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The fallacy of “balance” and “fairness” about unscientific health claims in the media: A case study

For those of us who have dedicated ourselves to promoting science-based medicine, one of the most frustrating impediments to our message is the media. Time and time again, I’ve complained about how the media takes unscientific health claims, particularly when it comes to vaccines, and gives a credulous hearing to them. Sometimes, it’s a filmmaker with a distinct ideological axe to grind who is not making even the pretense of trying to be objective. Sometimes it’s a reporter with a clear bias favoring the antivaccine movement parroting the most idiotic of unscientific lies. Other times, it’s celebrities who think their “education” from Google University trumps science, clinical trials, and epidemiology, often given aid and comfort by sympathetic physicians. Add to that others inclined to support pseudoscience against science-based medicine, such as Don Imus, Larry King, and others, and is it any wonder that the media seems like one huge cesspit of woo?

However, more often, it’s none of these things. As much as they infuriate me, I believe that most reporters in the media do really want to get it right. However, they are hobbled by three things. First, many, if not most, of them have little training in science or the scientific method and are not particularly valued by their employers. For example, witness how CNN shut down their science division. Second, the only medical or science stories that seem to be valued are one of three types. The first type is the new breakthrough, the cool new discovery that might result in a new treatment or cure. Of course, this type doesn’t distinguish between science-based and non-science-based “breakthroughs.” They are both treated equally, which is why “alternative medicine” stories are so popular. The second type is the human interest story, which is inherently interesting to readers, listeners, or viewers because, well, it’s full of human interest. This sort of story involves the child fighting against long odds to get a needed transplant, for example, especially if the insurance company is refusing to pay for it. The third type, unfortunately, often coopts the second type and, to a lesser extent, the first type. I’m referring to the “medical controversy” story. Unfortunately, the “controversy” is usually more of a manufactroversy. In other words, it’s a fake controversy. No scientific controversy exists, but ideologues desperately try to make it appear as though a real scientific controversy exists. Non-medical examples include creationism versus evolution and the “9/11 Truth” movement versus history. Medical examples include the so-called “complementary and alternative medicine” movement versus science-based medicine and, of course, the anti-vaccine movement.

But the thing that most prevents the scientifically accurate evaluation by the media of unscientific health claims has to be the “tell both sides” culture of “balance” demanded by journalists. Telling both sides is, of course, very important when one side is not obviously correct compared to the other. Examples of such a situation include virtually any political controversy, where there almost always are two (and usually more) sides to an issue. In contrast, in science and medicine, there are not always two sides to an issue. (Again, think of creationism versus evolution.) In science and medicine, there is often a side supported so overwhelmingly by evidence, experimentation, and observation that the “other side” does not warrant being told, as it has already been considered and rejected by science. An excellent example of this is homeopathy. Another excellent example of this is the antivaccine movement, and, unfortunately, a prime example of “telling both sides” of the “vaccine debate” reared its ugly head a couple of weeks ago. Worse, it reared its ugly head on a show that ostensibly claims to be medically accurate, so much so that it features four doctors as its hosts.

I’m referring to a TV show called The Doctors. If the episode segment I’m about to discuss, which aired on December 11, is any indication, these are Doctors that anyone seeking scientifically sound information about medicine should run, not walk, away from.
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Posted in: Health Fraud, Medical Academia, Science and the Media

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Battlefield acupuncture revisited: That’s it? That‘s all Col. Niemtzow’s got?

It’s like the zombie that wouldn’t die, isn’t it?

I’m referring to so-called “battlefield acupuncture,” a topic that I wrote about last week for this very blog. With a week separating my usual posts, I normally don’t write about the same topic two times right in a row, but I’m making an exception for this topic. There are three reasons. First, I remain appalled at how one ideologue, Col. (Dr.) Richard Niemtzow, a radiation oncologist and Air Force physician turned number one advocate of acupuncture use in the military, has succeeded in introducing acupuncture into not only military hospitals like Walter Reed Army Medical Center and Landstuhl Regional Medical Center (which is, by the way, the first stop outside of the Middle East for our wounded soldiers from Iraq and Afghanistan), but has even started to train U.S. Army Rangers in the technique. While before I thought the term “battlefield acupuncture” was a misnomer because it wasn’t actually being used on the battlefield, but rather for phantom limb pain and other chronic pain conditions, this latter development shows just how far Col. Niemtzow wishes to go with this “technique.” Second, Col. Niemtzow’s acupuncture technique isn’t even “real” acupuncture. He calls it “auricular acupuncture,” and it involves sticking needles a mere 1 mm into the earlobe. Worse, he justifies this technique through ignorance of anatomy, claiming that “the ear acts as a ‘monitor’ of signals passing from body sensors to the brain” and that “those signals can be intercepted and manipulated to stop pain or for other purposes.” He even made a comment about 18th century pirates wearing a lot of earrings in order to improve their night vision. I kid you not. Third, and finally, Col. Niemtzow has published another one of his “studies” to support the use of acupuncture in chronic pain syndromes among our combat wounded veterans.

Last time around, I referred to an earlier study by Col. Niemtzow published in Military Medicine in 2006. This study was clearly labeled as a “pilot study.” Although it was randomized (good), it was small (tolerable for a pilot study); it was unblinded (bad); and there was no placebo or “sham acupuncture” control group (horrible). There were multiple other serious shortcomings, but those are the main ones. In other words, Col. Niemtzow’s 2006 study was custom-designed to show a “positive” result that could be entirely explained by the placebo effect, and that’s exactly what it did. Indeed, even by that standard, its results were unimpressive. Although the pain scores in the acupuncture group were reported to have decreased by 23% initially, compared to the conventional therapy group, which did not decrease measurably, within 24 hours after treatment there was no difference between the two groups. I’ve referred to this study as “thin gruel” upon which to base the creation of a military acupuncture program, much less expanding that program into combat and training military physicians and medics being sent to combat zones in Iraq and Afghanistan to do auricular acupuncture. I still say it’s thin gruel,.

So what about this new study by Col. Niemtzow, hot off the presses in the latest issue of Medical Acupuncture?
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Posted in: Acupuncture, Medical Academia, Science and the Media

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Farewell To The Medscape Journal: Profits, Losses And A Canary In A Coal Mine

On January 31, 2009 The Medscape Journal will be discontinued.* One can only assume that the journal’s parent company, WebMD, could no longer justify the cost associated with a free, open-access, peer-reviewed medical journal that receives no income from advertisers or sponsors. The Medscape Journal’s budget has been supported by revenue generated from Medscape (the website), and their robust Continuing Medical Education (CME) business.

In these challenging economic times, American companies are taking a cold, hard look at their P and L spreadsheets and nixing the least profitable parts of their businesses. The inevitable “non-profit” casualties present an ethical dilemma. What will become of the noble pursuits that are based upon “doing the right thing” rather than making a profit?

There is no such thing as completely unbiased publishing (humans all have personal agendas – whether conscious or unconscious), though The Medscape Journal came about as close to it as any medical journal ever has. The journal is free to authors and readers, and provides 24-hour online access to both professional and lay viewers from around the globe. There are no advertisements or outside sponsors, peer reviewers work without compensation or specific recognition, and editors are paid a minimal salary (full disclosure: I know this because I was an editor for The Medscape Journal several years ago). CME credit is offered for articles determined to be of special relevance, but no articles are commissioned specifically for the purpose of CME.

The Medscape Journal is a wonderful experiment in high ethics. It espouses, in my opinion, the gold standard principles of medical publishing. Tragically, market forces (or perhaps the lack of perceived value by its own parent company) killed it. So what does this mean for medical publishing? If there is no economic model for “pure science” then are medical journals doomed to go the way of health media – promoting sensational or biased science for profit?
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Posted in: Announcements, Medical Academia, Science and the Media

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Now there’s something you don’t see on TV every day…

I rather like Late Night with Conan O’Brien. Unfortunately, I seldom get to watch, mainly because I usually show up at work sometime between 7:00 and 7:30 AM, and I don’t like watching more than a few minutes of video on my computer.

However, Hugh Laurie, star of House, was interviewed by Conan and revealed himself to be not unlike me in that he’s definitely a booster of reason and science in medicine over irrationality and dubious “complementary and alternative medicine” (CAM) therapies. In fact, his attitude towards CAM appears to be not at all unlike that of the character he plays on House. Check out the interview. (If you want to watch, the relevant part of the interview begins at about 23:50 into the show.)

For those who might have problems playing Internet video, I’ve found a transcript:
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Posted in: Health Fraud, Humor, Science and Medicine, Science and the Media

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Credulous medical reporting

Science and medicine reporting is hard. In this space and otherswe’ve dealt with some of the problems that arise when “generalist” reporters try to “do” science and medicine. And now, CNN has shut down its science unit. Given the increasing complexity of medical and scientific knowledge, this is very bad news.

As a fine example of poor medical reporting, let’s look at a local business magazine. The article, called “The Fatigue Factor”, is about fibromyalgia, and manages to get it wrong from the very beginning.

Some medical reporting is destined to be bad simply because the topic is too complex for a generalist reporter. But sometimes, a reporter succumbs to journalistic sloth. In this story, for instance, if the reporter had spoken to a recognized local expert rather than a self-proclaimed expert, she would have written a much different article.

Let’s start with the headline:
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Posted in: Science and Medicine, Science and the Media

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How not to win friends and influence people

BLOGGER’S NOTE: The incident described in this post is true, although somewhat embellished to protect the names and identities of the innocent, if you know what I mean. This conversation occurred a few years ago at a large national cancer meeting.

The question caught me by surprise.

While attending a large national cancer meeting, I was having brunch with a friend, a colleague with whom I used to work when I was doing laboratory research, someone whom I hadn’t seen in a long time. She and her husband had brought along two of their oldest and dearest friends, whom they had known for decades, as well as another of my former coworkers from my old lab. We were idly chatting away and eating, when one of the occupational hazards of being a doctor presented itself. Tthe conversation drifted to medical topics. And then it came.

“What do you think of Dr. Gonzalez?”

Ah, hell.
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Posted in: Cancer, Health Fraud, Science and the Media

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Psychological support and breast cancer – again

Does the degree of efficacy is depend on the time at which it is measured? Apparently so. The case of psychological support and breast cancer longevity again.

After an original 1989 report of positive effects on metastatic breast cancer, by 2006- 7 the majority of RCTs on such effects had settled the issue in the negative. This was only after 20 years of repeated research grants and RCTs based on hunches and feelings that somehow emotional support really affected the course of cancer. Investigations continued despite analyses showing the few original positive studies had been so flawed in design or defective in reported details, that they should have been dismissed and perhaps excluded from systematic reviews. (Spiegel D, Bloom JR, Kraemer H, Gottheil E. Psychological support for cancer patients, Lancet ,1989 Dec 16;2(8677):1447., Fawzy FI, Fawzy NW, et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence an survival 6 years later. Arch Gen Psychiatry. 1993 Sep;50(9):681-9.)

But to advocates, conflicting results served as motive to prove the claims by repeating the studies for 20 years, “doing them right this time.” As of mid-2008, consensus was the issue was still “negative.” Now another study, claimed to be positive, makes the news.

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Posted in: Cancer, Clinical Trials, Science and Medicine, Science and the Media

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Open-Access Peer Review: Increasing the Noise To Signal Ratio

Readers of Science Based Medicine are quite familiar with the distressingly common logical leap made by disgruntled healthcare consumers into alternative medicine. It goes something like this: I had a terrible experience with a doctor who [ignored/patronized/misdiagnosed] me and I also heard something horrible in the media about a pharmaceutical company’s misbehavior [hiding negative results/overstating efficacy/overcharging for medications], therefore alternative treatments [homeopathy/acupuncture/energy healing, etc.] must be more effective than traditional medicine.

Much to my dismay, a similar logical leap is being made about online health information. It goes something like this: Peer reviewing is biased and often keeps innovative research hidden to the world at large, therefore the best kind of peer review is open-access where anyone in the world can contribute.

You may feel free to slap your forehead now.

While I have absolutely no doubt that doctors have their shortcomings, and that some have created less than pleasant healthcare experiences for their patients – the solution to these shortcomings is not to dive headlong into snake oil. Moreover, I agree that the current peer-review process has its flaws and limitations – the solution is not to ask Aunt Enid in Omaha what she thinks of the recent meta-analysis of perioperative beta blockers in patients having non-cardiac surgery.

Peter Frishauf, the founder of Medscape, recently published a webcast editorial predicting that:

“Peer review as we know it will disappear. Rather than the secretive prepublication review process followed by most publishers today, including Medscape, most peer review will occur transparently, and after publication.”

He goes on to describe a Wikipedia-like review scenario where:

“Any user can start an article, link it to related sources, and publish revisions with a click of the mouse. Anyone who reads an article can edit it.”

I know and like Peter very much, and his foresight (that publishing should become open-access), combined with the leadership of editorial heavy-weight, Dr. George Lundberg, led to the creation of the first really successful, quality, free online medical journal. This was no small feat, and a sure victory for global medical education efforts.

But the reason for The Medscape Journal’s success is not the “democratization” of peer review – but the democratization of access to trustworthy information. The quality controls are still in place – and must remain so – otherwise its value as a peer-reviewed journal will be utterly lost. Who should trust the edits of unqualified readers? Should science be determined by popular vote? Should all research be published by journals, regardless of its fatal flaws?

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Posted in: Science and Medicine, Science and the Media

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Does TV Cause Teen Pregnancy?

I’ll be the first to admit that the quality of TV programming, especially network programs, leaves much to be desired. Critics of television have blamed TV for everything from violence to obesity. Now studies have shown that teens who watch sexy programs are more likely to become sexually active and to get pregnant. I’m not so sure that these studies really show what TV critics think they show. My local newspaper was equally skeptical.

We frequently criticize media coverage of scientific issues, so for once I’d like to offers kudos to the Tacoma News Tribune for publishing this editorial:

TV and teen pregnancy: A lot else is also at work
THE NEWS TRIBUNE
Published: November 5th, 2008 12:30 AM

For parents, the headline was ominous: “Study links TV, teen pregnancy.”
The article that appeared in The News Tribune Tuesday reported on a Rand Corp. study published in this month’s issue of Pediatrics magazine. Researchers say they found a link between higher teen pregnancy rates and watching television shows that have lots of sexual dialogue and behavior – ones like “Sex in the City, “That ‘70s Show” and “Friends.”
“Friends”?
The implication is that if teens watch such racy programming, they’re more likely to become sexually active themselves – and therefore more at risk of getting pregnant or impregnating someone else.
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Posted in: Science and the Media

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Do over one in five breast cancers detected by mammography alone really spontaneously regress?

ResearchBlogging.orgIt figures.

Last Wednesday, right before the four-day Thanksgiving holiday weekend, as I was far more interested in preparing to have family over the next day than in what was going on in the medical news or the blogs, the results of a most fascinating study hit the news. In Medscape, the title of the news report was Mammography Study Suggests Some Breast Cancer May Spontaneously Regress; on WebMD, the story ran under the title Can Breast Cancer Disappear?; on Medical News Today, Mammograms May Identify Cancers That Would Otherwise Just Regress by Drs. Per-Henrik Zahl, Jan Maehlen, and H. Gilbert Welch. Not surprisingly, the study found its way out of the medical news and into mainstream media outlets as well, given how provocative the findings seemingly are. From the Medscape report on this study:

A mammography study from Norway has come up with the controversial proposal that one fifth of breast cancer detected on screening may spontaneously regress. But there is no easy way to verify whether this is the case, say experts.

The study was published in the November 24 issue of the Archives of Internal Medicine. It found that the cumulative incidence of invasive breast cancer in a cohort of women, aged 50 to 64 years, who received 3 mammograms over 6 years was 22% higher than in a control group of age-matched women who received only 1 mammogram at the end of a 6-year period.

In their review of possible explanations for the difference in the breast cancer rates between the 2 groups — which had similar risk factors for breast cancer — the researchers write that the “natural course for some screen-detected breast cancers may be to spontaneously regress.”

“I anticipate that many clinicians will react negatively to the possibility of spontaneous regression, said coauthor Jan Maehlen, MD, PhD, professor of pathology at the Ulleval University Hospital, in Oslo, Norway, in an interview with Medscape Oncology.

Before I discuss the study itself, let me briefly discuss why clinicians may have a bit of a problem with the implications of this study, if they accurately reflect the biology of breast cancer.
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Posted in: Cancer, Clinical Trials, Diagnostic tests & procedures, Science and the Media

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