A few days ago a story in a popular online news magazine caught my eye. You may have seen it too. “Mental health problems are linked to a risk of dangerously high blood sugar levels,” the headline warned.
Ok. No surprise there. Antidepressants are still one of the most-hyped types of drug on the market, despite the fact that they’re no more effective than a placebo and carry a big package of possible side effects. But as I read through the rather short article I discovered something interesting. The story changed the further down the page I read.
What began as a straight-up statement that depressed people with diabetes are more likely to get their blood sugar under control morphed into a completely different story by the end of the page.
Stories like this are a marketing ploy for Big Pharma — and here’s how it works
It starts with a hopeful-sounding headline. In this case, the headline was taken directly from the Reuters story that spawned it.
“Taking drugs for depression linked to better diabetes control.”
That sounds good. It sounds positive. It sounds hopeful. And you know what? That headline is as far as most people will read. 98% of us will never read further than that headline. Most of us will click away to something else. But — we’ll remember the headline. We might even share it on Facebook or Twitter.
Next comes a statistic. “When diabetics do get depressed,” the article says, “taking antidepressants is linked to 95 percent higher odds that their blood sugar will be well controlled, the current study found.”
Wow. That sounds pretty impressive.
This is in the third paragraph, about 1/3 of the way down the page. And guess what? That’s where most of the people who’re still reading will stop.
Creative marketing researchers have used eye-tracking technology see just what parts of webpages people actually read. And what they’ve found is that most people only read what’s “above the fold” — that is, in the top part of the webpage. If we have to scroll to read it, most of us won’t bother. And if we do, we seldom really read it, we just skim.
If you read beyond the fold, however, this story gets even more interesting.
The middle 1/3 is the boring bit. It tells you how many people they studied and so on. A big yawn, in most people’s books. They’ll scroll quickly past, maybe without even skimming. If they do skim, they’re probably reading only the first 3 or 4 words at the beginning of each paragraph. Nothing interesting there.
The last 1/3 of the page has some more statistics — these are eye-catching if you’re just skimming. 44% of the diabetics in the study, the article says, got their blood sugar under control. 51% of those who took antidepressants got managed it, while only 35% of those who with untreated depression did.
The article closes with a convoluted quote from one of the researchers stating that getting depression under control “by whatever means” can — not help them actually control their blood sugar, but get motivated to do it. The quote is such a mess of doublespeak that your eyes will glaze midway through. However, by the time you get to this point you’ve already been programmed to read more into it than what it actually says.
What did the story REALLY say?
If you read on the web the way most people do, what you’d take away from this article is that a decent-sized study published in a major medical journal says that if you’re depressed and diabetic, taking antidepressants helps you get your blood sugar in check.
That’s not quite what is said, though. If you waded through the boring middle, here’s what the story really said:
First of all, the study didn’t involve real people in a lab setting. Instead, it looked at people’s primary care medical records. It used billing codes to see who’d been diagnosed with diabetes and depression, and at prescription orders to see who was given antidepressants. It used A1c test results — which tell how well you’ve controlled your blood sugar in the last 2-3 months — to decide who had “good control” and chose 7% as an arbitrary measure of “good”.
These facts alone are a problem for several reasons. Primary care physicians are trained to deal with physical symptoms, not psychological. They sometimes prescribe antidepressants inappropriately. Second — just because a prescription was written doesn’t mean the person actually took it. Being unable to verify if the medication was actually taken makes any conclusions nearly irrelevant.
And last, the number chosen as “good” blood sugar control is at odds with what the American Diabetes Association recommends. According to them, 8% is good, and 7% is “excellent”. The story implies that anything above 7% is dangerous. The study also only included 265 people with depression.
The researchers go on to say that they had no idea whether treating depression led to better blood sugar or whether lowering blood sugar makes depression better. Another researcher, not involved in the study, adds that some antidepressants are associated with poor blood sugar control.
But wait. Wasn’t the whole point of the article — and the study — that antidepressants improve blood sugar?
The study author responds by saying, “That’s why it is important to have those medications prescribed by a healthcare provider who will be following along closely enough to detect that and determine when changes are needed.”
So the study authors are saying, in short: We don’t know if depression causes high blood sugar, or high blood sugar causes depression. But it’s important to get yourself on antidepressants anyway so you can lower your blood sugar. Oh, and by the way — they might make your blood sugar higher, so you’ll need even more drugs to lower it.
This is nothing but a shameless plug for Big Pharma. It was a poorly designed study with little value, but it’s big news. It might even influence your doctor. The takeaway? Read carefully when you read a health-related story. What it implies and what it really says may be two different things.