Misleading Headline and Story on Anxiety and Dementia

"Staying Calm 'Prevents Dementia," is the headline on a BBC article today. Seems like an innocuous headline but in fact it is both wrong and misleading.

As a group, older people who scored as "calm and relaxed" in their answers to a survey had a 50% lower risk of developing dementia over the next six years, the BBC reported. (There's another no-no: giving a relative risk figure without giving the absolute risk number.)

But if you go to the abstract of the actual study in the journal Neurology (by Dr. Hui-Xin Wang, et al), you find the authors actually reported something quite different. Anxiousness (or in their terminology "high neuroticism") was NOT linked to an increased risk of dementia. The increase in risk occurred only if the person was also socially isolated.

Even with that caveat in mind, finding an association between anxiety in the social isolated and developing dementia does not mean a) that there is a cause-and-effect relationship or b) that mitigating the cause will reduce the effect.

Anxiety in the presence of social isolation might increase the risk of dementia or it and dementia may both be markers of some other condition or this may all be coincidental. Similarly, is the social isolation a "cause" of dementia or a "consequence" of it? It is a fact of life that other people tend to shy away from those with dementia.

In any event, even if an anxious disposition increases the risk of dementia, there is no evidence from this study that anxious people who become calm--through meditation, taking medication, etc--will lower their risk of dementia. Or that having lots of friends will decrease the risk of dementia.

On the other hand, you can make a strong argument that calming your anxiety and making more friends will improve your quality of life--whether or not you develop dementia.

Teaching Journalism Ethics

Starting in May 2009, I'll be teaching a class in journalism ethics at New York University as part of the Science Health and Environment Reporting program. I've already selected several case studies--particularly with respect to conflict of interest in medical reporting. And I have lined up a media lawyer to come talk to the class about libel and other legal issues.

Now I need a few good cases that highlight the use of freedom of information legislation in science, health or environment reporting. I'm building a list of FOIA resources and cases on my delicious links.

If you have any to suggest, please either use the comment form below or use the "for:cgorman1271" tag on delicious. I am especially looking for first-hand accounts of what it is like to file a FOIA request on science, health and environment topics.

How Will New Medicare Rule Play Out?

Medicare's new policy not to pay for 10 "reasonably preventable" medical mistakes seems good in theory. I'll be interested to hear from readers how the new rule, which goes into effect today, works in practice.

Press Fails to Say Who Funds Drug Studies

The news media often fail to report when a drug study has been funded by pharmaceutical companies, according to a report in the Journal of the American Medical Association. Press accounts often use brand names instead of generic names when talking about medications.

The first problem is a bigger issue than the second because it speaks to a larger point about conflicts of interest. (Using generics names instead of brand names may simply be too idealistic a request--like remembering to ask for a tissue instead of a Kleenex).

Just because someone pays for a study doesn't mean it's necessarily biased but you should at least have the information. Which is why I'm glad that some pharmaceutical giants are now now making public the fees they make to outside doctors. Often the toughest part about medical reporting is not getting the technical facts right but rather finding an expert who hasn't been paid to promote his or her opinion.

Redesign at Healthfinder.gov

Check out the new design at healthfinder.gov, one of my favorite sites for reliable information about personal health. The site is brought to you by the folks at the US Dept of Health and Human Services but includes links to credible sources of information outside of government as well.

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.