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.)

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.

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.

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.

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.

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.

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.

How Money Affects Results in Breast Cancer Studies

Breast cancer studies funded by pharmaceutical companies are more likely to report positive, or beneficial, results than those funded by government or non-profit organizations, according to a new report in the Journal Cancer. That doesn't necessarily mean that the results are wrong, as Amanda Gardner points out in the Washington Post. You would expect drug companies to have a better track record in researching new drugs.

But the Cancer study also fits with previous research that shows that scientists in general are less likely to report (and journals are less likely to publish) negative results--in which a drug or other therapy didn't work--than positive ones. Now add the typical reluctance of a for-profit company to announce that a drug it's developing doesn't work, and you have a bias against studies that show negative results.

That doesn't mean that for-profit drug companies are bad. It just goes to show that you knowing who funded a particular study can be just as important to evaluating a study as understanding the science behind it.

More on Vitamins and Pregnancy

One of the hardest parts about writing health stories is figuring out what to leave out. Last Friday I wrote a post that focused on prenatal vitamins and the risk of pediatric cancer. Although the vitamins reduced the risk of some cancers by 50 percent, I calculated that that was not a huge change because the absolute risk of getting cancer in childhood is so low.

"But isn't taking vitamins during pregnancy a good thing?" a reader asked. Yes, absolutely. Taking folic acid, for example, which is found in prenatal vitamins and fortified bread and other cereals, has dramatically reduced the numbers of neural tube defects in newborn babies.

I should have acknowledged that fact in the last paragraph of Friday's post. My oversight serves as a reminder that whenever you read or hear health news, you should ask yourself what has been left out. Even the best health writers can't cover everything.

Vitamins Reduce Cancer Risk--Relatively Speaking

A new study shows that women who take multivitamins and folic acid during pregnancy reduce the chance that their baby will develop some childhood cancers by almost 50%. Your first question on reading this should be "50% of what?"

In other words, you want to know what the absolute risk of developing pediatric cancer is. Then you can figure out whether a 50% reduction (the so-called relative risk) is a lot or a little.

Fortunately, the overall risk of childhood cancer--such as leukemia or neuroblastoma--is very low. Joseph Hall of the Toronto Star, for example, characterizes the absolute risk of neuroblastoma this way: "the disease affects about one in every 6,500 children under five years in North America."

Do the math and you realize that he's talking about a 0.015% chance of developing neuroblastoma. A 50% reduction in relative risk means that the real-world chance of developing a neuroblastoma has dropped from 0.015% to less than 0.008%.

Such a slight decrease is not a bad thing--especially when you consider how easy it is to take vitamin supplements during pregnancy and how devastating neuroblastoma can be. But most health stories in the popular media focus on relative risk and ignore absolute risk, giving you an incomplete picture.

Treating Herpes May Prevent HIV Transmission

Everyone takes shortcuts--even medical researchers. That's not necessarily a bad thing. After all, where would we be if Christopher Columbus hadn't decided to take a shortcut to Asia? Hmm, maybe that's not the best example.

The point is that the best health-and-science journalists, like Alice Chang of the Associated Press, tell you right away when scientists are taking shortcuts.

Chang reported on a study that concluded that treating genital herpes might prevent transmission of the AIDS virus in people who are infected with both herpes and HIV. This makes sense since doctors already know that folks who are infected with herpes, or another sexually transmitted disease, are at greater risk of getting infected with HIV as well if they are exposed to the AIDS virus.

Near the very top of her article, Chang makes this important point:

In the latest study, conducted in Africa and published in Thursday's New England Journal of Medicine, women who took the herpes drug valacyclovir had less HIV in their blood and in their genital secretions.

The study did not look at whether the drug, sold as Valtrex by GlaxoSmithKline PLC, actually reduces transmission of the AIDS virus. However, scientists generally have found that the more virus someone has, the greater the risk of transmission.

In other words, the study investigators didn't measure whether the women in the study group actually passed on the virus less frequently than their untreated counterparts--that would have taken far too long and would have exposed more people to HIV. Rather the researchers measured the amount of HIV in the women's bloodstream and inferred that because the HIV levels dropped in the treated women, their risk of passing on HIV to someone else had fallen as well.

The researchers' assumption is reasonable but there is a chance it is mistaken. And that's why calling it to your attention, as Chang did, is a sign of good journalism.

Premature Babies and Happy Endings

Readers sometimes wonder whether journalists allow their politics or their advertisers to influence how the news is covered. But I've noticed a different bias over the years in coverage about extremely premature infants. Call it the bias in favor of a happy ending.

Take, for example, the opening sentences from Monday's article by Erika Beras in the Miami Herald under the headline "Miracle Baby Going Home to Homestead with Parents":

When she was born, she was 9 ½ inches long and weighed about 10 ounces. The doctors didn't give her much of a chance.

But Amillia Taylor is a fighter.

This week, Amillia, now 17 weeks old and weighing 4 pounds, drank from a baby bottle for the first time.

And today, she'll go home.

But in fact, the odds are stacked against a baby born this small. And whether we like it or not, little Amilla Taylor, whose conception occurred as a result of in vitro fertilization, has many medical problems that will likely plague her the rest of her life.

Who doesn't want a happy ending when it comes to little babies? But I've seen it happen so many times before. Initial enthusiasm over a very premature baby who weighed less than a pound at birth gives way to grim updates--if any appear at all--about the baby's health.

And indeed, I now see that doctors are not releasing Amilla from the hospital after all. She has, according to the (shorter) followup story in the Miami Herald, "a number of ailments" and "needs extra care."

Women and Heart Disease

You've got to understand risk if you want to stay healthy. Why do women fear breast cancer more than heart disease? As a group, women have a 4% chance of dying from breast cancer vs. a 38% chance of dying from heart disease. But because women are less likely than men to develop heart disease in their 40s, they (and their doctors) often assume they don't need to worry too much about cardiac problems.

So, the American Heart Association has come up with new guidelines on preventing heart disease that emphasize a woman's lifetime risk. The idea is for women to understand their real risks better and, hopefully, to motivate them to exercise more and adopt a healthier diet. Indeed, there's probably more you can do to prevent heart disease than to prevent breast cancer anyway.

Autism Gene Is Found--Or Is It?

Headlines are often major sources of error. The Canadian Press just ran a story under the banner "Autism Gene Found." Trouble is, if you read the CP story, or the scientific study in Nature Genetics on which it was based, it's clear that no single gene--or even collection of genes--for autism has been found. Instead, researchers scanned genetic samples from 1,400 carefully selected families with autism and discovered suspicious patterns in their DNA that suggested where they might look for genes that could potentially predispose a person to autism.

In other words, if families with austistic members share similar DNA patterns, then it's possible those patterns might tell you something about a genetic predisposition for autism.

Notice all the caveats and hedges in these statements? Researchers use associations--like the ones found in this autism study--as ways of figuring out where to look for interesting results. That doesn't guarantee they will find anything.

Just as there's no guarantee that just because you found a few football players who wear red jackets that all football players wear red jackets.

Or, as the Canadian Press article by Sheryl Ubelacker (2/19/2007) puts it:

What’s important about the discovery, said [autism researcher Stephen] Scherer, is that it has given scientists in the field a new foundation for further research, which eventually could lead them to specific mutations on specific genes that cause — likely in combination — the spectrum of disorders that fall under the autism umbrella.

Welcome!

We learn a lot about our health from the media--books, magazines, television, radio and the Internet. But you can't always trust everything you read, hear or see. I should know. I've written about health and medicine for more than 20 years--mostly at TIME magazine. This blog is aimed at evaluating health stories in the media, identifying the good, the bad and the ugly and helping you to be a better consumer of health information.