January 5th, 2008 by Dr. Val Jones in Uncategorized
No Comments »
Welcome to 2008’s first edition of Revolution Rounds, my biweekly round up of the best Revolution Health expert blog posts. Not surprisingly, there’s a decidedly New Year’s theme in this collection of posts. If you’re looking to stick to a New Year’s resolution, be sure to check out the Revolution Health groups section of the site. Whether you’d like to lose weight, quit smoking, or improve your relationships – there’s a group of like minded souls out there resolving to do the same!
Health tips
Dr.
Stacy has 20 New Year’s resolutions for kids. She has even organized them
by age group for you.
New
Year’s resolutions are more likely to succeed if you follow this advice. Mira Kirshenbaum has some great tips for adults.
Would
you like to lose weight effortlessly? Sandra
Foschi suggests that good sleep habits can contribute to
weight loss.
Reading
the right blog could save your life. Dr. HJ Lenz describes how one woman
learned about certain treatment options from his colorectal cancer blog, and it
changed her life.
Would
you like to stop snoring? Dr. Steve Poceta
has some excellent tips.
The best treatment for autism may not be a drug, but human caring.
Robin Morris discusses the findings of some recent research.
Do
you struggle with jet lag? Dr. Vivian Dickerson has some suggestions for
reducing your symptoms.
Pedometers
can encourage increased exercise. Dr. Jim Herndon suggests that a pedometer
might be an excellent addition to your weight loss resolution!
In
case you need another good reason to quit smoking: Dr. Mark Perloe reminds
us that smoking a pack a day can increase the risk of erectile dysfunction by
40%.
Think
you know how to insert eye drops? Think again. Dr. Jackie Griffiths has
some special advice for those of you who need eye drops regularly.
Did you know?
San
Francisco’s mayor has proposed a soda tax. Dr. Jim Hill explains that this
money is unlikely to put a dent in the obesity epidemic.
In
some cultures childhood epilepsy is treated by burning the feet with hot coals.
Dr. Jide Williams describes this horrific practice in rural Africa.
Snowblower
injuries are still quite common even though manufacturers have been working for
over 30 years to make the machines safer. Dr. Jim Herndon explains.
It
is possible to create embryos for the purpose of treating certain diseases, not
strictly for procreation. Dr. Mark Perloe discusses some of the ethical
dilemmas associated with stem cells.
Fitness
is more important than fatness. Dr. Vivian Dickerson explains.
Excess
weight in childhood is linked to adult heart disease. Dr. Jim Hill suggests
that fitness and weight control should begin early to promote good health in
adulthood.
Many
physicians need to work on their empathy. Dr. Mike Rabow explains that
younger physicians may be more empathic than older ones.
Your
emotional state can dramatically affect your physical health. Dr. Joe Scherger discusses this mind-body connection.
Demanding
parents may cause their childrens’ teachers to burn out. Dr. Stacy Stryer
describes this unfortunate phenomenon.
Skim
milk consumption may be linked to prostate cancer. Dr. Julie Silver raises
the question of whether or not skim and low fat milk are over-rated in their
health benefits.
You
don’t need both eyes to have good depth perception. Dr. Jackie Griffiths,
Revolution Health’s ophthalmologist, explains.
Newer
isn’t automatically better. Dr. Mike Glode bemoans the fact that we have
the tendency to rush after the latest medical technology without stopping to
analyze the cost benefit ratio.
Personal Stories
One
woman had an unpleasant surprise on her 40th birthday: a massive
stroke with left hemi-neglect! Dr. Olajide Williams describes the event
with poetic language.
Laughter
is the best medicine. Dr. Stacy Stryer describes how she puts this axiom
into practice in her family.
Dr.
Julie Silver was prompted by her daughter to become one of Charlie’s angels.
You’ll have to read the post to get the reference.
Vitamin
hawkers exaggerate their product’s benefits without recourse. Dr. Mike
Glode describes one interesting example of this phenomenon.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 27th, 2007 by Dr. Val Jones in Book Reviews
No Comments »
This is my final post in a series inspired by Dr. Barker Bausell’s recent book, “Snake Oil Science: The Truth About Complementary and Alternative Medicine.” Since I began this series, the New York Times has published a rave review of Bausell’s book, which only further confirms the importance of Bausell’s contributions.
Although Bausell’s main thesis is that there are currently no large, randomized controlled trials (published in leading medical journals) demonstrating the effect of any CAM therapy beyond placebo, I have chosen to highlight some of his thinking about research methodology as it applies to the medical literature in general.
So far I have explained why most research (if not carefully designed) will lead to a false positive result. This inherent bias is responsible for many of the illusionary treatment benefits that we hear about so commonly through the media (whether they’re reporting about CAM or Western medicine), because it is their job to relay information in an entertaining way more so than an accurate manner (i.e. good science makes bad television).Then I explained a three step process for determining the trustworthiness of health news and research. We can remember these steps with a simple mnemonic: C-P-R.
The C stands for credibility– in other words, “consider the source” – is the research published in a top tier medical journal with a scientifically rigorous review process?
The P stands for plausibility– is the proposed finding consistent with known principles of physics, chemistry, and physiology or would accepting the result require us to suspend belief in everything we’ve learned about science to date?
And finally we arrive at R – reproducibility. If the research study were repeated, would similar results be obtained?
This third and final pillar of trustworthy science is a simple, but sometimes forgotten, principle. If there is a true cause and effect relationship observed by the researcher, then surely that cause and effect can be demonstrated again and again under the same conditions. Touching a hot stove burner always results in a burned hand. No matter how frequently you test this causal relationship, the result will be similar.
Sometimes conflicting results are obtained by repeating a study. When this happens, the reader should be careful in interpreting the conclusions – there may be a flaw in the study design, or it may be that the conclusions drawn were inaccurate. There could have been a false positive result, or no appreciable effect of the treatment under consideration, therefore leaving the results to chance. Flipping a coin gives you heads one minute and tails the next. Yet a person unfamiliar with coins could conclude (after one flip) that it has a head on both sides. In the end, therefore, one can be more confident in a study’s result if it is born out by other studies.
And so as we conclude this series, I hope that you now feel well equipped to perform CPR (credibility, plausibility, reproducibility checks) on health news. A little healthy skepticism can protect your brain from all the mixed health messages that barrage us each day. At the very least, now you’ll appreciate why most health news reports include an expert quote stating something to the effect of “it’s too early to know for sure if these findings are relevant.” That statement may be the most trustworthy of the entire report.
***
Next up: Shannon Brownlee’s book “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer.” Shannon and I corresponded about this book two years ago, so I’m looking forward to seeing how it has turned out. Once I’ve finished it I’ll give you my thoughts here in this blog.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 20th, 2007 by Dr. Val Jones in Book Reviews
No Comments »
Which news source do you trust more: The New York Times or The National Enquirer? Which news reporter would you trust more: Charlie Gibson or Jerry Springer? As it turns out, medical journals and science researchers run the gamut from highly credible and respected to dishonest and untrustworthy. So as we continue down this road of learning how to evaluate health news, let’s now turn our attention to pillar number one of trustworthy science: credibility.
In medical research, I like to think of credibility in three categories:
1. The credibility of the researcher: does the researcher have a track record of excellence in research methodology? Is he or she well-trained and/or have access to mentors who can shepherd along the research project and avoid the pitfalls of false positive “artifacts?” Has the researcher published previously in highly respected, peer reviewed journals?
2. The credibility of the research: does the study design reflect a clear understanding of potential result confounders and does it control for false positive influences, especially the placebo effect?
3. The credibility of the journal that publishes the research: top tier journals have demonstrated a track record of careful peer review. They have editorial boards of experts who are trained in research methodology and are screened for potential conflicts of interest that could inhibit an objective analysis of the research that they review. The importance of careful peer review must not be underestimated. Some say that the quality of a product is only as good as its quality control system. Top tier journals have the best quality control systems, and the articles they publish must undergo very careful scrutiny before they are published.
So as a lay person, how do you evaluate the credibility of a health news report? In practical terms, here’s what I’d recommend:
1. Look at the name of the journal reference – where was the research published? Is it from a top tier journal? R. Barker Bausell considers the following journals to be “top tier:” The New England Journal of Medicine (NEJM), The Journal of the American Medical Association (JAMA), Annals of Internal Medicine, Nature, and Science. I might cast a slightly larger net, but no one will argue that these are certainly some of the most respected journals in medicine and science.
2. Look at the study design described in the research article abstract. Was it a randomized, controlled, double-blind, placebo-controlled trial? Were there more than 50 subjects in each group? Did the authors overstate their conclusions? This sort of analysis is challenging to the lay person – so do it if you can, but if it proves too difficult, fall back on credibility check #1.
3. Look at the primary author of the research. Search for his/her name in the National Library of Medicine’s Medline database and see what other research he or she has done, and where it was published.
If the news report is based on credible research, you may feel confident in taking the results more seriously (so long as the media is representing them accurately). But before you hang your hat on a journal’s reputation, let’s take a look at the other 2 pillars of trustworthy science: plausibility and reproducibility. These two will help you navigate your way through the vast gray zone, where the credibility check doesn’t pass with flying colors – or maybe you’re dealing with neither Charlie Gibson nor Jerry Springer.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 19th, 2007 by Dr. Val Jones in Book Reviews
No Comments »
Have you ever been surprised and confused by what seem to be conflicting results from scientific research? Have you ever secretly wondered if the medical profession is comprised of neurotic individuals who change their mind more frequently than you change your clothes? Well, I can understand why you’d feel that way because the public is constantly barraged with mixed health messages. But why is this happening?
The answer is complex, and I’d like to take a closer look at a few of the reasons in a series of blog posts. First, the human body is so incredibly complicated that we are constantly learning new things about it – how medicines, foods, and the environment impact it from the chemical to cellular to organ system level. There will always be new information, some of which may contradict previous thinking, and some that furthers it or ads a new facet to what we have already learned. Because human behavior is also so intricate, it’s far more difficult to prove a clear cause and effect relationship with certain treatments and interventions, due to the power of the human mind to perceive benefit when there is none (placebo effect).
Second, the media, by its very nature, seeks to present data with less ambiguity than is warranted. R. Barker Bausell, PhD, explains this tendency:
1. Superficiality is easier to present than depth.
2. The media cannot deal with ambiguity, subtlety, and diversity (which always characterizes scientific endeavors involving new areas of investigation or human behavior in general)
3. The bizarre always gets more attention than the usual.
I really don’t blame the media – they’re under intense pressure to find interesting sound bites to keep peoples’ attention. It’s not their job to present a careful and detailed analysis of the health news that they report. So it’s no wonder that a research paper suggesting that a certain herb may influence cancer cell protein expression in a Petri dish becomes: herb is new cure for cancer! Of course, many media outlets are more responsible in their reporting than that, but you get the picture.
And thirdly, the scientific method (if not carefully followed in rigorous, randomized, placebo-controlled trials) is a set up for false positive tests. What does that mean? It means that the default for your average research study (before it even begins) is that there will be a positive association between intervention and outcome. So I could do a trial on, say, the potential therapeutic use of candy bars for the treatment of eczema, and it’s likely (if I’m not a careful scientist) that the outcome will show a positive correlation between the two.
There are many reasons for false positive results (e.g. wrongly ascribing effectiveness to a given therapy) in scientific research. “Experimental artifacts” as they’re called, are very common and must be accounted for in a study’s design. For fun let’s think about how the following factors stack the deck in favor of positive research findings (regardless of the treatment being analyzed):
1. Natural History: most medical conditions have fluctuating symptoms and many improve on their own over time. Therefore, for many conditions, one would expect improvement during the course of study, regardless of treatment.
2. Regression to the Mean: people are more likely to join a research study when their illness/problem is at its worst during its natural history. Therefore, it is more likely that the symptoms will improve during the study than if they joined at times when symptoms were not as troublesome. Therefore, in any given study – there is a tendency for participants in particular to improve after joining.
3. The Hawthorne Effect: people behave differently and experience treatment differently when they’re being studied. So for example, if people know they’re being observed regarding their work productivity, they’re likely to work harder during the research study. The enhanced results therefore, do not reflect typical behavior.
4. Limitations of Memory: studies have shown that people ascribe greater improvement of symptoms in retrospect. Research that relies on patient recall is in danger of increased false positive rates.
5. Experimenter Bias: it is difficult for researchers to treat all study subjects in an identical manner if they know which patient is receiving an experimental treatment versus a placebo. Their gestures and the way that they question the subjects may set up expectations of benefit. Also, scientists are eager to demonstrate positive results for publication purposes.
6. Experimental Attrition: people generally join research studies because they expect that they may benefit from the treatment they receive. If they suspect that they are in the placebo group, they are more likely to drop out of the study. This can influence the study results so that the sicker patients who are not finding benefit with the placebo drop out, leaving the milder cases to try to tease out their response to the intervention.
7. The Placebo Effect: I saved the most important artifact for last. The natural tendency for study subjects is to perceive that a treatment is effective. Previous research has shown that about 33% of study subjects will report that the placebo has a positive therapeutic effect of some sort.
So my dear readers – if the media wants to get your attention with exaggerated representations of research findings, and the research findings themselves are stacked in favor of reporting an effect that isn’t real… then how on earth are we to know what to make of health news? Luckily, R. Barker Bausell has explained all of this really well in his book and I will attempt to summarize the following principles in the next few posts:
1. The importance of credible scientific evidence
2. The importance of plausible scientific evidence
3. The importance of reproducible scientific evidenceThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 12th, 2007 by Dr. Val Jones in True Stories
1 Comment »
A few months ago I wrote about my dear friend who was diagnosed with stage IV colon cancer just after having her first baby. Her optimism and positive focus was inspirational to me, and I marveled at her ability to live life unencumbered by prognosis.
Today I am happy to report that she has completed her 7th round of chemotherapy (with avastin, oxaliplatin, 5FU, and leukovorin) and her liver tumors have already shrunk by two-thirds. She is bothered by neuropathy (burning sensations in her hands and feet – a known side effect of this drug regimen) and has lost the ability to taste food fully, but otherwise she is maintaining her weight and her blood counts are good. She told me that her plan is to complete 12 rounds of chemo and then meet with a liver surgeon to consider surgical removal of the remaining tumors. Miraculously, her doctors believe that she may be a candidate for liver resection and eventual cure.
This couldn’t be any better news and I am so pleased to be able to celebrate my friend’s success. I have learned a great deal myself about the journey, and about how many people are willing to reach out and help those who are struggling. As for my friend, she has greatly benefited from:
1. CarePages – an online gathering place where friends and family can find out the latest news about her progress, and leave well wishes and virtual gifts. CarePages is part of the Revolution Health family.
2. The Colon Cancer Alliance (CCA) – this wonderful non-profit organization linked my friend up with a mentor who has been through a similar treatment regimen and diagnosis and can speak to her about what to expect. The CEO of CCA has even taken time out of his busy schedule to make sure that my friend gets the best support available and has put her in touch with top liver surgeons.
3. Dr. Lenz’s Colon Cancer Blog – Dr. Lenz is a leading medical oncologist and Co-director of both the Colorectal Center and the Gastrointestinal (GI) Oncology Program at USC/Norris Comprehensive Cancer Center in Los Angeles. He also prepares 3 fresh blog posts per week here at Revolution Health, to make sure that cancer patients have access to the latest research and information about colon cancer.
With incredible advances in evidence-based cancer therapies and these terrific online resources, colon cancer patients have a brighter future than ever before. I’m so pleased that my friend is doing well, and I’m grateful for the many people and organizations that have touched her life. Expect another update on her progress in March!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
