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.