Laura Pemberton was in labor and ready to give birth at her home in Florida when a sheriff arrived at her door, took her into custody, strapped her legs together, and forced her to go to Tallahassee Memorial Regional Medical Center, where doctors had instigated urgent court proceedings.
They claimed that Pemberton was risking the life of her unborn child by attempting to have a vaginal birth after having had a previous cesarean surgery. The judge ordered the woman to undergo the operation, which she did against her will later that day in 1996.
Regina McKnight, 21 years old and pregnant, suffered a stillbirth that led to her arrest and conviction on homicide charges in South Carolina in 2001. Although the stillbirth later proved to be the result of an infection, prosecutors argued that McKnight caused the stillbirth because she used cocaine. A jury found her guilty after 15 minutes of deliberation and she was sentenced to 12 years in prison.
Pregnant with her second child in 2005, 20-year-old Rachael Lowe went with her husband to a hospital to get help for her addiction to Oxycontin. An emergency room doctor reported her to Wisconsin state officials and Lowe wound up confined against her will in a psychiatric ward, where she received no prenatal care. She remained incarcerated for more than 25 days before a doctor testified that Lowe’s addiction posed no significant risk to the health of the fetus and a judge ordered her release.
Last week, I encountered yet another example of why it’s so important to always read the whole study — not just the press release. In this case, it was actually a report, not a study. A press release from Alzheimer’s International with the somewhat misleading headline, “Smoking Increases Risk Of Dementia” arrived in my inbox, citing a new World Health Organization report that put smokers at a 45% higher risk for developing the disease than non-smokers.
When I opened the report, I learned that the “news” touted in the press release was actually just a summary of old research. There was nothing new here. Nor was there proof of causation – the cited evidence showed associations.
As I looked more closely at the report, I found an error that appeared to undermine its conclusions and suggest a sloppiness and lack of rigor.
While beauticians and tattoo artists are regulated in the state of Oregon, midwife certification is voluntary and, even then, the hurdles for certification are rather minimal.
But with midwives largely operating outside of the established health care system, there was little more than anecdotal evidence about the safety of home births to go on. That changed last year.
Markian Hawryluk, a health reporter with The Bend (Ore.) Bulletin and an AHCJ Regional Health Journalism Fellow, describes how he took advantage of new data collected by the state of Oregon to shape an article that revealed high mortality rates for home births in his state.
“If home birth were a drug,” he wrote, “it would be taken off the market.”
Read more about how he reported the story and get links to resources he used.
Recently, Dr. Ben Goldacre (@bengoldacre), a prominent critic of drug studies, wanted to find out how often side effects reported by users of cholesterol-lowering drugs called statins were genuinely caused by the medications.
The study he co-authored concluded that most reported side effects of statins aren’t often due to the drugs themselves, but to other causes. The study generated front-page headlines in the U.K., with an article in The Telegraph declaring, “Statins have virtually no side effects, study finds.”
Outcry ensued. Patients who experienced side effects on statins begged to differ, and Goldacre’s fans wondered if he had suddenly gone soft on pharmaceutical companies.
In response, Goldacre penned a nuanced explanation of the study findings, explaining* that its conclusions were flawed because it was based on incomplete data.
The statin study controversy aside, his blog post makes some key points about how side effects are reported in medical journals that are helpful for health reporters to keep in mind when covering the downsides of new drugs. I’ve boiled some important points down and included them in this tip sheet for AHCJ members.
*Editor’s note: An earlier version of this post used the word “admitting.”
What if experts wanted to figure out the rate of tonsil cancer, but forgot to exclude all the people who’d had their tonsils removed?
Those people are no longer at risk for tonsil cancer, and since there are more than half a million tonsillectomies performed each year in the U.S., counting them in the risk pool would dramatically dilute the true rate of the disease.
That’s what seems to have happened with cervical cancer, according to a thought-provoking new study published in the journal Cancer.
Image by Mark Robinson via flickr.
The military uses the phrase “the fog of war” to describe the miscalculations and botched decisions that get made in the heat of combat.
But you need not sign up for active duty to run into foggy thinking. Just call a scientist and interview them about their own research.
One of my favorite examples of this is when researchers conduct observational studies that can’t show cause and effect, yet interpret their findings to reporters as if they do. Continue reading
Photo: BlatantNews.com via Flickr
Recently, an editor sent me a study to cover on concussions in teenagers. At least, that’s what we thought the research was about, based on the title of its press release: “Teenagers who have had a concussion also have higher rates of suicide attempts.”
And I was excited to cover the study. Like gut bacteria and anything to do with chocolate or coffee or stem cells, concussion is a hot topic right now. That’s partly because brain scientists are just beginning to understand the lasting impacts of these sometimes subtle but probably cumulative injuries.
And they affect everybody from pro athletes to pee wee football players. So when parents and coaches see the word “concussion,” their thoughts rightfully turn to young athletes. About half of concussions in kids ages 8 to 19 are sports-related, according to a nationwide study of concussions published in 2010 in the journal Pediatrics.
The press release said the study found that kids who have had concussions were not only more likely to try to commit suicide, but to engage in other sorts of high-risk behaviors like taking drugs, stealing cars, setting fires and bullying.
The message here is that a kid who gets hit in the head too many times – presumably playing sports – might turn to drug abuse, self-injury and other sorts of criminal behaviors. And that’s the way it was covered in the press. Continue reading
Image by Jay Reimer via flickr.
Medical study authors routinely claim to have “controlled” for socioeconomic status.
That kind of sweeping assertion should set off alarm bells. The authors probably haven’t come close to fully accounting for something as difficult to measure as a person’s place in the hierarchy of self-determination and power, neighborhood quality, working conditions, job security, income and wealth.
To assume otherwise is a mistake that can lead to misleading conclusions.
Consider, for example, a recent study in the journal Nature Medicine describing a genetic variation that might account for lower heart disease survival among African Americans. News coverage of the study caught my attention because whatever role genetics plays in the black/white disparity in heart disease, it’s probably small.
Some researchers have concluded that socioeconomic disadvantage is the most significant root of the problem, not genetic differences. And there is pretty good evidence that the traditional risk factors (diabetes, high blood pressure, lack of physical activity, obesity, smoking) account for all of the difference in heart disease mortality between black and white men in the United States, and most of the difference between black and white women. Continue reading
When writing about medical studies, reporters should always ask researchers about any financial relationships with drug companies or device manufacturers. That was one of the main lessons from a panel on conflicts of interest on Saturday at Health Journalism 2014.
Starting in September, sunshine provisions in the Affordable Care Act will require drug companies to disclose most payments to doctors. Some companies have already started to publicize their financial relationships with doctors. But most medical journal articles do not give accurate information on researchers’ potential conflicts of interest, said panelist Susan Chimonas of the Institute of Medicine as a Profession at Columbia University.
“You shouldn’t be uncomfortable asking these questions,” Chimonas said. “They owe you this information. They owe everyone this information.” Continue reading
The U.S. Preventive Services Task Force issued recommendations on Tuesday on the value of routine cognitive screening for older adults, concluding “the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment.”
The task force said there was inadequate direct evidence on the benefits, and that several drug therapies and non-pharmacologic interventions have a “small effect” on the short term cognitive function measures in patients with mild to moderate dementia. They said the extent of clinically relevant benefit is uncertain. This is the same conclusion reached in previous assessments of the clinical benefit of cognitive screening.
They did find evidence that interventions targeted to caregivers have a small effect on caregiver burden and depression, but the scope of clinical relevance is still uncertain. This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 and have no signs or symptoms of cognitive impairment. Early detection and diagnosis of dementia through the assessment of patient-, family-, or physician-recognized signs and symptoms, some of which may be subtle, are not considered screening and are not the focus of this recommendation. Continue reading