Tag Archives: jama

Was a study of chelation fatally flawed or just countercultural?

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

Four AHCJ members power JAMA’s new blog

We’re proud to note that AHCJ members Bridget M. Kuehn, Mike Mitka, Joan Stephenson and Rebecca Voelker are writing for JAMA‘s new health news blog.

In the first month, the bloggers have used their relationship with the Journal of the American Medical Association as a tool, taking advantage of access to JAMA sources while still covering a wide range of news found in other journals and sources.

To keep up with the new blog, just point your favorite RSS reader to http://newsatjama.jama.com/feed/.

How HHS can improve data infrastructure

Better data means better public health. That’s the message put forth in a new commentary piece in the Journal of the American Medical Association, and one which we can all get behind. The authors praise HHS for the progress it has made toward data access thus far, and then push it to make its data even more useful and available. They’re writing from the perspective of researchers who use the data in their work but much of what they say is applicable to journalists as well.

For the record, HHS’ 63-page open government plan can be found here. The authors argue that the Federal Coordinating Council for Comparative Effectiveness Research has mentioned that a better data infrastructure will be crucial to the success of its mission, and that the best way to achieve that infrastructure will be to follow their three-part strategy:

  • Expansion of Data AccessThe Research Data Assistance Center is in the midst of a 5-year exclusive contract to provide CMS claims data to researchers. Ending that exclusivity, the authors write, would simultaneously drive down prices and improve access to data.
  • Leverage Nongovernmental Partners and ApplicationsIf data is made more accessible, the authors argue, then the private sector will add all sorts of value with innovative data and geospatial applications. Journalism would seem to be a big component of this added value.
  • Improve Data Iteratively and Create Awareness“The DHHS must view its data as a strategic asset and expand data quality, completeness, and access iteratively over time, influenced by data users. The data should be released in standardized formats without intellectual property constraints. Also, the DHHS and the private sector need to communicate and create awareness of data availability to ensure use.”

Access to the Journal of the American Medical Association is, of course, one of the many benefits of being an AHCJ member.

Cancer society’s messages on screening conflict

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.

Journals pay for cracking down on industry funding

Paul Basken reports in the Chronicle of Higher Education that major medical journals, whose financial viability often depends heavily upon industry support, are faced with an “inherent conflict of interest” when it comes to filtering possible industry bias from their articles.

Basken’s report relies on an analysis of industry-funded studies presented at the International Congress on Peer Review and Biomedical Publication in Vancouver. Once the Journal of the American Medical Association introduced an independent verification requirement for industry-funded studies in 2005, Basken reported, it “saw the percentage of industry-supported studies in its pages drop 21 percent, from more than 60 percent of its published trials to 47 percent. Lancet, however, saw a growth of 17 percent, and The New England Journal of Medicine had an increase of 11 percent, the group reported.”