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No more dieting, and 7 other things we do differently after reporting on health care

Everyone collides with the medical system at some point in their lives. As health reporters with a combined decade of experience on the beat, we encounter it every single day.

The lessons we've learned on the job have carried over into our personal lives, and transformed the way we view medicine. Some of the changes have been practical — informing what kind of insurance to buy or what birth control method to use. Others are a little more abstract, changing how we decide which health sources to trust or how we think about diseases such as cancer.

Before we started reporting on health, we had no medical training. We came at this beat with fresh eyes and lots of questions. More than ever, we appreciate how complex — and sometimes opaque — medicine can seem. This daily study has deepened our understanding, and here we wanted to share some of what we learned with you.

1) Stop dieting

scale toes

As a neophyte health reporter, I wrote about new diet fads as, well, fads, sometimes uncritically. As the years passed, and I learned more about the science of weight loss (and saw many diets come and go), I now think about diets of the moment in an entirely new way: as lies, wastes of money, and threats to public health.

The billion-dollar diet industry pushes short-term thinking and promises quick results. It tells people that if they just eat a certain way, or try a particular shake, supplement, or pill, they'll be thin. In reality, of course, there are no miracle pills. Very restrictive diets that require people to cut out major food groups or deviate in the extreme from what they normally eat are mostly unsustainable — and even cause people to put on more weight in the long run.

Every trip we take to the doctor's office comes with the risk of something going wrong

This insight is liberating. It means you can save your money and tune out the fads that will inevitably come in and out of fashion. There's no need to wedge your habits and preferences into an unreasonable diet plan that time has shown will fail. Instead,the leading weight loss and obesity researchers and thinkers I've spoken to over the years have consistently shared one clear message: cut calories in a way you like and can sustain, focus on eating more healthfully, and redesign your lifestyle in a way that encourages healthy habits. Think long term: do it slowly, and don't expect miracles.

This doesn't mean losing weight will be easy; but it means you'll probably have more success in the long run if you find a program that fits your lifestyle and preferences. You'll also save a lot of money.

–Julia Belluz

2) Ignore most news stories about new health studies

Before I started exclusively reporting on medicine and public health, I had little appreciation for the quality and limitations of particular medical studies. I thought it was up to the scientific community to police the quality of research, and if something was published it could probably be trusted.

Now I know that was wrong. First of all, some studies are just poorly designed or hopelessly biased. Second, even the best individual studies have their flaws and limitations. This isn't because all science is bad or untrustworthy. It's because it's an iterative process, and it takes many studies to get at the truth of the matter. Individual studies will almost never give the final word on a particular question. That's just how science works.

So, more often than not, single studies contradict one another — such as the research on foods that cause or prevent cancer. For a study on whether everything we eat is associated with cancer, academics randomly selected 50 ingredients from recipes in The Boston Cooking-School Cook Book. Most of those ingredients had studies behind them claiming both positive and negative results.

The truth can be found somewhere in the totality of the research. I now rely less and less on single studies and more on meta analyses of systematic reviews that bring together the best research to come to more fully supported conclusions. (You can read more about why you can't trust single studies here, and see here to learn about different types of studies.)

Julia Belluz

3) Getting health care is dangerous, so use the health-care system as little as possible

Medical errors kill more people than car crashes or new disease outbreaks. They kill more people annually than breast cancer, AIDS, plane crashes, or drug overdoses. Depending on which estimate you use, medical errors are either the third or ninth leading cause of death in the United States. Those left dead as a result of their medical care could fill an average-size Major League Baseball stadium — sometimes twice over.

We typically think of hospitals as places where we go to get better. And that's definitely true; we've seen lifespans extended and diseases cured as a direct result of advances in modern medicine.

At the same time, hospitals are dangerous places. This is something I've learned a lot about in the past six months, as I've been working on a yearlong series about fatal medical harm. I've come to understand that every trip we take to the doctor's office and every stay in the hospital comes with the risk of something going wrong.

In many cases, screening doesn't help people — it turns healthy people into patients unnecessarily

The doctor could prescribe us the wrong drug, or the wrong dose of the right drug (this happens about 1.5 million times each year). Improper hygiene practices — a nurse who forgets to wash her hands before accessing a central line catheter, for example — could lead to a deadly blood infection. This happens about 30,000 times each year.

This is not to say health-care professionals are trying to harm patients. Quite the opposite — every doctor I've ever met is trying to do his or her absolute best to help patients. That is, after all, why they went into medicine in the first place.

Medical harm reflects the fact that medicine is complicated and humans are fallible. Doctors will make mistakes if their hospitals don't set up the proper systems to safeguard against harm — if they don't, for example, create a checklist that reminds a nurse to wash her hands before accessing a central line, or switch to a digital prescribing system that makes it way harder for a pharmacist to misread a doctor's scribbled drug prescription.

Modern medicine can do incredible things, and the work providers do day in and day out is humbling. But each trip to the hospital is a chance for something to go wrong, too — something I keep in mind thinking about my own care decisions.

Sarah Kliff

4) Stop Googling your health questions

When we're sick, many of us turn to Dr. Google. In fact, searching for health information is one of the most popular online activities. The problem is that the top hits in search aren't always the best ones. Some come from sources that aren't trustworthy, have industry ties (such as WebMD), or are out of date. Also, when we Google to self-diagnose, we often get a false impression of the relative weight of possibilities. So it seems our stomach pain could stem from cancer just as likely as from indigestion, or that the rash on our back could be dryness — or a flesh-eating disease.

This is not a recipe for empowering ourselves with good information; it's a recipe for driving ourselves crazy. Now I rarely hit Google for health information. I got to these alternatives instead. You should consider them, too.

Julia Belluz

5) The most popular forms of birth control aren't the best

Writing about and researching different contraceptives led me to change my mind, and I quit my birth control pills a few months ago in favor of an intrauterine device, or IUD: a small, T-shaped device that a doctor inserts into the uterus.

Here's why: birth control pills have to be taken regularly, and are susceptible to human error. This is why the pill has a 6 percent failure rate; out of 1,000 women on the pill, 60 will become pregnant in a typical year.

iud (Shutterstock)

IUDs are a way more reliable birth control than pills. (Shutterstock)

Among women who use an IUD, that number will be much lower — between 2 and 8, depending on which IUD they use. The failure rate for IUDs is low because they don't leave space for human error: once inserted by a doctor, they can last for as long as 12 years. (They can also be removed earlier, if a woman decides she wants to become pregnant).

Getting an IUD inserted can be painful; for me, at least, it was an intense pain of about 15 seconds or so. One study found that 72 percent of women describe the experience as "moderately painful." That was, for me, the one downside. But the upside: multiple years of pregnancy protection, no space for human error, and a very low chance of side effects. That's a trade that, after researching my options, I'm happy I made.

Sarah Kliff

6) Be wary when your doctor prescribes antibiotics

I grew up within the "more health care is better" paradigm. And part of this meant that antibiotics should be given for anything, at any time. But we know antibiotics can't fight viral infections — like flu, bronchitis, and many ear infections — and that overusing antibiotics can actually cause a lot of harm. Still, many of us misuse these drugs.

Take bronchitis, which can't be treated with antibiotics. Recent research showed that doctors still prescribe antibiotics for 71 percent of bronchitis cases — an outrageous number that actually increased between 1996 and 2010.

When we use antibiotics unnecessarily, not only do we expose ourselves to unnecessary side effects, but we also contribute to the broader "superbug" problem. That is, the more we consume antibiotics, the more quickly they stop working. In recent years we've sped up the natural process of antibiotic resistance, causing bacteria to build up defenses against the drugs we have available and rendering some of them useless. This is really frightening; it's not an overstatement to say much of modern medicine would be undone without antibiotics. Routine procedures like hip replacements, c-sections, and chemotherapy would become infinitely more dangerous or even too potentially harmful to undertake.

So now, for my own health and the health of others, I avoid taking antibiotics when I don't really need them. To learn more about how to use antibiotics judiciously, see this page at the Centers for Disease Control and Prevention.

Julia Belluz

7) More cancer screening really isn't necessarily better

Growing up in Canada, I knew of a doctor who prescribed full-body scans in the US for all of his patients. The purpose: to detect potential health problems brewing, particularly abnormalities that could be early cancer. At first, this sounded sort of reasonable: why not get checked annually to make sure your cells are healthy? But as I learned about the benefits and risks of screening — especially with no indication, family history, or prior health problem — I realized this was ridiculous.

That's because in many cases, screening doesn't actually help people. Instead, it turns healthy people into patients unnecessarily, leading them to needless treatment and hospitalization, panicking them, and creating "cancer survivors" who actually would have lived even if their cancers were left untouched.

thyroid cancer graphic

This chart shows that while more thyroid cancers were diagnosed in South Korea after a mass screening program was introduced, it didn't actually improve the mortality rate. (New England Journal of Medicine)

Consider a recent study in the New England Journal of Medicine on thyroid cancer in South Korea. In 1999, the country launched an ambitious campaign to improve health by finding and treating diseases like cancer. Part of this effort included a state-subsidized mass screening program. In two decades, the number of South Koreans diagnosed with thyroid cancer rose 15-fold. While this might sound like a great success, the country didn't actually succeed at its mission: improving health. Thyroid cancer deaths remained stubbornly stable as the incidence of the disease skyrocketed. The additional screenings were leading to the discovery of many more cases, but those additional diagnoses — and the invasive courses of treatment that came along with them — weren't making thyroid cancer any less deadly.

There's also evidence of overdiagnosis in other cancers, from breast and kidney to melanoma and lung. Population-based screening for prostate cancer even had to be scaled back after the realization that most men with the disease will die with, not of, the disease.

Mammography didn't improve the rate of breast cancer death. (Harding Center for Risk Literacy)

To be clear: not all mass screening programs are bad. Colorectal cancer screening, for example, has been shown to save lives as a result of early detection, and the Pap test transformed cervical cancer into a treatable disease. And, of course, mass screening is different from using technologies like ultrasounds to diagnose people at risk of a disease or who have symptoms that require investigation.

But everyone should talk to their doctors about their particular risk profiles, and then screen accordingly. More screening isn't necessarily better, and it can send you into a cascade of care that won't actually improve your health — and could make you sicker.

Julia Belluz

8) Narrow networks aren't always terrible in health insurance

waiting room

Narrow networks don't always mean it's harder to see the doctor (Shutterstock)

The idea of narrow networks — health insurance plans that limit enrollees to a small set of doctors — is not a concept that's especially popular with consumers. Who wants a health insurance plan, after all, that tells you your favorite doctor is one it won't cover?

Narrow networks are common on Obamacare's new exchanges, as health insurers try to hold down premium prices by contracting with fewer doctors. McKinsey and Co. estimates that more than a third of the plans sold on the new marketplaces didn't include 70 percent of the region's large hospitals. This, unsurprisingly, led to a barrage of negative headlines about insurers leaving well-known hospitals out of network.

But narrow networks aren't all bad. Health economists actually tend to be quite fond of these products, as they help hold down spending. And as a consumer, I would generally prefer this type of plan.

More often than not, single studies contradict one another — such as the research on foods that cause or prevent cancer

Here's why: narrow network plans tend to have lower premiums. They do this by refusing to contract with really expensive doctors. And, to be clear, these are not the best doctors: there is a huge body of health-care research showing no connection between how much doctors charge and the quality of the care they provide. We often conflate price and quality; usually more expensive things are better. In health care, however, that's not the case.

One recent study in Massachusetts showed that when people switched to narrow network plans, their health spending fell by a third — and the quality of the care they received didn't change.

There are some narrow network plans that have really great reputations, too, like Kaiser Permanente. Kaiser is a health-care system that limits patients to a very small set of doctors — but makes it easier for all those doctors to share records and communicate with one another. That's a hidden advantage of small plans: they can help facilitate the coordination of care.

Narrow networks aren't for everyone, particularly those who need access to one specific specialist. But for many people, I've become convinced they're a much better option than typically thought — and that they don't always sacrifice quality of care while limiting choice.

Sarah Kliff


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