Dr. Rebekah Gundry, Director of UNMC's Center for Heart and Vascular Research on evaluating medical claims, misinformation, and health headlines.

Transcribed automatically and lightly corrected.
Michael Lyon: This is Heartbeat, conversations about medical science, research, and the discoveries that touch all of our lives in collaboration with the University of Nebraska Medical Center. We're exploring how science works, how it matters, and how today's research could shape tomorrow's care. My guest today is Rebecca Gundry, PhD, the director of the UNMC Center for Heart and Vascular Research.Hello.
Rebekah Gundry: Hello.
Michael Lyon: We're laying some of the foundation blocks for how we can, as a community, better understand what medical science is and what its relevance is to each of our lives. And we covered some of those basic aspects in our first episode. And in the second episode, I thought we'd really like to take a look at evaluating medical claims, misinformation, and health headlines, because that's something that we all deal with. We're surrounded by health information every day: news stories, TikTok videos, podcasts, AI summaries, social media posts. And I want to ask you whether it's become that much harder for the public to know what information to trust and whether any of it is really useful.
Rebekah Gundry: Good first question. So, I think certainly I see that in my own interactions with my own family, how it can be perceived now that maybe historically it seemed really straightforward.You go to your doctor, you ask a question, or you ask a scientist that you know, and there wasn't always maybe this assumption that there was a conspiracy behind it. and I think that with a lot of this information coming from different directions, it can be really challenging to know what's true, and what's really supported by the scientific evidence. I'll just take examples from when I, when I talk to my own family, is that I remind them that most biomedical researchers, well, we're all human and most of us come to this place in our life because of a reason; we want to investigate heart research, in my case, because it has personally impacted my family. And so that's some of my rationale for why I do what I do. And there's millions of us around the world that have some kind of motivation like that. So, remember, there's really good people out there that have a really strong dedication to this really difficult work. and that often we are not the ones who have all the training in how to answer all the gotcha questions. We're not always the most polished or poised when it comes to speaking publicly about science, right? And then there are others who have those skill sets, but maybe not the scientific background. So sometimes if something sounds really polished, it's probably for a reason, that there's someone who really has a motivation to get that message out.
So when you're thinking about kind of this onslaught of information that's available, I think it's really easy to be overwhelmed initially, but, remember that in order for medical treatments to come about, to really be adopted, in the medical field, that there are decades of research that goes behind that. There are numerous studies that have to be done by many different investigators with many different patients before it can really be adopted. And then even after it's adopted, we're continuing to evaluate the safety and the efficacy of those treatments. So, if you see a claim that is based on one study, then I think you want to look a little bit more closely into that, in that we know that a single study alone is generally not sufficient, to make an impact, at least on changing the course of a medical treatment or the development of a drug or a therapy.
Michael Lyon: It's a sort of a double-edged sword in some ways because, having a variety of information which we've never had access to before as the public, it can be fraught with misconceptions, as you've just pointed out, but it can also be very useful, too. So let's talk about some of the steps that I and some of the other people that don't have your background would consider when we encounter a headline about a breakthrough or a new study. What are the first questions we should ask ourselves?
Rebekah Gundry: Sure. So, I think understanding the process of how that information comes to light or is used is, helpful to know. So, from a research perspective, when we conduct a research study and we have findings that we have data to support the conclusion, often one of the most common things that we do is we publish that.That's our responsibility, especially if, for example, we're using taxpayer dollars to fund our research. It's our responsibility to conduct that study and to make it understandable and to put it in the public domain, and that's what we call publishing. So, we're publishing a scientific paper. And in that process, it undergoes peer review. So, other scientists around the world who have, oftentimes more experience in an area than we might, will evaluate it and offer critical feedback and expertise. And then from there, it can be published in a scientific journal. So that's one of the first things you wanna look for, is the outcomes of a particular research study, how and where and when has that been made available, and by whom.Who funded the research? And who funded the research doesn't always mean that the research was done in a way that favors that funder, because that's not always true. But knowing what to look for is really important. So was it published from a group of scientists who have a lot of expertise in this area, who, published it in a very well-respected scientific journal? Was it peer-reviewed, or was it not peer-reviewed and is maybe published as an editorial or published as a marketing material? Those are very different types of, of evidence. and then has that information been what we call reproduced? So has another group of researchers that maybe works at a different laboratory, at a different institution, in a different country, been able to conduct a similar study and come up with the same conclusions?That can be really strong evidence that someone else in a different place with a, maybe a different motivation, but answering the same question, comes to the same conclusion. That can be really strong evidence that this claim is well-supported by the scientific data.
Michael Lyon: So what we really have to do then is, have a process by which we evaluate all of those things, and look at the study itself within a National Institutes of Health publication or some other place. and I don't recall ever seeing any information on those papers as to where the funding came from. Where would one find that?
Sure. So if you go-- there's a, a website called PubMed, P-U-B-M-E-D, and there you can search for scientific literature.you can also Google search for scientific literature, and often it will find you the scientific reference. And when you open up the publication, the publication normally will have a title. You will find all the information about the authors who participated and wrote the study, and then you can look at, where they're affiliated with.Then you'll find kind of the scientific content about what was done and what was learned, and then at the very end, generally, there will be a section called Acknowledgments or Funding, and in there, we're required to state the source of the financial resources that were used, to conduct the study. And oftentimes it's very typical for a research study to have multiple sources of funding.
Michael Lyon: Let's see if we can boil that down into some things that are good for somebody like me who may have a very simplistic understanding of the process and of, a particular course of research and say, "Okay, maybe I'm capable of going through that entire process," but perhaps there are red flags that would alert me right away when hearing about some scientific discovery or study that would tip me off to the fact that this is not quite finished or not quite kosher or completely wrong because somebody's making money from it via a social media post, and they have rewritten the summary of what's happening, and suddenly we feel there's some great piece of research that's just been done and that will benefit all of mankind, you know—this year.So, what would be the red flags that would tell us to just put the brakes on?
Sure. So if, if there's no, ... If it's not easy to find the source material, so the source meaning the original scientific study that was published to support that claim, or was it just social media, and this social media reference leads back to a Facebook post, which leads back to a newspaper story, but that original source material that we all learn about, I think, in middle school science class, that source material is really important.when you get to the source material, look at who the authors are. and I mean, is there one author or many? Oftentimes, big scientific studies require multiple different brains. So, if it's a single author, doesn't mean it's not correct, but it's definitely worth considering, is this something that really is just one from one individual, and it maybe isn't as rigorous as it would be if it was multiple individuals?And then also having a track record in an area is also really important. So, you can easily often Google scientists and see what area of expertise they have. Where did they do their training? How long have they been in this career? How long have they been doing research in this area? That can be really helpful. And most of us, you know, have kind of somewhat public profiles. So if someone has published a single author paper and you're unable to find that that investigator has any training background in this area or has any other rigorously reviewed published material in the scientific discipline, then also probably worth another look.
Michael Lyon: I wonder how many general practitioners actually look in depth at the research and utilize the sort of process that you've described for evaluation.What's your sense of how much these sort of studies, filter down to the practitioners themselves?
Well, I think there's really good evidence for that. there are a lot of tools that are available to clinicians that help distill down kind of the latest and greatest research.Sometimes they get updates every week, every day. They can get snippets and summaries related to their area of practice, and then they can use that as a hook to go find the details of that published literature. So, I think- The physicians are kind of constantly inundated with new information as it's coming out, and they may not always communicate that to you as a patient.
I know in my own experience, because I am a scientist, every clinician that I see for my own personal medical needs knows that, and they actually do a really good job of kind of taking the extra time to explain to me the whys and the what's and the rationale behind it because they know A, I'm eager and I'm curious about it, but they know that I'll have some understanding of it.
So I think if you ask your physician, you might get more of that information than I know that some physicians may think that if they provide too much of that, it may be overwhelming or intimidating, and so they may hesitate to do that. But if you ask for it, they should be able to provide it because I think they have a lot of great access to that.
Michael Lyon: And of course, there's, a difference between one study and scientific consensus, something that we covered in the first episode of Heartbeat. Am I right in, in saying that there are two types of consensus? One would be when you have multiple, research partners on a project, that there is a kind of a consensus that's obtained, and then there's a different kind of consensus, which is when that paper is published and then is, adopted, and agreed to in principle by the general scientific community.
Yes, I think that is an accurate statement, but I also remember that once it's published, that isn't the end. Once it's published is when the world gets access to it, right?So early on, it- the folks who have access to it are the folks doing the research themselves. Then through the publication process, the folks involved in the peer review process to accept it into the journal see it, but that's usually a handful. And then when it's, it's published, it's available worldwide.And that is when a lot of the really additional great research begins because, one, as a scientist who is reading this work for the first time, I may be inspired by a new way to see data or a new way to think about it or a new opportunity for treatment. I also might be someone who does research in that area and says, "Oh boy, I don't agree with this at all.I get that they did the study in a way that I wouldn't have done it or that the reviewers, saw it maybe in a different perspective than I did." I don't have to agree with it simply because it's published, and that's really important. Just because it's published doesn't mean it's true. We wanna see that multiple laboratories, multiple investigators with different tools, different approaches, different tests, different patients can also come to a similar conclusion, and that eventual consensus for, let's say, adopting something into medical treatment, again, doesn't come from one paper being published. And it doesn't come from, a vote not a formal vote, really. It comes from multiple investigators trying it, seeing for themselves that it's working, and then as a community, adopting the information or the knowledge or the approaches that were presented into formalized care.
Michael Lyon: So many of these studies are not conducted on humans, but they're conducted on animals, rats, mice, and I wonder whether you would just expand on why that is different than studies that are conducted on humans, and whether there's any time period from when a study using animals like that, translates to something that affects human existence?
It could be decades. It's important to remember that different stages of the research process make use of different tools and models. So early on, when you're kind of at the infancy stage of a concept or an idea or testing something, you generally want to strategize it in a way that's very, cost-effective, but also uses tools and models that are relevant, and that doesn't harm any living organism,and so oftentimes, we'll use cells in a dish to get kind of the basic concepts of how something might work. And then we might move into animal models, to test whether the observation that we saw in a dish of cells is relevant in a complex organism. So remember, a dish of cells might have one or two cell types, but it doesn't have all of the blood vessels.It doesn't have all that complicated human physiology to really represent what would actually happen in a human. So animals are useful because we can control the genetics, we can control, the disease process a little bit more, and we can see-- But it offers the complicated physiology that we can kind of test what's gonna happen.But we also have to remember that animal physiology, just fundamentally at the molecular level, they don't have all the same pieces that humans do, right? And I'm a protein biologist, so they don't have all the same proteins and the sugars that humans do. And so sometimes that can make a really big difference on whether a drug that seems to work in an animal would actually work in a human, because maybe that protein looks a little bit different in an animal than it does in a human, and that affects the way that the drug works.So there is a really important role for animal models to play because not everything that we wanna test in a human is something you'd want to test in a human. So I'm a heart researcher. We absolutely need access to control, so normal, healthy heart tissue, to compare to the diseased heart We're not volunteering, no one's volunteering to donate their healthy heart for research, right? So that's a really obvious example of where an animal model can be really helpful, because in that case, we can have healthy control animals versus disease and make that comparison. You still have to validate it eventually in human, and the way many researchers at UNMC do this are take advantage of the fact that we collect, patient donor samples. So many patients that come to UNMC will choose to donate kind of the leftover specimens that are collected during surgery for research, and that is an unbelievably valuable resource because it gives us the ability to do things that other institutions can't do. We can test drugs using cardiac tissue in a lab. So that's one of the things that my lab does. We take pieces of heart tissue, and we make little slices, and then we can test the drugs and how they affect that heart tissue right in the laboratory. So we're not hurting, we're not causing any harm to any humans, and we're also doing research that's very relevant to humans because it is, it's human material, and we don't have the same challenges that we have if we were trying to test that drug using mouse hearts, for example.
Michael Lyon: What do you hope the public better understands overall about medical research and the scientists doing this work, especially here in Nebraska?
Sure. Well, we're humans. That's really important to remember, is that we all have a humanity in us. We have a curiosity. We are driven because something influenced us, maybe at an early age, maybe as we got older, a family member, a friend, we all have a personal motivation to make a positive difference, and that's where the research begins. And we're all, I'd say, generally curious in different ways and we bring different disciplines to answer a question, and I think there's sometimes this conception that scientists start out with trying to prove something's true, and that's not actually what we're doing usually we're actually asking a question, and we pose what we call a hypothesis or a question of, "Is this how something works?" And then we design a set of experiments to test, is that true or is it not true, or is it supported by the data or is it not supported by the data? And very often, as we do the research and we evaluate the data, we learn something that we didn't anticipate, and that will take us in a different direction, and oftentimes more meaningful. And I think, one of the, the phrases that I heard some time ago that has always stuck with me is that, when we think about the research that we do, and sometimes it takes a long time, and it kind of maybe has a circuitous route, and we, we are often, let's say, criticized perhaps of maybe not all the research that the scientists are doing is medically relevant, I think I hear that, you know, concern a bit, is to remember that if we only fund what already looks medically useful, we starve the discoveries that don't even look like medicine yet.The biggest leaps almost always come from somewhere nobody was looking. And that is the fun part of the science, is the unanticipated and the exciting new things that we can see that, you know, in our example, we discover new molecules in the human heart that no one else around the world has ever seen before. That's really exciting, and it means that we can do lots of new things with that information. not all of it will translate into a medical therapy or a device or, a biomarker, but it adds to the knowledge that we have, and that view is constantly changing. And that's the other important thing is, when we think about the scientists, whether they're local or global, we're all human, and we're always constantly evaluating, and that is the beauty of the scientific process, in that what seems like a scientist or a discipline is changing its mind, that's actually the science doing its job.
Michael Lyon: Normal part of the scientific process.
That's the normal part of the scientific process that we create information, we evaluate that information, we interpret it in the context of the other information that we have. But as time goes on- technology gets better. We get more information. We see things in a different way, and then we can reevaluate, "Oh, well, the data that I viewed this way 10 years ago, now I know all this other information that actually helps me interpret the data in a different way, maybe a more correct way.”So, when we're updating the literature, or maybe it looks like we're changing our mind on a particular conclusion that was published some time ago, that's exactly what we're designed to do. That's our job.
Michael Lyon: My guest today has been Rebecca Gundry, PhD, Director, UNMC Center for Heart and Vascular Research.We've been talking about how to evaluate medical claims, misinformation, and health headlines. I'm Michael Lyon, and this is Heartbeat.