WDDTY on UTIs and antibiotics

Women with UTIs get better in a week without drugs
Sometimes WDDTY so grossly misrepresents its sources that a rebuttal takes very much longer than the original content. This is one of those times.

A subset (70%) of a subset (55%) of a subset (37%) of a subset (137) of  a subset (176) of a small (205) eligible pool of people asked to consider delaying antibiotics, got better anyway. In other words, the uncomplicated UTIs that doctors told them might get better on their own, sometimes did.

This is spun by WDDTY as brave maverick women who refused antibiotics generally getting better anyway. But they didn’t refuse, they were asked to defer treatment to see if the condition resolved spontaneously, as it sometimes does.

WDDTY’s agenda-driven style is expertly dissected below by Nurture My Baby.

“What Doctors Don’t Tell You” magazine on UTIs and antibiotics

Reblogged with permission from nurturemybaby (@nurturemybaby)

UITsIf you want some background about this magazine that promotes quack nonsense and potentially puts lives at risk, I’ll just refer you here and also to Josephine Jones’s master list which contains all manner of relevant blog posts including ones that debunk the articles in this magazine.

I did write a letter to the supermarkets stocking it too, so that might be of interest if you want to further understand some of the issues, or if you want to write your own letter you can find the relevant email addresses there.

Anyway, I’d like to talk about a specific article from the magazine in this blog post.

Here’s a headline from the December 2013 edition:

WOMEN WITH UTIS GET BETTER IN A WEEK WITHOUT DRUGS

This got my attention, having suffered from this particular affliction myself repeatedly over the years.

Actually, 7 days after giving birth to my son I was admitted to hospital for three days and nights and put on several IV antibiotics for what started as a UTI. Only later did I realise I had “Sus Seps” scrawled over my notes. That means suspected sepsis. Sepsis. That’s quite serious.

Anyway I digress.

Let’s see what happens next.

What follows is FOUR sentences which try to report on this this paper.

The research was clearly so trivial and straightforward and easy to summarise that it required a mere four sentences to explain:

Women with urinary tract infections (UTIs) such as cystitis who refused antibiotics have found that the problem cleared up on its own within seven days.

Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs, a new study from the University of Amsterdam has found. In the study, women with the problem were asked if they would postpone taking antibiotics. One-third of the participants agreed, and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

I don’t really think research is ever so clear-cut that you can say anything useful about it with so few words. You need context.

Even the last sentence which tries to explain some of this context and show a bit more clearly where the figure of “nearly three-quarters” comes from is wrong, but we’ll get to that later.

I think we need to start with why this research was carried out in the first place. WDDTY don’t think this is important, but I do.

You might think from WDDTY’s article that the research was done to find out what proportion of women with UTIs that don’t take antibiotics are likely to get better. (I think that’s what WDDTY want you to believe.)

From the details of the study given in the piece it seems an odd way to go about trying to figure out this number. (Which I think WDDTY want us to believe is 70 or 75%)

That’s because this is not the purpose of the research at all. The purpose was to find out how many women would delay antibiotic treatment if asked by their GP. (Yes they did also look at how many women who agreed to not take antibiotics managed stay off them and get better – but the context is important. I think the study design means that whatever numbers they got for this are not applicable to a wider population) Why would the researchers be interested in numbers of women willing to delay antibiotics? Well it seems to me that they are basing this interest on the fact that antibiotic resistance is a bad thing and as previous research (from placebo arms of randomised trials) has shown that 25 – 50% of women would spontaneously get better without treatment, it seems it might be worth looking at.

Yes that’s right, the figure that WDDTY wants us to believe is 70% (based on a study designed to give information about something different) is actually, according to previous research quoted in the very same paper, 25 – 50%.

So now we better understand the purpose of the research lets take a more thorough look at the article.

Clearly the headline is massively sensationalist and misleading. It’s even misleading when you just compare it to WDDTY’s fabulous four sentences without looking at the research paper.

It’s rather a generalisation, and I don’t find it terribly….honest, or helpful, or meaningful. Look, it’s just stupid, OK?

It would appear from this headline that this “finding” would apply universally. Silly me then for letting those daft doctors prod me with those nasty sharp things and shove antibiotics into my blood stream!

Of course, from reading the paper, apart from bit where it is not the intention of the study to give any indication of how many women generally would get better without antibiotics, it’s obvious that someone in my situation would not have participated in this study. Perhaps it’s a given that this research would not apply to someone who looked like they had a serious infection, I don’t know, perhaps I should forgive WDDTY for failing to provide this particular bit of context terribly well in their headline, or in their next sentence, which continues the generalisation. Here’s that sentence again:

Women with urinary tract infections (UTIs) such as cystitis who refused antibiotics have found that the problem cleared up on its own within seven days.

Interesting use of the word “refused”.

This is not really what happened.

To reiterate some details about how the study was carried out:

Eligible participants (ie. over 12 and visiting GP with painful and/or frequent micturition and who did not meet any of the following exclusion criteria: pregnancy, lactation, signs of pyelonephritis, having used antibiotics or having undergone a urological procedure in the past two weeks, known anatomical or functional abnormalities of the urogenital tract, and being immunocompromised (with the exception of diabetes mellitus).) were ASKED BY THEIR GP if they would consider DELAYING ANTIBIOTICS FOR AS LONG AS POSSIBLE.

This is not the same as refused. Come on WDDTY, if you’ve only got four sentences you should use them wisely. At least try to accurately provide information on how the study was carried out. A bit much to ask when you ignore the purpose of the study in the first place, I suppose.

I guess “refused” just sounds cooler or something. After all it does fit in with the agenda of this rag, doesn’t it? Quick! Run away from your doctor and find some vitamin C/magic water pills/quack remedy pick of the day! You might say that putting it in this way fits in with a certain message that WDDTY want to give out. You might. Certainly I think you would say it’s not very accurate.

All this context is important, (ie. who took part, how the study was performed, the purpose of the study(!)) I think, when you are trying to interpret research, trying to help the reader “make better health choices” as they splash on the front of their glossy cover. WDDTY consistently defend themselves by saying that they just report the research that allows their readers to make an informed decision. It’s arguable that this is not possible to do in four sentences in the first place, but nothing that we have read here so far has indicated that they are capable of, or even genuinely interested in doing this.

Next up (I repeat):

Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs, a new study from the University of Amsterdam has found. In the study, women with the problem were asked if they would postpone taking antibiotics. One-third of the participants agreed, and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

Oh right, so here we do find out that refused was a stupid word to use. Are they deliberately trying to make their writings confusing and hard to understand? I don’t know.

And they’ve also let us in somewhat (only somewhat, mind, as we’ll see when we look at the figures – and we’ve still not been told the purpose of the study) on how misleading their own headline and opening sentence is by clarifying that it’s uncomplicated UTIs we are talking about, and by giving us some numbers rather than suggesting this applies to everyone (even if the numbers are questionable). A whole magazine dedicated to helping people make health decisions and they go down the route of sensationalist, meaningless headlines and almost contradict themselves within the space of two sentences. (And did I mention they don’t even tell us the purpose of the research ;) )

Bah.

Anyway.

Let’s look at the numbers

This 70 per cent lark. Bearing in mind that this figure is what was observed as part of a study that aimed to look at something else and they are presenting it as the main finding and purpose of the research I think this figure is misleading. What I’m trying to say is that is was never the intention of the researchers, I don’t think, to take this 70%, and apply it to the general population. The paper already quotes a figure of 25-50% as being something that might be applicable in a more general sense.

I think it all makes more sense if we look at just how this figure is reached, so let’s go through some of the numbers from the study, as I see them, and then we can compare them to what WDDTY have told us:

Across 20 GP practices 205 women were eligible to take part.

Interestingly, 1 surgery thought that it was a wholly bad idea to ask patients presenting with a UTI if they would consider forgoing antibiotics (Obviously WDDTY aren’t going to tell you that though!). So 25 patients from that practice ended up not taking part. A further 4 were not included because their records were missing.

This leaves us with 176 women.

Of these 176, the actual number of patients who ended up being asked by the GP to consider delaying treatment was 137.

Of all the 137 patients asked to delay treatment, 51 (37%) agreed to it.

(At least WDDTY got something right. Well 37% is not quite the same as one-third, but I’ll let them off.)

So what happened to the 51 people who agreed to delay treatment (out of the 137 that were asked)?

Well, it was made clear to the participants that if they wanted to start on antibiotics at any point then they should and so at the 7 day follow-up it was observed that 15 of the 51 decided that yes, antibiotics were a jolly good idea after all. 8 did not report on antibiotic use.

So out of the 51 patients that agreed to delay treatment we know that 28 of them (55%) had stayed off antibiotics at the 7 day follow-up.

And so what happened to those 28?

Well 20 of them reported that they felt better or were cured. There we go. This is where the 70% (or 71.4%) comes from.

So when WDDTY say:

“Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs”

I put it to you that they are once again misrepresenting the research they cite.

I think the context that they have failed to provide is a huge problem.

It is 70% of 55% of 37% of 137 people asked to consider not taking antibiotics (out of 176 included participants out of 205 of eligible participants).

I do think all of this is quite relevant. Also, I don’t know why they say “up to 70%” but never mind.

Looking at how we got to these 28 women who did not take antibiotics, I think it’s fair to say that this 70% figure is in no way going to apply in a wider more general sense, to all women suffering from uncomplicated UTIs (Of course! Because this is not the purpose of the study!) It’s up to you whether you think WDDTY are trying to infer this from their article, but I think they do, as I’ve said.

Of course there is lots of other stuff in the paper that you are never going to capture if you condense it into four sentences. Data from the women was collected pertaining to the severity of their symptoms, whether they’d had a UTI before, whether they thought they were currently suffering from a UTI etc. and a urine sample was checked for blood, nitrites and leukocytes (all of which indicate infection) and was sent of to a lab to see if any bacteria were present. It is interesting to look at this data and look at the differences between those the GP asked to delay and those that the GP didn’t; those who agreed to forgo antibiotics and those that didn’t; and those that managed the 7 days without antibiotics and those that decided to take them even after agreeing to delay as long as possible.

I don’t really want to go into all these details right here, as I think the main point is that none of this has been mentioned at all, (nor have the limitations of the study) but I do find it interesting for example, that women who had haematuria and leukocyturia on urinalyis were less likely to be willing to delay antibiotic treatment when asked. Also of note, is that when the results of the culture came back it turned out to be positive for 51% (26/51) of the delaying women and for 67% (58/86) of the non-delaying women. This is especially interesting in light of the fact WDDTY is trying to make out these 28 women (not that they tell you there’s only 28 of them) who ended up delaying treatment are somehow representative of the wider population.

Whether you agree with me or not that WDDTY are trying to take this study and infer that 70% of women in the general population can get better from a UTI without antibiotics, it’s definitely fair to say that there is no mention of any of the above. There’s definitely a lot of context missing.

But what can you do when all you’ve got is four sentences.

Well you could at least try to get the last one right. I repeat:

One-third of the participants agreed [to forgo antibiotics], and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

Do you see what they did there? In trying to give at least some context to this figure of “up to 70%” (or as they now call it “nearly three-quarters”) they have chosen to completely ignore the fact that not all participants who said that they would delay treatment did in fact stay off antibiotics. The 70% figure comes from looking at how many of the remaining 55% of participants, that did actually stay off antibiotics, (ie. 28) got better. Not by looking at how many of the one-third of participants that agreed to not take antibiotics (ie. 51), got better, which is what WDDTY would have you believe.

If you want to look at the amount of people who got better expressed as a percentage of the participants that agreed to forgo antibiotics then it would be 20 out of 51, by my reckoning. Which is 39%. Which is not nearly 75%. So I think that sentence is plain wrong. Never mind lacking in context and likely inferring things that shouldn’t be inferred, just wrong.

Overall not a great 4 sentences. At best the article is meaningless, out of context nonsense. At worst it’s misleading and inaccurate.

Have I been unfair? Please let me know if I have, or if there are any inaccuracies, or if there is anything that I could write more clearly. I’m not an expert at this. I haven’t quite got through my Big Pharma Shill training yet.

What Doctors Don't Tell You
Why don’t doctors tell you that UTIs sometimes get better on their own without antibiotics?
They do.

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