Tag Archives: risk

Context, context, context: How journalists can avoid confusing readers with the latest research findings

Tara Haelle

About Tara Haelle

Tara Haelle (@TaraHaelle) is AHCJ's medical studies core topic leader, guiding journalists through the jargon-filled shorthand of science and research and enabling them to translate the evidence into accurate information.

Whatiguana via Wikimedia Commons

Whatiguana via Wikimedia Commons

A recent editorial in the Journal of the American Medical Association explored the responsibility that journals have to public health in reporting on the association – or lack thereof – between adverse events and different drugs, devices or vaccines.

Reporting on these kinds of studies is a mainstay for most regular health beat reporters: Every week a new study says that this drug may increase the risk of that condition, or that this device is no longer thought to increase the risk of some other condition.

While the editorial points out the journal’s responsibility in publishing these studies, so that doctors can discuss risks of treatment possibilities with their patients, what is a journalist’s responsibility on reporting these findings? And how do journalists avoid fatigue – and help their readers avoid fatigue – with findings that regularly contradict each other (eggs and heart disease, anyone?) or that have been reported dozens of times already but never go away (e.g., vaccines not causing autism)? Continue reading

Return to McAllen illustrates changes ACA has brought to health care system

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Peter Dutton via Flickr

Photo: Peter Dutton via Flickr

In June 2009, Atul Gawande wrote an influential New Yorker article, about the community of McAllen, Texas, which has some of the highest per-capita Medicare costs in the nation. At the time, “The Cost Conundrum” had a significant impact on the national debate over the legislation that would become the Affordable Care Act – not so much on the health insurance coverage aspects but about wasteful spending and flawed incentives built into our payment system.

McAllen was awash in waste, fraud and abuse, with millions spent on care of little to no value to the patient. The spending could not be blamed on socio-economic factors because nearby El Paso was a very similar community, but with half the per capita Medicare costs, and same or better outcomes. Gawande wrote this about McAllen: Continue reading

Frailty affects quality of life, makes seniors more vulnerable

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 and other outlets. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Image by Alex E. Proimos via flickr.

The term “frailty” seems to be practically synonymous with aging. And while it’s true that adults naturally have a gradual physical decline as they age, not every older adult is frail and not every frail person is old.

Aging, also called senescence, refers to the biological process of growing older. As people age, it becomes more difficult for the body to repair itself and maintain optimal health, according to Neal S. Fedarko, Ph.D., professor of medicine, division of geriatric medicine and gerontology, Johns Hopkins University. People age differently based on both genetics and lifestyle factors.

Frailty is considered a chronic and progressive condition, categorized by at least three of five criteria: muscle weakness, unintentional weight loss, low physical activity levels, fatigue and slow walking speed. The body loses its ability to cope with everyday or acute stress, becoming more vulnerable to disease and death, as Samuel Durso, M.D., director of geriatric medicine and gerontology at Johns Hopkins School of Medicine explained in a recent AHCJ webcast.

Learn more about frailty, and how it affects people’s quality of life as they age, in this new tip sheet.

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.

NEJM article: Media partially to blame for slow adoption of cost-effective health care

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.

In a new “Perspectives” piece in the New England Journal of Medicine, Victor R. Fuchs, Ph.D., and Arnold Milstein, M.D., M.P.H., examine why cost-effective health care has been slow to catch on in the United States.

They point to a number of factors, including insurance companies’ desire to protect profits, large employers that don’t want to alienate employees, legislators who collect campaign contributions from the health industry, hospital administrators protecting their revenue, doctors who are generally resistant to change, manufacturers that fear losing market share and more.

The authors also point blame at the media, saying it doesn’t adequately explain who really pays for health care:

Great harm is done when employment-based insurance is discussed as if it were a gift from “generous” employers rather than an alternative to wage increases.

They also mention a topic that is surely familiar to Covering Health readers: relative risk vs. absolute benefit.

The media also mislead the public by emphasizing the relative benefit of clinical interventions (“reducing risk of death by one third”) when the absolute benefit (“reducing risk from 0.03 to 0.02”) is usually more relevant.

“Misleading headlines, designed to attract larger audiences,” also get a share of the blame.

What do you think? Does media coverage have an effect on how cost-effective care is accepted? If so, do you have suggestions on what reporters could do differently?