Abortion, Text Messaging and Free Speech

Verizon changes course on censoring text messages after it becomes the focus of a front-page article in the New York Times.

Like a lot of other advocacy groups, NARAL wanted to keep in touch with like-minded folk by allowing them to sign up for short text messages. But when the abortion-rights group talked to Verizon about setting up such a service, the telecom giant balked. Abortion is just too controversial to allow text messages about it on their network, Verizon decided.

Adam Liptak wrote about the text message ban in today's New York Times and within hours Verizon announced it was changing its policy to permit text messages from the abortion rights group, which after all, go only to those people who have signed up for them.

Liptak's article is well worth reading because it shows how certain rights--such as free speech--can get lost with the adoption of new technologies.

Let Them Eat SCHIPs

Nobody likes to read boring stories, which is why most of us skip articles about healthcare policy. Unless, of course, they have to do with children, especially sick children.

And so the avalanche of recent news articles and blog posts about the current fight between Congress, the Adminstration and various states of the Union over the State Children's Health Insurance Program have made for riveting reading.

That's because paying for kids' medical bills is something that many folks know about from deep personal experience.

Check out Bill Scher's roundup of editorials on SCHIP at Common Sense. (Hat tip to Larry Hollon, who hinted at his own tale of woe on kids' medical bills in Perspectives.)

See also Marilou Johanek in the Toledo Blade and the back and forth between the editors of the Wall Street Journal (subscribers only) and the critical reply by folks at the American Association of Retired Persons and the American Medical Association (important enough to look up at the library).

Somewhere Molly Ivins, rabble-rouser extraordinaire, is rooting.

What Do Colds Have to Do With Obesity?

Not much. It's silly season again with all the reports that a viral infection may make some fat cells fatter. Some journalists--or their editors--apparently couldn't resist headlines that suggest that you can "catch obesity." No doubt visions of anti-fat vaccines are dancing in their heads.

Here's a clunker, by Roger Highfield, Science Editor of the U.K.'s Telegraph: "Being Fat May Be Catching, A New Study Says."

No. If you sit down next to a fat person you are not going to get fat. If you eat a fat person's diet, however, you might. Or if you sit down and never get up to run, jump or play.

At any rate, whenever you read or hear or see a story like this, you're first question should be "What's the evidence?" And then your second question should be "How good is the evidence?"

Believe it or not, you can tell a lot about scientific evidence based on where it's found--whether in a peer-reviewed journal (no guarantees there either, of course) or at a poster session at a scientific conference, as in fact this latest research was.

Poster sessions are like gossip fests among scientists. It's a chance for them to say, "Hey look at this neat thing I think I found. What do you think?" They're sort of like trial balloons--easily shot down.

As for me, I know that watching what I eat and getting plenty of exercise is the only thing that keeps the pounds off. Sigh.

Lead Kills Whether in Toys or Jewelry

Say what?! It's against the law to put lead in toys but the U.S. still does not ban lead in jewelry. Lead-containing trinkets are particularly dangerous if swallowed since that can lead to acute lead poisoning, resulting in seizures, brain damage and even death.

Under growing public pressure, the U.S. Consumer Product Safety Commission is now considering adopting a ban on lead in children's jewelry and has asked for comment.

Meanwhile, toy-making giant Mattel is set to announce another recall of lead-tainted products manufactured in China.

Update: complete list of toys in latest Mattel recall.

Cross-posted in Global Health Report.

On the Road

There's going to be little or no posting for most of the rest of July. I'm heading off to South Africa in a few days, courtesy of the Kaiser Family Foundation, for a traveling seminar on HIV/AIDS. After that, I'll do some of my own reporting and traveling. I'll try, if I can, to post while on the road, but no promises.

So, in the meantime, check out some of my favorite health blogs:

Aetiology Just where do pathogens come from anyway?
Crof's H5N1 blog All bird flu, all the time
Effect Measure Angry but well-informed
Perspectives Global health meets A Higher Power
Pharmalot A journo's take on the pharmaceutical industry

And for something completely different:
Rootless Cosmopolitan The Middle East from a South African perspective, plus the latest football (soccer) scores

What's a Few IQ Points Between Sisters?

Just because you can measure that something is different doesn't necessarily mean that you've learned anything meaningful. That's my take on the latest study that purports to show that, as a group, first-born children tend to have a slightly higher IQ or intelligence quotient than their younger siblings. The IQ difference, reported in the research journal Science, was only 2.3 points (where 100 points is the average) in a study of male Norwegian military recruits.

The decision by the editors of the New York Times to showcase Benedict Carey's reporting about the Norwegian IQ study on the newspaper's front page guaranteed that the report would get picked up by many other news venues and bloggers--me included.

Let's take the study at face value for a moment and assume that there's nothing wrong with the methodology or conclusions. Such a modest difference may be statistically significant--meaning that the possibility that this result is due to random chance is low--but that doesn't necessarily mean it makes a difference to individuals or even society at large. Can you really tell the difference between someone with an IQ of 100 or 103? 120 or 123?

Furthermore, even if true, a slightly higher IQ doesn't necessarily mean that firstborns will excel in business, succeed in starting their own company, create great music or advocate for social change. Nor will a slightly higher IQ necessarily protect them against racism, sexism or the heartbreak of psoriasis.

Science is full of examples of finding differences that turned out to be unimportant. Taking estrogen for years after menopause increases an older woman's good cholesterol levels and lowers her bad ones. Turns out, as the Women's Health Initiative Study showed, that does not to make one bit of difference in whether she'll have a heart attack--in fact, in some cases, it actually increases her risk slightly.

So, I don't set much store in the Norwegian IQ study--even though I am a firstborn myself. The history of IQ studies is so flawed, the purported difference is so slight, that it just doesn't mean much to the real world in which most of us live.

Source: Kristensen and Bjerkedal. "Explaining the Relation Between Birth Order and Intelligence." Science 22 June 2007: Vol. 316. no. 5832, p. 1717

Drug-Resistant Bugs Much More Common

Antibiotic-resistant infections are ten times more common than previously thought, according to a new study from the Association for Professionals in Infection Control & Epidemiology (Chicago Tribune). And you don't have to be an inmate in a jail or a hospital patient to be at risk. Although jails and hospitals have been hot spots in the past, dangerous super bugs like methicillin-resistant staph aureus are now much more common in the general community as well, as I wrote in TIME Magazine last summer.

In any case, poor infection control and improper use of antibiotics are the immediate cause of the growing epidemic of drug-resistant bacteria. But there's also a larger cause: our unwillingness to spend much money or devote much people power to public health measures that, in the long run, benefit all of us--rich and poor, jailed or free--alike.

More Sloppy Headlines on Parkinson's Disease

What's wrong with these headlines--one from HealthDay News and the other from ABC News Radio?

First Gene Therapy Trial Effective Against Parkinson's and New Parkinson's Treatment

A reasonable person would conclude that there's a new treatment involving gene therapy for Parkinson's disease. In fact, the study in question, which was just published in the research journal Lancet, was not even designed to show whether this alleged treatment is effective or not. It is merely a safety study of 12 people designed to show whether the experiment will clearly kill or otherwise injure potential subjects of future experiments.

Now, everybody repeat after me, a safety study (technically called a Phase I clinical trial) is not a dosage study (phase II) or an efficacy trial (phase III). Phase I studies are the first baby steps of figuring out whether to even pursue this line of research in humans. Unfortunately, this gets glossed over time and again in general press reports.

It's entirely possible that whatever suggestive hints of efficacy showed up in this incredibly limited trial were the results of the surgery used to implant the viruses that carried the target genes--and not the genes themselves. The implanting operation uses many of the same techniques as deep brain stimulation, which has already shown some benefits with respect to Parkinson's.

I know, I know. Journalists typically don't get to write their own headlines. But this is playing with the hopes and fears of folks with Parkinson's disease and it's wrong.

In addition, as the AP's Malcolm Ritter reported, the lead investigator of the Parkinson's study Dr. Michael Kaplitt has a financial interest in the company that is developing this so-called treatment. Clearly that's another potential source of bias and a further reason to remain wary about all the enthusiastic press.

Source: MG Kaplitt et al. "Safety and tolerability of gene therapy with an adeno-associated virus (AAV) borne GAD gene for Parkinson's disease: an open label, phase I trial." The Lancet 2007; 369:2097-2105

Incarcerex Spoof Parodies Drug Ads

Nothing like a parody to highlight the very stylized way pharmaceutical advertising evokes our anxieties. Whatever you think of the war on drugs, this video spoof touting the made-up drug Incarcerex nails the images and tones commonly used to hook consumers.



Want more? Check out last year's video on "motivational deficiency disorder" from Australia. A clever spoof that's almost too subtle about its major point--which is the creeping medicalization of many challenging, if otherwise normal, parts of life.

Consider the Source

Why do scientists hate journalists so much? They're counting the ways over at Tara Smith's Aetiology blog. She definitely struck a nerve with her post asking fellow academics how they handle press requests. Lots of vitriol in the responses, especially about being misquoted (understandable) and a strong belief that journalists mostly stand in the way of good communications.

I have a quibble or two about the broader diatribes. But they serve as a useful reminder that most of what we read about health or science whether in the mainstream media or online is mediated by someone, even if he or she is quote unquote an expert. That's why I pay a lot of attention to the byline of whoever has written an article or post that I'm reading and I try, whenever possible, to check out the original sources for an article--whether it's a scientific paper or an interview. Is the author trying to be objective? (And that doesn't necessarily mean every argument has two sides.) If you drop all the adjectives and adverbs, what are you left with?

You get a feel for certain writers and their credibility. You learn to trust certain journalists/outlets more or less than others.

We all need to be doing a lot more weeding and evaluating of sources in coming days. One of the truisms of the Information Age was that information is not the same thing as knowledge, or wisdom. Nowadays in the post-Information Age in which Opinion (the more provocative the better) is King, we need to realize that neither is all content the same as information.

Condom Ads Don't Fly at CBS, Fox

Check out trojanevolve.com for the condom commercial that Fox and CBS think is too unseemly for your innocent eyes and ears. Although both networks had previously accepted ads that highlighted a condom's ability to prevent the transmission of the AIDS virus, according to The New York Times, they balked at airing a commercial that focused on a condom's ability to prevent pregnancy.

Okay, so the pigs are a little over the top. But they're certainly memorable. And, based on the 5 bajillion ads we've all seen over the years promoting Viagra and the like, that does seem to be the point.

Vaccines, Autism and Conflicts of Interest

The Boston Globe was far too subtle in disclosing Paul Offit's conflict of interest in a recent op-ed piece about vaccines, according to Ed Silverman, a New Jersey journalist who blogs about the pharmaceutical industry at Pharmalot. The Globe described Offit as the inventor of a particular vaccine but didn't make it crystal clear that as such, he would stand to lose financially if an upcoming lawsuit that claims a link between vaccines and autism is successful.

Fair enough. But the anti-vaccine crowd have their own conflicts of interest, which typically are never even touched on by the press. After all, if claimants think they can get their hands on some of the money in the federal vaccine compensation fund, doesn't that represent a conflict?

I'm sure there are plenty of other people besides Offit who could have argued in favor of vaccines. Trouble is, sources with financial conflicts are often also in the best position to know something about a particular topic. At any rate, the potential conflict should be made clear.

Meanwhile, the most rigorous scientific studies to date have shown no causative link between vaccines and autism.

Indeed, one of the most careful studies of all, published in the Archives of Pediatrics and Adolescent Medicine in 2005, showed that most of the increase in autism cases from the late 1980s onward in the U.S. at least, occurred as a result of a change in the definition of autism. Earlier, doctors tended to say that children exhibiting similar symptoms were "developmentally delayed" rather than suffering from autism.

For the record, I own no pharmaceutical stock and have never invented a vaccine.

Sources:

KM Madsen et al, "A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism." New England Journal of Medicine. Volume 347:1477-1482; November 7, 2002.

WJ Barbaresi et al, "The Incidence of Autism in Olmsted County, Minnesota, 1976-1997." Arch Pediatr Adolesc Med. 2005;159:37-44.

Covering Global Health Meeting

I'm in Washington, D.C., attending the annual meeting of the Global Health Council. I'm giving a talk at the media luncheon tomorrow. (Update: here's a link to my talk on covering global health news.)

Will post more items from the conference on my other blog, www.globalhealthreport.com (The link was broken earlier but now it's fixed.)

Super Bug Rages Through Chicago

Paying attention to poor people's health is not just a worthy humanitarian goal, it could also save your own life or that of someone you love. Judith Graham has a chilling story in the Chicago Tribune about how a drug-resistant skin rash is spreading rapidly through the poorest parts of Chicago. Caused by the methicillin-resistant staph aureus (MRSA) bacteria, the rash is potentially fatal--particularly if it spreads into the lungs.

The focus of Graham's piece is on the Cook County Jail, but she could have easily included the larger problems in Cook County's public hospitals and clinics. Although this deadly bacterium seems to be targeting poor neighborhoods, MRSA is increasingly being found in a lot of other wealthier folk, as I reported in an article for TIME last year.

Sure hope Graham isn't one of the journalists being cut at the Trib.

Nieman Fellows in Global Health are Named

I'm pleased to report that yours truly, Christine Gorman, has just been named one of three Nieman Foundation Fellows for Global Health Reporting at Harvard University for the class of 2007-2008. The other two global health journalists are Ran An (China) from China Newsweek and Andrew Quinn (United Kingdom) from Reuters.

We'll be joining 27 other Nieman Fellows who will be exploring such wide-ranging topics as increasing friction between Muslim and Christian societies, racial implications of urban sprawl and the impact of government regulations on alternative energy technologies.

In addition to exploring basic healthcare infrastructure in developing countries, I plan to use my Nieman year to figure out ways of expanding coverage of global health news beyond traditional media outlets.

Here's the press release with more information about all 30 Nieman Foundation Fellows for 2007-2008.

Warning on Tomatoes and Prostate Cancer

Photo: C.P. Storm/Creative Commons

Bad news: lycopene, an anti-oxidant found in large quantities in tomatoes, doesn't prevent prostate cancer.

Worse news: Beta-carotene might actually increase the risk of developing an aggressive form of prostate cancer, according to a study published in the journal Cancer Epidemiology Biomarkers & Prevention.

So men can stop stuffing themselves with tomatoes in the hopes of warding off prostate cancer.

Researchers carefully measured the amount of anti-oxidants in 28,000 men's blood, looked to see who among their study subjects developed prostate cancer and compared them to those who had not developed cancer. (This is called a case-controlled study and as such is not definitive but merits further exploration.)

The investigators found no evidence that lycopene offers any protection against developing prostate cancer.

At least, lycopene doesn't increase the risk of developing prostate cancer either.

Alas, the study investigators found that high levels of beta-carotene, a popular vitamin supplement, was linked to more cases of cancer that had spread beyond the prostate.

Whether beta-carotene actually causes the increased risk of aggressive prostate cancer is, of course, an open question that case-controlled studies, like this one, are not designed to answer. But the findings echo another beta-carotene study from 1996 that was randomized, double-blind and placebo-controlled (the most rigorous scientific study design available.) The 1996 study found that smokers who take even modest amounts of beta-carotene have a higher risk of lung cancer. Presumably the vitamin fueled the cancer's growth.

Next question, posed by Tom Paulson at the Seattle Post Intelligencer: Will Heinz stop marketing its Classico pasta sauce as one way to reduce men's risk of prostate cancer? (Kudos to Paulson for bringing up the advertising link, but he may want to brush up on the differences between lycopene and beta-carotene, which he confused in his article.)

Bottom line: Eating lots of vitamins or even lots of tomatoes won't make up for an unhealthy lifestyle. And even if you do everything right, you can still develop cancer. Tomatoes are food and should be enjoyed as food, not taken as medicine.

Sources: U Peters, et al. Serum Lycopene, Other Carotenoids, and Prostate Cancer Risk: a Nested Case-Control Study in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer Epidemiology Biomarkers & Prevention 16, 962-968, May 1, 2007

GS Omenn, et al. Effects of a Combination of Beta Carotene and Vitamin A on Lung Cancer and Cardiovascular Disease. New England Journal of Medicine; Volume 334:1150-1155, May 2, 1996.

Warning on Vitamins and Prostate Cancer

Men who take too many vitamins may (or may not) increase their risk of developing an aggressive form of prostate cancer, according to preliminary evidence published in the Journal of the National Cancer Institute.

Of the dozen or so articles I've read about the study, the best is by Liz Szabo in USA Today.

Right up front, Szabo lets you know that even if the suggested link turns out to be true, the consequences are relatively small. She talks about a "possible link" between heavy use of multi-vitamins and prostate cancer. Then she makes this important point:

If doctors followed 10,000 men for 10 years, there would be about 30 extra cases of advanced prostate cancer and seven or eight extra cases of fatal prostate cancer associated with heavy supplement use, says lead author Michael Leitzmann of the NCI.

This is a variation of the "number needed to treat" figure that should be included with almost any medical story about a proposed new intervention but often isn't. The number need to treat, or NNT, tells you how many people have to follow a particular medical regimen in order to save one person's life or prevent further problems down the line.

For example, you can expect that giving antibiotics to 16 people who have been bitten by a dog will prevent one case of infection. Great for the one person who avoided infection and only a mild nuisance for the 15 others--although you'll never know who was who. (Mike Lemonick had a nice article on the NNT in TIME Magazine in February.)

In the case of vitamins and prostate, Szabo uses it to show that even if the link is true--it's not a huge deal, as these things go.

It may also help explain why the study showed no overall increase in the risk of prostate cancer with more-than-normal multi-vitamin use: the vitamin overdose may not trigger the tumor to grow in the first place, just help it grow faster than it otherwise would have.

Bottomline: go easy on the vitamins, for crying out loud. If you feel you have to take vitamins, one multi-vitamin per day is all you need.

Source: K.A. Lawson, et al. "Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health–AARP Diet and Health Study;" Journal of the National Cancer Institute 2007 99(10):754-764.

Stupid Headline Award (Oral Sex Category)

The "award" for worst headline of the week goes to The Register in the U.K. for its recent article titled "Oral sex could be more dangerous than cigars." This craven attempt to titillate readers deliberately mis-characterized the results of a recent study about oral cancer in the New England Journal of Medicine.

Making matters worse, Lewis Page, the author of the Register piece, goes on to say that "The study appeared to suggest that throat-cancer risks from booze and cigs were insignificant compared to those from getting too frisky."

Did you even bother to read the study, Lewis? The NEJM study authors were trying to show that a virus--one of many strains of human papilloma virus or HPV to be exact--may play a role in triggering cancers of the mouth and tongue.

Table 4 clearly shows that study participants who were NOT infected with HPV but who smoked more than a pack a day for 20 years or four packs a day for five years (both amounts are considered equivalent to 20 pack-years) increased their risk of oral cancer nearly THREE-fold.

And those who were not infected with HPV but who had more than 20 pack-years under their belt AND who drank at least 15 alcoholic drinks per week increased their risk nearly NINE-fold.

The reason the NEJM researchers included a question about oral sex in their study was to give an indication of one mechanism by which HPV might be spread from one person to another. They also looked at number of vaginal sex partners--which increased the risk as well. But the focus is still on the virus, not the means of transmission. (By the way, regular condom users showed no increased risk of oral cancer.)

The NEJM researchers also found that study participants who did not brush their teeth every day increased their risk of oral cancer by five times. No HPV connection there. But "Brushing Your Teeth May Prevent Oral Cancer" isn't the sexiest headline in the world--is it?

It's important to note that the NEJM study was not definitive. It was a preliminary study that looked at only 100 people with oral cancer and compared them to 200 people who didn't have oral cancer to see what the differences might be.

Bottom line: the intriguing suggestion that HPV may (or may not) help trigger oral cancer still needs to be proven. Unfortunately, headlines like the one found in the Register serve only the puerile interests of their writers and do not help the general consumer at all.

Source: G. D'Souza, et al. "Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer." New England Journal of Medicine; Volume 356:1944-1956 (May 10, 2007), available in full for free.

Cigarette Ads Snare Teens as Well as Adults

We all believe we are more immune to the effects of advertising than we really are. That's one of the reasons why ads for cigarettes work so well. Never mind the ads in magazines or the so-called product placement of cigarettes in movies. A study in the Archives of Pediatrics and Adolescent Medicine showed that even the display ads found in stores increase the chances that younger teenagers who can't legally buy cigarettes will try smoking.

Other promotional gimmicks, like free makeovers, are also, not surprisingly, pretty effective at getting young people to experiment with smoking.

Indeed as Jocelyn Noveck points out in an Associated Press article on the launch of a new Camel brand of cigarettes aimed at women, "80 percent of new smokers are under the age of 18, and one-third of teenagers now smoking will eventually die from it. "

Source: SJ Slater et al, "The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake." Archives of Pediatrics and Adolescent Medicine (Vol. 161 No. 5, May 2007), available in full for free

Trace Amounts of Melamine May Be in Fish, Too

And now we learn that farmed fish may have been fed melamine-contaminated meal. This is quickly shaping up to be the worst food scandal since the the "mad cow disease" debacle of 1996.

We keep learning a lot more than we wanted to know about how domesticated animals are fed.

Ten years ago, the general public discovered that cows were fed cows' brains as a matter of course. Now we're learning all about fillers like wheat gluten--or possibly wheat flour, according to the latest reports--that are added to animal feed.

At least in the melamine scandal, so far, no people seem to have died.

I still plan to cook some farmed salmon this weekend for dinner.

Vigorous Exercise: More Real-Life Examples

Andy Ness from the University of Bristol in England has pointed me to some more real-world examples of vigorous, as opposed to mild or moderate, exercise: hiking, rowing, dancing, bicycling 10 to 16 mph.

You can find more examples of vigorous exercise at the Healthful Life website, published by the University of Medicine and Dentistry of New Jersey.

Ness recently co-authored a scientific paper that showed that children who are vigorously active are less likely to be overweight or obese. That prompted many of you to wonder, "What is vigorous exercise?" Or "How can I tell if my child is engaged in vigorous play?

The easy rule of thumb for measuring vigorous exercise, as I wrote in April, is the singing/talking test.

If you can sing while exercising, that's mild exercise. If you can carry on a conversation but cannot sing, that's moderate and if you can only speak a sentence or so at a time, that's vigorous exercise.

Businessman Arrested in Pet Food Scandal

With the arrest by the Chinese government of a local businessman for allegedly contaminating pet food ingredients with the industrial chemical melamine, the current food safety scandal has taken another turn--from the assumption of accidental contamination to growing evidence of deliberate behavior, from contamination of pet food to possible contamination of human food.

Ever notice how a particular story--like the melamine scandal or the death of Anna Nicole Smith--will keep showing up in the news? Journalists call this a story with legs.

In this case, the melamine scandal continues to resonate because it taps a growing fear of food that has become a hallmark of our globalized age. There was a time when food couldn't travel far without spoiling. Now fresh fruit from South America can fill the plates of North America out of season and for little cost.

Eating fruit is, of course, a very good thing. I wouldn't want to have to depend on all my food coming from local farmers and ranchers.

And yet, we're growing increasingly concerned about the long distances our food has to travel before it gets on our plates. What do we really know about the food we eat? Is shipping all this food long distances contributing to global warming?

In a sense, the many pets that have died from melamine contamination have served as the canary in the coal mine--an early warning system of something that has gone wrong.

How To Think About Hormones and Dementia

How old a woman is when she takes supplemental hormones may determine whether it helps to protect her against developing dementia later in life, according to a new analysis of data from the Women's Health Initiative that was presented at the American Academy of Neurology annual meeting in Boston.

Readers of this blog will immediately note the "Mighty May" and will mentally rewrite the news as "hormones, depending on when they are taken, may or may not help prevent dementia."

Here's why this research is considered preliminary and not definitive.

The researchers looked at the original Women's Health Initiative (WHI), which conclusively showed a few years ago that years and years of hormone replacement therapy (either estrogen alone or estrogen plus progestin) actually increased the risk of dementia in women 65 and older.

The new analysis was designed to answer the question whether timing matters when starting hormone therapy. But instead of conducting a randomized, controlled clinical trial--which would give a definitive answer but would be costly and unlikely to get many participants because of what has already been shown about long-term hormone therapy--the researchers, led by Victor Henderson of Stanford University in California, looked at the questionnaires the women filled out.

Based on the women's responses, Henderson and his colleagues created a new set of data points that showed which women started hormone therapy early--before menopause or after menopause.

On the basis of those answers, the researchers determined that early hormone therapy was protective, while later therapy--started after age 65--was not.

But the conclusion rests on what the women reported about themselves so it's subject to recall bias.

Also, women who turned to hormone therapy throughout the 1980s and 1990s are known to be healthier overall than those who didn't. In other words they started off healthy, wanted to stay that way and had access to doctors. So even if they accurately remembered whether or not they took hormones, that could simply be a measure of how healthy they were in the first place.

The bottom line: if you're having severe menopausal symptoms and want relief, you may want to consider hormone therapy--but only for one or two years. Taking hormones in the hopes of staving off Alzheimer's or heart disease in the future is still more likely to hurt you than to help you.

On the other hand, if you're worried about dementia, there's compelling evidence that your best bet is to get plenty of exercise and avoid getting hit in the head.

Sources:
1. The Women's Health Initiative
2. Shumaker SA, et al. "Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial," JAMA. 2003 May 28;289(20):2651-62
3. Shumaker SA, et al. "Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study," JAMA. 2004 Jun 23;291(24):2947-58
4. Larson, EB, et al."Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older." Ann Intern Med. 2006 Jan 17;144(2):73-81
5. Guskiewicz KM, et al. "Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005 Oct;57(4):719-26

Is Sleeping in Bed Harzardous? Not!

Most people die in bed, the NIH's Dr. Jacques Rossouw said yesterday while the two of us were waiting to participate in a media panel on communicating complicated nutrition science. That doesn't mean that beds are hazardous to your health.

We were talking about how easy it is to draw the wrong conclusion from studies that detect a link or association between two different--and yet objectively truthful--factors or trends.

These so-called observational studies are the least rigorous type of scientific study and yet they often get lumped in with well-controlled, randomized trials in terms of believability.

Observational studies are responsible for more cases of what I call the "Mighty May" than just about anything else.

Still, they can be useful. Observational studies were the first evidence of the very real cause-and-effect relationships between smoking and lung cancer, emphysema and heart disease.

Other times, observational studies lead you down the garden path to the wrong conclusion. They have their place in the scientific enterprise but should be interpreted with caution.

Otherwise, you get headlines that are the equivalent of saying "Sleeping in a bed may be hazardous to your health."

Seminar: How the Press Covers Nutrition

Interested in how the media covers nutritional issues? I'll be one of the panelists this Sunday afternoon at a session of the big Experimental Biology annual meeting in Washington, D.C.

Not sure if any of it will be available on the Web, but I'll be sure to summarize the experience in a future post. Later Sunday evening, I'll be accepting an award from the American Society for Nutrition for my reporting on nutrition issues in TIME Magazine. (See especially "The Real Story about Low-Fat," which I wrote in February 2006.)

Here are the details for the afternoon session from the EB meeting catalog:

110. ASN PUBLIC INFORMATION COMMITTEE MEDIA TRAINING SESSION: COMMUNICATING COMPLICATED SCIENCE: THE WOMEN’S HEALTH INITIATIVE AS A CASE STUDY Special Session SUN. 3:00 PM—CONVENTION CENTER, ROOM 150A

Session Goals/Objectives: After this two-hour session, attendees will have a working knowledge of how journalists approach, research, and source their stories and articles. Attendees will learn how to put a media relations plan together and why having a plan is critical when communicating complicated nutrition science

Part I: Panel Discussion Moderator: N. Wellman, ASN Public Information Committee Panelists: J. Ingmire, Director, Media Relations, JAMA. C. Gorman, Time Magazine. S. Borra, President, IFIC.

Part 2: How to Develop a Media Plan. P. Daniels. 3D Communications. Students and recent graduates are encouraged to attend.

Connecting the Dots on Food Safety

The best health articles, like the one Ariana Eunjung Cha wrote in the Washington Post Wednesday on the ongoing pet-food crisis, typically touch on the theme that you can't be healthy in isolation. What others do affects how healthy you are, just as what you do affects others.

Eunjung Cha connects the dots that link "food safety in China" to "food safety in the U.S." through the story of the recent melamine contamination of pet food products.

That sets the stage for these key observations from her article:

"With China playing an ever-larger role in supplying food, medicine and animal feed to other countries, recognition of the hazards has not kept up.

By value, China is the world's No. 1 exporter of fruits and vegetables, and a major exporter of other food and food products, which vary widely, from apple juice to sausage casings and garlic. China's agricultural exports to the United States surged to $2.26 billion last year, according to U.S. figures -- more than 20 times the $133 million of 1980.

China has been especially poor at meeting international standards. The United States subjects only a small fraction of its food imports to close inspection, but each month rejects about 200 shipments from China, mostly because of concerns about pesticides and antibiotics and about misleading labeling. In February, border inspectors for the U.S. Food and Drug Administration blocked peas tainted by pesticides, dried white plums containing banned additives, pepper contaminated with salmonella and frozen crawfish that were filthy."

Powerful stuff in an increasingly globalized economy.

Just What is Vigorous Exercise or Play?

Ever since a March study highlighted the importance of moderate-to-vigorous play in keeping children from becoming overweight or obese, several readers have wondered how to decide what exactly is moderate or vigorous exercise.

The simplest method, if you don’t have an actigraph or access to a physiology lab, is the talk test.

If you can easily sing while exercising, that’s a light level of activity.

If you’re lungs are working too hard to sing, but you can carry on a conversation while exercising, that’s a moderate level of activity.

And if you can’t say more than a few words at a time, that’s a vigorous level of activity.

Your body can sustain light to moderate activity for a long time. Vigorous activity is, by definition, something that you can practically do only in short spurts—perhaps 15 to 20 minutes—before you need to rest.

Vigorous activity helps keep your heart in shape, as well as keeping the weight off. As always, check with your doctor first before starting a new exercise routine if you have a serious cardiovascular or respiratory condition.

For folks who are into numbers, you can also measure your activity level with what’s called the Borg Relative Perceived Exertion (RPE) scale. (The older version goes from 6 to 20, while the more recent one is a simpler 0-to-10-point scale.)

"The good thing about the RPE scale is that it makes you listen to your body," says Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston. Brisk walking, she notes, might be vigorous for one person while it takes a pretty fast run for another to become winded.

Don’t get discouraged if you can’t fit a lot of vigorous exercise into your life. You can still build up your stamina and maintain your figure with plenty of moderate activity. You may also suffer fewer injuries as a result.

Source: Measuring Physical Activity (CDC website), accessed on April 20, 2007

Update: See also these real-life examples of vigorous activity.

Ethanol or Gasoline: Which is Better for People?

What's good for the planet may not be so great for people, according to a Stanford University comparison of the health effects of gasoline and ethanol. Atmospheric Scientist Mark Jacobson performed a complex computer simulation that determined that if more cars ran on ethanol--which is supposed to reduce the number of greenhouse gasses in the atmosphere--there would be a small but significant increase in smog-related deaths from health conditions like asthma, particularly in places like Los Angeles.

Predicting the future is never easy, of course. And, as Janet Wilson points out in the Los Angeles Times, there may be technological solutions that could take care of the slight increase in health risks. Wilson is right to cast the conclusions as uncertain.

I wish, however, Wilson had indicated that Jacobson is such a strong proponent of wind energy. That suggests he might be a little biased against ethanol. He might also be right, of course. (We all have biases; that doesn't necessarily make us blind.) Mentioning Jacobson's wind-power research just makes for a more complete picture.

More research is needed, as always. But this story definitely bears watching.

Source: MZ Jacobson, "Effects of Ethanol (E85) Versus Gasoline Vehicles on Cancer and Mortality in the United States," online edition of Environmental Science & Technology (April 18, 2007)

Focus on Domestic Violence in Virginia Tech Shooting

Students, journalists and others are asking why more warning wasn't given after the first shooting at the Virginia Tech campus took place Monday morning. A few hours later, more than 30 people were dead. The response by university officials tells us a lot about how domestic violence is perceived across the U.S.

Here's how Sue Lindsey of the Associated Press put it:

Virginia Tech President Charles Steger said authorities believed that the shooting at the dorm was a domestic dispute and mistakenly thought the gunman had fled the campus. "We had no reason to suspect any other incident was going to occur," he said.

Now it's true that domestic violence is limited to intimate partners and family members most of the time. In addition, murder-suicides typically do not involve strangers. So there's a certain brutal, if tragically flawed, logic to believing that the rest of campus was not in danger.

But this is not a 100% hard-and-fast rule, as the Virginia Tech and other killings so horribly prove. The night before Charles Whitman shot and killed a dozen people in 1966 from the tower at the University of Texas in Austin, he murdered his wife and mother.

It took me a long time to realize domestic violence is a health issue--and not just something that happens to "other people." It is still covered as an isolated "crime of passion" much of the time. And yet, one study estimates that between 1,000 and 1,500 people are killed in murder-suicides across the U.S. each year.

My thoughts and prayers are with the friends and families who lost loved ones on April 16, 2007 in Blacksburg, Virginia.

Source on estimated deaths due to murder-suicide: Yekeen A. Aderibigbe, “Violence in America: A Survey of Suicide Linked to Homicides,” Journal of Forensic Sciences 42, no. 4 (1997): 662-665; cited by the Violence Policy Center in "American Roulette"

Nail-Gun Injuries Triple: How Much Does it Matter?

Injuries from nail guns--those handy high-powered tools that propel nails into wood and, unfortunately, other objects like your body more easily than a hammer--have tripled among do-it-yourselfers over the past sixteen years, according to a report from the Centers for Disease Control. And just so you wouldn't have to guess about the numbers, Dan Childs of ABC News reported that that means visits to the emergency room for nail-gun injuries jumped from "4,200 home users . . . in 1991 to about 14,800 in 2005."

That's a sign of good medical reporting. If Childs had left the statistic unanchored--reporting that nail gun injuries had tripled without giving the numbers, you wouldn't have a clear idea of the scope of the problem. Are talking about ten people, 100 people, or in this case, nearly 15,000 people?

Still, it make you wonder. Maybe this increase isn't so unexpected? After all, nail guns have become more widely available to home owners (as opposed to professional construction workers) over the years. If nail-gun use has also tripled, then the number of injuries is simply keeping pace with the popularity of nail guns.

Alas, the authors of the article in the CDC's Morbidity and Mortality Weekly Report were unable to provide that kind of usage information. (Often good numbers are the hardest things to come by in medical stories.)

But the study authors did suggest one important safety feature could make a difference. Nail guns that are equipped with what's called a "sequential-trip trigger mechanism," meaning you can't just shoot nails automatically, may be associated with fewer injuries.

In another sign of thorough reporting, ABC's Childs picked up on that safety tip (which means he read to the bottom of the CDC report). Several other press accounts I read did not.

Sources: Nail-Gun Injuries Treated in Emergency Departments --- United States, 2001--2005, HJ Lipscomb et al, MMWR, April 13, 2007/56(14);329-332

Nail Gun Injuries Surge, Dan Childs, ABC News, April 13, 2007

Do Blogs Influence People in High Places?

And if so, can they work for positive change in social and government policy? Or are they just another echo chamber for scandal, gossip and rumor?

Those are some things I'll be talking about at the National Press Club in Washington, D.C. on April 24, 2007. The event is being sponsored by Forum One Communications, a tech-saavy communications-and-strategy firm in Alexandria, Virginia.

Here's the description from Forum One:

Titled "Blogging and Policy Organizations: Influential Channel for Social Change," speakers will include bloggers from the ONE Campaign, Education Sector, the Smithsonian American Art Museum, and Time Magazine's "Global Health Update."

Session Summary
What: Blogging and Policy Organizations: Influential Channel for Social Change
When: Tuesday, April 24, 2007, 8 a.m. to 11 a.m.
Where: National Press Club, Washington, DC
Cost: $90 ($75 before April 16). Space is limited.

Learn more and Register: http://www.forumone.com/policyblog

Genetic Tests Not Helpful for Predicting Heart Disease

There's no proof that most of the genes that researchers have linked to an increased risk of heart disease do in fact cause heart disease, according to a comprehensive new analysis of the data, which was published in the Journal of the American Medical Association (JAMA). This conclusion deserves a lot more attention than it's getting in the mainstream media because it reveals one of the major blind spots in health research and reporting today.

The belief that your genes determine your destiny is so ingrained amongst journalists, the general public and indeed many medical staffers that it's accepted as a universal truth. And of course, some genetic variants--like the one for Huntington's disease--are so detrimental that they are always bad news.

But when it comes to heart disease and other chronic conditions, the combination of genetic and lifestyle risk factors is so complex that it can be very tough figuring out what the true culprits are.

Trouble is, as this highly worthwhile news item from Nature makes clear, we're already lining up for genetic tests to try to learn our predisposition for heart disease and other chronic conditions. One common test, for a genetic variant called apolipoprotein E-4, is supposed to show that you have an increased risk for heart disease. The link has shown up in a number of small studies.

And yet the association (remember, associations do not prove causation) disappeared in the JAMA analysis, which looked at much larger groups of patients.

This is not to say that there are no genetic risk factors for heart disease--just that we're not as clever at finding them as we think.

One more thing: the JAMA study technically applies only to Caucasians since the researchers included only Caucasian populations in their analysis. They didn't want to have to account for the possibility that race plays a role as well in predisposition to heart disease as well.

That's understandable in terms of scientific design--it's very difficult to study two things at once. But it doesn't describe the complex, real world in which we live.

Source: Nonvalidation of Reported Genetic Risk Factors for Acute Coronary Syndrome in a Large-Scale Replication Study, TM Morgan et al, JAMA 2007;297:1551-1561 (available in full for free as of April 11)

Choosing Between A Healthy Diet And A Weight-Loss Diet

The word "diet" is the source of a lot of confusion in health stories. Sometimes it's about restricting your food intake to lose weight. Other times, it's about your regular food habits and their effect on your health. And sometimes it's about both. Not knowing the difference could lead you to an early grave.

A couple examples: a recent UCLA study concludes that dieting to lose weight leaves most people worse off than if they hadn't "dieted" at all. Meanwhile, a report in the Montreal Gazette talks about the challenges of following a "healthy diet" if you don't have a lot of money to spend on food.

And now, some quick guidelines to navigate the double meanings:

What you need to do to increase your chances of staying healthy typically starts with a daily habit of eating lots of fruits and vegetables and cutting down on saturated fat (like that found in ice cream and hamburger) combined with daily exercise--at least 30 minutes a day of brisk walking, jumping rope, swimming, dancing or other activities.

What you need to do to lose weight--and keep it off--starts with increasing your physical activity to at least 45 minutes a day most days of the week for the foreseeable future. Then you need to add more soluble fiber to your diet (real oatmeal, vegetables) so you won't feel as hungry (the fiber keeps the stomach from emptying too soon).

And yes, you might have to actually cut out certain foods, like ice cream or alcoholic beverages, to reduce your calorie count just enough to lose a pound or two a week at most. Any more than that, and you're in danger of packing the pounds right back in a matter of months because your "diet" is not sustainable.

Sloppy Headlines on Parkinson's Disease

Here's a catchy headline that's guaranteed to get your attention: "Smoking and Caffeine May Protect Against Parkinson's Disease."

It was written by the good folks at the Duke University press office. But it does a disservice to anyone who has Parkinson's disease, or cares for or loves someone with the neuro-degenerative condition.

To make matters worse, it gave journalists permission to use similarly dumb headlines for their copy, like this one from the Miami Herald: "Study: Cigarettes, coffee may help ward off Parkinson's."

How sloppy is the Duke press release on Parkinson's disease? Let me count the ways:

1. Regular readers of The Health Media Watch should pick up right away on the "Mighty May" in this title. Whenever you read the word "may" in a health article (or press release) you should always add the phrase "or may not" to the sentence. In other words, "Smoking and Caffeine May or May Not Protect Against Parkinson's Disease."

2. The risk picture is incomplete. "Individuals with Parkinson's disease were half as likely to report ever smoking and a third as likely to report current smoking compared with unaffected relatives," according to the press release. No clue what the absolute risk is of developing Parkinson's disease in one's lifetime as to compared to, oh let's say, LUNG CANCER.

Instead we get just the following dutiful sentence: "Smoking cigarettes and consuming copious amounts of caffeine carry their own risks and should not be taken up in an attempt to avoid developing Parkinson's disease, cautions study investigator Burton L. Scott, M.D., Ph.D., associate professor of medicine."

For the record, about 1 in 100 (or 1%) of people develop Parkinson's disease at some point in their LIFETIME, according to data from the Centers for Disease Control.

But a 68 year-old man who has smoked two packs per day for 50 years and continues to smoke has a 15% chance of developing lung cancer in just the NEXT TEN YEARS (Bach PB, et al. Journal of the National Cancer Institute, 2003).

3. An association does not prove causation. Maybe the folks with Parkinson's were less likely to have smoked because they have less addictive personalities. In that case, smoking would be a side effect of whatever genetic predisposition made you less likely to develop Parkinson's disease. Or maybe, as Maggie Fox of Reuters pointed out in her article, people who are predisposed to developing Parkinson's disease just don't like coffee as much as their counterparts.

Gone Fishing

Will be posting again on April 9.

Update on Elizabeth Edwards

From the American Cancer Society:

"The survival statistics on the American Cancer Society Web site and in Cancer Facts & Figures apply to a woman who presents initially with a stage IV breast cancer, not a woman who has a recurrence after primary treatment. The outlook for a woman who walks into the doctor's office with metastatic disease is significantly worse than for a woman, like Mrs Edwards, who presents initially with disease confined to the breast and adjacent lymph nodes. The survival statistic for patients who present with Stage IV disease has no meaning in Ms. Edwards' case, and should not be interpreted as a suggestion of her survival chances. There are no nationally validated statistics on survival when breast cancer recurs after primary treatment."

Price of Contraceptive Pill Soars on Campus

Prices for birth control pills on college campuses are doubling and tripling thanks to a complex change in Medicaid rules.

Justin Pope of the Associated Press has done a little digging and found the reason why the price of birth control pills has gone up on college campuses. As he explains:

"The change is the result of a chain reaction started by a 2005 deficit-reduction bill that focused on Medicaid, the main federal health insurance program for the poor. College health officials say they had little idea the bill would affect them.

Before the change, pharmaceutical companies typically sold drugs at deep discounts to a range of health care providers, including colleges. With contraceptives, one motivation was attracting customers who would stay with their products for years.

Another reason the discounts made business sense was that they didn't count against the drug makers in a formula calculating rebates they owed states to participate in Medicaid.

But in its 2005 bill — which went into effect in January — Congress changed that. Now the discounts to colleges mean drug manufacturers have to pay more to participate in Medicaid."

Pope reports that the American College of Health Associations is considering petitioning the federal government to change the rules again so that college campuses can benefit from the discounts again. Might also be a good cause for college-aged women and men who depend on birth control to keep from becoming mothers and fathers too soon.

Source: Birth Control Pices Soar on Campuses, by Justin Pope. Associated Press, March 23, 2007.

Using Customized Search to Target Original Documents

I've created a customized search engine that favors results from original documents in medical journals, government sites and a few carefully selected (and labelled) blogs. Give it a try--it's on the right-hand side of this blog (used to be in the upper-right corner). I think you'll find it returns top-quality results with fewer distractions.

Using a regular search engine often brings up sites that repackage material from other sources. I'm not always sure if they've done it right--what they've added or left out. Typically these re-purposers don't even say how old the information is. That's a big no-no in my book.

Enter my customized search engine (thank you, Google).

So far, I've been pretty pleased with the results. Yesterday, I needed to look up the top ten causes of death in the U.S. Here's what I got when I typed [major causes of death] into the search box of my customized Google search engine (You may have to enlarge the screen to read it):



My very first result is from the National Center for Health Statistics and gave me exactly what I was looking for. Number two and three weren't shabby either. I can use the journal article on the changing health of China for a different project I'm working on and the W.H.O. page is a good reminder of the lives lost to tobacco around the world.

And here's what I got from Google's regular search engine:



The first entry from regular Google search is from Ben Best, president of the Cryonics Institute, an organization that freezes people after they die in the hopes of reviving them later on. The second entry is a repackaging of the statistics from the National Center for Health Statistics. What I'm looking for shows up in the number three position.

I would have found what I wanted eventually, but I like the quality of the results on my customized search engine better.

So, give my customized search engine a try and let me know what you think. You can use the search box in the upper right hand corner of this page. (Click here for the homepage, if you want to add this search engine to your site.) Or you can create your own customized search engine at Google Co-op.

If all you want to do is search this blog, then type your entry in the search box in the upper left of this page.

Breast Cancer: What Betty, Nancy And Now Elizabeth Have Taught US

See update below.

Democratic Presidential hopeful John Edwards and his wife Elizabeth today announced that her breast cancer has returned and spread, or metastasized, to her bones. While most media outlets considered the political implications of such news, it's important to consider the human consequences as well.

Elizabeth Edwards, 57, has Stage IV breast cancer. The average five-year survival rate in such cases is 7 per cent, according to the main cancer database at the National Institutes of Health. That means that out of 100 women with Stage IV breast cancer who receive appropriate treatment, seven are still alive after five years.

NIH cancer statistics also show that half of all women being treated for Stage IV disease are still alive after 18 months.

Edwards first announced she had breast cancer in November 2004. She underwent chemotherapy, lumpectomy and radiation. Now, the cancer is back.

Nearly 25 years ago, when then First Lady Betty Ford first went public about her own breast cancer diagnosis, women didn't talk much in public about the disease. Now, breast cancer advocates are among the most effective at getting their message across.

Later, when then First Lady Nancy Reagan opted for surgery over minimally invasive treatment and radiation, she struck a blow for women to make their own decisions about what is the right kind of therapy for them.

Today and in the coming months, Elizabeth Edwards will be teaching a different lesson about breast cancer. May she, and her family, find the strength and the grace to move forward.

Update (March 22,2007): From the American Cancer Society: "The survival statistics on the American Cancer Society Web site and in Cancer Facts & Figures apply to a woman who presents initially with a stage IV breast cancer, not a woman who has a recurrence after primary treatment. The outlook for a woman who walks into the doctor's office with metastatic disease is significantly worse than for a woman, like Mrs Edwards, who presents initially with disease confined to the breast and adjacent lymph nodes. The survival statistic for patients who present with Stage IV disease has no meaning in Ms. Edwards' case, and should not be interpreted as a suggestion of her survival chances. There are no nationally validated statistics on survival when breast cancer recurs after primary treatment."

Lots of Juice Linked to Obesity

We're constantly being bombarded by messages about health--like this photo I snapped of the side of a truck, advertising the POM brand of fruit juices and tea. Notice how the "O" in POM is shaped like a heart. Must be good for you--right? After all, fruits are good for you; they're full of anti-oxidants and all that good stuff.



But fruit juices are also full of calories. Sixteen ounces of POM (480 ml) is 320 calories, for example. You'd have to eat at least three pomegranates (at 105 calories apiece) to get the same calorie-count as in one bottle of POM juice.

Chances are you wouldn't eat three pomegranates in a row. But it's pretty easy to drink 16 oz of POM juice--that's just two glasses. Our bodies don't notice calories in liquid form; liquids don't fill us up the way solid food does. So it's very easy to overindulge on fruit juices.

Indeed, a recent study from Deakin University in Australia found that children who consume just over 16 ounces (500 ml) of fruit drinks a day were more likely to be overweight or obese. And those who drank more than 25 ounces (750 ml) were twice as likely to be overweight or obese.

Now as I've said before, an association doesn't prove cause and effect. It doesn't prove that drinking lots of juice is what caused these children to be overweight. (Also, I haven't been able to find the original study, just press accounts.) But in this case, particularly given the calorie counts, it should make you mighty suspicious.

Bottom line: fruit is better than fruit juice. If you drink fruit juices, limit your consumption.

See also obesity prevention program at Deakin University in Australia.

The Stress of Writing About Stress

Now it can be told. Back in January when I wrote "Six Lessons for Handling Stress" (TIME issue dated Jan. 29, 2007), I was under a tremendous amount of pressure myself. I knew layoffs were coming and I was seriously considering leaving the magazine to pursue other projects.

So I actually used the tips I was researching to try to keep myself sane. I can tell you that the three I found most helpful were daily exercise, deep breathing and regular get-togethers with my friends from church--both inside and outside of Sunday morning services.

(If you read the article online, you get just a part of the story. The tips on how to relax were published in the print magazine only--don't ask me why.)

I didn't achieve Nirvana or anything and I was still pretty stressed out--as was most of the staff. But I do think I came through it better than I would have otherwise.

One thing I wasn't able to write about in the article as much as I would have liked to have: new research that suggests that employers also have a responsibility to try to reduce stress in the work environment.

Christina Maslach, a pioneer in burnout research at the University of California, Berkeley, told me that she thinks of stress reduction as the new ergonomics of the workplace--that it is possible to design jobs and work environments that are less stressful.

In other words, Maslach says, too much of the emphasis in stress reduction has been placed on employees (what they can do to deal with stress) and not enough on employers (what they can do to keep additional stress out of the system).

There's no such thing as a stress-free job. But there is a lot of stress that's unnecessary. Smart companies and employers will figure out ways to keep that extra stress to a minimum.

So what did I finally end up doing? I decided to take a buyout in order to pursue new projects. Will keep you posted as they develop.

Vigorous Play Keeps the Pounds Off

Are fat people fat because they don't exercise enough? Or do they not exercise enough because they are fat? These questions are actually tougher to answer than you might suppose, as a study from the U.K. in the open-access journal PLoS: Medicine makes clear.

Investigators found that moderate to vigorous physical activity in a group of 5,500 12-year olds was associated with a lower risk of obesity. But the researchers couldn't say whether the kids were active because they were already slim. Or in their own words: "our study is cross-sectional and we cannot therefore rule out the possibility that these associations represent reverse causality, and that obesity leads to a reduction in physical activity."

However the data are consistent with the idea that brief bursts of vigorous physical activity on a daily basis--running around, playing soccer--increased calorie output enough to lower the risk of obesity in children. Total physical activity (which included more leisurely exercise) was not as important as moderate to vigorous activity.

Naturally, most press accounts emphasized the word "brief" in their reports. But as the study makes clear, the more active the children were, the less likely they were to have trouble with their weight.

Bottom line: Kids still have to eat healthfully--calorie intake being the other half of the weight equation--but physical activity should not be overlooked.

Update: See also my post from April 20, 2007 that helps you determine the difference between moderate and vigorous excerise.

Source: Ness AR, Leary SD, Mattocks C, Blair SN, Reilly JJ, et al. (2007) Objectively Measured Physical Activity and Fat Mass in a Large Cohort of Children. PLoS Med 4(3): e97v doi:10.1371/journal.pmed.0040097

How Doctors Think

And now for a bit of shameless self-promotion. My review of "How Doctors Think," a new book by Dr. Jerome Groopman of Harvard Medical School, is in the current issue of TIME Magazine (the one with a photo-shopped image of Ronald Reagan crying).



I don't recommend many books but this one is definitely worth your time. It looks at the kinds of mental traps or cognitive errors that can lead a physician astray in trying to reach the correct diagnosis--things like falling for subtle or not-so-subtle stereotypes or being too focused on one part of the body to the exclusion of the rest. This is one way bias happens.

In the course of writing this book, Groopman learned that perhaps 80% of medical mistakes are a result of these cognitive errors; the rest are because of technical errors like mixed-up test results.

Actually, all human beings are prone to these cognitive traps, but here's the extraordinary thing: Groopman believes that patients can help jog their doctors thinking by asking the right questions so that the healers are less likely to make those mistakes.

As I said in my review, I believe Groopman's book is "must reading for every physician who cares for patients and every patient who wishes to get the best care."

This Blog is Banned in China!

The ban may not extend to all of China and there are ways to get around it, but what a surprise this morning when I typed the url "www.thehealthmediawatch.com" into the search box on greatfirewallofchina.org, a new website that allows you to check if sites are censored in China.

The message I got back was "Your URL is Blocked!"



Was it something I said? Or just the fact that I want my readers to be informed consumers of health information? Is that too dangerously close to being an independent thinker for a timid censor's taste?

Or is it all just some kind of weird technical error, as greatfirewallofchina.org admits is a possibility? Maybe the censorous servers of China don't like the fact that www.thehealthmediawatch.com is a domain-forwarding site that points you to www.thehealthmediawatch.blogspot.com. (I did that to make it easier to recall the url.) Too phishy?

At any rate, it shows once again the value of a free press--not just with respect to political news but to any kind of information, including health information.

Black Men, Tuskegee and Prostate Cancer

Difficulties getting health care, not lack of information or education, explain why black men fall behind on treatment for prostate cancer, according to a new study in the research journal Cancer. Distrust of medical personnel, while significant, was also not a factor.

Whenever journalists try to explain why black people often distrust doctors in the U.S., someone is bound to bring up the notorious Tuskegee syphilis experiment, in which a group of black men with syphilis were left untreated even after a cure for the sexually transmitted disease had been discovered. Other potential explanations include lack of education or folk beliefs.

But a study of African American men in North Carolina shows that, in this case at least, study subjects were well aware of their heightened risk of prostate cancer. They also accepted personal responsibility for seeking health care. What they didn’t have was easy access to health care or the ability to take time off from their mostly blue-collar jobs to follow up on that care.

The study, which compared 207 African American and 348 Caucasian men who had recently been told they had prostate cancer, found that the black men typically depended on walk-in clinics and emergency departments for their care and so were less likely to see the same doctor regularly. There simply wasn’t time to develop a trusting relationship with a physician. They also had trouble getting time off from work to get to public clinics.

“The problem isn’t in the patients,” says Dr. James Talcott of the Center for Outcomes Research at Harvard Medical School and one of the study's authors. “It’s in the obstacles that their situation presents in getting the care they know that they need.”

What’s particularly important about the way this study was designed is that it doesn’t just measure disparities in health care but the investigators took the next step and actually talked to patients about their situation.

Other researchers had assumed “that because [these men] are less well educated—and they certainly are—means they don’t get it, they don’t understand the problem or modern medicine,” Talcott explains in a telephone interview. “They do get it. These folks are motivated. They understand they have a role in their own health."

"But they just don’t have access," Talcott continues. "They have less insurance. They get their care in inconvenient settings like walk-in settings and emergency depts. That results in greater waits than private settings. They’re more likely to have blue collar jobs, which results in not being able to take time off or extra time off to seek medical care.”

Source: Talcott, et al. Hidden barriers between knowledge and behavior (CANCER, published online: 12 March 2007; DOI: 10.1002/cncr.22583)

Seeing is Not Necessarily Believing

People trust television over what they read in print. Is that because they have the illusion of witnessing the event firsthand--as opposed to relying on someone else's description? And yet we know images can be manipulated just as much as words--and I'm not talking about faking here. Camera angles, music, production values and the like influence our perceptions as much as the adjectives, verbs and nouns used in traditional print media.

At first when I looked at this chart from the latest State of the News Media report by the Project for Excellence in Journalism, I fixated on how much more believable consumers found television over print media (full disclosure: I used to work at TIME and am still a contributor for them). More people believed cable news over either magazines or newspapers. Ha, I thought. I know better.



Then I looked at the overall picture. The best any news outlet scored was 25% believability. That means at least 75% of viewers/readers say they don't believe all or most of what they see or hear on the news.

It reminded me of a time when I covered a large demonstration in midtown Manhattan and one of the writers back at TIME's headquarters told me that he knew it was a violent demonstration because he had seen it on television. I, however, who had been there for several hours, saw no sign of violence.

There was one point--when the TV news cameras showed up--that someone burned an effigy of a person. And that's what the writer had seen and why he concluded it was a violent demonstration. That two-minute piece of street theater was more real to him than my own eyewitness account.

What does this have to do with health? Just this: that health coverage is part of the larger environment of news coverage. I used to think health news was somewhat insulated from those larger forces but not anymore. I'll have more to say on that in future posts.

Source: The State of the News Media 2007 (Project for Excellence in Journalism, a program of the Pew Research Center), accessed March 14, 2007

Why Do You Trust The Web?

A British study suggests that web users looking for medical information avoid many high-quality sites in favor of those with a more personal look and feel. But doing that could prove harmful to your health. Drug companies often have the most accurate information about their products and stodgy government sites are typically worth their weight in gold.

Readers of this blog may get the impression that I ignore research studies funded by pharmaceutical companies, for example, because of the potential for funding bias. Not so. I'm just careful about how I use that information. Pharmaceutical companies often have the best information about potential side effects--they are required to by law, after all.

So if you needed to look up information about the common allergy medication Zyrtec, for example, zero in on the "prescribing information" section on the zyrtec.com site, maintained by Pfizer. It will tell you what the company has told the Food and Drug Administration. Then check out the history of the drug at the FDA's own database. That will tell you about an FDA warning that pharmacists have been known to confuse Zyrtec and Zyprexa, an anti-psychotic medication, when filling prescriptions. Then you can expand your search to other sites that offer more personal experiences.

One such site that I'm now exploring provides the personal point of view for various medical procedures. It's called Dipex.org and was started by a couple of physicians who realized when they themselves became sick (one had cancer; the other needed a knee operation) that despite having a lot of medical information at their fingertips they didn't have the real-world experience that would help them make better decisions about their own health care. The site has plenty of videos and print stories to get you started. Well worth a look.

Overall, I'd say whenever you're searching for health information on the web, you need to balance authenticity and authority. Some of those authentic-looking personal sites have no authority--meaning their information is unreliable--while some of those authoritative web sites are sadly lacking in real-world experience.

Source: Briggs et al, How do patients evaluate and make use of online health information? Social Science and Medicine, available online 27 February 2007.

Why Chocolate is Not a Health Food--Sigh

I've always loved chocolate--especially dark chocolate. But the recent flurry of stories that chocolate could be some kind of wonder food leaves a bad taste in my mouth. This falls into a category of stories that journalists love to report and consumers love to read: Hey, what you think is bad for you is actually good. (And let's not forget another closely related category: what you think is good for you is actually bad.) This is the kind of story that tells you a lot more about human nature than it does scientific truth.

The latest round of chocoholic wish fulfillment is based on a study by Dr. Norman Hollenberg in the International Journal of Medical Studies (IJMS). In it, Hollenberg and his colleagues assert that the reason why the Kuna Indians of San Blas Island off the coast of Panama seem to suffer from less cancer and heart disease than their counterparts on the mainland is that the Islanders drink five or more cups of cocoa each day.

We're not talking Swiss Miss here. The cocoa is minimally processed from local cocoa plants (and if you've ever tasted real cocoa, you might wonder how they can swallow five cups of the stuff a day--boy, is it bitter!)

But there are plenty of red flags in even the most gleefully credulous press reports of Hollenberg's findings. To start with, we have the "mighty may." Cocoa may--or may not--help prevent cancer and heart disease. Even the authors have this to say about their own study: ". . . there are many risk factors and an observational study cannot provide definitive evidence."

There's also a potential funding bias since the research was supported in part by the Mars company, manufacturer of M&Ms and other fine candies.

Hollenberg is in the radiology department at Brigham and Women's Hospital in Boston. Nothing against radiologists but what do they know about nutrition? Yet, in my admittedly unscientific review of the popular press, I found not a single case of a reporter who had contacted a nutrition researcher for comment.

The further I dug into the original research paper in the IMJS, the more questions I had. For example, the investigators compared Kuna Indians on the island to everyone in Panama--not just to Kuna Indians on the mainland. That's like comparing apples to oranges.

Also, the quality of the original data is in question since the causes of death were derived from death certificates that may have been less precise on the island.

And why did more island residents die of infections than those on the mainland? Could that have been the result of drinking too much cocoa?

Well, you get the picture. I love chocolate. I think flavenoids are some of Nature's most important disease-fighting agents. But I eat chocolate--in moderation--because I love its taste, not because I think it's some kind of health food.