An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 14.A, Idea: Outliers & Outsiders (Part Ten)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: August 8, 2017

Issue Publication Date: September 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 3,395

ISSN 2369-6885

Abstract

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC. He discusses: practical health tips; most recent research; journalists and medical reporting; medical doctors and researchers making the research more accessible for journalists; being bothered when reading the news; wife as a researcher; collaborations with wife; organ replacement with machines; Metformin and use of substances without a prior condition; David Sackett and evidence-based medicine; genetic therapy for diseases; keeping Canada “competitive”; costs of medicine going up over time; and final feelings and thoughts.

Keywords: Canada, Gordon Guyatt, medicine.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six)^{[1],[2],[3],[4]}

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*​

1. Scott Douglas Jacobsen: Aside from keeping aware of bad medicine, or knowing the research at large, what are the most practical tips Canadians can take into account for their own health, outside of quitting smoking?

Professor Gordon Guyatt: First, they don’t need to keep track of too many things. What they need to do is when they suffer from health problems, find out something about them and then they go to clinicians to help, asking clinicians about what the evidence is what is being suggested.

They should stop smoke. It would be one major thing people could unequivocally do for their health. Beyond that, there is strikingly little that you can be confident of. So we don’t know the best diets for improving health. We don’t know if particular diets are better than one another. We have a sense that it’s probably a good thing to exercise.

The evidence of the merits of the degree of impact that prevention might have on your health is limited. We have to screen for breast cancers, screening for colon cancer, and it turns out, the gains in terms of improving life span by those inventions are very minimal. You have to be screening hundreds if not thousands of individuals to have a single individual whose life span is prolonged.

So there is a lot of talk about prevention and trying to eat whatever you perceive as a healthy diet, or exercising, can’t be bad, but whether it’s really only going to have major positive health effects is much less certain.

2. Jacobsen: We last talked several months ago. I want to ask an update. What is your most recent research or research that’s ongoing?

Guyatt: I work with a number of people. It’s been a long time since I initiated my own research endeavors. I have much more fun helping other folks to lead theirs. I already mentioned PJ Devereaux who is working on investigation and management to prevent adverse cardiovascular events after noncardiac surgery.

Mohit Bhandari is leading the world in terms of interventions for orthopedic injuries. He’s the one who also is investigating low and middle-income country trauma, epidemiology, and eventually interventions to deal with that. I also have colleagues who work in the intensive care unit conducting clinical trials.

One of those trials in intensive care units is looking at whether treatments that have been around for a while in patients to prevent gastrointestinal bleeding may be doing more harm than good. Another colleague, who happens to be my wife, who is also an intensive care specialist, is looking at how we can improve the outcome of organ transplants by improving the care of organ donors who are in critical care units. So those are ones that come to mind in which I am involved.

3. Jacobsen: I’m going to make a transition to public information. So this is more self-reflective about journalists. We apparently live in an area of “fake news.” There’s a large amount of responsibility in being a journalist and delivering accurate information to the public.

I do not necessarily mean more tabloid magazines but in serious outlets. What are some mistakes that are common among journalists in general, when they report on medicine or new medical discoveries?

Guyatt: I am extremely sympathetic to the problems of journalists reporting health claims; we actually did some work in this area. I worked with journalists and published a paper suggesting guidance with the journalists. It was 15 or 20 years ago. My sympathies are because journalists, from my limited understanding of the journalistic world, are competing for space.

In the competition for space, it will be much more challenging if you report what might be an active, possible new treatment with possible modest effects, versus a new treatment that has bigger effects.  Most of the time our advances are limited and require cautious interpretation and that would possibly be less interesting to the general public and less likely to get an editor’s approval or a publication.

Health journalists have a big challenge that way. They can be involved with treatments that have been shown to be useless, or next to useless, that can legitimately grab their attention, especially when a lot of people use the ‘treatment.’ There are areas where the public has major concerns, so, for instance, we recently produced guidelines about the best way of using opioids for chronic noncancer pain.  This would be an area of major journalistic attention because of the opioid epidemic and its consequences.

But in many cases, it’s a challenge for journalists if they are going to operate at high integrity, follow various rules that we have suggested, knowing some of the basic principles of trustworthy versus less trustworthy evidence.  It’s also a good idea to be extremely attentive to issues of conflict of interest.  A researcher comes up with a new finding of whatever sort, and the researchers, even if they do not have a financial conflict of interest, they typically have an intellectual conflict of interest. Everybody thinks their own research is the best and everybody should pay attention to what they have found and what they have found must be closer to the truth.

As a result, the best people to go to about a research finding would not necessarily be the people who made the finding but other people working in the area who are in the position to take a much more dispassionate approach to what is found with that problem.  They shouldn’t be direct competitors who might want to underplay in general, but rather somebody who does not have either financial or intellectual conflict of interest would be a better way of getting closer to the truth.

4. Jacobsen: How can medical doctors or researchers make the information more accessible for journalists who don’t have, frankly, the expertise?

Guyatt: Gosh. I would say by explaining things, giving explanations that are understandable to the health journalists and teach them about the principles underlying the research. I try to do that all the time. So, for instance, in this conversation, when big data came up, I tried to explain why big data is not particularly trustworthy in terms of telling us about the magnitude of treatment effects.

That’s when talking about world research and other people’s research, an attempt to explain the underlying principles of what makes some evidence more trustworthy than others is what some researchers could do to help journalists.

5. Jacobsen: What is bothering you when you read the news and it’s reporting on medical science?

Guyatt: It is the failure to recognize the limitations. Indeed, it is unfortunate and I’m sympathetic to journalists who feel compelled to present things as more exciting or better than they actually are. There is a failure to attend to the conflict of interest of the sources that are being cited. Sometimes, journalists get missions about what they think is a good idea and what problems are, which is a natural human tendency; we believe in something, and so that is what we see.

People with particular missions can in every way run into trouble with difficulty seeing things.

6. Jacobsen: Your wife is also a researcher.

Guyatt: That’s right. She is a specialist who deals with critical illness in intensive care units and does research work in that area.

7. Jacobsen: Have you done any collaborations with her?

Guyatt: Yes, lots. She’s switched directions in her research career. She, for the first 15 years or so, did academic research looking at people who are critically ill who have breathing tubes in to breathe for them. Her first research was a number of important studies dealing with ventilation of people when you put in a breathing tube and then we breathe for them.

8. Jacobsen: Not only with organ donation, what about the future of, reasonable near future, organ replacement with machines? So as with artificial heart, a pacemaker for people that have Parkinson’s disease for and replacement of function for the damaged portions of their brain.

Guyatt: You are talking about areas beyond my expertise, but I think there is some evidence that warrants optimism in Parkinson’s disease. But probably for a very limited proportion of that population.

Mechanical heart transplants are not and never will be successful soon over the long term.  They may help people through a short period of time while they’re waiting for a human heart, but the mechanical hearts for not for the long term – that requires human hearts. It is, of course, a great priority in making sure that they try to optimize the availability of heart transplants and have the donors managed in such a way that the best outcomes can be possible for people who receive those transplants.

9. Jacobsen: There’s, maybe, 70 million Americans prescribed Metformin, the diabetes drug.

Guyatt: Yes.

10. Jacobsen: Some use this when they don’t even have diabetes. That is when I extrapolate that to people also using substances for “health” reasons when they don’t have a condition for which the substance is meant for, what is a concern for you as someone entrenched in the field?

Guyatt: I have no idea how much this happens. The question, why are people doing this? My concern in that area is what is called too much medicine. So why might people without diabetes take metformin?

One reason they might be doing so is the industry is now doing trials to prevent diabetes, which is extending the definition to lower and lower levels of blood sugar. So, you have people at lower and lower risks taking treatments, so you have people treating pre-diabetes and pre-hypertension.

The problem with those situations is you’re treating lower and lower risk individuals. You are expanding the proportion of the population taking the medication. You may well be doing more harm than good. So I don’t know why people, the people that you were thinking of, are taking medications, but one reason may be that the medical community has hugely expanded its range in intrusion into people’s lives – sometimes, unequivocally doing more good than harm. But as these expand the somewhat questionable range of sick people, almost nobody over 50 is actually healthy anymore.

11. Jacobsen: In our first interview, we talked about evidence-based medicine. Who was David Sackett? What was the importance of him to evidence-based medicine?

Guyatt: David Sackett was a guy who laid the groundwork for evidence-based medicine. Dave was my personal mentor and established the basis of my career. I, of course, learned enormous amounts. He was one of the pioneers with a clear vision about how physicians were not using evidence often to inform their patient care and made major contributions to advancing the science of how to do the best experiments and interpret their results in such a way that would optimize patient care.

He had a major initiative in starting to teach how to understand and interpret the evidence which was not part of medical training at the time. He talked about critical appraisal of the medical literature and then moved towards evidence-based medicine. He articulated many of the fundamental principles that subsequently became evidence-based medicine. Basically, he set the direction for all that we have done in disseminating evidence-based approaches worldwide.

12. Jacobsen: What diseases are given genetic therapy?

Guyatt: If you mean manipulating genes in one way or another for cancer therapy, there’s nothing I do in my clinical practice I would classify as gene therapy. So that it would be very sub-specialized at the moment.

13. Jacobsen: If you take Canada’s medical innovations and its medical research community, what can keep Canada “competitive” in that international market where those that lead in advances will lead in the technology?

Guyatt: This has to do with where you decide to specialize and building up, finding people with talents and leadership skills, and then you can become competitive and a world leader. So, 20 years or 25 years after evidence-based medicine got started, McMaster is one institution in Canada, not a big institution, considered the worldwide leader in continued advances in evidence-based medicine.

Another area in Hamilton and across Canada where a guy named Jack Hersh came, probably 40-50 years ago now, and trained a whole host of people who are still leading the world in a management of thrombosis. He is a world leader and in Canada. I have no doubt PJ Devereaux is leading the world in addressing cardiovascular complications of noncardiac surgery. He is training a whole host of people who is going continue to lead the world in the next generation.

Same with another colleague who is leading the world in orthopedic trauma clinical trials and training folks who will continue to play international leadership roles. So I, of course, am familiar with what goes on in my institution. I’m sure there are many people across Canada, saying, “Here’s an area that our institution is providing international leadership.”

If you find the right people and have the institutional commitment and focus, it’s quite possible for Canadians to take international leadership in a whole host of medical areas.

14. Jacobsen: Do you foresee the costs of medicine going up further over time for Canadians?

Guyatt: Yes, the main drivers of the cost of medicine are technological advances that have improved people’s health. Now, I think there’s a way of controlling things considerably if for example, we extend single payer to drugs, and if we get tough with not letting drug companies charge exorbitantly.

However, it’s a good thing that there’s always going to be a continual upward pressure in terms of cost because we keep discovering new ways to keep people healthy and these technological advances require some resources.

So I think by good management of the system we can limit costs, but the cost pressures are going to continue to the extent that we continue to find important new advances, technological advances, that contribute positively to health. In that sense, the cost pressures are a very good thing.

15. Jacobsen: Any final thoughts? Any thoughts or feelings based on the conversation today?

Guyatt: No, we covered a wide range of areas. One thought I had is you found out about some of my limitations in terms of breadth of knowledge about what’s going on outside of the areas I’m familiar with; I hopefully have offered something within the areas I am familiar with.

16. Jacobsen: Thank you very much for your time, and I hope you have a good day.

Guyatt: Okay, take care, bye-bye.

References

1. Bennett, K. (2014, October 31). New hospital funding model ‘a shot in the dark,’ McMaster study says. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/new-hospital-funding-model-a-shot-in-the-dark-mcmaster-study-says-1.2817321.
2. Blackwell, T. (2015, February 1). World Health Organization’s advice based on weak evidence, Canadian-led study says. Retrieved from http://news.nationalpost.com/health/world-health-organizations-advice-extremely-untrustworthy-and-not-evidence-based-study.
3. Branswell, H. (2014, January 30). You should be avoiding these products on drugstore shelves. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/you-should-be-avoiding-these-products-on-drug-store-shelves/article16606013/?page=all.
4. Canadian News Wire. (2015, October 8). The Canadian Medical Hall of Fame announces 2016 inductees. Retrieved from http://www.newswire.ca/news-releases/the-canadian-medical-hall-of-fame-announces-2016-inductees-531287111.html.
5. Cassar, V. & Bezzina, F. (2015, March 25). The evidence is clear. Retrieved from http://www.timesofmalta.com/articles/view/20150325/life-features/The-evidence-is-clear.561338.
6. Clarity Research. (2016). Clinical Advances Through Research and Information Translation. Retrieved from http://www.clarityresearch.ca/gordon-guyatt/.
7. Craggs, S. (2015, July 21). We can actually win this one, Tom Mulcair tells Hamilton, crowd. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/we-can-actually-win-this-one-tom-mulcair-tells-hamilton-crowd-1.3162688.
8. Escott, S. (2013, December 2). Mac professor named top health researcher. Retrieved from http://www.thespec.com/news-story/4249292-mac-professor-named-top-health-researcher/.
9. Feise, R. & Cooperstein, R. (2014, February 1). Putting the Patient First. Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56855.
10. Frketich, J. (2016, July 8). 63 McMaster University investigators say health research funding is flawed. Retrieved from http://www.thespec.com/news-story/6759872-63-mcmaster-university-investigators-say-health-research-funding-is-flawed/.
11. Helsingin yliopisto. (2017, March 23). Clot or bleeding? Anticoagulants walk the line between two risks. Retrieved from https://www.sciencedaily.com/releases/2017/03/170323083909.htm.
12. Hopper, T. (2012, August 24). You’re pregnant, now sign this petition: Group slams Ontario doctors’ ‘coercive’ tactics to fight cutbacks. Retrieved from http://news.nationalpost.com/news/canada/youre-pregnant-now-sign-this-petition-group-criticizes-doctors-who-encourage-patients-to-sign-anti-cutbacks-letter.
13. Kerr, T. (2011, May 30). Thomas Kerr: Insite has science on its side. Retrieved from http://news.nationalpost.com/full-comment/thomas-kerr-vancouvers-insite-clinic-has-been-a-resounding-success.
14. Kirkey, S. (2015, October 29). WHO gets it wrong again: As with SARS and H1N1, its processed-meat edict went too far. Retrieved from http://news.nationalpost.com/health/is-whos-smackdown-of-processed-meat-a-considerable-overcall-or-just-informing-the-public-of-health-risks.
15. Kolata, G. (2016, August 3). Why ‘Useless’ Surgery Is Still Popular. Retrieved from https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=0.
16. Maxmen, A. (2011, July 6). Nutrition advice: The vitamin D-lemma. Retrieved from http://www.nature.com/news/2011/110706/full/475023a.html.
17. McKee, M. (2014, October 2). The Power of Single-Person Medical Experiments. Retrieved from http://discovermagazine.com/2014/nov/17-singled-out.
18. McMaster University. (2016). Gordon Guyatt. Retrieved from http://fhs.mcmaster.ca/ceb/faculty_member_guyatt.htm.
19. Neale, T. (2009, December 12). Doctor’s Orders: Practicing Evidence-Based Medicine Is a Challenge. Retrieved from http://www.medpagetoday.com/practicemanagement/practicemanagement/17486.
20. Nolan, D. (2011, December 31). Mac’s Dr. Guyatt to enter Order of Canada. Retrieved from http://www.thespec.com/news-story/2227923-mac-s-dr-guyatt-to-enter-order-of-canada/.
21. O’Dowd, A. (2016, July 21). Exercise could be as effective as surgery for knee damage. Retrieved from https://www.onmedica.com/newsArticle.aspx?id=e13a0a94-5e96-43b9-86b7-7de237630beb.
22. Palmer, K. & Guyatt, G. (2014, December 16). New funding model a leap of faith for Canadian hospitals. Retrieved from http://www.theglobeandmail.com/opinion/why-new-funding-model-a-leap-of-faith-for-canadian-hospitals/article22100796/.
23. Park, A. (2012, February 7). No Clots in Coach? Debunking ‘Economy Class Syndrome’. Retrieved from http://healthland.time.com/2012/02/07/no-clots-in-coach-debunking-economy-class-syndrome/.
24. Picard, A. (2015, May 25). David Sackett: The father of evidence-based medicine. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/david-sackett-the-father-of-evidence-based-medicine/article24607930/.
25. Priest, L. (2012, June 17). What you should know about doctors and self-referral fees. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/what-you-should-know-about-doctors-and-self-referral-fees/article4267688/.
26. Rege, A. (2015, August 5). Why medically unnecessary surgeries still happen. Retrieved from http://www.beckershospitalreview.com/population-health/why-medically-unnecessary-surgeries-still-happen.html.
27. Science Daily. (2016, October 26). Ultrasound after tibial fracture surgery does not speed up healing or improve function. Retrieved from https://www.sciencedaily.com/releases/2016/10/161026141643.htm.
28. Spears, T. (2016, July 7). Agriculture Canada challenged WHO’s cancer warnings on meat: newly-released documents. Retrieved from http://news.nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents.
29. Tomsic, M. (2015, February 10). Dying. It’s Tough To Discuss, But Doesn’t Have To Be. Retrieved from http://wfae.org/post/dying-its-tough-discuss-doesnt-have-be.
30. Webometrics. (2010). 1040 Highly Cited Researchers (h>100) according to their Google Scholar Citations public profiles. Retrieved from http://www.webometrics.info/en/node/58.

Appendix I: Footnotes

[1] Distinguished University Professor, Health Research Methods, Evidence and Impact, McMaster University.

[2] Individual Publication Date: August 8, 2017, at http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-five; Full Issue Publication Date: September 1, 2017, at https://in-sightjournal.com/insight-issues/.

[3] B.Sc., University of Toronto; M.D., General Internist, McMaster University Medical School; M.Sc., Design, Management, and Evaluation, McMaster University.

[4] Credit: McMaster University.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six) [Online].August 2017; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

American Psychological Association (APA, 6^th Edition, 2010): Jacobsen, S.D. (2017, August 8). An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six). Retrieved from http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six). In-Sight: Independent Interview-Based Journal. 14.A, August. 2017. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six>.

Chicago/Turabian, Author-Date (16^th Edition): Jacobsen, Scott. 2017. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six).” In-Sight: Independent Interview-Based Journal. 14.A. http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

Chicago/Turabian, Humanities (16^th Edition): Jacobsen, Scott “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six).” In-Sight: Independent Interview-Based Journal. 14.A (August 2017). http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

Harvard: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six)‘, In-Sight: Independent Interview-Based Journal, vol. 14.A. Available from: <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six)‘, In-Sight: Independent Interview-Based Journal, vol. 14.A., http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

Modern Language Association (MLA, 7^th Edition, 2009): Scott D. Jacobsen. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six).” In-Sight: Independent Interview-Based Journal 14.A (2017):August. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six>.

Vancouver/ICMJE: Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Six) [Internet]. (2017, August; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-six.

License and Copyright

License

In-Sight Publishing and In-Sight: Independent Interview-Based Journal by Scott Douglas Jacobsen is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at www.in-sightjournal.com.

Copyright

© Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal 2012-2017. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal with appropriate and specific direction to the original content.  All interviewees co-copyright their interview material and may disseminate for their independent purposes.