Tag Archives: medical journalism

JAMA announces new editor-in-chief

The Journal of the American Medical AssociationThe American Medical Association (AMA) was founded in 1847, a time of significant change in the practice of medicine and of intense competition among practitioners. It began publishing its peer-reviewed medical journal, The Journal of the American Medical Association or JAMA in 1883. The AMA has just named a new editor-in-chief for that journal, Howard C. Bauchner, a pediatrician from Boston University School of Medicine.

The two medical journals in the US that cover general medicine — as opposed to specialties — are JAMA and The New England Journal of Medicine (NEJM, founded in 1812). Both have their strong points. JAMA preserves the humanistic tradition of medicine. Each issue includes poetry, a personal essay, book reviews, and artwork on the cover that’s thoughtfully discussed.

It’s much more stodgy than NEJM, however, at least in my opinion. During the presidential election and then during the debate over health care reform, NEJM published timely commentaries on the issues and made them available online to non-subscribers. It continues to cover topics such as the legal challenges to the health care bill. Not only does JAMA give less space to these issues. Articles in JAMA are not available online without a subscription ($165 for 48 issues).

Reaching the general public in an online world

That may change with the new editor-in-chief. Dr. Rita Redberg, editor-in-chief of the Archives of Internal Medicine (also published by the AMA) told Reuters that JAMA faces the same issues that confront newspapers and magazines these days: “how to live and flourish in this online world.” Read more

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Chocolate has antioxidants but is that a good thing?

Chocolate antioxidants Valentine's dayChocolate is a perennial favorite as a health topic. Readers are eager to learn of medical research that justifies something they want to do anyway.

WebMD recently ran an article called “Is Chocolate the Next Super Food?” The excuse for this particular article was a study that found the antioxidant activity of dark chocolate was higher than that of various “super” fruits (blueberry, acai, cranberry, pomegranate).

The article’s very last paragraph did mention — very casually — that the number of calories and fat grams in a serving of dark chocolate exceeds those of fruit juice. There was nothing but praise, however, for the ability of the antioxidants in chocolate to fight free radicals. The wisdom of the widespread consumption of antioxidants has recently been questioned. Getting the word out on that subject may prove awkward for WebMD, a site littered with ads for antioxidant supplements.

Free radicals fight toxins and cancer

Health and science journalist Sharon Begley had an excellent article on antioxidants and free radicals – “Antioxidants Fall From Grace” – in a recnt Newsweek. (emphasis added) Read more

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Andrew Wakfield: The integrity and validity of science

Andrew WakefieldAndrew Wakefield has received a great deal of negative publicity over the past few weeks, ever since journalist Brian Deer, writing in the British Medical Journal, presented evidence that Wakefield faked the data in his study linking the MMR vaccine to autism. Deer also made the case that Wakefield’s motive was financial gain: Wakefield was employed by a lawyer who planned a highly lucrative lawsuit against vaccine manufacturers and investors were promised millions.

Wakefield has publically responded to the charges. In a story from Bloomberg he asserts that his study was “not a hoax.” He also says: “I have lost my job, my career and my country.”

Given the stressful nature of Wakefield’s situation – some accuse him of a moral crime, others feel he should be prosecuted – it’s both eerie and fascinating to watch him defend himself. He appeared on “Good Morning America,” where he was interviewed by George Stephanopolous. In that interview, Wakefield claims his accuser committing a fraud by selectively omitting data.

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Should I stop taking calcium?

Calcium supplement pillsI generally resist changing my behavior in response to health news. Whatever research findings are touted this week could be contradicted by next week’s latest study. But I stopped taking calcium last week after reports of a correlation between calcium supplements and an increased risk of heart attacks.

Given the millions of women who faithfully take their daily calcium pills, this news reminded me of the 2002 announcement about hormone replacement therapy (HRT). After reassurance from physicians that HRT was the way to go, turns out HRT increased the risk of breast cancer, heart attacks, and strokes. With HRT, adverse effects began to show up after five years. With calcium, it’s 3.6 years.

Both incidents were complete reversals: Take it, it’s good for you … oh, wait a minute … don’t take it, it’s bad for you. Both affect a large number of people, especially women. Both were a bit of a shock for the public, I fear.

This isn’t news

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Health Culture Daily Dose #17

Additional stories related to health. Categories include: More articles on Health Care Reform, History of Medicine, Medical Journalism, Medical Technology, Medical News, Pharmaceuticals, Pop Culture, Social Media and the Internet, and The So-Called Obesity “Epidemic.”

HEALTH CARE REFORM

A ‘Common Sense’ American Health Reform Plan (The New York Times – Uwe Reinhardt)
After studying this nation’s perpetual “national conversation” on health reform for over three decades now, I am firmly convinced that any health reform that is the product of logical cerebral processes automatically misjudges what Americans appear to see as “simple common sense” in health care.
The Experts vs. The Public on Health Reform (Kaiser Family Foundation)
In repeated Kaiser polls, we see a divide between what experts believe and what the public believes about some of the key issues in health reform. There is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform.

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Health Culture Daily Dose #9

In today’s Dose:

Health care reform
(Robert Reich on the public option)

Health news
(Migraines, Nipple piercing and breast feeding)

Obesity politics
(TB and the thrifty gene)

Medical journalism
(Drug company ties to journalists)

Health care reform

  • As you may have noticed by now, I’m a fan of Robert Reich. He has an opinion column in the Wall Street Journal that pulls together much of what he’s been saying in his blog posts on health care, such as his insistence on the importance of a public health insurance option.

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Grapefruit and the Pill

Got Taste?

Contraceptive pillsIn my last post I described a story that appeared in The Lancet: A woman with many risk factors for a life-threatening blood clot developed a clot, a deep vein thrombosis (DVT). In addition to her many risk factors, she had been eating grapefruit for the previous three days. Here’s how the media covered the story.

The most responsible headlines

I collected the available news stories on this incident from Google News in early April. All but one featured grapefruit, which is, after all, the only thing that makes this story newsworthy. Here are the most responsible headlines:

“Grapefruit, birth control pill interaction may have caused weird blood clot case” (The Canadian Press)

“Grapefruit May Have Raised Blood Clot Risk in Unusual Case” (Medical News Today)

“Grapefruit Breakfast Shares Blame in Leg Thrombosis” (Modern Medicine)

“Hunt for DVT Cause Reveals Link to Grapefruit” (Medpage Today)

“All things in moderation” (phillyBurbs.com)

The Canadian Press, which did follow-up interviews, and Forbes.com had the best coverage. Forbes had an unfortunate headline: “Grapefruit-Heavy Diet Helped Spur Dangerous Clot.” The diet wasn’t grapefruit heavy. As I’ve mentioned before, journalists are often not allowed to write their own headlines. The subhead was much better: “The fruit, combined with contraceptive pill and a genetic mutation, almost cost woman her leg, doctors say.”
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"Killer" grapefruit?

Got Taste?

A few months ago, in a post on medical journalism, I noted: “The unstated assumption … is that ‘scaring the bejesus out of people’ is a recognized journalistic practice when it comes to health news.” This post describes a medical case in which grapefruit played a minor role. The next post illustrates how the media turned this innocent, everyday item into an object of fear.

Grapefruit

Image source: J. Tome

The British medical journal The Lancet recently published the case report of a 42-year old woman who developed pain in her low back, left buttock, and left leg after a 90-minute car trip. The next day, when her leg had turned purple, she went to an emergency room. She was light headed, short of breath, and had difficulty walking. Her medications included Levothyroxine (Synthroid) for low thyroid levels and birth control pills, the estrogen/progestin combination type.

On examination, the woman was found to have a blood clot in her leg, a deep-vein thrombosis (DVT) that extended from her hip to her calf. What makes this story of interest to physicians is not the diagnosis, which was obvious, but the etiology: What caused this woman to have a DVT?
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Gupta vs. Sicko: Are there socially acceptable mistakes?

Among those opposing Obama’s choice of Sanjay Gupta as the next Surgeon General is Adrian Campbell, a Michigan woman who appeared in Michael Moore’s film Sicko. Gupta told his television audience:

In Canada, you can be waiting for a long time. A survey of six industrialized nations found that only Canada was worse than the United States when it came to waiting for a doctor’s appointment for a medical problem.

In the film, Mrs. Campbell takes her daughter to Canada for an ear infection. She feels personally offended by Gupta’s statement. “When Dr. Gupta said that Canada has longer waiting times, I felt like I was being made fun of.”

Michael Moore & Sanjay Gupta on Larry King Live

Michael Moore got some valuable publicity out of this controversy. CNN’s Wolf Blitzer interviewed Moore shortly after Sicko was released. Since the movie was newsworthy, Moore may not have expected an attack. But preceding the interview was a prerecorded “Sicko Reality Check” by Gupta. It was overwhelmingly negative and accused Moore of “fudging the facts.” Moore responded with his characteristic forcefulness. CNN subsequently arranged a debate between Moore and Gupta on Larry King Live. (See Sources below for links to the Blitzer interview and the three segments of the debate.)

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Sanjay Gupta a victim of obesity myths?

Sanjay Gupta Fit Nation

One group that opposes the nomination of Sanjay Gupta as the next surgeon general is the Center for Consumer Freedom (CCF), an organization that promotes the interests of the restaurant and food industries. Anyone who suggests eating less can expect criticism from an industry that wants us to eat more. Gupta took on the topic of obesity in 2006 with his “Fit Nation” campaign.

In the CCF we encounter two of my favorite and related subjects. One is the difficult balance between corporate and public interests in a free-market economy. The other is how the “personal responsibility for health” mantra works against our best interests. If you are personally responsible for your own healthy lifestyle, then the food industry is totally innocent of contributing to heart disease, high blood pressure, diabetes, and obesity. The slogan of the CCF is “Promoting personal responsibility and protecting consumer choice.” They’re a wolf in sheep’s clothing.
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Sanjay Gupta, George Lundberg, and Obama’s Enneagram type

Sanjay Gupta

Back in November, following a two-hour meeting in Chicago, president-elect Obama offered Sanjay Gupta the position of Surgeon General. (This from a presumably reliable source: Gupta’s mother, Damayanti.) Gupta has been prudently tight-lipped about the appointment ever since the Washington Post broke the story in early January.

Gupta, the chief medical correspondent for CNN, discussed the situation with his employer in mid-December. He no longer covers health policy stories for CNN, but he can still be seen on “House Call,” his weekend health and wellness feature. When a plane crashed into the Hudson, CNN called on Gupta to discuss hypothermia, and when Senator Edward Kennedy collapsed at the post-inauguration luncheon, he was similarly “pressed into duty.”

The majority of press coverage has been favorable. Ezra Klein, in a “Momma said wonk you out” column, says the 1993 Clinton healthcare reform failed because it didn’t have a media strategy. The selection of Gupta signals that the Obama administration realizes it needs “a far more sophisticated media operation.”

On the other hand, Fox News refers to Gupta as “the TV doctor,” as if he were a cast member of General Hospital. Michigan Congressman John Conyers, a strong supporter of universal health care, opposes the nomination. He’s promoting Dr. Herb Smitherman, a public health advocate from Detroit.

There’s also support for Dr. George Lundberg as Surgeon General. Lundberg, a surgeon like Gupta, was the longest-running editor of JAMA, the Journal of the American Medical Association (17 years). He was abruptly fired by the AMA when he chose to publish the research article “Would you say you ‘had sex’ if…?“, a survey on the definition of “having sex” among college students. The offense was not simply the subject, but the timing. The publication date of the article was January 20, 1999. The Monica-Lewinsky-inspired impeachment trial of President Clinton had begun on January 7. Lundberg was fired on January 15. The AMA, of course, did not cite this incident as the reason for firing Lundberg. (For those curious about the results of the survey, see the footnote below.)

Lundberg, the author of Severed Trust: Why American Medicine Hasn’t Been Fixed, has a lot to recommend him. See the extensive commentary on the post “Dr. George Lundberg for Surgeon General” on The Health Care Blog (THCB). One thing I don’t see mentioned at THCB is that Lundberg’s appointment would be a slap in the face to the AMA, assuming 10 years isn’t long enough to let bygones be bygones. Such lack of diplomacy would be highly uncharacteristic of Obama, who strikes me as a Nine on the Enneagram.

The Enneagram is a spiritually based personality typing system, associated with Gurdjieff, Oscar Ichazo, and Claudio Naranjo. Type Nine on the Enneagram is called the Peacemaker. Since I’m a Nine myself, my opinion on this is highly subjective.

Here’s a cartoon about the nine Enneagram types that I think illustrates how we tend to see in Obama what we value in ourselves. That’s a good quality in a leader. If Obama thinks Sanjay Gupta is the right choice for Surgeon General, I’m inclined to agree.

Barack Obama Supporters Come In All Types
Obama Supporter Enneagram Types Cartoons

Cartoons by Elizabeth Wagele

Footnote: Would you say you “had sex” if…?

The JAMA article doesn’t say this, but one conclusion you could draw from the survey of college students is that they make a distinction between sexual activity that can lead to pregnancy and behavior that leaves one technically a virgin. The research survey was done in 1991 at a midwestern college and included students from 29 states. Close to 80% considered themselves moderate to conservative politically. Sixty percent reported that what happened between President Clinton and Ms. Lewinsky does not qualify as having “had sex.”

The medical purpose of the survey was to ensure that public health officials are gathering accurate information relevant to disease transmission. The sexual activity with the greatest risk of transmitting an HIV infection did not qualify as having “had sex” for 20 percent of those surveyed. In a situation comparable to that alleged between Clinton and Lewinsky, 75 percent of students would not list the other party as a sexual partner. (This latter statistic is from a later (1996) survey.)

Sources and additional links:

(Hover over book titles for more info.)

Editor, Gupta’s Surgeon General Appointment Runs Into Opposition, The Link, January 26, 2009

Reuters, Obama offers CNN’s Gupta US surgeon general post, January 6, 2008

Brian Stelter, Still Calling Dr. Gupta, The New York Times, January 20, 2009

Ezra Klein, The Three Constituencies for Health Reform. The American Prospect, January 8, 2009

FOX News Watch, January 10, 2009

Kenneth P. Vogel, Conyers: Gupta not up to S.G. post, Yahoo! News, January 8, 2009

Stephanie A. Sanders and June Machover Reinisch, Would you say you “had sex” if…?,
JAMA 281 (3), January 20, 1999, 275-7.

George Lundberg, Severed Trust: Why American Medicine Hasn’t Been Fixed

Brian Klepper, Dr. George Lundberg for Surgeon General, The Health Care Blog, January 25, 2009.

Here’s an article that argues Obama is an Enneagram Nine with a One wing (the same as Abe Lincoln).
Barack Obama’s Enneagram Type: The Peacemaker (9w1)

Here’s a blog post that labels Obama an Enneagram Six, based on his community leadership experience, and types Michelle a One.

Here’s a site where you can peruse or join the discussion of Obama’s Enneagram type.

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How to read health news

Here’s a good companion thought to HRT and the incredible shrinking brain. It’s from Dr. Alicia White, an employee of Bazian, the evidence-based medicine firm in Great Britain. Bazian does research for the health news on Behind the headlines, the National Health Service site I recommend as a source of health news.

If you’ve just read a health-related headline that has caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick), it’s always best to follow the Blitz slogan: “Keep Calm and Carry On”. On reading further, you’ll often find the headline has left out something important, such as, “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumours eventually. (Study funded by The Association of Tea Marketing)”.
The most important rule to remember is: don’t automatically believe the headline. It is there to draw you into buying the paper and reading the story. Would you read an article called, “Coffee pretty unlikely to cause cancer, but you never know”? Probably not.

Sources:

Dr. Alicia White, How to read health news, Behind the headlines, January 6, 2009

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HRT shrinks women's brains? What's wrong with this picture?

There was a widely reported story today about hormone replacement therapy (HRT) and a decrease in the size of women’s brains. The headlines were predictably but needlessly sensational. In fact, the study did not measure a decrease in the brain size of any individual woman.

Amsel Incredible shrinking woman

Source: Richard Amsel, The Movie Posters

First, the headlines. There were 27 stories listed when I checked Google news this afternoon. 19 of these (70 percent) used the word “shrink,” definitely a frightening choice of words when talking about one’s brain. Five stories (18.5 percent) used a less provocative descriptor: brain-tissue loss… reduced brain size… reduction in brain volume… affects brain mass… loss of brain tissue… You get the idea. Three stories (11 percent) elected not to refer to brain size in the headline. But two of those talked about brain “shrinkage” in the first paragraph, another waited until the third. So all of these stories led you to believe that the brains of women on HRT got smaller.
The rush of stories was based on two papers published in the January 13 issue of Neurology. The primary paper analyzed brain scans for abnormal tissue (lesions) in blood vessels. The second paper analyzed MRIs of the brain and reported:

Much to our surprise, we found a small but significant decrease in the hippocampal and frontal volumes, and a nonsignificant trend towards reduced total brain volume in women who had been randomized to hormone therapy.

I haven’t had an opportunity to see the original study, but none of the quotations I have seen use the word “shrink.”

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Does chocolate prevent heart disease?

chocolateThe Journal of Nutrition published a study on chocolate this month that was immediately picked up by the press. The headline of choice was “Dark Chocolate Prevents Heart Disease.” Slightly more discriminating publications were willing to say “Dark Chocolate May Prevent Heart Disease.” A marginally more accurate but still flawed headline: “Dark chocolate linked to lower risk of heart disease.”

The title of the original journal article is “Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population.” OK. Medical journalists need to translate dense, academic prose into everyday language. But there really is a big difference between saying you can prevent heart disease by eating chocolate and saying there’s a correlation between chocolate consumption and a medical marker associated with the risk of heart disease.

The first implies a cause and effect relationship. With the second, you have no way of knowing if the correlation is a coincidence and some other factor actually explains what you’re observing. You need to look at more than one study and the right type of study. Jumping to the headline “Chocolate prevents heart disease” is simply a quick way to get attention. That’s why you need to beware of health news. Read more

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Health news and competitive journalism

Do you eat trans fats and high-fructose corn syrup? If you know the ingredients of what you’re eating, you can choose to avoid certain foods. But what about the consumption of health news? There is an enormous appetite for the latest medical findings, but no labels to tell us the ingredients: how are the stories selected, what are the sources of information, how accurate is the reporting. If we knew the ingredients, would we choose to avoid the majority of stories on medical research and health? In this post, I’ll discuss the ingredients of health news and, in the next post, I’ll suggest a reliable source.

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