Category Archives: Studies

Clearing the air on a WHO study

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

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.

Continue reading

More evidence links speaking multiple languages to better cognitive function in older adults

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Image by Tobias Mikkelsen via flickr.

Image by Tobias Mikkelsen via flickr.

A study published in the Annals of Neurology indicates that cognitive decline may slow down when people speak two or more languages — even if they learned their second language in adulthood.

While it’s been known for some time that speaking more than one language benefits cognitive function, across the lifespan, scientists could not conclusively determine whether people improve their cognitive functions through learning new languages or whether those with better baseline cognitive functions are more likely to become bilingual.

“Our study is the first to examine whether learning a second language impacts cognitive performance later in life while controlling for childhood intelligence,” said lead author Dr. Thomas Bak, of the Centre for Cognitive Aging and Cognitive Epidemiology at the University of Edinburgh, in a statement. Continue reading

Breast cancer screening recommendations up for review

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

With mammograms in the news lately, it’s worth noting that the U.S. Preventive Services Task Force has posted its plan for reviewing and updating its recommendations for screening for breast cancer. The draft research plan lays out the “strategy the Task Force will use to collect and examine research and is the first step in updating the 2009 recommendation,” according to Ana Fullmer at USPTF. Recommendations are updated every five to seven years, so she says a new recommendation probably won’t be finished for a few years.

The panel is seeking answers about the specific benefits and harms of screening mammography for women over 40, they’re asking if benefits and risks vary by imaging technique – digital mammograms, ultrasound or MRIs; and importantly, they’re trying to find out how common ductal carcinoma in situ (DCIS) is in the U.S. and what benefits and harms are involved in treating it.

Experts recently recommended renaming DCIS to exclude the word “carcinoma” so the finding wouldn’t be so frightening to patients. DCIS is an abnormal pattern of cell growth in the milk ducts of the breast. In many cases, it doesn’t progress to cancer. Yet a growing number of women have decided to remove both breasts rather than take their chances that it isn’t dangerous.

Interested parties who want to weigh in on the draft plan are encouraged to submit comments and questions to the Task Force by Dec. 11.

Project focuses on cognitive health as a public health priority

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

The Alzheimer’s Association and Centers for Disease Control and Prevention kicked off “The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018″ today at the 2013 Alzheimer’s Association International Conference in Boston.

This program is a follow up to their 2007 “Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health.” According to a press release from the association, the goal is to “create a tool for public health officials to improve the quality of life for those families and advance cognitive health as a integral component of public health.”

A morning workshop about the program included panelists from Johns Hopkins School of Medicine, Emory University, The Alzheimer’s Association, New York Department of Health and the Association of State and Territorial Health Officials. Participants focused on action steps the public health community can take at all levels, across disciplines, to address cognitive health and impairment, including implementing the Road Map and making cognitive health a priority.

News from the conference this past weekend included results of a Georgetown University study on possible associations between pre-diabetes and Alzheimer’s, an inverse relationship between Alzheimer’s onset and cancer, new therapies that target physical changes in the brain and possible association between the diabetes drug metformin and decreased risk of dementia.

Note: Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Some resources:

Catching more cancer with vinegar than with money

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

Sterile vinegar bleaches suspect cells white when it's swabbed on the cervix.

Image by Sweet One via flickr.

It can be tough to find a medical study that is both important and compelling. But that was the opportunity presented to health reporters this week in the shape of a big study on a humble condiment, vinegar.

What makes this study even more wonderful, in a way, is that it was presented at the American Society of Clinical Oncology, a medical meeting that’s awash in high-stakes, big money, endlessly pitched and spun drug research.

In the midst of that madding crowd was Dr. Surendra Shastri, a preventive oncologist at Tata Memorial Hospital in Mumbai who needed an inexpensive, low-tech way to screen for cervical cancer – the leading cancer killer of women in India.

He found it in the form of sterile vinegar which bleaches suspect cells white when it’s swabbed on the cervix. Continue reading

Drugs remain on market despite fraudulent research; FDA withholds information

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Despite concluding that a drug research lab’s violations “were so ‘egregious,’ and pervasive that studies conducted there between April 2005 and August 2009 might be worthless,” the FDA didn’t pull the drugs tested there from the market, according to a ProPublica piece by Rob Garver and Charles Seife.

pills

Photo by Grumpy-Puddin via Flickr

The FDA is refusing to release information about those drugs, saying that “We believe that this did not rise to the level where the public should be notified.”

A statement from the agency said, “The issue is not a lack of transparency but rather the difficulty of explaining why the problems we identified at Cetero, which on their face would appear to be highly significant in terms of patient risk, fortunately were not.” Continue reading

Was a study of chelation fatally flawed or just countercultural?

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

This is the second of two posts about a study of whether chelation therapy might benefit some patients who have suffered a heart attack. In the first post, I gave health reporters high marks for their coverage.

Early in my career, I covered a story on chelation therapy. It was the first time I’d ever heard of the alternative treatment. I was a broadcast producer, and we needed video, so we visited a chelation clinic. Looking back, I can’t recall what our story was about, but I do remember what it was like to talk to the patients as they sat in recliners that lined the walls of the narrow storefront.

They were all hooked up to IV bags filled with a vivid yellow liquid that was a mixture of B-vitamins and the chemical EDTA that they believed was flushing heavy metals, minerals, and toxins from their bodies.

Many spoke of chelation with fervor. One man, a diabetic, credited the regular three-hour infusions with saving his legs, which were riddled with sores.

Chelation has been around for decades. It is accepted treatment for lead poisoning and other kinds of heavy metal toxicity. But alternative practitioners have greatly expanded its use, with claims that it can treat myriad ills, everything from autism to Alzheimer’s to problems caused by metal hip implants.  There’s almost no scientific evidence to back up these claims.

It was against this backdrop – lots of claims, enthusiastic patients, evangelistic providers – that the NIH set out to test the practice.

The Trial to Assess Chelation Therapy, or TACT, has again ignited a heated debate among doctors.

Here’s another voice to add to the discussion. He is lead study author Gervasio A. Lamas, M.D., chairman of medicine at Mount Sinai Medical Center in Miami Beach, Fla., and professor of clinical medicine at Columbia University Division of Cardiology. I asked him to talk about the process of publishing TACT and asked him to respond to a few of the main criticisms of the trial. These are lightly edited questions and answers from our interview: Continue reading

Researchers share work on regeneration, reconstruction #ahcj13

Alma Martinez

About Alma Martinez

Alma Martinez is a associate producer at Radio Bilingue in Fresno, Calif. She is attending Health Journalism 2013 on an AHCJ-Ethnic Media Health Journalism Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust.

In a Health Journalism 2013 panel focused on research taking place in regenerative medicine, Dany Adams, Ph.D., an associate research fellow at Tufts University, described her research with African frogs.

Through her research with bioelectricity, or electrical signals, she has proven that African clawed frogs can regenerate tails. She added that this particular species of frogs was a good candidate for the research, as the regeneration happens with a minimum risk of infection. What was most surprising when it came to the tail regeneration in the African clawed frogs is that the muscle, skeleton and spinal cord regenerated on their own, without the need of any additional therapies. She also shared that children can re-grow finger tips before the age of 10.

Adams said the possible implications for human benefits are great and implored journalists to cover such research so the public and legislators, who decide on funding for the continuation of such research, know about it. Continue reading

Stem cells: Hope or hype? #ahcj13

Lisa Krieger

About Lisa Krieger

Lisa Krieger is a science and medicine writer at the San Jose Mercury News. She is attending Health Journalism 2014 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

The public’s hope for stem cell cures remain high, but scientists warn that many basic problems with this approach remain to be solved – and that investors demand profits far faster than research can be finished.

“We’ve created a system that is unrealistic and short sighted,” said Dr. Darrell Kotton, director of Center for Regenerative Medicine at Boston University’s Boston Medical Center.

Few of the 38 publicly traded stem cell companies will survive, said Philip Reilly, a physician, attorney and venture partner with Third Rock Ventures.

It is very difficult to produce returns in “venture time,” defined as less than five years, said Reilly. “There is tremendous disconnect,” between investors and biologists’ timelines, he said.

The best strategy, he believes, is for a small company to show data with enough promise – what he called “an inflection point” – that it wins the interest of a larger company, with the resources to carry the research across the finish line.

“Few will make it,” he said, of existing companies. At almost all, the cost per share has fallen below the opening price. “They were launched too soon.” Continue reading

Don’t fudge the facts on chocolate studies

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

Studies that support a link between chocolate and good health are popular with readers. But the reality is that most chocolate studies are observational in nature and are therefore limited in what they can tell us about its supposed benefits.

Photo by “Nikita!” at Flickr.com.

Skilled health reporters use these kinds of studies as opportunities to gently educate readers about the limits of observational research, such as confounders. Read on for tips on recognizing confounding, factors that confuse or obscure the association between a primary exposure of interest and an outcome, and explaining it to your readers, viewers and listeners.
Here’s a recent case in point—a study published in Neurology called “Chocolate Consumption and Risk of Stroke.”

The study followed 37,000 men in Sweden for 10 years. That’s a plus. Bigger numbers and longer follow-up usually mean more reliable results.

At the start of the study, researchers asked the men to recall how much chocolate they’d eaten in the previous year. That’s the first problem with the study. People are bad at remembering what they eat. It’s called self-report bias. There’s a concise and well-sourced discussion of this major flaw in nutrition studies at the website Unite for Sight.

Based on that one measure, the men were divided into four groups that ranged from those who reported eating no chocolate to those who ate the most, about 63 grams a week. That’s about the size of one-and-a-half regular Hershey bars. They used hospital discharge records to confirm stokes. That was also a strength of the study. Because the Swedish health system keeps extensive medical records on its citizens, it’s unlikely that many strokes went uncounted.

Brenda GoodmanBrenda Goodman, AHCJ’s topic leader on medical studies, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover medical research.

If you have questions or suggestions for future resources on the topic, please send them to brenda@healthjournalism.org.

Over the next 10 years, 1,995 men – about 5 percent of the study population – had a first stroke. The men who ate the most chocolate had a slightly lower risk of stroke compared to men who said they didn’t eat chocolate. That would all be pretty suggestive, except that a penchant for indulging a chocolate craving wasn’t the only way the men differed. The biggest chocolate consumers were also younger, more educated, less likely to smoke or have high blood pressure. They also reported eating more red meat, drinking more wine, and eating more fruits and vegetables. With the exception of eating a lot of red meat, those other things also reduce stroke risk. Those are called confounders because they confuse the effect of the exposure (chocolate) on the outcome (stroke).

Researchers adjusted their data to try to remove the influence of those factors. Adjustment is an important step, but it’s not perfect, as Gary Taubes explains in a post for Discover magazine’s Crux blog.

Here’s the table where researchers reported the adjustment (click to view full size):

Here’s a tip about confounding. Look at relative risks (RR) before (green arrow) and after (red arrow) adjustment for confounders for the total stroke numbers. If there’s little confounding in a study, those numbers should be very nearly the same. If they are different, that’s a good indication that confounding is a problem and that there are other factors influencing risk that weren’t measured. For an effect size that’s already small to begin with — just a 23 percent reduced relative risk – these relative risks shrink even more, to 17 percent for the men who ate the most chocolate. Keep in mind, that’s just the difference in relative risk. If 5 percent of the men had a stroke over the course of the study, a 17 percent reduction in that risk would reduce the absolute risk for having a stroke by about .8 percent.

Perhaps recognizing the limits of their own study, researchers took the work a step further and conducted a meta-analysis, a study of studies.  Meta-analyses are powerful tools for establishing the weight of evidence. But as Gary Schwitzer points out in AHCJ’s slim guide, “Covering Medical Research,” the quality of a meta-analysis depends on the quality of studies it includes. Two of the five studies included in the meta-analysis found associations between chocolate and stroke risk that were non-significant. All measured chocolate consumption by asking study participants to remember how much chocolate they ate and how often they ate it. There’s that self-report bias again.

When all the results were pooled, chocolate appeared to reduce the relative risk of stroke by 19 percent.  Reductions in absolute risk were not reported, but they probably look a lot less dramatic.

That’s a lot to try to explain to readers who are short on time and attention.  Here’s how Amy Norton handled it in her story for Reuters Health:

It starts with a deft lede:

Men who regularly indulge their taste for chocolate may have a somewhat decreased risk of suffering a stroke, according to a study out Wednesday.

That’s very different from saying that chocolate may reduce or could lower a man’s risk of having a stroke. The vast majority of stories used that approach, and while it’s not technically inaccurate, words like reduce and lower imply that chocolate is causing the stroke reduction, which is something the study simply doesn’t have the power to prove.

Norton goes on to give the study some context but also to explain why readers shouldn’t go on an immediate chocolate binge (at least not to prevent a stroke):

The study, published in the journal Neurology, is hardly the first to link chocolate to cardiovascular benefits. Several have suggested that chocolate fans have lower rates of certain risks for heart disease and stroke, like high blood pressure.

But those studies do not prove that chocolate is the reason. And the new one, funded by the Swedish Council for working Life and Social Research and the Swedish Research Council, doesn’t either, according to a neurologist not involved in the study.

Other things to like about this story include the use of independent researchers for comment, a discussion about flavonoids in chocolate and why scientists think they may benefit health, and numbers that reflect absolute as well as relative risks.