NF Info Webinar Informationsfalle Internet

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good evening welcome to our first informational webinar by ns children today we are dealing with the topic of online research, especially for people and relatives of a chronic disease neurofibromatosis, for example, is of course very important as resourceful information and of course you go online and research but how can you now distinguish more credible from implausible information that is often not that easy and that is why i am very pleased that we have the editor-in-chief of the magazine , magister jörg wittlinger, as guest speaker today, who will now take the floor and talk about a few slides we will inform you how to do useful online research afterwards we will have a small discussion round and now i will hand over the floor to whom i prefer jörg kind lets go of war also thanks for the invitation [applause] [music] i have cobbled together two lectures i hope i.e as a result, we are now if not just follow up with questions if anything niklas is about how do i recognize good health information on the internet i will now go less into tools such as search engines and more into how i have to find whatever i have to keep an eye on came what i would like to tell you a short lecture first what is good health information definition for that then a little media criticism how evidence-based reports media and why not i think that is relatively important because for most people the normal public media are the most common point of contact with scientific studies it may be that with a group of patients who are as well informed as you are now meeting the whole i hope it will still be useful i will then go through the short checklist of how to get to know good information on the internet based on formal and content-related criteria i have e, however, collected one together and claas has someone so that you can evaluate the whole thing a bit.

Very short studies and their validity make so what is good health information at all there is a very useful quote from klaus koch from the institute for quality and economy good health information in the healthcare system is correct and up-to-date also not misleading and does not make a decision and before the first points are relatively clear of course the information should always be important if it is not up-to-date that most is no longer correct should not mislead that is a a bit more delicate because we lead can also be very subtle in that we have information and since a very important feature that may not be clear at first glance is that it does not dictate any decisions because if we search for information on the internet then of course we would like to find something what helps us to make decisions or maybe even makes the decision for us in the case that patients would like a doctor to make the decision for them good health information does not make any decisions for them but rather tries to inform them in such a way that they as a responsible patient , being able to make decisions yourself, that means it doesn't mislead you, it doesn't try to get you to do anything, it simply provides the information that hopefully enables you to make a good health decision to meet that he finds a very important feature is sometimes, as i said, only recognized at first glance or is quite conscious as i said i think very often comes to studies via the media reading now not all really studies in the in the original publications and the parquet but let's see how the standard m watch TV and of course the question arises as to how well the media reports themselves.

We looked at the 100 without university krems at the time, and we did so by taking the articles as media and comparing what is in these articles with the actual ones scientific evidence on the same topic that means the question how i was treated we then looked at the scientific evidence searched through all the studies and if you do that then you realize that 60 percent of all media reports health reports in the media are heavily distorted and only just Eleven percent of what is in this media report strictly corresponds to the scientific data situation, there are then a few relatively sad details, namely that the quality media only perform slightly better than in July. They sometimes make very nice stories in which everything is correct, but also quality media mues sen fill your pages and therefore bring more content than you can actually evaluate qualitatively and then the good information outnumbers bad information and said you perform much better than tabloid media there are automatically differences more interesting because it is the least distorted in the report prince about prescription drugs is about cleanest work and worst cut reports on cosmetics or weight loss have about 90 percent of all articles that deviate from how the science is the evidence has other examples of why it happened why media reports are not evidence based partly the scientists themselves are to blame because scientific results also have to be sold in order to get into the media at all in the media itself there is time pressure from hasper reports would be accepted there are conflicts of interest on the one hand, both among the journalists themselves and among the newspapers n the shrinking editorial staff and simply don’t have time to report to the editors to check then there are city specialists sitting there as generalists the big media have hardly any trained medical journalists it’s easy to have experts for every subject on the other hand it would be a lot of experts in its ranks is the industry that can afford lobbying and professional per the conflicts of interest of the media themselves as consumers so these are the framework conditions that means most of the media and also their online offshoot dishes are not as evidence-based as we would like, that means we should be critical of the reports and there are checklists for this that you can look at on the one hand formal criteria where you don't have to look at the content but where i simply look at the homepage as a whole and think about what the sake of who I am what is the in aim i make one fold further one of these formal criteria is that i look at who is behind such a homepage that should be in the imprint a little bit so an imprint is basically mandatory there should be who is responsible for the site however that is often not the case ie represents sometimes at some point I don't know exactly who is behind it , if I can't tell from the imprint who is actually responsible for the content of the site , that stangl is a warning signal, which I can also look at when looking at the whole site, is the financing who pays for this site and how does the site earn their money that 's basically not a bad thing the media want to make money is that if i advertise on a site itself it's nothing bad but it should help me to classify the information and i can't just ignore it it is important that I can find out the one s side earns money that must be somehow obvious if now the side and karg side has no advertising i have to find out who is behind it either with a look at the imprint or if it is good health the information then is somehow then must be listed somewhere like The site is financed and because of public donors and so on, if I don't find out how the site earns money, that's another alarm signal and I should relatively war the step to report in connection with how the site earns money , of course dependencies can be seen but the suspicion of a dependency is if i, for example, is true that one side is financed by the state of lower austria that will be over and not too critical since then but of course there is also a dependency that can lead to conflicts of interest another formal formal criterion is a automobile With that information I can find out who really wrote this article that I posted with the post you can maybe even find out what qualifies them to be the author of the message nice if I find it should also be relatively obvious on one page that’s always quite good if i can tell the difference is the message i am reading that on this page because it is up-to-date and interesting or is your financial interest behind it topicality is clear, although many pages make the mistake of writing nicer about their studies or their reports from bundy senders on the internet real error [music] and then what is really nice what the really good sites do what has to be recognized is they are transparent as far as their methods are concerned that means there comes a point at some point where they explain how can I keep up how they also come what to say about very four eyes principle you have a systematic search easy h if you as a site report how it works then that helps me to classify how much i can trust the results these would be formal criteria and then of course there are content- related criteria that make up customer health information a very important social underestimated comprehensibility it’s not just about that that it appeals to a wider audience if it is understandable but it is about avoiding misunderstandings is we use the best information mix if it is understandable for a very small circle that i mentioned at the beginning it should not be judgmental that means don't try it to persuade you to do something but the goal should actually be the information itself good good sides naturally have sources and a source does not mean that you once say somewhere there is an american study but sources must be findable and be specific it's to say yes an american study says that helps me then actually find this study that's no sources long there were one can forget so and the next thing i myself don't have a source for everything i somehow search but I have to have every single claim ok with health information in particular there is still the criterion that a good report now comprehensively applies to me now of course not for every single detail but if I am informed about a therapy on one page then that should be the case It has to cover a lot for me, namely it has to put me as a reader in a position to weigh up the costs and benefits or weigh up the risks and benefits and for that it needs a bunch of things that have to be in there and these criteria are almost not, so almost never in full fulfill because what do i need to decide or therapy are how i do ic h must be able to see the benefit and i must have the benefit in front of me in understandable and concrete numbers there is, for example, the hammer needed to treat or also a risk reduction in the ski area there it is only the benefit that needs to be communicated in an understandable way, the benefit alone was strong but not yet about the therapy, of course, i also have to know the side effects and the costs so that she can assess the risk and use all of that and risk we don’t use anything yet if i don’t compare to alternatives, i.e.

If something informs during the therapy , it has to be informed whether it is there are also other therapies otherwise i can't weigh up this benefit and what is also another point what is almost always about in the reporting is uncertainty short message everyone everyone also in psn is always trying to evaluate everything with the greatest security but the us when it comes to scientific questions, it is almost always missing and this zi el with uncertainty is something that good times do and which good ones conceal okay with studies on studies comments back there is a rule of thumb you can estimate relatively well how strong the significance of the study is where else design is about animal experiments laboratory experiments and whether a lot of potential turned after a short, for example, everything is quite theoretical if i cut out all the practical examples from the presentation from the long one , but an example of the difference is somehow how the presentation in the media can be or, as always, just finds it easy on the internet in addition, the evidence r looks there is here with the quote that was made literally in several quality media so dan ammann that there is a scientifically proven outstanding effectiveness of the terol cellulite cream against orange peel skin if you then look at it and try studies on f Inden one finds as the only one who has interviewed a field report from the manufacturer 20 users without comparative control without any form of evaluation and then the no study comes, nevertheless it is reproduced by several quality media as scientifically proven and such things have to be in the back of your mind when you read about studies in the completely normal public media an example of neurofibromatosis from the glass house shows quite nicely how a few this man is quite good at time to cook with the euro but has found a drug or a drug that is already being used shows in a small study the chance that this could possibly also help with neurofibromatosis and if you skim the study sigma what always happens in small studies it tries to make their importance big, that means less and less describes what the study does and can do and what it actually says but you describes the hope that maybe someday it will come true and i now rely on the cast games sometimes shows something that just didn’t come true and that is very often so many studies show great results in animal experiments laboratory tests on cell cultures show great results maybe great results in pilot studies and when you then do a real clinical study there is simply nothing left that is the normal case that usually happens it is very rare that at the end of the development process you actually get what you would like and the results are small who cheers massively and that is a second example is so you have to be a bit more specific we come to the list from the bottom left there are actually not that many bibles I would like to have I have now taken out all the public media and why is so between I think understandable I have from class the page with taken home because she is of course important as the first point of contact now regardless of the chair how she interprets studies is of course important but that is known in the circle of austrian times i can recommend medicine transparent that is financed by the state of lower austria and the ministry that looks at health claims media and advertising and send the evidence and that is if you want to know about various questions how the evidence actually stands the scientific state of things is that a very good side knowing what works is a bit blog-like they also summarize them scientifically but they reports from all sorts of areas very patients after is only a very small site but also very useful then there are two sites in Germany that are extremely important is one of the hedgehog monitor chambers there you ca n’t have paid for that service from the cash register there, according to the status it s a lot about alternative medical stories but not only but about everything that happens on the edge of evidence-based medicine around the page for patients in poor health information that everyone that the page from the German institute for quality and efficiency in health care if you are on a topic the topics that the site has dealt with should be looked at there they are pretty much the most reliable patient information site you can find the media constantly reporting doctoral theses on the boundary between medicine and criticism of medicine reporting on the subject of cancer the German Cancer Information Service is a very good one page and what you can still do with recordings whether it is in the health blogs and media blogs we can recommend this is not the most objective variant of health information but it conveys a lot of background knowledge maybe my own blog in brackets a bit assuming the truth learns that that's quite polemical that's going to be demolished now as objective health information but of course I have to have a bit of my own [music] media blogs that's why I'm in the exact media unfortunately it's replaced as the first source most draw another source isn't anything at all In the meantime, the source of the information provided when viewed from a global perspective is wikipedia and that is an amazingly good source .

Some people may also rejoice in that it is not always relatively difficult to assess its reliability, but wikipedia is actually the source from a global perspective and that is not the worst development and there is now wikipedia working with metatrain, among other things , and with other institutions and trying to make its health information evidence-based and it doesn't work badly that doesn't mean that every wikipedia article is about health en break out in enthusiasm but all in all it's not a bad source at all had to look at it with the usual ability to criticize and it's an advantage if you can speak English the English wikipedia is usually better filled the dig on the top left I can recommend with a clear conscience there are on the page from die von gesundheitsinformation de there is again a very good guide on how to find good health information that means if you don’t think my lecture is particularly great that I can still find a lot of tips collected there I also have a turn please don’t history where in the size of for your self-help group particularly interesting that massa for the lecture but still i think symptoms google brings nothing because you always end up with cancer forums are forums are very critical history i only venture into a forum if i am the one who knows them best otherwise is the information there us Klich very critical and above all they are always there emotionally and with personal stories and it then has a very high impact on the way you evaluate information yourself and that's something where I'm happy really cautious almost the opposite of the sober look at you history, the trembling is quite small, but it actually makes the evaluation of information rather difficult, so skip to the next point, that with important, but what I personally still like about the old against the monster, most of us are on social media channels and that’s where health minutes still shared amazingly quickly and uncritically yes that would be nice it would be easy because that almost always amounts to disinformation if we have really good information that you want to spread that is of course a useful channel but it is precisely the further sharing of fast emotional ones reports I believe one of the biggest things is always wasting the period of time where we can all take matters into our own hands i would now if there is still time it is clear how to say ok very briefly something about studies what are studies anyway why do i need studies and with them studies i can trust also need it that me the individual perception the anecdote that what i experience very very little knowledge with print why why can he from a single experience such as a game i put my socks on now i have no head anymore why doesn't that help me why doesn't that bring any knowledge with it because it plays a big role if i have certain expectations i normally don't document my personal stories very precisely and very important reason there is never a control group for everything i experience i can do not play through the situation several times and I do not have an idiosyncratic one that is exactly the gl oak you can increased and don't know an alibi twins with which you can then evaluate it statistically then the subjective perception naturally plays a role always a limited perspective then that an individual life is never that can be evaluated statistically and what is still correct in medicine that experiences is there is a natural course of the disease and without a control group we cannot know what is happening then, of course, as the disease progresses or can be attributed to a cure so what do i have to do i need a studio that is probably the very simplest representation of what i can do can be studio the definition is to be taken with caution the come to myself and practice part gone the studio is every method try if i can find the advance if something works that is down there like i said so they controlled the simplest illustration of another mission s Tudie I have two groups, one receives therapy, the other no therapy and then I see whether the groups have different results in the groups compare new therapy with an established therapy and modern stars get by so we have the randomized controlled study on not lucky that means randomized that means coco and group d have to be comparable and for that to happen i see it with a random principle which group I don't understand, I'm in between sparks, but that's just one type of study, that's always possible.

I can do a randomized controlled study, for example , about the consequences of the 1000 because I can't force a hundred people to save 50 every day for a year i be another study it goes easy with different strengths of significance for everything and different study design there is therefore a hierarchy of evidence betting evidence what is really interesting to remember about the pyramid is that case reports and expert opinions are at the very bottom in the hierarchy of hot & reason because experts actually are mostly dependent in some form and are not always and in real always up to date it is so that in many medical exploratory stories where new findings are very important the experts are of course more advanced than the actual study places on things that don’t work are public and so on but basically when we read in the media that we are defined by the opinion or therapy about an expert always keep in mind that the expert opinion of the license areas is at the bottom that puts it above it gi bt non- controlled studies observe different forms of observational studies controlled observational studies where I have a comparison group are already improved then the randomized controlled study is our best tool if it is done cleanly than individual studies then there is the systematic review work that summarizes the other types of studies there are then there is also a so-called network meta-analysis that summarizes the overview work and if things are done well, the highest level of conclusiveness of the meaningfulness comes, whereby one always has to say that of course overview work can only summarize what is there if there are no basic studies on a topic then helps with the systematic overview work, how do you recognize the bars which study cunningly that doesn't go through itself a bit too precisely but there are different is such an algorithm i know it's clear we can use this to make it available or that they are happy to bite yes could also make it available as a download if you like that because I think you can work your way through it a bit and then with the help of the graphics you can at least read it in assign a row quite well where in this hierarchy of evidence you look at the area from which it is very useful but there is something like a few rules of the thumb that are usually sufficient to get a picture of the report by looking at the degree of freeness that gives me such a first impression give victims study what can and what is not seen for the first time are we talking about animal experiments or a clinical study animal experiments are interesting that is scientifically quite often justified delivers great results when it comes to discovering mechanisms it has zero clinical significance i can never conclude from an animal study whether it worked in humans it's just still far too far away why is it important if i often leave messages where first it's explained what it's about where the topic was explained where then it's advertised in great detail what will one day be anchored and that the study opportunities will be five times a stand for 100 people through search was made was then the city lived there is often tried to cheer that finally is medium presentation of the study means that different cell cultures are used, for example, is also scientifically fundamental, of course, but here too there is simply no statement at all as to whether it will work on my skis will that work of course can't conclude from that whether the thing will be clinically successful i just need clinical studies for that the next thing is where i can take a look so good pi that the study says the design says the study type that's just this one Indians in the hierarchy do not always simply because for example, the abstract of a study sometimes doesn’t say exactly what it is, so some studies get bigger they are then you actually have to take part in the methods, is that 1000 correct and try to draw them, then i can find that somewhere i can restrict that somewhere exactly then you can look non- controlled study can never convince me of anything clinical the selection is enough for that if i have a randomized controlled study of mine there are a few things that he as a layman can check i can for example look at the look at the size of the study and there are rules but that doesn't really apply to the clinical study that decides but has some effectiveness the claim has some effect only helps me in a window of around 300 participants what that is of course in one area from rare diseases something wrong we achieved accordingly tame the whole story has been correspondingly difficult to admit that he the discussions because I sometimes got because a lot of work has to be done with data and numbers that I don't really don't have the space to give me a very reliable result is that they had to then you have to other hand but basically when I say a nice thing he presents a nice randomized study of 300 to actually prove the clinical effectiveness everything you see in this largest group where you often come across so with 20 to 50 participants from the pilot studies yes they can we don't provide hints nor do we provide prices a little bit of research that can then if it's of interest ask the questions you can look at how the randomization is because it's something that's very important if the randomization worked well that the randomization in groups is the prerequisite for this that actually the last first study can shoot if it doesn't work or if it 's done badly it's always worth the study are sure we can look at it relatively well financing is what you get relatively easily because that's why it's usually quite well indicated financing I can come out but a study by a pharmaceutical manufacturer and most of the studies are financed by pharmaceutical manufacturers that does not mean that the evaluation should not be so good studies at all you have to think along with it, it is still very important there it is again more about alternative medicine city of hemer with which i do more or actually Are there ideological conflicts of interest if you have, let's say, a homeopathy study in which only I -button was involved and are there ideological conflicts of interest you can be stronger the financial and what is very important no matter who, what kind of study it is and how clear you go you can only really really know something if you include this one study in the overall evidence that is something we are very happy to let individual studies lead us in some direction in our interpretation it makes no sense we always have to look at what the whole is saying of all scientific studies as is the evidence as a whole and is this one study that i am looking at in the evening that, in contrast to what we know so far , does it supplement it or is the possibility perhaps already old hat this classification in the entire evidence would be easy a final point thank you very much for the lecture, which I think is really very easy to understand and many, many important topics were addressed.

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I will now start with a few questions that were asked of the jet, some of which may have already been answered at the end exactly this question was answered from when is a s tudie meaningfully declined statistically only then meaningfully from 300 participants and that is also called the problem with the rare diseases it is not easy to find so many participants there are also that’s why the european medicines agency always has special regulations for rare diseases they don’t have to now show the number of participants in your studies if you don’t want to let a drug do this for rare diseases, the general appropriate regulations offer the incentives so that the pharmaceutical industry also invests in rare diseases, e.g.

Get this early scientific advisory scientific advice from the authority who can exchange information quite early on whether your study is set up well planned the important outcomes are also measured , i.e. the endpoints study endpoints that are measured so that it becomes a meaningful study that will speed up the whole approval process nigt they have increased and extended patent protection, these are such incentives for the pharmaceutical industry to invest in some diseases , and that has already taken effect, so more and more drugs for rare diseases are being approved, which helps if the study does not actually have enough or not as many patients as one would like it to be carried out one can also imagine that a very rare side effect will most likely not occur in a study even with 300 patients .

That means there are four studies in this phase after which the market approval is followed by further data being collected the possibility of a side effect also being reported directly by patients and so you can then collect data and should it then turn out that this data reveals that the drug is not as safe as assumed it can of course also be withdrawn from the market then we have n another question about wikipedia, the english wikipedia texts are mostly of better quality but the question does it help if you can translate it using a translation program or does the german version work even better the translation programs are better it depends that's it You can't say that across the board because the problem is usually that the German page says something wrong, but just a lot less than the English page. Wikipedia gives you the option of displaying the same article in a different language and then you can you can compare very directly and if you come up with it now, for example i click on the english version and says in german only two paragraphs are there and the english version would be a detailed article then i would rather look at this detailed article you can have it filled I had I always ask how far the translations are then, so it's a bit of a language game to close everything there, but it's better than it's about the information that's not there in German , it's not wrong, it's simply not enough happens relatively often you then go to English articles and find pages and pages of stories to make was the German team a sales increase from my experience now as far as neurofibromatosis 12 armature is concerned , the wikipedia pages are not bad when it comes to describing the disease in principle Symptoms are described, but that there are no approved therapies yet, you will of course not find any information on therapies and treatment options there either, so you have to turn to the nf expert you trust, where both are also basically a quality feature that there are any treatments in there who do not e.g You definitely have an interesting question about christina too, how do you recognize studies that are n’t being embellished a bit what have you already explained I think the key word statistics with statistics you can bend everything the way you want and there might be quite a bit about it they have a bit of a fix there so it's true you can actually do a lot with statistics and there are separate seminars for how to recognize that from my personal experience it's not at all that's not the trickiest point, statistics and the exact statistics tricks that you have are not always the most dangerous and have traps or the problem that there are some that are so complicated that you do n't have to be an expert to see through them, which you can, however, do with attentive people read as well as finds these are the systematic error of a study, so look at the statistics in detail of course there are different things like this is done very often and what you can see through the suffering is that in a study hundreds of things can be tested which kamps also mentions and that is a popular method i do the study and make 300 cars be so i have i disassemble that in the train groups my participants i measure how big they are not west their blood pressure before and after and their heartbeat i just need hundreds of measurements because something will be different afterwards in something the group will appear and then take I what I find statistical questionnaire measures things then even if everything happens cleanly somewhere around it as a coincidence statistical differences and then I take this one difference and the couch as that 's my result and that's a trick that makes relatively often case was and in the sense that this is the case and that I don't already have that for my study n at the beginning it was clear what the studio was actually on board but the power a very large wide range of test devices and looks on the internet concludes that he comes and says it does n’t exist and you can see that from the study the really hardcore statistics tricks trautmanns leyen but has the teeth usually nothing is embellished with other sexy the basic design because they do not separate the customers cleanly, for example , red with comparable customers have and what also happened to stay with the cars but only a few take there are so-called hard and soft escapes so since the hardest endpoints we know the death the measurement error is relatively small and then it goes back parameters i can, for example, instead of measuring whether the people are better after the study can not measure whether you whether your ecg and has a significant change or i can consult you with any questionnaire dismantled who has validated the possibility nothing says or i can develop my own questionnaire and so on that means i can cheat relatively well in the study by looking for an endpoint that may change but nothing about the real one with the disease and should i say there is a lot in return parameters are something you have to be aware of, that's just I have a look, they've actually looked at something that's relevant to this disease and that 's what I think is with you on the FA topic where I have to look at all sorts of things but, for example, not now quality of life the patient with history and will remind us correctly that everyone is trying to bring the sea in and absurdly there are studies that look totally irrelevant you can so know he is n't doing any good but you can get a significant result forward what i also observe is sometimes the axes with statistical tricks distorted so that this curve looks steep as if it is going to be healthy and then something is presented as significant which is actually not that significant, so you can also look at a medium purchase there 's another story, and that's the famous trend that says only if a result isn't significant but you say a trend has emerged that's a sign that you actually don't do it often even if the number of participants was very small if you count ten twelve people had a study you see a trend then you say yes we are in this trend that the receipt of a larger number of participants is interesting to repeat that can be a trend but if it is not confirmed then it is not meaningful is simply numbers of participants under 20 plays the coincidence I was able to play such a big role that you can draw conclusions from it f what can be expanded in the large study and the large study can only say as an example, for example, a study that has now been carried out for an association of patients, a phase 2 study with a drug that makes flexi form a treatable for residents that was with just under 30 percent carried out and is so strong from the results that over more than 70 percent have a significant response cap of at least 20 percent reduction or more and they then continue instead of being seen in none the tu times have grown sometimes simply the change of less than 20 percent and tula reduction of 40 to 60 percent and that has now gone so far that an approval study is now running in america but that is still a relatively small target group but very clear results within this target group just like that a bit of coincidence communities actually depends on the numbers like v Many people I need in a study can tell you how big the effect is if I compare using a parachute, for example, we don’t use falling, then I would have a statistically significant result from a number of ten participants because the result is like this is huge and if means says that 70% are responders then I actually need fewer participants to speak of a clearly significant result.

Unfortunately, with almost all medications we have by far such a clear effect I now have a few more questions that I have written down myself, are there any more questions from your side, otherwise I would now go into one point, yes, I think I am, I think it is very important that they use the Igel monitor as source called grad what so edge areas of the evidence ded iced medicine is concerned it is neurofibromatosis of all types so that there are currently incurable diseases and also fernanda relatives of course scour the net to look there is maybe something that helps here and of course you are quickly inclined or you just end up too scared so then quickly stick to medicine that is not evidence-based, the hedgehog monitor is well suited to looking at it, yes, like the area for the special disease will not give much, whereby the team will help, for example, with and a general distinction therapy anyway, how should I put it, certainly the credibility will be able to do that very well and we will show okay there is a little something behind it there are other indications there is a result of the dead fish and suitable for nf special believe something gives it is the they take on the big stories mainly he if it is all right from from from from alternative medical stories of the city 60 by the way audi cancer aid quite good because of course cancer patients also tried everything logically and the hedgehog monitor cut badly and yes otherwise there are currently a lot of nutritional stories good sides as medicine transparently checken to see that we have been here with the next question is the topic of nutrition is was just with the affected system was unfortunately often exaggerated that you just need to change your diet and almost every cancer can be cured or as i have it now but not in there as one would assume that you probably know that very well with these general rules was should immediately become skeptical if someone promises an effect without side effects yes that you are not sure if I could think of two examples where it actually exists or if someone from of healing talks about things that are not d currently only considered incurable if someone propagates a method for all diseases so if someone says i have the miracle cure it doesn't matter what you what you yourself in any case these are stories the alarm bells should ring immediately are also frequently picked up by the media topics such as methadone, for example, or all the cannabinoids that are now considered universal remedies, it was natural to say that that sounds spectacular if you don’t really have the time to investigate that’s a very good tip , ignore the information turn and then go to the sources of these delicate follow-up work spectrum of science is, by the way, relatively counts of history yes that is a really great guy the work is supposed to follow stories relatively often and since otherwise the methadone story still started and then make a good summary invest this service forced is with nutrition it is is it really s Difficult because there are an enormous number of providers who then make promises because, in contrast to the medicinal products, they do not go through any approval that they can promise anything with them as long as they are reasonably cautious legally and have to be able to prove the effect in reality on most people really serious illnesses have the main problem that you know exactly and just accommodate there are all these diet tips that often become quite radical real problem because the real problem would be that people in a good nutritional condition somehow find the absolute now try it right there again the question e.g.

Dietary supplements do not have to prove an effect it is so that the number to be able to let the drug do you need approval studies the whole thing had to go to many stock market authorities and prove demos in clean studies that the claims are true and not just there ss that you have to prove the effect must prove the safety to the outside with food supplements you have to first of all you have to be careful what you claim because there is no longer any healing and there are newron with formulations that start there that fits and how to formulate it you have to be able to make concrete promises of salvation and those who are smarter then formulate it accordingly after there is a catalog with a picture and you don't need approval, so not for those who hardly see the market as food supplements, not as medicines and there we also online again and again that mentors suddenly land on facebook links from some dietary supplements which are then very exaggeratedly advertised in terms of their effect although as you said as you rightly said that they were never tested in a study yes that is the city’s problem in part because of the also some doctors on it spri ngen and ourselves in one or the other food dietary supplements sometimes sell directly on the homepage of the practice with the online shop offered because as a doctor you can of course then claim various deficiencies and then yes, you can always buy them right from me in dietary supplements that's history for me today the doctors take part in such things need food supplements got very white now so let's experiment here make something yourself and from a big style rips helped me was resell it no so there are minimum conditions that you of course had to eat as food you have to abide by the law but that's all you just have to do in the you formulate what your great thing can do after our games you have to be careful but you could, for example, set up a homepage and tell them you got money from it your personal g you can illustrate history and you can hire ten other people you can also pay them to have visitors think about who did it a manufacturer has paid bloggers put the videos online with the positive experiences that you haven't had and they're quite good there everyone pays 100 euros for positive reviews and the internet is flooded with positive reviews for the fact that this could be effective here what is being advertised as performance -enhancing active ingredients is amazing and so much money is being made with it yes yes there are other questions otherwise i would briefly summarize that fortunately a lot is happening in enev research at the moment so there is a lot internationally in progress we are as an association eleven children with these various research groups possible in close contact plan also on european level with the american organization regularly to publish really understandable news from research to laypeople also have contacts to doctors where we where we can ask if we find something suspicious that there is something in circulation where we would like to have an expert and what is really there so we can offer everything else we can also give a little preview we will be a patient again on 16 17 november hold conferences in vienna where there is a unique opportunity to get into discussions with various specialists, listen to specialist lectures, ask questions, exchange ideas and network, i hope that many will take part, and otherwise i can really only recommend visiting the websites the respective patient n to provide information or to contact them directly and ask questions i often see that a lot is posted on facebook a lot of well-intentioned advice what is well-intentioned it is not always really good and then you are there even if you are an administrator on these pages yourself you can't see that quickly that something has been divided and laid 13 times again yes you have to be in the maintenance of jörg I think I really gave very short tips on how to critically analyze the whole thing which points you can work through yes if now no question, those are from you, then i would like to thank you very much, jörg, for the great presentation, also that we can provide the slides and publish the video on our website on facebook, yes, and i am happy about this beautiful one kick-off for our webinar series says many thanks also to those who took part and watched the video no ch will watch and yes, if there are any suggestions for further topics for the webinars, please write to kontakte tennis and we will take your suggestions into account for further planning, thank you very much for tuning in and watching

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