Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

New York Times: Lou Gehrig May Not Have Had Lou Gehrig’s Disease?

This was one time when the headline was okay, but the story that followed had our heads spinning. “Study Says Brain Trauma Can Mimic Lou Gehrig’s Disease” is a story that was troubling on a number of fronts. It reported on a study which at the time had not yet been published suggesting that some “athletes and soldiers given a diagnosis of amyotrophic lateral sclerosis…might have been catalyzed by injuries only now becoming understood: concussions and other brain trauma.”

To be clear — and please don’t anyone miss or miscontrue this point — this is an important and fascinating area of research. But the story did not exhibit the best of health/medical/science journalism:

1. It was based on a study of 3 people. (The ALS Association says there are up to 30,000 people in the U.S. living with ALS.)

2. It stated, “Lou Gehrig might not have had Lou Gehrig’s disease.” (No evidence for this was provided. He also may not have been a great left-handed hitter. That may have been an optical illusion.)

3. It said this could “perhaps lead toward new pathways for a cure.” (After a suggestive finding in just three people?)

4. The story later says, “The finding’s relevance to Gehrig is less clear.” (Hedging already after a bold earlier statement in the story.)

5. But just a few paragraphs later, the story says, “The new finding…suggests that Gehrig might not have had (ALS).” (Head spinning yet?)

6. The story dropped lots of big names — Gehrig, Stephen Hawking, Michael J. Fox, former NFL players Wally Hilgenberg and Eric Scoggins, Cal Ripken — in a jumble of claims, associations — or was it just plain name-dropping in order to make the story more appealing?

7. The story brought in “recent epidemiological studies” in soccer players and soldiers without one word about the possible limitations of such studies.

8. It went into detail that a historian or sports nut would love about Gehrig’s football concussions or baseball beanings or fights with Ty Cobb. But all of this just fed the theory that was not supported by anything but guesswork and innuendo.

The story ends with a quote from a Gehrig biographer:

“Lou Gehrig wanted to know everything possible about his own illness — he got to know his doctors, talked with scientists with obscure approaches, and volunteered himself as a guinea pig to find any way to combat the disease. He wouldn’t stick in the sand and not want to hear about this. If he were around today, he would continue to have that same curiosity, and that burning desire, to help his situation, or to help others.”

As we said earlier, this is important and fascinating research. So we don’t think anyone should stick their head in the sand over this research either. But the story also didn’t require any hype — the kind it received from the New York Times.

Additional thoughts from Dr. Steven Atlas of Massachusetts General Hospital, one of our medical editors:

“This represents a small and interesting case series. The lowest rung on the clinical evidence ladder. It is a pretty big stretch to imply that Lou Gehrig may not have had ALS. To imply that one would need to know how common this is. One line of evidence is that NFL players may be more likely to be diagnosed with ALS than the general public. But it is also possible that given their occupational history, one may look for it more carefully. Another way would be to do a case control study. One could take individuals diagnosed with ALS and maybe age and sex matched controls to see if there is a history of prior brain trauma. For pathologists, one method would be to work to do postmortem exams on more patients with ALS to see if they had the pathological changes of ALS or recurrent brain trauma. One could independently get history of prior brain trauma to see if history and pathology line up. The bottom line as you mention is that this is an intriguing study. It is doubtful that such a study may lead to a “cure” unless one means that we seek to decrease brain trauma in the first place. As the article mentions well into it, we won’t know whether Gehrig has ALS or not, but one can’t help but surmise that he did have ALS until data shows that much of ALS is in fact a side effect of brain trauma. Finally, even if brain trauma is associated, it is possible that genetic factors that would lead to ALS are present in these individuals with brain trauma. Specifically, is it the severity of the brain trauma that predicts this? Or is it the genetics that dominate and the trauma is the straw that broke the camels back?”

Complexities that, despite its long word count, this story didn’t address.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »