60%!!") in ways that are incomprehensible. (That heart attack reduction statistic, for example, makes no sense unless the patient gets an honest answer to this question: 60% of what? *) The problem may be due to the fact that, like most of us, many doctors have difficulty understanding statistics. This was demonstrated in surveys of practicing physicians conducted in the 1980s that showed those with no formal education in epidemiology and biostatistics had a poor understanding of statistics and therefore a limited ability to interpret study results.
As things have gotten all the more complicated since then, Donna W. Windish, MD, MPH, and colleagues at Yale University School of Medicine, conducted a survey of medical residents to determine whether any of the necessary improvements have been made in physician education. The 277 medical residents who participated came from 11 different residency programs. The results were published last month in the Journal of the American
"Seventy-five percent said that they did not understand all the statistics they encountered in journal articles, but 95% felt it was important to understand these concepts to be an intelligent reader of the literature.o Windish and colleagues concluded: uMost residents in this study lacked the knowledge in biostatistics needed to interpret many of the results in published clinical research."
Reporting a DrugLs Side Effects
Have you ever reported a drugLs side effect to your doctor, only to have it dismissed? This response is common where it concerns statins, according to Beatrice Golomb, MD, and colleagues at the University of California, San Diego, who have been soliciting patient experiences with these cholesterol- lowering drugs for years through an online survey (www.statineffects.com). Often, says Dr. Golomb, physicians chalk up statin side effects to aging.
Six hundred and fifty adults who had already participated in Dr. GolombLs online survey agreed to take part in an additional survey designed to learn from statin users how their physicians responded when side effects were reported. Eighty-seven percent said that they spoke with their doctors abut a possible connection between statin use and their symptom.
The survey showed that physicians were more likely to deny than affirm the possibility of a connection. Worse, rejection of a possible connection was reported to occur even for symptoms like memory problems, muscle pain and neuropathy that had strong support in the published medical literature. This survey was published in the August issue of the journal Drug Safety.
There is a major limitation that applies to this survey and the two others involving physicians. The participants are not representative of the patient or physician population. The statin survey participants, for example, were drawn from the pool of people who contacted the University of California Web site and were therefore more likely to have serious side effects than the average statin user. The physician participants of the first two surveys on the previous page were newly minted doctors who might have been more willing to test their knowledge than seasoned practicing physicians.
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