Tuesday, March 27, 2007

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."

Monday, March 26, 2007

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.

Friday, 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.

Thursday, March 22, 2007

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.

Wednesday, March 21, 2007

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.

Tuesday, March 20, 2007

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

Monday, March 19, 2007

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).

photo of bookjacket of Groopman's book

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."

Friday, March 16, 2007

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.

Thursday, March 15, 2007

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)

Wednesday, March 14, 2007

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

Tuesday, March 13, 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.

Monday, March 12, 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.

Friday, March 9, 2007

Who Is Really Behind Your Health News?

It's official. Video news releases are now contaminating health news as well.

VNRs (also called "fake news spots" and no, we're not referring to Comedy Central's news spoofs) are pre-packaged videos that are made to look and sound like a television station's own news spots but that have been produced entirely by outside organizations like PR agencies, non-profit groups and other institutions.

Trudy Lieberman takes an in-depth look at some fake news spots that are being produced by the Cleveland Clinic, of all places, for local television stations across the U.S. The hospital boasts a brand new broadcast studio that employs a handful of journalists as part of its Cleveland Clinic News Service.

Now mind you, the Cleveland Clinic's reputation is sterling but that's not the point. These video spots provide a dollop of news in a very sophisticated advertising wrapper.

As Lieberman writes in the Columbia Journalism Review:

. . . Cleveland Clinic News Service stories almost always feature Cleveland Clinic doctors and patients touting some new surgical technique or medical breakthrough, like anti-aging proteins or a new sensor to measure spinal disc damage, or sometimes offering basic health tips, like flu shots or exercise. Stories occasionally mention research from another institution or a medical journal, but never a doctor from a rival hospital in Cleveland. . .

Real health reporting is expensive and lots of traditional news organizations are pulling back from it. (The same holds true for international news.) There's no question we're going to have to figure out new ways of financing news coverage. But VNRs are not the answer.

In the interests of transparency, these particular video spots should be more clearly labelled as promotion from the Cleveland Clinic.

And in case you're wondering about The Health Media Watch. No one's paying me to write this blog. It's a labor of love based on my 20-plus years covering health and medical topics. (And yes, I realize that's not a sustainable business model.)

Thursday, March 8, 2007

Atkins vs. Ornish vs. Real Life

The best recap I've read of the new study showing that women who tried to follow the Atkins diet lost slightly more weight in the course of a year than those who stuck with three other diet plans comes from Denise Gellene at the Los Angeles Times. In it she zeroes in on this salient fact:

Lead author Christopher D. Gardner, a Stanford University assistant professor of medicine . . . said he suspected that the bulk of the weight loss in the Atkins program came from women substituting water for soft drinks.

Which brings up the point that what actually makes a difference in any diet plan and what the promoters of that diet plan say makes a difference are not necessarily the same thing. In other words, you don't actually have to follow the Atkins plan to take advantage of this healthy tip: don't drink your calories!

Gellene also got at the difference between dieting to lose weight (typically a short-term goal) and eating healthfully for the long term. Eating more fruits and vegetables, cutting down on saturated fat (marbly steaks, ice cream), avoiding processed foods and not drinking your calories--all while getting plenty of exercise--are still your best bets for longterm health.

Wednesday, March 7, 2007

How to Be Healthy in an Unhealthy World

Always be on the lookout for the unwritten messages in health. At first glance, this ad for Special K from a New York City street corner looks like just a promotion for a breakfast cereal. But it's really also pushing personal responsibility. Your health is in your own hands. You've got to make the resolution to be healthy. And if you're not healthy, it's your own fault.



Trouble is, it's very hard to be healthy if you live in an unhealthy environment. Eating a particular breakfast cereal isn't going to counteract the damage done by your parents' smoking or the fact that the only affordable food in your neighborhood is fast food.

Let's not even get started thinking about germs or genes that sometimes make it impossible to be healthy.

I believe in sharing good, validated information about health so that people can make the best choices available to them. But there's no hiding the fact that good health is often out of an individual's control.

By all means, eat healthy, get plenty of regular exercise and don't smoke. But also agitate for those things that are society's responsibility--like clean drinking water, vaccination and access to basic health care.

Tuesday, March 6, 2007

Sex Sells--Just Don't Talk About It

We have no trouble watching glamorous women suggestively stroking gleaming automobiles in television ads. So explain to me why doing something about a sexually transmitted disease that causes cancer is so controversial.

A new vaccine against the most dangerous strains of the Human Papilloma Virus (HPV)--which is the ultimate cause of nearly all cases of cervical cancer--is now available and some states are making it mandatory for young girls. But the Washington Post and other news outlets are reporting resistance among parents.

Personally, I suspect the controversy is overblown--more of an anticipated threat than an actual one. Everyone told me they were bracing for demonstrations in the streets or at least a little outrage last summer when the new HPV vaccine was up for approval. It didn't happen. (Take note: journalists get fooled all the time.)

Meanwhile, there are lots of important issues about the new cervical cancer vaccine that are getting overlooked because of all the reporting on the controversy--things like whether boys should get the vaccine (maybe, further research is required), the fact that since the vaccine is not 100% protective, you still need to have a Pap smear and issues about cost.

Is this going to be another medical intervention that is more widely available to the relatively well-off of the world? Will cervical cancer, like AIDS before it, become a disease almost entirely of the poor and marginalized?

I've spent the past couple of weeks on this blog looking at how health is covered in the media. This is a reminder that what doesn't get covered is every bit as important--and sometimes (especially when it comes to sex scandals), even more so.

Monday, March 5, 2007

Why 68 Vitamin Studies Are Better than None

Not all scientific studies are created equal--a fact that most reporters don't make note of in their stories. The recent study from Europe that concludes that taking vitamins may be harmful to your health is a perfect case in point.

It's not really a new study--in the way most of us think of studies. The investigators, lead by Dr. Goran Bjelakovic of Denmark, did not recruit thousands or hundreds or even ten participants and then give them vitamin supplements and see how they did. Instead, the researchers pooled together the data from 68 previous studies on vitamins to see what they could learn.

The idea of combining many smaller studies into one big study, called a meta-analysis, was championed in the 20th century by a British scientist named Richard Peto. Indeed, he was knighted by the Queen for his use of meta-analysis in cancer research, so technically, we should refer to him as Sir Richard Peto.

But the tricky thing about meta-analysis is that all those studies you want to combine were conducted by different investigators using very different methods. In other words, you cannot compare apples to apples. You're basically comparing apples to oranges and strawberries and bananas and maybe an eggplant or two--and that requires some pretty fancy statistics.

It can also lead to its own form of bias since meta-analyzers have to rank the studies they're looking at by how scientifically rigorous the studies are and that can lead to some very subjective decisions.

So if you look at all 68 studies that were pooled together by Bjelakovic and company, you find that taking vitamin supplements have no effect on lifespan--a fact the researchers duly noted and something you might expect in countries that have a plentiful supply of food.

But when they looked only at what they considered to be the most scientifically rigorous studies, they found a slight increase in premature death in participants who took vitamin A, beta-carotene (a precursor of vitamin A), and vitamin E.

There's a certain amount of biological sense in finding a problem with vitamin A, beta-carotene and vitamin E since they are all fat-soluble vitamins and so can build up to high levels in the body's tissue. But as statisticians are fond of saying, association does not mean causation. Just because researchers found a link doesn't mean that they have proven cause and effect.

After all, if you're taking vitamins because you're a smoker, you shouldn't be surprised if you develop lung cancer. And a surprising number of people take vitamins because they think the supplements will make up for whatever bad habits they have.

At any rate, the finding of potential premature death is what got trumpeted by the press--although without the long explanation.

The real conclusion to take from this meta-analysis is that there are no shortcuts to good health. If you eat right, exercise regularly and are an active participant in your community, you are more likely to be healthy--but even then there are no guarantees.

Friday, March 2, 2007

Concussions May--Or May Not--Be Bad For You

The mighty "may" strikes again. This time Dr. David C. Viano, of the National Football League's research committee on concussions, used a form of the word to hedge a dubious argument that concussions suffered by high school football players may not be as serious a health concern as is generally thought.

Here's the relevant section from a New York Times article by Alan Schwarz (March 1, 2007):

. . . [In a 2005 article in Neurosurgery] the committee wrote in its conclusion: “It might be safe for college/high school football players to be cleared to return to play on the same day as their injury. The authors suggest that, rather than blindly adhering to arbitrary, rigid guidelines, physicians keep an open mind to the possibility that the present analysis of professional football players may have relevance to college and high school players.”

Asked about the apparent contradiction, Viano said, “I think under that particular scenario the word ‘may’ is appropriate.” . . .

Considering that the bulk of research to date suggests that concussions in high school-aged football players may be even more dangerous than those in slightly older professional ball players--and the problems that professionals are seeing as a result of playing soon after concussions--"may" or "might" are highly inappropriate words for Viano to be using. The Times reporter was right to call him on it.

Thursday, March 1, 2007

Vitamins May--or May Not--Shorten Your Life

Lots to chew on in a recent study that concludes that taking vitamin supplements may shorten your lifespan. Look at how much is hanging on that single word “may.” Vitamins may shorten your life--or they may not. The researchers and the journalists writing about the study are definitely hedging their bets.

The closer you look at health stories, the more you realize that “may” and other hedge words are used pretty regularly. Sometimes that’s unavoidable. But I have found over the years that the word “may” frequently hides sloppy thinking or writing.

Interesting side note: users of British English typically use “could” in situations where American English speakers would use “may.”

So keep an eye out for “may,” “could,” and other hedge words like “many” or “often.” Sometimes they reflect unavoidable scientific uncertainty. But more often (notice the hedge), they hide laziness on the part of the writer.

I'll have more to say on this vitamin study in future posts.