“The scientific theory I like best is that the rings of Saturn are composed entirely of lost airline luggage”. This is from Mark Russell, the famous satirist and “scientific” theorist. Another theory, ours, is that Jupiter, the ‘romantic’ gravitational ‘partner’ of Saturn, decided to put a ring on it! Which of these “theories” is correct? Well, neither obviously as both were presented in jest to make a point, which is that anyone with a computer or smartphone and an online connection can publish, host or disseminate false or unsubstantiated claims and represent them as true without, in general, any form of fact-checking or censure. So how to tell the difference between science and pseudoscience, which Webster defines as “a system of theories, assumptions, and methods erroneously regarded as scientific” especially in a “post-truth” era for someone without a formal medical/clinical education?
Well, that’s a good question—without an easy answer. Formal disclaimer, we’re no experts on the difference between them, far from it, in fact. That said, a good starting point is to consider the source. In other words, is the source likely to be trustworthy or untrustworthy? Examples of the former are scholarly or peer-reviewed journals such as Science, Nature or PNAS and respected science magazines like Scientific American or the Smithsonian that tend to cite data from peer-reviewed journals. Examples of the latter are Twitter, online “influencers”, “fringe” journals or “alternative” publication outlets that contain no or few citations and that tend to express opinions rather than facts, and those with an obvious ax, political or otherwise, to grind.
Red flags to watch out for are the use of exaggerated language (e.g., ketosis cures all autoimmune diseases), and paranoid statements such as “the pharmaceutical industry deliberately spreads diseases”, which is only true insofar as it probably benefits from the invention of new disease categories such as prehypertension, prediabetes, and preosteoporosis to expand markets for new products not that it actually introduces and propagates diseases for its drugs to treat. One rule of thumb that we use is if a publication, journal, drug or author is not searchable on PubMed, a free inventory of biomedical and life sciences journal articles, abstracts, and authors then it is probably not credible. Below is a screenshot of a search on PubMed for our small molecule, RRx-001.
Figure 1. PubMed Search of RRx-001
Another rule of thumb that we follow to distinguish between opinions and solid evidence is this classic catchphrase from the Wendy’s commercial, where a little old lady repeatedly complains, in reference to the giant bun and small hamburger patty of other fast-food competitors, “Where’s the beef?”. In this case, “where’s the beef” means “where’s the evidence”?
The best form of medical or clinical evidence, which is what we mainly focus on as physicians, is from a clinical trial, preferably randomized. The second-best tier of evidence, if clinical trials have not been performed, perhaps because the disease or condition under study is too rare to enroll patients in it, is case reports or case series. Case reports are in-depth or intensive studies of the treatment and clinical course of a single individual (aka n-of-1) treatment, while case series group similar case studies/case reports together. Content in need of confirmation is company press releases and “pre-prints” without peer review. To be regarded as false or misleading is information based only on opinion, information that has been disproven in clinical trials, and claims without any supporting data e.g., the rings of Saturn are composed entirely of lost airline luggage, as shown below in Table 1. To be fair, however, the airline has not offered up a more convincing explanation for what happened to our suitcase on the last company trip to the East Coast.
Table 1. Ranking Evidence for Medical Claims