Review

Acupuncture worth a shot for COPD?

People suffering from COPD may find some relief with acupuncture treatments, according to researchers from Kyoto University and Meiji University. The study was a small, preliminary clinical trial. And although the results seem promising, researchers need to overcome the single-blinded limitation before people start making any definite conclusions. The study is important, as there is no cure for COPD, but only therapies to relieve its symptoms or to prevent the condition from worsening. After reading this WebMD article, however, readers may come away with the feeling that acupuncture is the greatest thing since penicillin.

I was first reviewer for this HNR review.

The story fell short on many levels – most importantly, on breaking down the research and its significance for readers. This was a small clinical study with limitations.

Our Review Summary

The story includes several independent experts for comment, but the article fails to put the study into perspective. With language like, “Clearly… a viable alternative,” readers leave with the wrong impression regarding the significance of the research. The story would have done better to include facts, such as :

  • small, single-blinded clinical trial
  • study participants only followed for three months
  • some quantification of  study data (ie. How were improvements measured to merit the claims made by researchers?)

Why This Matters

Many patients with COPD, a condition often due to long-term use of cigarettes, have shortness of breath with activity resulting in impaired quality of life. Though there are a number of medications that have been available to treat COPD for years, patients often still have symptoms that affect their daily function. Thus, safe and effective new treatments for COPD would be welcome. For the reader of this article, that new treatment would appear to be acupuncture. But there is good reason to believe this is more based on hype and hope than reality and evidence. This is a small study from Japan and even if true, COPD is a heterogeneous disease, meaning that it is crucial to repeat in other settings and patients before declaring it effective. It is also important to know whether this helps a bit or a lot – it isn’t clear from reading this article. Just because acupuncture is safe and may work doesn’t mean it should be embraced. The experts quoted in this piece have lowered the bar with their supportive words. The article needs someone to say the obvious – this may offer hope but let’s wait for larger, more definitive studies. The net result is that the reader is misled. [HealthNewsReview.org]

You can see the full reviews on my site at Journalism -> Review and also at HealthNewsReview.org.

New Implant Procedure, No Side Effects?

For those suffering from inner-ear damage, a new device called Esteem is out on the market. A surgeon implants the prosthetic inner-ear stimulator during a three-hour outpatient procedure, with the patient under general anesthesia. According to the article, it seems that the implant procedure and device have no side effects.

I was first reviewer for this HNR review. The Chicago Tribune ran the story.

Not a good example of reporting on new technologies: one glowing patient anecdote – same profiled in a news release.  No data provided.

Our Review Summary

No discussion of costs, or of outcomes data (benefits or harms).  Only one positive patient anecdote with no explanation of whether her result was representative of what’s been seen in any other patients.  There was no independent perspective provided.

Why This Matters

The story illustrates the difficulty in reporting on a new device and new implant procedure that has not become a mainstream practice. Much scientific data may not yet have been published. If this were the case, the story could have explicitly stated so and alerted the reader on the lack of data currently available. [HealthNewsReview.org]

You can see the full reviews on my site at Journalism -> Review and also at HealthNewsReview.org.

Debate on Thyroid Checks During Pregnancy

A debate is brewing in the physician community : Should all pregnant women should be screened for thyroid function? And  should women with milder cases of hypothyroidism be diagnosed and treated? The problem is that there is little evidence regarding the effectiveness of treatment for milder cases. Scientists are unsure whether diagnoses and subsequent treatment sufficiently help pregnant patients or, instead, waste money on blood testing and thyroid medication.

I was first reviewer for a HNR review on a recent Quest Diagnostics study that looked at records and surveys from half a million pregnant women. The AP ran the story.

Overall, the story does an excellent job weighing the pros and cons of thyroid screening and treatment in pregnant women.

Our Review Summary

The article gives extensive context to the recent Journal of Clinical Endocrinology & Metabolism study and refers to other research done in the field.

Why This Matters

The article effectively breaks down and explains a complex debate in the physician community – whether all pregnant women should be screened for thyroid function and whether women with milder cases of hypothyroidism should be diagnosed and treated. The story says this will “add pressure” for science to settle this issue, but that pressure already exists from endocrinologists and obstetricians – with, as the study shows, about 1 in 5 pregnant women being tested from 2005-8. [HealthNewsReview.org]

You can see the full reviews on my site at Journalism -> Review and also at HealthNewsReview.org.

Fish, Brain Health and Alzheimer’s

Apparently, eating fish may be good for brain health.

I was the second reviewer for two HNR reviews looking at a recent study presented Wednesday at the Radiological Society of North America in Chicago. Researchers looked at the correlation between 3-D MRIs and gray matter in the brain. Here are two competing reports from HealthDay and WebMD :

Another confusing story about an observational study that fails to explicitly state and explain to readers the limitations of observational studies. Please read our primer on this topic.  It would help prevent these mistakes.

Our Review Summary

Readers heads must be spinning worse than Linda Blair’s in “The Exorcist” when they read – in one story – that this “must be viewed as an association, rather than a cause-and-effect” – yet they get cause-and-effect language such as:

  • “Raji said he was ‘amazed’ that this effect was seen”
  • “may boost brain health”…”lower the risk”…”helps to preserve gray matter neurons, strengthening them”…”cranial benefit”

Why This Matters

Over and over again, many news stories confuse readers about observational studies.  It leads to a loss of confidence in science and a loss of credibility in journalism.  That’s why this matters. [HealthNewsReview.org]

 

Slightly better story than the competing HealthDay story on the same study. Still weak on explaining the limitations of observational studies.

Our Review Summary

The story allows the researcher to say, “More fish, more brain, less Alzheimer’s.”   Pithy.  Quotable.  But simplistic and not proven by this study.

Why This Matters

At least the competing HealthDay story interviewed an independent source who wondered about other possible confounding factors in the research and stated, “For now, the connection must be viewed as an association, rather than a cause-and-effect.”

So even though the WebMD story scored better, the HealthDay story did slightly better on this critical piece of analysis. (The HealthDay story had its own flaws – for example, burying that “association” line instead of placing it high in the story and overwhelming it with cause-and-effect language throughout the story.) [HealthNewsReview.org]

You can see the full reviews on my site at Journalism -> Review and also at HealthNewsReview.org.

Health News Reviewing on HD

From now, you can find all my full-length health news reviews under my Journalism -> Review tab. I will post only my main comments on my home page.

I was again first reviewer for a HealthDay story on Huntington's disease, which covers a phase III drug study that was recently published in The Lancet Neurology.

  • The main problem in the story was its contradictory statements regarding the drug’s benefits. The article stated that a higher dose of pridopidine showed a “significant benefit,” but how significant? Later in the story, an independent source commented that the “benefit is modest.”
  • The story did not mention anything about the researchers’ inability to meet their primary endpoint. The apparent benefits of the drug were found in the tertiary endpoint – a sign that the magnitude of the drug’s effects may be smaller.
  • The article did not detail any research methods from the study. For example, how did researchers measure improvements in motor function?

Why This Matters:

The story highlights the difficulty in deciphering ambiguous medical evidence for the general public. On one hand, the researchers were not able to prove their main hypothesis. But they uncovered benefits in another endpoint that may prove to be promising. The article could have differentiated this evidence and provide a more cautious interpretation of the study’s findings, which could have made for a more thorough and more accurate story. [HealthNewsReview.org]

Study of the Mozart Effect?

Another review for HealthNewsReview.org. Again, I was the first reviewer.  

Could Listening to Mozart Help Doctors Spot Colon Polyps? October 31, 2011

RATING:

Another story based on a talk at a recent conference AND based on a news release. Although the article acknowledges the study's limitations with the usual disclaimer (“conclusions should be viewed as preliminary"), the story still raises many red flags.

Our Review Summary

  • Small study?  How small?
  • Study based on two doctors' performance?  How were they selected?  How much experience did they have?  These are very important details not explained in the story.
  • The article fails to mention anything about the study's confounding factors, or to caution that "correlation does not imply causation" in such a small study. An independent expert could have commented on these issues. But the story provided no independent perspective.
  • This is a one-source story, with the same quotations from the lead investigator as the news release.

Why This Matters:

The story again highlights the difficulty in covering presentations from academic conferences, as such studies are not yet peer-reviewed and published in medical journals. Although the correlation between Mozart and detection rates is interesting, the article could have gone beyond the press release and looked at the study from a more critical angle, with a more thorough explanation of the so-called "Mozart Effect." Although the news release was a bit of a challenge to decipher, the story based on it did not clearly explain its meaning for the reader.

Criteria:

  1. Establish the availability of the treatment/test/product/procedure? - NOT APPLICABLE There's no question about the ability of anyone to listen to any of kind of music while doing colonoscopies.
  2. Discuss costs?- NOT APPLICABLE
    There are no extensive costs associated with listening to Mozart's music.
  3. Avoid "disease-mongering"? - SATISFACTORY The story provided some brief information on invasive colorectal cancer, based on the information in the news release.
  4. Evaluate the quality of evidence?- NOT SATISFACTORY
    The article does state that "data and conclusions should be viewed as preliminary until published in a peer-reviewed journal." However, the story should have discussed the limitations of such a small study and clarified the researchers' methods and results. The story does not mention if other variables were accounted for, or if the correlation between Mozart and higher detection rates could have been due to other factors. The study only had two physicians in it and was not truly blinded.
  5. Quantify the potential harms? - NOT APPLICABLE No foreseeable harms or side effects in listening to music during procedures.
  6. Establish the true novelty of the treatment/test/product/procedure? - SATISFACTORY
    Many studies, both positive and negative, have been conducted on the so-called "Mozart Effect." And the story makes brief reference to past studies.
  7. Quantify the potential benefits? - NOT SATISFACTORY The absolute dfference in adenomas was not reported, only percentages.  We're told it was a small study.  How small?
  8. Appear to rely solely or largely on a news release? - NOT SATISFACTORY The story clearly was based on a press release by the American College of Gastroenterology. Similar language and the same quotations were used. There was not any evidence of original reporting.
  9. Use independent sources and identify conflicts of interest? - NOT SATISFACTORY There were no independent sources cited from outside the study. The only comment came from the lead researcher, Dr. Catherine Noelle O'Shea from the University of Texas Health Science Center.
  10. Compare the new approach with existing alternatives? - NOT SATISFACTORY Was music the only option for improving detection?  Experience of the physician is probably closely related to detection rate, as well as number of procedures done per year. Let's give Mozart his due, but let's analyze the evidence on other alternative explanations as well.

 

Total Score: 2 of 7 Satisfactory [HealthNewsReview.org]

HealthNewsReview.org Rookie

Here's a medical story that I helped analyze for HealthNewsReview.org, where I just started as a reviewer. I was the first reviewer for this one.  

Can NSAIDs Cut Colorectal Cancer Deaths in Older Women? October 24, 2011

RATING:

Another rush-to-publish, straight-off-a-news-release, story about a talk at a scientific meeting. At least some caveats were included.

Our Review Summary

The HealthDay story covers a study presented at a recent conference and appropriately states that "conclusions should be viewed as preliminary." However, there were some problems with the article:

  • The story reports that women using NSAIDs, at the beginning of the study and also three years later, had a lower rate of death. However, it fails to touch upon another critical piece of the puzzle, in that duration of NSAID use was associated with lower colorectal cancer mortality rates. Specifically, the article neglected to mention that researchers observed "significant reductions in colorectal cancer mortality among women who reported at least 10 years of NSAID use."
  • The article fails to mention anything about dosage or any possible side effects associated with prolonged NSAID use.
  • This is a one-source story, with a doctoral student providing the only comment on the study. It is also obvious that there was no original reporting beyond the news release.

Why This Matters:

The story highlights the difficulty in covering presentations from academic conferences, especially since a peer-reviewed, published journal article is not yet available for background and reference. Although this was a short story, it could have been much more thorough with a short comment from the principal investigator and also from an independent source.

Criteria:

  1. Establish the availability of the treatment/test/product/procedure? - NOT APPLICABLE Aspirin and ibuprofen are widely available in US pharmacies.
  2. Discuss costs?- NOT APPLICABLE
    The costs of over-the-counter drugs like aspirin and ibuprofen are not in question.
  3. Avoid "disease-mongering"? - SATISFACTORY There is no disease-mongering, but the story did not provide any context or epidemiology on colorectal cancer.
  4. Evaluate the quality of evidence?- SATISFACTORY
    While the article does caution that the study does not "prove a cause-and-effect," it should have expanded on that statement and explained the limitations of the study. The story does not mention if other variables were accounted for, or if the researchers found any other correlations in their study, which seems likely. However, it does point out that the study "data and conclusions should be viewed as preliminary until published in a peer-reviewed journal."
  5. Quantify the potential harms? - NOT SATISFACTORY There was no mention of potential harms of prolonged aspirin use, such as stomach bleeding and gastrointestinal ulcers.
  6. Establish the true novelty of the treatment/test/product/procedure?- NOT APPLICABLE
    Aspirin is not a new drug.
  7. Quantify the potential benefits? - NOT SATISFACTORY The only benefit mentioned in the story was the "roughly 30 percent lower rate of death from colorectal cancer," as stated in the press release, but 30 percent of what?
  8. Appear to rely solely or largely on a news release? - NOT SATISFACTORY The story clearly was based on a press release by the American Association for Cancer Research. Similar language and the same quotations were used. In fact, the press release was a bit more thorough than the actual HealthDay article. There was not any evidence of original reporting.
  9. Use independent sources and identify conflicts of interest? - NOT SATISFACTORY There were no independent sources cited from outside the study. The only comment came from a doctoral student at the University of Washington.
  10. Compare the new approach with existing alternatives? - NOT SATISFACTORY The story failed to detail any existing alternatives for colorectal cancer, such as targeted drug therapies for people with advanced colon cancer.

 

Total Score: 2 of 7 Satisfactory [HealthNewsReview.org]