Earlier this month, Mehmet Oz, MD celebrated his 1,500th “Dr. Oz” show. Oprah Winfrey, Gayle King and Martha Stewart made appearances, proffering congratulations and discussing everything from mercury in fish to the #metoo movement.
I felt less jubilant: In the decade that The Dr. Oz Show has been on the air, it hasn’t been unusual for me to encounter patients who ask about topics, treatments and suggestions mentioned on the program and another popular medical show, “The Doctors.” The advice my patients tell me they’ve heard on these shows often does not square with what I know about the medical evidence.
While I may know that TV shows should be considered entertainment, my patients may not. After all, in our culture, a white coat and a “Dr.” title is a powerful symbol for a trustworthy person of knowledge.
TV shows likes these are, in part, why the American Medical Association recently formalized a set of guidelines titled “Ethical Physician Conduct in the Media,” which recognize our responsibility to use our knowledge and skills “for the benefit of the community as a whole.” It also highlighted the risks when medical advice is not appropriately conveyed or does not reflect the standard of care.A deep dive into the accuracy of TV medical shows
It was that phrase–“standard of care”–that brought me back to a project I worked on in 2013 assessing the accuracy of health claims and recommendations made on “The Dr. Oz Show” and “The Doctors.”
The idea for the project came while I was speaking to colleagues about our experiences with “Dr. Oz phenomenon” — an exasperating situation involving answering a patient’s questions about claims they heard on the show. “Should I eat that berry to lose weight? Will that root extract boost my immunity? Can that supplement really prevent cancer?”
There are times when we know right away the answer is an emphatic no; other times we aren’t so sure. It is always possible we might miss some important new study and need to check the source of the information. With patients who are not simply inquiring, but instead telling us they were doing something based on a Dr. Oz recommendation, it also raises questions for us: Are there any harms that we should warn them about?
For the project, we sought to answer: What are the shows’ sources of information? Are they valid? Reliable? Trustworthy? And do they reflect “the standard of care?”
What we found: The recommendations made on these shows only occasionally follow evidence-based guidelines. Often, we couldn’t find any literature citation (such as a medical study) to confirm the claims made on the show. The costs and harms of the suggested treatments were often overlooked. And, the hosts on the show frequently hawked products made by companies that advertise on the show.How we collected information
My colleague Dr. Jeffrey Weinfeld, medical librarian Michele Malloy, and I enlisted a group of medical students to tape and view all episodes of “The Doctors” and “The Dr. Oz Show” airing during a full month.
Our students logged all the health recommendations made on the shows, and noted whether harms or costs were discussed, and if a source or reference was given for the health recommendation. Our students also watched and noted the advertisements aired during the show and tracked whether advertisements were related to the show’s content, possibly suggesting a conflict of interest.
We counted more than 300 health recommendations, and we randomly selected a subset of them for further analysis. Our analysis included categorizing each statement into one of several “levels of evidence” based on a standard evidence-based medicine best practice resource (the Oxford Centre for EBM), and searching the medical literature to find the source of the information.
We further classified each source we found for the on-air recommendation into the following categories: 1) significantly supports claim, 2) supports claim but with limited statistical strength, 3) supports claim with extrapolation (i.e. animal study, in vitro, very small sample size), 4) unclear, 5) no source identified matching claim.What we discovered
While it was common for the shows to make medical recommendations, these recommendations typically didn’t include discussions of the risks or costs of treatment:
- On average, there were 6.91 (Dr. Oz) and 9.55 (The Doctors) health recommendations made per show.
- Discussion of potential harms or risks were noted in only 8.6% of Dr. Oz’s recommendations, and in 13.1% of The Doctors’ recommendations.
- The cost of the various recommended interventions was mentioned 23.7% of the time on the Dr. Oz show, and 3.1% of the time for The Doctors.
Nor did the recommendations typically follow evidence-backed guidelines:
- About 78% of statements made on the Dr. Oz show did not align with evidence-based medical guidelines, society recommendations, or authority statements. For The Doctors, this was about 80%.
More than half of all recorded shows had content linked directly to advertisements:
- In the Dr. Oz show: 13 out of 19 (68.4%) shows had ads related to general show content, 11 /19 (57.9%) had specific products mentioned by the host using their commercial name, and 4/11 (36.3%) shows mentioning products by name named more than one product.
- In The Doctors: 12 out of 18 (66.7%) shows had ads related to general show content, 13 /18 (68.4%) had specific products mentioned by the host using their commercial name and 11/13 (84.6%) shows mentioning products by name named more than one product.
The literature supporting the recommendations was weak, and sometimes non-existent:
- For both shows, about half of the literature supporting the claims made on the show television was statistically insignificant or required extensive extrapolation. No literature support could be found for about a third of the claims. Of the supporting evidence we could find, about a third had Oxford EBM classification 3b or lower (the lower end of what’s considered good quality evidence).
We started the project having serious questions about the quality, validity and accuracy of the advice given during daytime health talk shows, and at the end, we weren’t reassured.
Our results lent further support to the general feeling among many scientists and clinicians of the shows’ sub-par level of evidence and low quality of information.
Many of the studies we identified as potentially providing support for the claims made on the shows were problematic–with only a few people enrolled, or they were animal-based, or “test tube” studies. If these sources we found are indeed the sources of information used for the shows, then it appears the show researchers frequently relied on preliminary findings–in lab animals, tissue samples, or very small human trials–and then applied them to everyone.
This practice is at best misleading to the general viewer, and potentially harmful to viewers and patients with serious or chronic illnesses.
Finding a match or a source in the literature for a recommendation made on the show – even when the searching was conducted by highly skilled individuals with years of experience combing the medical literature – proved to be extremely time-consuming. It would be especially challenging for a lay person to find sources: Our searches were conducted with access to subscription databases and journals not always available outside of academic settings.How could these shows improve?
Given their huge popularity, these shows aren’t likely to go away. Instead of presenting dubious claims, they have an opportunity to be leaders in health promotion and education. The AMA guidelines mentioned earlier provide important starting points to bridge that gap.
At a minimum, my colleagues and I believe that these TV shows must:
- be clear about study limitations (e.g. animal study);
- be clear about information sources used;
- be upfront about potential harms;
- be transparent about conflicts of interest and advertiser influence
Transparency must take priority, allowing viewers and healthcare providers to find the information sources used to back their claims. This can easily be addressed by providing the citations or links on the shows’ websites, after or during the rolling of the credits, or by putting them at the bottom of the screen. At the moment, it doesn’t appear that anything like this exists–an “important message” from Dr. Oz is all we could find about the claims made on the site. We could find no sources or disclaimers on the The Doctors web site.
We also think the shows could raise their ethical standing by acknowledging when a product or brand being discussed on the show is linked to an advertiser. As the very least, there could be disclosure at the bottom of the screen in the final credits, or on the shows’ websites, that explains the connections.
Show staff should develop or adopt internal review criteria that are responsible and viewer-centered, perhaps adapting already existing standards of quality health reporting such as those suggested by HealthNewsReview.org.
At the same time, we continue to encourage our patients, the viewers of these shows, to embrace skepticism and to recognize that TV entertainment is not, and should not be, a source for high-quality medical advice.
As one Twitter commenter recently noted on a Dr. Oz tweet promoting a segment about detoxing with tea: “One good way to start a detox is to stop listening to Dr. Oz.”
Dennis Overbye’s story, which covered two teams of scientists as they struggled to close in on the Higgs Boson, won a National Academies Keck Future Initiative Communication award in 2014. Overbye has been a reporter at The New York Times for almost 20 years.
Meyrin, Switzerland — Vivek Sharma missed his daughter.
A professor at the University of California, San Diego, Dr. Sharma had to spend months at a time away from home, coordinating a team of physicists at the Large Hadron Collider, here just outside Geneva. But on April 15, 2011, Meera Sharma’s 7th birthday, he flew to California for some much-needed family time. “We had a fine birthday, a beautiful day,” he recalled.NATIONAL ACADEMIES KECK FUTURES INITIATIVE COMMUNICATION AWARD The Keck awards promote effective communication in science, engineering, medicine and any interdisciplinary work within and beyond the scientific community. This story won in the newspaper/magazine category in 2014.
Then Dr. Sharma was alerted to a blog post. There it was reported that a rival team of physicists had beaten his team to the discovery of the Higgs boson — the long-sought “God particle.”
If his rivals were right, it would mean a cascade of Nobel Prizes flowing in the wrong direction and, even more vexingly, that Dr. Sharma and his colleagues had missed one of nature’s clues and thus one of its greatest prizes; that the dream of any physicist — to know something that nobody else has ever known — was happening to someone else.
He flew back to Geneva the next day. “My wife was stunned,” he recalled.
He would not see them again for months.
Dr. Sharma and his colleagues had every reason to believe that they were closing in on the Great White Whale of modern science: the Higgs boson, a particle whose existence would explain all the others then known and how they fit together into the jigsaw puzzle of reality.
For almost half a century, physicists had chased its quantum ghost through labyrinths of mathematics and logic, and through tons of electronics at powerful particle colliders, all to no avail.
Now it had come down to the Large Hadron Collider, where two armies of physicists, each 3,000 strong, struggled against each other and against nature, in a friendly but deadly serious competition.
In physics tradition, they were there to check and complement each other in a $10 billion experiment too valuable to trust to only one group, no matter how brilliant and highly motivated.
The stakes were more than just Nobel Prizes, bragging rights or just another quirkily named addition to the zoo of elementary particles that make up nature at its core. The Higgs boson would be the only visible manifestation of the Harry Potterish notion put forward back in 1964 (most notably by Peter Higgs of the University of Edinburgh) that there is a secret, invisible force field running the universe. (The other theorists were François Englert and Robert Brout, both of Université Libre de Bruxelles; and Tom Kibble of Imperial College, London, Carl R. Hagen of the University of Rochester and Gerald Guralnik of Brown University.)
Elementary particles — the electrons and other subatomic riffraff running around in our DNA and our iPhones — would get their masses from interacting with this field, the way politicians draw succor from cheers and handshakes at the rope line.
Without this mystery field, everything in the universe would be pretty much the same, a bland fizz of particles running around at the speed of light. With it, there could be atoms and stars, and us.
Leon Lederman, the former director of the Fermi National Accelerator Laboratory, or Fermilab, in Illinois, where the boson was being sought, once called it “the God particle,” scandalizing his colleagues but delighting journalists, who kept using the name. Dr. Lederman later said that he wanted to call it the “goddamn particle.”
The “Easter Bump Hunt” of April 2011, as it came to be called, was only one episode in a roller coaster of sleepless nights, bright promises, missed clues, false alarms, euphoria, depression, gritty calculation, cooperation and envy, all the tedium and vertiginous notions of modern science.
On the way to fulfill what they thought was their generation’s rendezvous with scientific destiny, the physicists dangled from harnesses in hard hats to construct detectors bigger than apartment buildings in underground caverns. They strung wires and cranked bolts to coax thousand-ton magnets to less than a thousandth of an inch of where they needed to be. They wrote millions of lines of code to calibrate and run devices that would make NASA engineers stand by the track with their hats in their hands in admiration.
In their down time, they proposed marriage and made rap videos in the tunnels where subatomic particles collided. They ate, slept and partied, threw snowballs and worried that an unguarded smile in the cafeteria or a glance at a friend’s laptop could bias a half-billion-dollar experiment or give away cosmic secrets.
Maria Spiropulu, a professor at the California Institute of Technology, put it this way in an e-mail, “The experiments are very large collaborations and they have the good, the bad, the crooks, the Sopranos, the opportunists — a prototype of the world as we know it.”August 2010: Promised Fireballs
Everybody agreed that the Large Hadron Collider was the last stand in the hunt for the Higgs boson. Circling for 17 miles underneath the complex of aging postwar buildings outside Geneva (and out into France) that constitute the European Organization for Nuclear Research, or CERN, the collider was designed to accelerate the subatomic particles known as protons to more than 99 percent of the speed of light — an energy of seven trillion electron volts — and crash them together.
The resulting tiny fireballs would recreate temperatures and densities that prevailed when the universe was only a trillionth of a second old. This was unexplored territory, and anything could happen, including — about once in every four billion collisions, according to theoretical calculations — a Higgs boson. To record it all, the two teams erected detectors, mountains of wire and computers, on opposite sides of the underground ring to capture the collisions.
“Either we find the Higgs boson, or some stranger phenomenon must happen,” said Fabiola Gianotti, a CERN scientist who led one of the groups, named Atlas. Their rival was called CMS. Both were named after their gigantic detectors. (Two other detectors, named Alice and LHCb, were built to investigate more specialized physics at the collider.)
The collider, 15 years and $10 billion in the making, was first turned on in September 2008. Then, just a week later, a section of it blew up when some electrical circuits proved unable to handle the currents needed for the giant superconducting magnets that steered the protons. Repairs took a year and a half; in March 2010, the collider started up again at half power to avoid stressing the circuits.
When I visited in August 2010, Dr. Gianotti’s desk on the fourth floor of a new building a stone’s throw from the main CERN cafeteria was as sleek and uncluttered as an aircraft’s wing, the few papers on it arranged with geometrical precision. A slender woman with dancing eyes, Dr. Gianotti gave the impression of being as graceful and strong as piano wire. She needed all of that.
As the spokeswoman for the Atlas collaboration, Dr. Gianotti, then 46, was the nominal herder of 3,000 putative Einsteins, the orchestrator of a hive mind of brilliance — responsible for getting all the trains to run on time; for all the calibrations and simulations to match; for all the physicists, from the computer analysts who massaged the final data to anyone who ever wielded a screwdriver in the detector cavern, to sign off on the results from those fireball collisions.
That made Dr. Gianotti the most visible woman in high-energy physics, a field notoriously laden with testosterone. Journalists always asked about that, but it was no big deal, she said, adding that a quarter of the Atlas collaborators are women — so many that on occasion she had gone out and recruited men to attend management meetings.
Growing up in Milan, Dr. Gianotti had been fascinated by philosophy. Seduced into physics by reading some of Einstein’s early work, she had taken two years off to study piano at the Milan Conservatory before getting a Ph.D. at the University of Milan in subnuclear physics in 1989 and joining CERN.
“Music is always in my mind,” she reflected one night, in lightly accented English, as we were driving home from dinner. Asked what kind, she punched a button on the CD player, and the car suddenly filled with Schubert — “the most romantic of the classicists and the most classic of the romantics,” she said.
At her desk, Dr. Gianotti was all business. She had made her mark working on liquid argon calorimeters, devices that could measure the energies and tracks of particles. Now she said she sometimes missed the chance to get her own hands dirty.
But then she gestured to the papers awaiting review on her desk.
“There is no typical day,” she said, ticking off a list of meetings. “My days are very full, this is for sure. I think they are wonderful.”
Asked what made her a good spokeswoman, Dr. Gianotti replied that it was her cheerfulness. Alluding to the explosion and shutdown, she said, “People in a difficult time want to see you are confident and optimistic.” Now, she added, “You can see the excitement in their eyes.”
Just down the hall was Dr. Gianotti’s opposite number and rival of sorts, Guido Tonelli, 63, an ebullient professor from the University of Pisa, newly installed as the spokesman of the CMS collaboration. The Atlas and CMS teams shared the same building, facing each other over an atrium covered with posters of their devices and a coffee bar, using the same printers — and sometimes, the joke went, sleeping with one another.
Dr. Tonelli was the third physicist to head the CMS team and perhaps the one who had traveled the longest road. The son of a farmer and a railroad worker, he had grown up in Pisa and was the first of his family to attend college — a result of effort and sacrifice “that I have tried to reward doing my best in the studies first and in my work later.”
He confessed that he had helped his own cause back then by allowing his professors to believe (incorrectly) that he was related to Leonida Tonelli, a distinguished mathematician whose statue stands near the university’s entrance. Guido Tonelli’s CERN office was dominated by a large poster of his daughter, a ballerina.
Dr. Tonelli had his heart set on discovering the Higgs boson, which he said was crucial to understanding the future as well as the past: measuring it could help determine whether the universe was stable or whether the Higgs field could twitch and dissolve us all back into that bland soup of massless particles.December 2010: Game of Bumps
Dr. Tonelli described his job as the search for anomalies.
For all their equipment and brainy multitudes, physicists would never be able to hold the Higgs boson in their hands. As soon as it was created, it would disintegrate in a shower of lesser particles — sometimes, for example, in a flash of gamma rays, or into a spray of lightweight particles.
So the signature of a Higgs boson or any other paradigm-shattering new particle would be an unexpected excess of gamma rays or some other particles — an anomalous bump on a graph. Dr. Tonelli said this happened about once a month now that the collider was running, but random flukes would also produce bumps.
If they were flukes, more data would make them fade into the statistical background, just as a flipped coin will eventually revert to an equal number of heads and tails. If not, the bumps would grow in slow motion into a bona fide discovery.
To physicists, the gold standard for a discovery is “5-sigma,” a term meaning that the odds it occurred by chance are less than 1 in 3.5 million.
So “we crosscheck everything” and “try to kill” any anomaly that might be merely random, Dr. Tonelli said. Ninety-nine percent of the time, that is just what happens.
“But you never know when one of them will change everything,” he said, adding, “Those have been the most exciting, intense days of my life.”
In a perfect world, the same 5-sigma answer would emerge from each group independently and simultaneously. But each wanted to be first, if only by a hair: neither wanted to be the team that failed to flag a bump that eventually grew to a major discovery, or the one that jumped too soon on a fluke and wound up looking foolish. On each side, there were hundreds of physicists monitoring the different ways in which the Higgs or something else could show up.
In December 2010, Dr. Tonelli heard a rumor that his team’s rivals in Atlas were chasing an auspicious bump that would be an even bigger deal than the Higgs: an unexpected massive new particle.
“This would be totally new physics,” Dr. Tonelli said.
Dr. Tonelli put together a “quick reaction team” to check out its own data. “After a few days of frantic crosschecks we concluded there was nothing there,” he said.
He said he was later told by an Atlas member whose name he cannot recall that the Atlas investigators had been encouraged by a plot from his own CMS team. It was shown during a workshop in Germany, and there was a small bump on it. Had Dr. Tonelli and his colleagues been chasing their own tail?
An Atlas physicist, Gustaaf Brooijmans of Columbia University, said that he vaguely remembered seeing a CMS plot, but that Atlas had undertaken the study in question of its own accord.
On another occasion the following year, another bump — implying the existence of a massive new force particle — had Dr. Tonelli and his colleagues convinced for a couple of months that they had discovered evidence of extra dimensions of space time. They notified the director general of CERN and drafted a paper — never published — describing the discovery. And then the signal faded like an old tied balloon.
“We’ve made many discoveries,” Dr. Tonelli said, “most of them false.”Spring 2011: The Easter Egg Hunt
The biggest false alarm, one that went around the world, came from Atlas.
For Sau Lan Wu, of the University of Wisconsin by way of Hong Kong and Vassar, the Higgs boson was unfinished business. She was one of a handful of scientists who thought they were seeing the evidence of the Higgs back in 2000 in data from an earlier CERN collider called LEP. Unconvinced, CERN shut that collider down so the Large Hadron Collider could be built in its place. In the spring of 2011, Dr. Wu thought she had found the Higgs again.
A cheerful and controlling presence, partial to wearing red, Dr. Wu thinks of herself as a mother to the 47 former students and postdoctoral fellows whose portraits line the hallway outside her CERN office. As a young postdoc at M.I.T. in 1974, she had helped Samuel Ting win a Nobel Prize for discovering the J/psi, a particle that was the last big surprise in physics, and later was co-discoverer of the gluon, the particle that holds quarks together in protons.
Dr. Wu’s team in Wisconsin was the first American group to join the Atlas collaboration, back in 1993. When the collider was restarted, they had hit the ground running. By Easter 2011, they had detected a telltale excess of gamma rays, pointing to the same Higgs she and others had thought they were discovering 10 years earlier.
Even more provocatively, Dr. Wu’s gamma-ray signal was much stronger than theory predicted, suggesting that on its way to oblivion the Higgs had temporarily changed into other massive particles yet unknown to science, a discovery that could dwarf that of the boson and shake not just physics but cosmology.
Her group wrote a short paper, an “internal note” to alert their Atlas colleagues, suggesting “that the present result is the first definitive observation of physics beyond the standard model.”
Their note was supposed to be confidential — results are not supposed to be released to the outside world until the entire collaboration has checked and approved them — but within hours the note’s abstract was posted in the comments section of a physics blog, Not Even Wrong, run by Peter Woit, a mathematician at Columbia.
Bedlam ensued in the physics world. Dr. Sharma and hundreds of other physicists abandoned their families and canceled vacations to go back to CERN.
The aftermath, when the signal turned out to be another fluke, was brutal. It was suggested that whoever was responsible for leaking the report should leave the Atlas collaboration.
Many physicists, Dr. Wu admits, thought that she herself had leaked the report. A year and a half later, she still found it hard to talk about the Easter event.
“I was so excited I couldn’t control my emotions,” Dr. Wu recalled. She wrote the note as a way of alerting the Atlas community, she said. “I thought CMS would go on vacation and we could get ahead. I’m sorry I did that.”
For Dr. Gianotti, the incident was a lesson in the need for keeping your mouth shut, helping to cement her distrust of bloggers. “Things should be properly understood inside the collaboration before being blogged outside.” Still, “things happen in life,” she added. “My attitude is always positive.”
For CMS, the incident served as what Dr. Sharma called “a good drill.”
Dr. Tonelli said: “In retrospect, this fear of being scooped by Atlas was useful. Once you are under attack, you start to focus.”July 2011: Still Missing
Thus tested, both collaborations began drinking from a fire hose of data as the collider kept racking up collisions by the hundreds of trillions. In the early summer of 2011, both Atlas and CMS began recording a surplus of W bosons, particles that carry the so-called weak nuclear force that drives radioactive decay. That was another telltale sign of the Higgs. On the eve of a big conference in Grenoble, France, Dr. Sharma, of CMS, and Bill Murray, of Atlas, held a summit meeting in the CERN cafeteria and opened their laptops.
“I showed mine, and he showed his,” Dr. Sharma said. “We had many coffees.”
Dr. Murray recalled: “Bang! It’s all looking good.”
The results were reported at the Grenoble conference with great hoopla.
But by the next big conference a month later, in Mumbai, India, the bump was gone.
Dr. Murray said, “It was bizarre: twice as much data and there was nothing.”
This was beginning to be the story of the Higgs.
Physicists already knew by the time the CERN collider started up that if the Higgs existed, it would be found in a narrow window of possible masses — equivalent to 115 billion to 200 billion electron volts of energy. Their task was to sort through that window, looking for the telltale excess, or bump, like a sports fan scanning the radio dial in his car looking for the Yankees broadcast.
By the fall of 2011, most of that window had been ruled out, and physicists worried that the whole window might be closed by the end of the year, meaning that the Higgs, or at least the simplest version predicted by the theorists, did not exist — and sending theorists back to their blackboards in search of a better understanding of our origins.
Paradoxically, many physicists, including Dr. Sharma, who admitted to an “anarchic tendency,” found that prospect thrilling.
The Higgs boson fit like a key into a lock into the Standard Model, a suite of equations that was a battle-tested explanation of most of the forces of nature. But physics, Dr. Sharma explained, advances on surprises.
“Every measurement I’ve made in my career has been in confirmation of the Standard Model,” he grumbled.
For Dr. Tonelli, however, it was a dark time. He recalled being at a conference in November where a theorist had summarized the situation by showing a “terrible slide” of a grave with the name Higgs on it. “Since Peter was 83,” he said of the physicist from whom the boson takes its name, “that was not a good idea.”October 2011: Too Big to Ignore
In the fall, there was a changing of the guard in Atlas. Eilam Gross, a former rock musician complete with earring and a Lou Reed haircut, from the Weizmann Institute of Science in Israel, joined Dr. Murray as co-convenor of the Higgs search, filling in for a colleague who was going on maternity leave.
Dr. Gross had followed an unlikely route to this mission. After serving in the Israeli military as an intelligence officer, he was studying sound engineering in New York when he happened to read “The Tao of Physics,” by Fritjof Capra, a popular book melding physics and Eastern thought.
He dropped everything and went back to Israel, studied string theory at the Hebrew University of Jerusalem and then moved on to experimental work, all the while trying to keep up his music career.
He became what he called a “Higgs soldier” while working on the LEP accelerator. “There are 6,000 Higgs soldiers,” he said of the Large Hadron Collider, “and they all deserve the Nobel Prize.”
He had been applying for the Higgs job in Atlas for years, and had given up until he got a call one day.
When it finally happened for him, Dr. Gross recalled expressing some trepidation about his new role. “What will I do?” he asked.
Dr. Murray told him not to worry, he was going to have the time of his life.
It didn’t take long.
While physicists fretted about the death of the Higgs, something was happening out in the wilds of uncertainty. One bump on physicists’ charts, from the W bosons, was disappearing. But another was blooming like the shy girl at a dance.
In retrospect, nobody could remember exactly when she had come in. But she was the one who would marry the prince.
The bump may have appeared as early as May. It was then, Dr. Murray said, that the Atlas group had discovered an “excess” in gamma rays corresponding to a mass of about 128 billion electron volts. (By comparison, a proton, the building block of the atomic nucleus, is about a billion electron volts.) The bump corresponded to a single particle, a flake of hypothetical energy, that weighed as much as an atom of iodine.
Nobody paid any attention. “End of story,” Dr. Murray said.
The bump persisted, rising and falling as data from more collisions and more channels were added, and kept being dismissed. It continued to grow over the fall until it had reached the 3-sigma level — the chances of being a fluke were less than 1 in 740, enough for physicists to admit it to the realm of “evidence” of something, but not yet a discovery.
Dr. Gianotti recalled being shown the bump during a meeting. Her reaction was characteristically guarded: “Hmm, hmm. That was nice, but let’s hope.”
Dr. Gross had a markedly different reaction. One evening late in November, he was in Paris at a workshop, staying at a colleague’s house. After a wine-soaked meal and some grappa, he fell asleep on the couch.
While he slept, a new data analysis came in from CERN. At 3 a.m. his colleagues Marumi Kado and Alex Read decided to wake up their gently snoring boss. They asked him if he wanted to see the Higgs boson.
Dr. Gross jumped up. “What? Where?” he asked. As he described it later in a blog post, they were all in a state of shock. The bump was too big to ignore anymore.
“We couldn’t believe our eyes. We looked at the screen for ages before we started to digest what we were seeing,” he said. “I think this was the first time Marumi, me and Alex realized it could be the real thing.”November 2011: Oozing Into View
On the other side of the wall of (mostly) silence between the teams, a signal was also oozing into view.
Dr. Tonelli, of CMS, saw it first on Nov. 8. He was making his rounds, talking to his young recruits. In the morning, one group showed him a pair of events that had resulted in a spray of four light particles, a rare “four-lepton” signal. That was one of the signature ways that a Higgs boson would dissolve.
That afternoon he met with a second group in the cafeteria. One of them opened a laptop and showed him a bump in the gamma-gamma channel, the other big Higgs decay channel. It was almost 3-sigma and was at the same energy as the morning bump, about 125 billion electron volts.
“At the end of the meeting, there was some light in their eyes,” he said. “It was my birthday. I considered it a sort of gift.”
The following week, at a meeting in Paris, some people were still talking about the death of the Higgs. Dr. Tonelli was one of the few people in the world who knew differently.
“I was laughing internally,” he said.
Dr. Sharma, of CMS, went home for Thanksgiving and a long-awaited reunion with his family.
In his pocket as he ate was a new plot combining the results from both channels, a new bump indicating a Higgs boson at 125 billion electron volts. A neighbor pestered him with questions about the search, but Dr. Sharma wouldn’t talk.
A year earlier, many of his colleagues had been ready to write off the Higgs boson, and with it the Standard Model. But “on Thanksgiving Day,” he said, “we knew the jig in some sense was up.”
“I would have preferred it the other way,” he said with a sigh, then added: “I knew before the rest of the world. That is all I need.”
Afterward he marveled at how attitudes toward physics had changed from a few years earlier, when some people feared the new collider would destroy Earth. That and the “God particle” talk had gotten the public’s attention, he had to admit: “Once neighbors find out that Sharma is involved in that black hole thing, the dog doesn’t pee in my yard anymore.”Dec. 13, 2011: The Long Hello
Neither Atlas nor CMS knew what the other had until Nov. 28, when the two team leaders, Dr. Gianotti and Dr. Tonelli, met with CERN’s director general, Rolf-Dieter Heuer, in his office.
It was apparent from the outset that nature had dealt Atlas the stronger hand, at least for the first round. Dr. Murray, of Atlas, felt both reassured and relieved.
“If there really is a Higgs, Atlas got lucky and CMS got unlucky,” he said.
According to Atlas, the new particle had a mass of 126 billion electron volts; according to CMS, it was 124 billion.
Neither experiment was even close to having the statistical goods — a 5-sigma level of significance — to declare a discovery. But the fact that two separate experiments were hinting at roughly the same answer was encouraging, and worth telling the world about. CERN scheduled a special seminar on Dec. 13. Dr. Gianotti, speaking through the pain of a toothache and dental surgery to an overflow crowd at CERN and physics fans everywhere clustered around Webcasts, went first.
“If we are just being lucky, it will take a lot of data to kill it,” she said.
It would also take a lot more data to confirm what was still at best a promising hint, with a 1-in-100 chance of being a fluke.
The results put the focus on the next big meeting, the International Conference on High Energy Physics, scheduled for July 4 in Melbourne, Australia, by which time the amount of data from the collider would have doubled. At the very least it would be an interesting progress report to see if the bumps were still there.
Dr. Tonelli made no bones about his belief that this was the Higgs at long last. He told Dr. Heuer, the director general, to “prepare the troops,” and his old friend Dr. Englert, a founder of the Higgs theory, not to book vacation for the beginning of July.
But the experimentalists had all seen promising bumps (and promising reputations staked on them) come and go. “I don’t see the smoking guns,” said Dr. Spiropulu, the Caltech professor. And Dr. Sharma cautioned: “The game is still on. People have to be prepared for there to be no Higgs.”January 2012: The Mother of Everything
Characteristically, Dr. Gianotti was playing her cards close to the vest. She was less excited about the nearly overlapping bumps, she said, than about the fact that they had now managed to exclude almost the whole mass range that had existed for the Higgs only a year before. Now there was nowhere left for it to be.
“This was really important,” she said. “For me, it was clear now where we were going to focus in the next months. So no additional distractions in other mass regions.”
From now on, the rules would be different.
To avoid bias, both teams proceeded to “blind” themselves and not look at the relevant data until the Melbourne meeting. Somewhere along that time, Dr. Gianotti admitted, she had stopped playing the piano, unable to give it the focus it deserved.
In January 2012, Dr. Tonelli handed the reins of CMS to Joe Incandela of the University of California, Santa Barbara. Asked if this was a bittersweet moment to step down, Dr. Tonelli said he had been living a dream. He compared himself to the third runner in a four-man relay race, “a runner that did a fantastic time in his fraction.” He said, “I could not have asked more of my life.”
Dr. Incandela, a man with a warm, casual demeanor, was not so sure at all that the Higgs had been discovered on the previous watch.
“Every other day I think we’ve found it, and every other day I think we haven’t,” he said over lunch shortly after taking over. He described collaborations like CMS as “the last bastion of communism,” and his new job as “a crisis a day.” The group had only a month after recording the last data to analyze the results from 2011, he complained. “So much stress,” he said. “We’ll have to do it again this year.”
He firmly rejected one idea that was buzzing around the blogosphere — that by combining their results the two collaborations could take a shortcut to the 5-sigma goal. “There’s no race — this is a 20-year program,” he snapped. “This is a serious business.”
Dr. Incandela had wandered into science from the art world. Growing up in Chicago, he studied at its Art Institute, intending to be a sculptor. He got interested in science while studying the chemistry of ceramics, went on to get a Ph.D. from the University of Chicago, and then worked at CERN and Fermilab, where in 1995 he helped discover the top quark, the last missing matter particle in the Standard Model.
He brought with him a deeply philosophical and historical viewpoint on the quest to understand nature. The Higgs boson reminded him of the ancient Stoic notion of “pneuma,” a sort of force or tension that permeated space and gave substance to things. It was the first example in history of people wondering about the origin of mass.
“The Higgs is sort of like the mother of everything,” he said. “It tells you something very fundamental about the entire universe. So measuring its mass, for instance, could tell us whether the universe is stable or not. This is really unbelievable if you think about it.”
“So that tells you how deeply we’ve touched into this fabric,” he went on, “and this fabric is everywhere. Throughout the universe. So for me that is a really profound thing about the Higgs. It’s not like other particles.”
In March, adding to the sense of momentum that the Higgs was finally being run to earth, physicists from Fermilab said they had measured their own bump in data from the lab’s Tevatron collider, which had been the world’s biggest for 20 years but had shut down for good the previous fall because the government couldn’t afford to run it anymore. As at CERN, there had been two groups and two detectors who were now combining their data for what would amount to a last hurrah and a what-might-have-been for the Tevatron. The Fermilab physicists had found a broad hump in their data, between 115 billion and 135 billion electron volts — the same general area as the CERN results.
Dmitri Denisov, a leader of the Fermilab effort, wrote in an e-mail at the time, “It is clearly not the answer to crossword, but an important piece of the puzzle!”
The data were of scant statistical significance, however, having a chance of about 1 in 100 of being a fluke. Over the following weeks, Fermilab would improve those statistics to a chance of 1 in 550, heartbreakingly short of the 3-sigma criteria required to claim “evidence” of the Higgs. If there really had been a race, one of the contestants was now out.
Back in Switzerland that same month, during a break when the Large Hadron Collider was not running, Dr. Gross took his girlfriend, Talia Levy Tytiun, down into the Atlas cavern. “I decided that I want to propose to Talia in the place which was the symbol of my life at this Higgs hunting period,” he explained.
“But believe me, I checked a thousand times with her before to make sure she will say yes.”June 2012: Opening the Box
On June 18, the two experiments stopped recording data in order to get ready for Melbourne. By then they had already collected as many collisions — some 400 trillion — as they had the entire previous year.
The Atlas teams had already begun analyzing the first batch of this data a week before. Dr. Gianotti was at a conference at Fermilab when her colleague Dr. Kado sent her a plot of the new data.
The gamma rays were still there, and had grown in significance, putting the boson on the verge of reality. Dr. Gianotti scrawled a note back: “Oh, my God.”
A week later, her team looked at another important decay channel, and her enthusiasm deflated. There was nothing. She spent a few days and nights with her “neurons spinning,” she recalled, wondering how they could have been fooled.
In the next two batches of data, however, nine candidates showed up in the “zed” channel, as they called it. “It was just beautiful to see those,” Dr. Gianotti said.
At 10 p.m. on June 14, small teams of CMS physicists began “opening the box” on their data. Later that night, Dr. Incandela received a plot from the so-called 4-lepton channel, showing a spike at 124 billion electron volts.
He later told the writer Ian Sample that his life changed at that moment.
That afternoon, almost 300 physicists crowded into the room to hear talks on the first results of the unblinding, and the entire collaboration learned that the Higgs was nigh. People were sitting on the floor and standing, Dr. Tonelli said. Another 307 people had linked in by videoconference.
The room was too hot, all the doors had been opened. Dr. Tonelli said, “Everybody was really feeling we were doing something important.”
On June 22, Dr. Heuer announced that there would be a special symposium at CERN on the morning of July 4, the day the Melbourne meeting was to start. Scientists who had already bought tickets to Australia rushed to rebook.
At the time, it seemed like a gamble: neither experiment had yet reached the all-important 5-sigma level.
But as various scientists were pointing out, CERN couldn’t go on almost discovering the Higgs boson forever. Some said CERN should just shut up until the discovery was official.
“If you only have 4.9 you are not allowed to call it a discovery,” Dr. Heuer said later. “But it was sure that even if being short of 5-sigma, if I see both experiments I can still call it a discovery because we are beyond 5 if we combine the two.”
The members of each of the collaborations had to approve anything that was to be presented at Melbourne, which meant that their leaders had a week to mobilize an army and read a thousand pages of papers and reports.
Dr. Incandela, of CMS, said he felt “like a hunted animal.”
“I felt tremendous stress, obviously, because things were very tight,” he recalled. “Several times per day, I would just say, ‘O.K., don’t panic, we’re going to make this.’ But my goal was to make sure we did everything right, and that the collaboration would not regret it, and that the collaboration would all feel part of it, because everyone worked on this in one way or another.”
In a conference room near his office, he set up a SWAT team of a dozen of his brightest young analysts, his “kids,” as he called them. “Keep your smiles to yourself,” he warned them, if they happened to find themselves in the company of their rivals.
On the night of June 24, the graduate students and postdocs in Atlas were tiptoeing toward the 5-sigma finish line. Among them was Sven Kreiss, a New York University graduate student who got a preliminary glimpse of the answer alone in his office late that night when, as part of a crosscheck, he combined the data from two signatures of the Higgs decay and found the result breached 5-sigma. The next day he sent a plot to his adviser Kyle Cranmer, whose birthday it was, saying he had a present for him.
Dr. Cranmer shot back a joyful expletive worthy of the discovery of a sacred particle.
The job of ultimately confirming the boson’s discovery had been entrusted to another pair of graduate students, Haoshuang Ji, a Wisconsin student, and Aaron Armbruster of the University of Michigan — who had sent the plot that Dr. Gross had woken up to in November. They were each working to combine all the Higgs data from all the myriad ways it could fall apart and leave a trace in the detectors. This calculation would make or break the Higgs, because the boson had to behave properly in all its guises.
On the afternoon of June 25, Mr. Ji announced he had gotten a result of 5.08 sigma, causing cheers to go ringing down the corridor outside Dr. Wu’s office; everybody ran to sign the printout. The next day, Mr. Armbruster arrived at the same result.
Atlas was at 5-sigma.
The scorecard, as later enumerated by Dr. Wu:
1,000 trillion proton-proton collisions
240,000 Higgs bosons
350 pairs of gamma rays
8 sets of lightweight particles from the lepton channel.
From this trickle of a trickle of atomic pitter-pat, 6,000 physicists had finally started to put a face on the ghost of the vacuum, the secret controller of cosmic destiny.
Filling in that face could take years. Not knowing yet how closely the new particle matched the predictions of the Standard Model, the physicists took to calling it a “Higgs-like boson.” Or as Dr. Cranmer put it, “Not a God particle but a God-like particle.”
“We don’t know what nature has prepared for us,” Dr. Gianotti said.
She added, “Clearly if we had not discovered the Higgs boson it would have been much more intriguing from a physics point of view. But it is so nice to find a new particle.”
On the eve of the scheduled announcement, Dr. Incandela rehearsed his talk and found that his team was still nervous. Were they ready to go public? It was too late, he told them. They were at 5-sigma. The train had left the station. “We have to stand by our data,” he said.
Later, he said it was what they needed to hear.July 4, 2012: Champagne and Pandemonium
CERN officials locked their auditorium three days before the special symposium to prevent people from camping out in it. Still, the night before, students and scientists began sleeping on the steps. Dr. Higgs and the other founders of the Higgs theory, Dr. Englert, Dr. Hagen and Dr. Guralnik walked into the auditorium on the morning of July 4 to a standing ovation.
Dr. Incandela finished writing his talk at 8:42 that morning. The seminar started at 9. When he walked in, he recalled, “I was just so happy that everything came together — I really enjoyed giving the talk.”
At one point, he noticed that the hand holding a laser pointer was shaking. “It was just the adrenaline,” he said. “My heart was pounding.”
At the end, he flashed a plot of CMS’s final data analysis, showing the big new bump. The room exploded in applause.
He thanked CERN and the world. “These results are global,” he said, “and now shared with all of mankind.”
Dr. Gianotti, of Atlas, now had to follow Dr. Incandela, having gone first in December. After the news from CMS, she wondered if anyone would even be interested in what she had to say. “I’m saying to myself, ‘Well, even if our results were essential, in some sense they will be nothing new compared to what they’ve seen already.’ ”
If nothing else, she thought, her talk would be a valentine to the passion and competence of the 3,000 Atlas scientists.
“Every slide was a reward to the work of many, many people,” she said. “So I was feeling so proud.”
“And I think I got the energy from the eyes of some of my Atlas colleagues who were sitting here in the auditorium,” she added. “The fact that they were looking at me with such intensity and attention was giving me really the strength to go on.”
When she showed the Atlas 5-sigma result, the audience exploded again. The applause seemed to go on forever. It had been left to Dr. Heuer to declare officially that a new particle had been discovered.
“I think we have it,” he said. The cheers began again. Dr. Higgs was seen wiping away tears.
The morning dissolved into pandemonium and Champagne, in the CERN auditorium and in labs, classrooms, conference rooms and living rooms in every time zone in which humans wondered about their universe. Dr. Wu waded through the crowd. She hugged Dr. Higgs.
“I’ve been looking for you my whole life,” she said.
“Well,” he replied, “now you have found me.”
You may read this story in its original format and view additional multimedia on The New York Times.
Take two topics well known to generate clicks: alcohol and longevity.
Find a study that suggests alcohol increases longevity.
Fail to mention the study is observational but still emphasize cause-and-effect language in your headline.
Here’s what you get:
Drinking Alcohol Key to Living Past 90 (NY Daily News)
But it gets worse.
Other unpublished findings from the “90+” cohort project at UC-Irvine — presented at this past weekend’s American Association for the Advancement of Science in Austin, Texas — led to even more sensationalistic headlines. Not only did their survey find that drinking the equivalent of two beers or two glasses of wine per day was associated with 18% fewer deaths, it also found that daily exercise of around 15 to 45 minutes was only associated with 11% fewer premature deaths.
TechTimes opted to blend these two findings into a single whopper of a headline:
Not only is this language unjustified in referring to a study that can only show association, not causation, but the survey did not directly compare alcohol and exercise. So the headline is very misleading.
But, on a very encouraging note, most of the news outlets we regularly review chose not to cover the preliminary findings of this unpublished, observational study. At least not yet. We encourage them to join the “Just say no to clickbait” movement.
Other reported findings of the study included:
- being slightly overweight (not obese) was associated with 3% fewer early deaths
- being involved in a daily hobby two hours a day was associated with a 21 % lower rate of premature deaths
- drinking two cups of coffee a day was associated with a 10% lower rate of early death
But these are observations and nothing more. Furthermore, they are based on self-reporting by the study subjects. That’s a notoriously unreliable way to get accurate information regarding people’s daily habits or behaviors.
The following widely used quotes by Claudia Klawas, MD, one of the UC-Irvine co-leaders, did not help matters:
“I have no explanation for it, but I do firmly believe that modest drinking improves longevity.”
“It’s not bad to be skinny when you’re young but it’s very bad to be skinny when you’re old.”
A co-leader of a 15-year-long cohort study should know it’s irresponsible to use such declarative and cause-and-effect language with the press when your data can not support it.
So, to summarize, here’s what you need to know:Getty Images
Welcome back for another installment of Ask TON. Here’s our latest question:
What are the essentials of a strong proposal for a journalism fellowship?
Fellowships can boost your career in many ways. They provide a supportive environment that can yield more impactful stories. They supplement commissions from journalism outlets (and often provide financial assistance for travel). And the prestige of a big fellowship doesn’t hurt a person’s résumé, either. Fellowships are also a great way to build relationships with your peers—camaraderie shaped during a fellowship can endure long after the fellowship period ends.
As Geoffrey Giller explains in “Paying for It: Getting Grants and Fellowships,” snagging a fellowship requires a heavy-duty application package that makes a strong case for your project’s urgency, showcases your track record and your ability to carry out what you propose, and includes enthusiastic letters of recommendation. Here, we’ve gathered advice about how to assemble a top-tier proposal.
She writes that “fewer adults at risk of advanced bone loss and fractures are undergoing tests for bone density, resulting in a decline in the diagnosis and treatment of osteoporosis” which “threatens to derail the progress that has been made in protecting the bone health of Americans.”
Brody’s column promotes the idea that more drug treatment is required, when, in fact, almost everything about osteoporosis is the subject of intense debate: the link between bone density and fracture risk, the usefulness of the tests for low bone density, the role of the pharmaceutical industry in reconceptualizing risks as disease, the notorious expanding disease definitions which contribute to overdiagnosis, as well as the marketing of drugs often of minimal benefit and evidence of substantial harm.
The study which forms the main basis of this article, describes hip fracture rates between 2002 and 2015 declining over most of that period but leveling off since 2012. The single biggest factor blamed on this leveling of rates is fear of the adverse effects of osteoporosis drugs. Those fears have certainly been stoked by FDA warnings indicating that longer term use of bisphosphonates increases one’s risk of developing an “atypical” fracture of the femur or thighbone. Taking a drug because of concern about fracture risk from osteoporosis, only to find it could cause the spontaneous snapping of the largest bone in one’s body is enough to make many people think twice. Surely there have been other factors that might affect hip fracture rates, but the story doesn’t discuss any. For every research group claiming that osteoporosis is underdiagnosed and undertreated, there are those on the other side–including patients, researchers and clinicians– pointing to evidence that it is overdiagnosed and overtreated.Osteoporosis: The emperor has no clothes
One of those researchers who has delved deep into – and written widely about – these controversies is Teppo Järvinen, MD, PhD, an orthopedic surgeon and researcher from the University of Helsinki in Finland.
“In my opinion, overstating the need to treat osteoporosis and downplaying the dangers of osteoporosis drugs together amount to a perfect storm of disease mongering,” wrote Järvinen in an email. “It is easy to exaggerate the effects of osteoporosis drugs, and maintain the fiction that vertebral fractures, which are rarely associated with any pain or other symptoms, are deadly and serious. Both of these are among the many tactics used to sell more drugs in the name of fracture prevention.”
In a journal article, “Osteoporosis: the emperor has no clothes,” Järvinen and colleagues wrote that the evidence supporting the use of bone-targeting drugs to prevent hip fractures is limited to women between 65 and 80 with established osteoporosis (whereas there’s meager proof the drugs help women over 80 or men at all ages). He noted specifically that the “anti-hip fracture efficacy shown in clinical trials is absent in real-life studies [while] many drugs for the treatment of osteoporosis have also been associated with increased risks of serious adverse events.”
You can learn more about Järvinen’s research in a 2015 podcast we produced with him.
So when the New York Times sounded the alarm bells and decried the alleged treatment gap in osteoporosis without delving into these many controversies, the newspaper delivered a serious disservice to their readers.Interviewing sources with conflicts of interest
Perhaps one of the reasons why the Times presented a one-sided argument promoting more osteoporosis drug treatment is that most of the authors of the journal article upon which the column is based have deep financial connections to a wide range of osteoporosis drug makers. In particular, the lead researcher discloses that he received “institutional grant/research support from Amgen, Merck, and Lilly; he has served on scientific advisory boards for Amgen, Merck, Lilly, and Radius.” Other authors’ admitted conflicts include:
- One is a paid data analyst for the International Society for Clinical Densitometry.
- One is a consultant for Amgen and Radius.
- One has received institutional grant/research support from Amgen and is a consultant for Pfizer.
- One has received research grants from Amgen, Lilly, and Merck and has served on scientific advisory boards for Amgen, Merck, and Radius.
- One has served on scientific advisory boards for Amgen, Lilly, and Radius; is a consultant for Amgen, Lilly, Merck, Radius, Medtronic, and Hologic; and is on the speakers’ bureau for Amgen and Lilly.
In this case, an independent expert could have reminded readers that this was an observational study, and may have been affected by uncontrolled or uncontrollable biases. There are other possible hypotheses which could explain the leveling off of hip fracture rates that have absolutely nothing to do with osteoporosis testing and treatment. For example, the overuse of certain types of drugs such as sedatives, benzodiazepines and opioids can affect the rate of falls and fractures and yet it is clear that those effects were not accounted for in this study. One might even assert a strong counter-hypothesis: that it is the increased use of opioids in the years from 2012 to 2015 which could help explain the increase in hip fractures.Disconnect with readers
There was a perceptible disconnect between the Times column and what may be going on with so many women. The article quotes one bone specialist: “many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medication at all, or when prescribed, refuse to take them.” Osteoporosis treatment decisions should be a matter for fully-informed shared decision-making encounters between patients and doctors. “Unequivocal need” for treatment might be questioned by some women in such settings.
There was an even more clear disconnect between the Times column and some of its readers, who left online comments such as:
- “It’s really not worth reading Jane Brody’s columns since one can find the same point of view in the barrage of Big Pharma marketing to which we are subjected. I’ve nothing against bone density scans (I’ve had two so far), but if the rationale for them is to get more women on Fosamax etc., much of the research seems to indicate that the outcome would be not only harmful, but difficult to reverse.”
- “I was disturbed by Jane Brody’s article- and felt she was simply writing for the drug companies, not sharing a true overall picture.”
- “I have been asking every clinician I see and have searched Pub Med for years, in search of the clinical proof of bone density increases (or in the least, a halting of the process that results in bone loss). My search comes up empty. And not one clinician has been able to find me a journal publication demonstrating density improvement….The medical profession wonders why we are skeptical? Give me answers to my questions.”
- “An excellent critical overview of the osteoporosis drugs is “Osteoporosis: The Emperor Has No Clothes,” published by Jarvinen et al. in 2015. The language used by Brody throughout her piece, e.g., ‘should be treated,’ and the multitude of quotes by physicians pushing the drugs, with not a single viewpoint from either a dissenting physician or a patient who has suffered one of the allegedly “very rare” side effects, reflects badly on The NY Times, which ought not be proselytizing for drug treatment under the guise of objective journalism.”
As we wrap this up, more than 250 reader comments have been left online following the Times column demonstrating the intensity of the public dialogue and debate, and further demonstrating how the Times column could have been improved.
Disclosure: Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and has collaborated on projects with Teppo Järvinen, MD, PhD, quoted in this story, and other researchers at the University of Helsinki.
‘Ultra-processed’ foods and cancer: Headlines show the right way, and the wrong way, to frame study results
Today’s headlines on ultra-processed foods and cancer offer a good case study in the right way — and the wrong way — to frame the results of an observational study about diet and the risk of disease.
The stories are based on a French study in which more than 100,000 people were asked about their diets. Researchers looked specifically at intake of what they described as “ultra-processed foods” (e.g. sugary snacks, soda, chips, chicken nuggets) and the rates of several common cancers. They found that “a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer.”
The researchers documented about 2,200 cases of cancer among the 105,000 participants during 5 years — a rate of approximately 2.1%. Put in absolute terms, then, a 10% greater risk might translate to 0.2 percentage point increase in the overall cancer rate — from 2.1% to about 2.3%.Association ≠ Causation
A study such as this is capable of determining a statistical association between two things — but not whether one thing caused the other to happen. The tentative nature of the relationship is appropriately conveyed by headlines suggesting a “link” between certain foods and cancer — or that these foods are “tied” to cancer risk. For example:
But it would be inappropriate to suggest, as these headlines below do, that ultra-processed foods “increase the risk” of cancer or that they “raise” cancer risk.
The framing of these latter headlines suggests that processed foods caused an increased in cancer risk — a leap that goes way beyond what this preliminary study is designed to show.
In fact, if you read further down into these stories, they all will tell you that the results are not proof of cause-and-effect, as NBC does here:
The researchers stress that the study does not show that the highly processed foods caused the cancers. People who eat a lot of junk food have other habits that predispose them to cancer, not the least of which is smoking.
Which raises this question: If the study isn’t capable of showing that highly processed foods cause cancer, why does the story immediately jump to speculation on that point in its headline (“Highly processed foods may raise cancer risk, study finds”)?
It starts the discussion on the wrong foot and addresses an issue that won’t be clarified for many years — if ever.
Meanwhile, just think of all the other habits and behaviors — beyond smoking rates — that might differ between groups of people who eat lots of junk food and those who eat more healthily. This list of confounding factors would include physical activity levels, socioeconomic status, and alcohol use — to name just a few. Attempts to “adjust for” these factors may not completely eliminate their impact on the findings.
And even if we assume that the researchers have identified a cause-and-effect relationship between diet and cancer risk, that relationship may not be as simple as “ultra-processed food causes cancer,” said Yoni Freedhoff, MD, a nutrition and weight management expert at the University of Ottawa and a HealthNewsReview.org contributor. “The question that leaps to mind is whether ultra-processed foods lead to increased cancer, or whether it’s simply more ultra-processed foods leading to a decrease in the consumption of foods that are protective?” he said.Why does this matter?
Even nutrition scientists agree that the public doesn’t trust scientific messages about nutrition.
That’s in part because of headlines that overstate the findings of observational studies, which are a mainstay of nutrition research.
Those headlines often emphasize benefits or harms of specific foods or diets, based on evidence that is incapable of proving those benefits or harms.
When new studies contradict the previous findings, a new round of contradictory headlines sows confusion and misunderstanding.
The solution is for everyone — scientists, journalists, and the public — to become more realistic and informed about what these studies can and cannot tell us about nutrition.
While it may seem like a small thing, a shift to more cautious language in news headlines may facilitate a shift to more accurate thinking about these issues.
Here are some more tips on how to write better headlines for diet studies.Getty Images
Congratulations to the 2018 NASW Travel Fellows to the Association for the Advancement of Science (AAAS) annual meeting, Feb.15-19 in Austin, Texas. These 11 undergraduate students from around the U.S. were selected by the NASW Education Committee from a competitive pool of applicants. Travel fellows will each write a story for publication on the ScienceWriters website and participate in the NASW Mentoring Program and NASW Internship Fair.Article type: FellowshipsGetting startedArticle topic: NASW newsNew to science writing
A recent analysis of once-secret clinical trial data concluded that a popular morning sickness drug, Diclegis, doesn’t actually work.
But those news reports didn’t mention a much bigger issue: the push to release comparable clinical data for thousands of other drugs and medical devices — data that has been kept under wraps by the FDA and other regulatory bodies.
Detailed data that companies submit to regulators when they seek a product’s approval — known as a clinical study report, or CSR — could enable researchers and clinicians to get a fuller picture of its benefits and risks.
Those reports haven’t been made public, often because manufacturers won’t sanction their release. A physician-researcher in Canada was able to obtain data about Diclegis from Canadian health authorities only after a four-year battle, helped along by some media publicity.
“It is practically impossible to do this type of work now,” said the researcher, Nav Persaud, MD, a family physician at St. Michael’s Hospital in Toronto. “Regulators have to make it easier for researchers to access this information.”More details could improve clinical guidelines
It’s not the first time independent scrutiny of comprehensive trial data has contradicted published research.
For example, a 2014 Cochrane review used CSRs to show that the benefits of Tamiflu to treat flu symptoms are smaller than previously believed and may not outweigh the harms. A 2013 review of the data behind Medtronic’s Infuse spinal implant concluded it was actually no better than an older treatment and may carry additional risks.
In both cases manufacturers voluntarily released the data under pressure from the research and medical community, but that’s unusual.Media coverage is ‘very, very important’
Some advocates say it’s time to uncork CSRs for all drugs and devices, which can amount to thousands of pages per product, including descriptions of every adverse event and the minutiae of how a trial was performed. They argue these nitty-gritty details could improve the quality of clinical practice guidelines and systematic reviews, which try to aggregate all evidence about a medical intervention.
“Transparency of clinical trial data is a no-brainer,” said Peter Doshi, PhD, an assistant professor of pharmaceutical health services research at the University of Maryland and associate editor of The BMJ, in an email. “It just requires reflecting on the fact that there is more to the trial than the 10-page report we see published in journals.”
Releasing the FDA’s trove of evidence could foster a “cascade” of better information to help clinicians, patients and policymakers make decisions about medical treatments, said Kay Dickersin, PhD, director of the U.S. Cochrane Center and a professor at the Johns Hopkins Bloomberg School of Public Health.
“Public awareness and media coverage is very, very important to promoting data transparency,” Dickersin said via email.Published data ‘cannot be trusted’
Tianjing Li, PhD, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, argued in a recent BMJ editorial that “information in the public domain cannot be trusted at face value” because companies can downplay adverse events and switch outcomes.
For example, a 2000 examination of 12 clinical trials of the drug gabapentin (brand name Neurontin) concluded that in eight of the studies researchers changed the primary outcome from what was stated in the original trial description, most often to indicate a more favorable result for the drug.
Advocates for disclosure also cite the 2004 Vioxx case, in which tens of thousands of people died from taking the painkiller after it was approved by regulators. If comprehensive trial data had been available for independent review, they argue, its safety problems could have been detected much earlier.
A sweeping Blueprint for Transparency by researchers and academics recommended the FDA take a number of steps including releasing CSRs to advance innovation, improve the design of clinical studies, and avoid exposing patients to drugs that have been shown to cause harm.
Broader transparency can empower patients, clinicians, researchers, and others to use information more effectively for a broad range of goals. For example, knowledge that a product failed because of problems with kidney toxicity may help patients and clinicians to understand the need for alternatives and lead researchers to focus on new assays of kidney function or develop new compounds that work through different mechanisms.
That document was supported by the Laura and John Arnold Foundation, as is Doshi’s project to collect data from unpublished or misreported trials. The foundation also funds HealthNewsReview.org.FDA lags behind other regulators
But while European and Canadian regulators have committed to releasing CSRs, the FDA has dragged its feet.
The European Medicines Agency (EMA) began routinely publishing CSRs in 2016. Health Canada announced in March 2017 that it would work to make clinical data for all drugs and medical devices public, including products that were rejected or are already on the market.
In January the FDA announced a pilot to release portions of CSRs for as many as nine approved drugs.
However, critics say the pilot is so narrow in scope it might not benefit consumers. It will include only drugs whose corporate sponsors volunteer to participate, and only parts of the evidence deemed “most important to the FDA’s assessment of the safety and efficacy of the drug.”Voluntary pilot leaves out some useful data
There’s no plan to release data that could prove more useful, such as CSRs for drugs that were not approved or were withdrawn, or for so-called “legacy drugs” that have been on the market for decades and make up the bulk of prescribing.
Nor are there plans to release data pertaining to unapproved “off-label” uses of drugs, or to medical devices.
Doshi said there’s “no real sign that the pilot reflects a change in FDA’s long-held view” that CSRs are protected by laws governing trade secrets.
“The real test will come if the FDA ever attempts to implement a CSR release program that is not voluntary for industry,” he said. “That is when things can get more confrontational.”
In Europe, some pharmaceutical companies brought legal challenges to block the release of CSRs, claiming they contain proprietary information. The EMA has maintained that clinical data isn’t proprietary.Open data movement has attracted coverage
The issue of open data in general is gaining some traction among journalists.
For example, the AllTrials campaign has focused media attention on the issue of unpublished clinical trials, showing how missing data from those studies — which may be shelved by drug company researchers because of negative results — can skew the medical literature and affect clinical decision-making.
There has also been some coverage of efforts to get drug companies and medical journals to share the underlying data from clinical studies that do get published. HealthNewsReview.org wrote about how lack of access to such data hampered the ability of the U.S. Preventive Services Task Force to issue optimal guidance on the use of statins.
But the role of the FDA and other regulators in promoting transparency has largely escaped scrutiny from U.S. news outlets.
A Times profile of FDA Administrator Scott Gottlieb, entitled, “FDA Chief Goes Against the Administration Stereotype,” offered an upbeat take.
Jennifer Miller, an assistant professor and clinical trials transparency expert at New York University School of Medicine, said a pilot program started by Dr. Gottlieb, in which pharmaceutical firms voluntarily release information about their clinical studies for approved drugs, was a step in the right direction.
“The industry is already trending toward releasing them,” Dr. Miller said. “It’s a safe time to roll out a pilot. I think he’ll likely be successful and learn what works and what didn’t.”Canadian journalists put regulators in the spotlight
By contrast, some Canadian journalists focused on the refusal of Health Canada to release clinical evidence on Diclegis. The Toronto Star ran a 2015 investigation that it called it “a story about secrecy,” documenting how drug companies wielded control over what data the government shared with the public.
Eventually Persaud, the Toronto doctor, obtained the CSR for the company-sponsored trial, after agreeing to keep it confidential. “I think people are shocked that this type of information was hidden,” he said.
His team concluded that selective reporting of outcomes in the published study had made the drug seem effective; measures that showed a benefit, such as time lost from employment due to nausea and vomiting, were included in the results while measures that did not show a benefit, such as time lost from household tasks, were left out.
While some observers caution that his analysis isn’t definitive, Persaud has called for regulators to reconsider their approval of the drug and for doctors to stop prescribing it.
Diclegis manufacturer Duchesnay Inc. has said more than a million prescriptions have been written for the pill, which costs about $430 for 60 tablets with a coupon, according to web site GoodRx.
Meanwhile, the FDA hasn’t responded to Persaud’s plea, made years ago, for its own data on Diclegis. “They are still processing my request,” he said.Getty Images
Eleven budding science writers won NASW Travel Fellowships to attend the 2018 American Association for the Advancement of Science (AAAS) annual meeting. Their reports on selected sessions are being posted on the ScienceWriters web site.Article year: 2018Article type: AAAS meeting coverageArticle topic: Conference reports
There are two viral diseases that, if they infect pregnant mothers, can cause birth defects and a range of other health problems for their babies. One disease affects thousands of infants each year in the United States, while the other affects fewer than a hundred. Why has news coverage focused almost exclusively on the less common disease? And what does that focus mean for public health efforts to control both diseases?
The first disease is cytomegalovirus infection, or CMV, which you may not have heard of. The second disease is Zika virus infection, which you have almost certainly seen in the headlines.Why the disparity in news coverage?
CMV is endemic to the United States, meaning it’s well established and the rate of transmission has not changed dramatically over time. Zika is not endemic. Although scientists have been familiar with Zika since it was first discovered in Uganda in 1947, it was thought of as being relatively innocuous – when it was thought of at all. But in 2007, things started to change. That’s when Zika first appeared in Micronesia. It then began appearing in other parts of the world: Cambodia in 2010, Thailand in 2012, French Polynesia in 2013 and – much closer to the U.S. mainland – Brazil in 2016.
And it was in February 2016 that Zika began drawing attention far and wide – that was when the World Health Organization announced that “a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven.” Microcephaly is a birth defect that impacts the development of the baby’s head and brain. It is linked to learning disabilities, hearing loss, and a range of other health problems. (Several other diseases, known as TORCH [toxoplasmosis, “other” e.g. syphilis, rubella, CMV, and herpes] infections, can also cause birth defects if the mother is infected during pregnancy.)
Suddenly, Zika was scary. And rather than an established, endemic disease, Zika was an epidemic – a disease that was spreading rapidly in new territory. And that difference was likely crucial.
“I think the difference is that one [Zika] appeared in epidemic form, with lots of unknowns about epidemiology, impact, etc.,” said David Tuller, DrPH, a senior fellow in public health and journalism at the Center for Global Public Health UC Berkeley’s School of Public Health. “The other [CMV] basically continues at the same level it always has – it’s endemic, and therefore wouldn’t be likely to trigger the kind of fear and anxiety that Zika created. People tend to get used to steady rates of various things – it’s when changes happen that coverage and attention shoots up.”Other experts agree: fear drives Zika headlines
“It has been our experience that diseases with a bigger public scare factor will garner headlines, while slow and steady epidemics tend to be widely ignored,” said Michelle Levander, founding director of the Center for Health Journalism at the University of Southern California.
Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity.
“I think the initial, widespread coverage of Zika was due to fear of the unknown, because we didn’t know how widespread the Zika epidemic would become, or how frequent the cases of congenital Zika would be from the initial reports,” said Sallie Permar, MD, PhD, a professor of pediatrics at Duke University who studies CMV. “CMV has had the same prevalence and incidence since the 1960s.”
But while the research community understood the attention being paid to Zika, they were frustrated at the lack of attention being paid to CMV.
“When seeing the news coverage of Zika, people in the CMV field felt like, ‘You guys, we have a Zika here already. It’s called CMV,’” said Permar.Some news outlets picked up on this theme
In 2016, articles appeared in publications like the New York Times, Nature and Quartz, all addressing CMV in the context of the Zika epidemic. As the New York Times’ headline put it: “CMV is a greater threat to infants than Zika, but far less often discussed.”
But those articles were one-offs, and there has been little or no ongoing coverage of CMV – which has not been the case for Zika.
For example, I searched for news stories featuring “Zika” for the three-month period from Nov. 6, 2017 to Feb. 6, 2018. That search turned up a host of news stories in high profile news outlets, such as NPR (at least twice), TIME (at least twice), and the New York Times.
During that same time period, there were almost no news stories in mainstream media outlets featuring the term “cytomegalovirus.” And the few stories we could find that did appear in mainstream outlets were not actually focused on CMV. For example, a human interest story from ABC News was focused on a little girl who got hearing aids from an “unlikely donor” – CMV was mentioned in passing as being why the little girl needed hearing aids in the first place.
“There was definitely some frustration in the CMV community about the attention given to Zika when CMV causes far more disease, and always has, and always will, until we make a breakthrough,” Soren Gantt, MD, PhD, MPH, an infectious disease researcher at the University of British Columbia, said.
Which raises another question…Does the disparity in news coverage matter?
The overwhelming response from CMV researchers is “Yes,” and for several different reasons.
“One reason is that CMV is a preventable infection,” Permar said. “Studies have found that, if pregnant women pay attention to handwashing and other prevention methods, you can limit the likelihood of congenital CMV. Pregnant women hear: Don’t eat lunchmeat, because of Listeria – but perinatal Listeria infections are extremely rare these days. CMV is far more common, but expecting moms aren’t hearing about what they can do to limit their risk – like, don’t put your toddler’s pacifier in your mouth.”
[Zika infection can also be prevented by protecting yourself from the bite of infected mosquitoes.]
“The OB-GYN community in the US has probably under-informed women about the risks of acquiring CMV in pregnancy,” said Mark Schleiss, MD, a professor of pediatrics at the University of Minnesota who has researched CMV since the late 1980s. “The CMV community certainly shares this view, by-and-large. I think it is because so many of us are pediatricians, and so many of us hear the same refrain over and over and over again from mothers of newborn and infants injured by CMV: ‘Why didn’t anyone tell me about this when I was pregnant? Why am I just hearing about this virus for the first time now?’”
[The New York Times story mentioned above delves into the reasoning behind the ob/gyn community’s decision not to counsel women regarding CMV prevention.]
A second reason researchers would like to see more coverage of CMV is diagnosis and treatment.
“We have good testing for congenital CMV in the infant,” Permar said. “We know it’s common, yet we don’t test for it. All of the diseases that we engage in standard screening for in newborns, put together, are less common than CMV.”
Screening is important, Permar says, pointing to research that suggests using antivirals in newborns who are diagnosed with CMV – and are displaying symptoms – can have at least a modest effect on reducing the severity of hearing loss and improving developmental outcomes. (However, it’s worth noting that there is ongoing debate in the pediatrics community about the proper approach to CMV screening.)
And, finally, there is the issue of creating public support for CMV research.
“There was definitely a big influx of money earmarked for Zika,” Gantt said.
“For federal funding agencies, I think that media coverage does have greater impact, since those who control the funding – the U.S. Congress – are accountable to voters, and voter impressions can be influenced by the media,” Schleiss said.
“Certainly as much money as has been devoted to developing a Zika vaccine should be devoted to developing a CMV vaccine,” Permar said. “The NIH budget is under congressional oversight. And if Congress people don’t feel like CMV is something their constituents need addressed – like it was with Zika – CMV is not going to be a priority for NIH or the CDC.”
And that raises one last question…Could, or should, reporters cover endemic diseases?
The journalism professors I spoke to think the answer is yes, there needs to be a more concerted effort to address endemic diseases that affect thousands every year – but that most people haven’t heard of.
“We don’t see things that aren’t changing,” Tuller said. “Why do we accept 30,000 car accident deaths every year, as we do? It’s because the number stays the same every year. We need reporting to challenge our biases.”
“Reporters can play a critical role in improving public understanding of less sexy diseases that exact a disproportionate toll,” Levander said. “Greater understanding can lead to real change — new resources, better disease tracking and a greater investment in solutions.
“At the Center for Health Journalism, we support journalists who write on health disparities without an obvious news hook,” Levander said. “They do so by diving deeper, by marrying great narratives with data and engagement. Finding the people who can bring the numbers to life can go a long way toward illuminating many chronic ills.”
Disclosures: Mark Schleiss is a consultant for Merck corporation. Sallie Permar consults with Pfizer and Merck on CMV vaccines. Soren Gantt receives research support from VBI Vaccines Inc. and Merck for CMV vaccine development and from Meridian Bioscience for CMV diagnostic test licensure.Getty Images Getty Images
The NASW Membership Committee is currently seeking several new members to help expand membership and improve benefits for existing members.Article type: GovernanceArticle topic: NASW news
A number of news stories on Monday linked the flu-related death of a Texas schoolteacher to her reluctance to fill a prescription for a generic version of antiviral drug Tamiflu.
They were misleading because there’s no evidence that antiviral medications can prevent an otherwise healthy person from dying of the flu.
They’re also emblematic of fear-mongering coverage that suggests otherwise healthy people are dropping dead in this year’s severe flu season.
Amid a steady stream of hair-raising statistics about local and national death tolls, the story of Heather Holland, a 38-year-old mother of two who died within days of feeling her first symptom, served to put a human face on the epidemic. It’s not at all clear, however, that her case is representative of people who have died from the flu.
After appearing last week in the Wall Street Journal and the Weatherford (Texas) Democrat, Holland’s story was picked up by several news organizations that focused on her decision not to fill a prescription for the antiviral:
Atlanta Journal-Constitution: Texas teacher dies from flu after spurning medication that cost $116Misplaced emphasis on antivirals
The coverage seems to imply that if Holland had received the medication she might have lived. But in fact, the FDA has concluded that Tamiflu is not proven to saves lives, as medical journalist Jeanne Lenzer wrote in 2015 in the BMJ.
The Food and Drug Administration told The BMJ that data submitted to it for review do not support the claim that the neuraminidase inhibitor oseltamivir (marketed by Genentech and Roche as Tamiflu) ‘saves lives.’ The FDA said that oseltamivir ‘has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.’
None of the stories made that point.
ABC’s Good Morning America featured the story of a different 38-year-old mother from New Hampshire, Amanda Franks, who chose not to take the Tamiflu prescribed by her doctor because of worries about side effects. “Two days later she got sicker and died on the way to the hospital,” the report tells us, adding that the drug is “proven to be effective.”
Other stories have fed potential concerns about the availability of antiviral medications due to heightened demand. They include GoodRx’s Tamiflu prescriptions reveal shocking flu trend and the Rochester, Minn. Post-Bulletin’s You need Tamiflu, but can you get it?
But HealthNewsReview.org contributor Preeti Malani, MD, a professor of medicine at the University of Michigan, cautioned there’s no way to tell whether taking a prescription antiviral would have saved the life of the Texas woman, or anyone else. Some patients take an antiviral promptly after getting their first flu symptoms and die anyway, she said.
“I don’t think people should be panicked if they don’t get their Tamiflu,” she said. “It is not this amazing panacea, the way an antibiotic might be in fighting an infection.”Only a modest benefit
While the CDC maintains there’s a role for antivirals in stemming the symptoms and spread of flu if taken within two days of the onset of symptoms, there’s only modest evidence of a benefit.
A 2014 Cochrane review based on a review of data of trials in more than 24,000 people challenged the assumption that antivirals Tamiflu (oseltamivir) and Relenza (zanamivir) are effective at fighting the flu.
The Cochrane review confirmed “small benefits on symptom relief, namely shortening duration of symptoms by half a day on average,” but said there’s little evidence that drugs reduce hospital admissions, lower the risk of developing pneumonia, or prevent the spread of the flu.
Another recent Lancet analysis found that Tamiflu can help prevent hospitalizations from the flu. But as Vox reporter Julia Belluz pointed out, this finding applies only to people who are at high risk of complications from the flu (for example due to an existing chronic illness); otherwise healthy people saw no reduction in rate of hospitalizations.
The hyped stories about Holland’s death didn’t mention the weak evidence about the effectiveness of antivirals or address the potential harms, which according to Cochrane includes heightened risk of nausea, vomiting, psychiatric effects and stomach pain in adults and vomiting in children.
ABC’s coverage mentioned those risks, but implied that Franks’ decision not to take the drug was foolish and tragic in hindsight because the medication could have saved her. ABC didn’t cover the substantial evidence that supports Franks’ choice to forego treatment.‘Seemingly health adults’ at risk
Along with overstating the case for antivirals, coverage has fixated on the notion that even healthy people are vulnerable.
The Journal’s piece, headlined “The Deadly Flu No One Saw Coming: Thousands of people have been treated at hospitals, including seemingly healthy adults, marking the worst season in a decade,” focused on Holland and one other 30-something mother who died of complications from the flu.
In both cases, the women reportedly died within a week of their initial symptoms. The Journal portrayed them as exemplifying thousands of people who “have been treated this season at hospitals for pneumonia and other complications, including seemingly healthy adults with no underlying medical problems.”
However, the story doesn’t offer data on how many “seemingly healthy adults” are actually dying of the flu.Deaths of healthy people are rare
Similarly, the USA Today Network declared that “reports of otherwise healthy or young people dying from the infection are flying around,” without providing data.
A Washington Post story reported that “officials are seeing unusually high levels of hospitalizations in non-elderly adults, with the rates for 50-to-64-year-olds significantly higher than what they were at the same period in the severe 2014-2015 season with the same predominant flu strain.” Its coverage included an anecdote about a 58-year-old woman who died of the flu, but again, with no data to back up the idea that the flu is killing scores of people in their prime.
The Post story also mentioned Holland’s death, writing that “the cost of prescription antivirals has led some patients to hesitate using them, with tragic consequences.”
Cases of seemingly healthy people dying of the flu are really an anomaly, Malani said, and news organizations need to point that out along with the fact that patients who die often have an underlying risk factor that isn’t always evident, such as such as pregnancy, heart disease, or obesity.
The CDC has estimated the total number of U.S. flu deaths these season could be close to 56,000, and most of those are expected to be either the elderly or young children.‘Over the top’ coverage
Harold DeMonaco, MS, a visiting scientist at the MIT Sloan School of Management and one of our expert reviewers, said via email that some of the coverage this flu season has been “a bit over the top.”
“I think that the message of getting a flu shot even now is being missed in most of the coverage,” he said. “The flu is not a benign infection so the stories of the unfortunate deaths are probably helping emphasize that point. The old adage ‘an ounce of prevention is worth a pound of cure’ comes to mind.”
That singular message about the importance of the flu vaccine is emphasized by the FDA.
Meanwhile, scary new reports appear to be contributing to record emergency room volumes at the University of Michigan Health System, Malani said.
“All these news stories about this person who was fine and hours later they died, they put people into a panic,” Malani said. “They need to be balanced with the actual numbers.”Getty Images
In 2012, ProPublica reporter Marshall Allen came across a staggering statistic: The U.S. health care system wastes an estimated $765 billion each year. That’s about a quarter of the total amount spent on health care and more than the entire budget of the Department of Defense. The statistic stunned Allen, who regularly covers health care and patient safety. It also gave him a new way to look at his beat. Perhaps politicians and journalists alike have been approaching the soaring cost of care and the challenges of expanding insurance coverage from the wrong perspective.
Last year, Allen decided to root out the sources of squandered funds within the system—an investigation that culminated in a series called Wasted Medicine. Allen discovered how hospitals discard unused medical supplies, how some drug expiration dates are meaningless, and how drug companies knowingly make oversized eyedrops—a story that prompted a group of U.S. senators to introduce legislation to reduce wasteful packaging of medicines.
And in his November 28, 2017 piece, “A Hospital Charged $1,877 to Pierce a 5-Year-Old’s Ears. This Is Why Health Care Costs So Much” (co-published by ProPublica and by the NPR Shots blog), Allen digs into the problem of health care providers pushing procedures their patients don’t even need. This story grew out of a tip from Margaret O’Neill, who accepted an offer to have her daughter’s ears pierced during a routine surgery at a children’s hospital in Colorado, only to be later stuck with an exorbitant bill for the perk. Then there’s Christina Arenas, an attorney who, after seeking treatment for common cysts in her breasts, was put through a mammogram and several ultrasounds that experts say were unneeded.
Allen’s story recounts these and other examples of unnecessary treatment, including data showing that hospitals are delivering costly intensive care to patients who may not even need it. But his reporting also equips his readers to be more critical consumers of their own care. This is partly because he gets into the nitty-gritty of each case, wading through dense medical records and talking to a host of experts—all while weaving a clear and compelling narrative. Here, Allen tells Rachel Zamzow about what inspired him to tackle the gargantuan topic of needless health care spending and how he found real people to make his story come alive. (more…)
The National Association of Science Writers established the Excellence in Institutional Writing Award to recognize high-caliber, publicly accessible science writing produced on behalf of an institution or other non-media organization. Entries close April 20.Article type: Grants & awardsArticle topic: NASW news
If only mice and baby pigs could read; or, at least, learn which oils and infant formulas are good for them.
If only headlines — like those we feature below — would stop misleading people. Especially when it comes to common health problems like Alzheimer’s and cardiovascular disease that are of interest to millions of people.
It’s a lot to ask, I know. So how about just one of the above?
So, once again, we’ve decided to take a look back at the news stories and releases we’ve systematically reviewed to see if the headlines and the content are in synch. This is what we found when we looked back at what we’ve published so far this year.News RELEASE report card: 8 of 15 (53%) headlines overstate evidence (we list three examples below)
Headline: Choose Omega-3s from fish over flax for cancer prevention, study finds
Study: Researchers measured tumor growth in mice with an aggressive form of breast cancer that were fed varying types of omega-3s.
Our review: Who’s supposed to “choose” the omega-3’s? The mice? Or humans who prematurely base their dietary choices on rodent studies? Our reviewers said:
“… there’s no conclusive evidence that eating fish reduces cancer risk, and no mouse study can prove otherwise. News releases shouldn’t extrapolate from the evidence as this one does by conferring benefits seen in a few unusual mice onto all humans looking to prevent any form of cancer. Such misleading news releases tend to produce misleading coverage …”
Headline: Prebiotics in infant formula could improve learning and memory and alter brain chemistry
Study: Researchers measured if adding prebiotics to “infant” formula influence brain development. The infants in question? Piglets. (Yes, this was industry-funded.)
Our review: “While formula-fed piglets might have shown higher scores on a “novel object recognition” test, it is far too early to imply that these results would be replicated in humans. The likely value of this research is in better understanding of the relationships between gut and neurological function. That’s important basic science, but not ready for clinical application.”
Headline: Proper exercise can reverse damage from heart aging
Study: A small study (~50 people) showing that fairly aggressive and regular exercise in sedentary, middle-aged adults can marginally increase maximum oxygen uptake and moderately improve the elasticity of the main pumping chamber of the heart (left ventricle).
Our review: The headline is misguided, and much of the language in the news release is unjustified. Here’s why, according to our reviewers:
The research can’t tell us if risk for heart failure has been reduced in these study participants. Nor does it establish what is meant by “heart aging” and how that has been “reversed” by the intervention. The news release would have been markedly improved if such terms had been dropped, and focused more on what is — and is not known — about poor fitness as a risk factor for heart failure.News STORY report card: 4 of 15 (27%) headlines overstate study evidence (we list two examples below)
Headline: Brain ‘pacemaker’ might help slow Alzheimer’s
Study: Designed to test for safety, this was a “proof of concept” study of deep brain stimulation (DBS) using an implanted device.
Our review: The headline states the device “might help slow Alzheimer’s,” but this concept was tested on just three people, and there was no control group to compare the results against.
Our reviewers concluded: “We think this study was one of those that isn’t quite ready for a consumer news audience; it’s just too preliminary and has the potential to stoke false hope.”
Headline: Sleep apnea patient finds rest with implant device: ‘It saved my life’
Study: An implantable device (called “Inspire”) was used to treat obstructive sleep apnea, and appeared somewhat effective for some people in the study (which was published in 2014).
Our review: The headline makes the device sound like a lifesaver, and the story cites a medical professional who calls it a “cure,” “revolutionary” and a “game-changer”–without telling readers that the doctor is a consultant for Inspire. There is also no objective medical assessment of the device’s effectiveness, as the medical professional quoted is also the treating physician.
You can find more from our Headline vs. Study series HEREGetty Images NewYork-Presbyterian/Weill Cornell Medical Center
Blocking the amino acid asparagine in genetically modified mice was linked to slowed breast cancer metastasis, according to a research letter published in the journal Nature.
It’s an interesting premise, and one that’s likely worth further study, but as several of our alert Twitter followers pointed out to us, some journalists went overboard on this one:
— Pietro Ghezzi (@PietroGhezzi) February 8, 2018
Some resulting news coverage bordered on scare-mongering, primarily by making it sound like the findings apply to people. By our latest count, the story has appeared in The Guardian, the BBC, HuffPost UK, Medical News Today, The Boston Globe, among others.
Bottom line on this one? In what was almost the bottom line at the end of The Guardian’s story was a quote from a UK breast cancer charity executive: “On current evidence, we don’t recommend patients totally exclude any specific food group from their diet without speaking to their doctors.”
What you need to know:
When the Zika outbreak swept Brazil in 2015, Brazilian journalists were the first to cover the event. But it can be a challenge for them to place stories like that in U.S. and European publications. Editors and freelance writers were asked about the challenges writers face in working across international boundaries.Article type: ScienceWriters magazineArticle topic: Science writing news
Anyone want to give me odds on any of the following news stories — which all showed up in our newsfeed before 9 AM today — winning some sort of Toilet Bowl for health news?Hey Newsweek! Watch your language!
Good news. If you’re a bald mouse with access to a McDonalds, your ship has come in.
Newsweek wants you to know that dimethylpolysiloxane — “the silicone added to McDonald’s fries to keep the cooking oil from frothing” — makes a great cell culture medium for growing “hair follicle germs” (HFG’s) that can be transplanted on to nude mice and make hair grow.
Apparently this “groundbreaking method” is enough of a “breakthrough” to justify the headline, but maybe not enough of one for McDonalds, whom we’re told “did not respond to Newsweek’s request for comment.”
There is one factoid included that might help explain the clickbait; we’re told, “in 2016, the U.S. hair loss treatment manufacturing industry was worth $6 billion.”
I think we already knew that. But I bet a lot of mice didn’t.One small step for a mouse, one giant leap for mankind
From McDonalds, the newly coiffed mouse can then head over to the local watering hole, and knock a couple down for memory’s sake.
While the news release does well to remind people that “excessive consumption of alcohol is a health hazard,” it’s only halfway into the release we learn this is a mouse study and the headline is, therefore, simply unjustified hype.
And then there’s this coverage from Fox News. Are these two sentences an attempt at balance?
… and …
“It’s important not to overdo it, though: Rodents exposed to high levels of alcohol fared less well, with inflammation, cognitive impairment and impeded motor skills.”
That second sentence is bio-speak for “drunk.”
And the headline emphasizing that alcohol “can help you fight Alzheimer’s” is simply called “guessing.” It’s based on the notion that if low levels of alcohol help clear waste from mouse brains — and that “waste” includes things like amyloid and tau which are associated with Alzheimer’s — then low-dose alcohol must help humans fight Alzheimer’s disease.
That’s one giant leap, indeed.Heart Health 101: Avoid talking in crowds of two or more?
Does it qualify as hype if you take an observational study looking at noise pollution and heart disease and write a headline like this?
Yes. It does. Because you can’t establish cause and effect with this kind of study.
And it’s also not in the public’s best interest to include a sentence like this:
“Noise pollution should be considered a risk factor for heart disease, similar to that of high cholesterol and obesity.”
ABC’s icing on the cake is including this quote from the lead author:
Though there is no set threshold to establish risk, we do know that anything above 60 decibels can increase risk for heart disease.
For the record, 60 decibels is the level of conversational speech. And we’re being led to believe we should be as worried about that as a large order of fries? (at least the latter will prevent baldness).Two patients ≠ ‘breakthrough
Rule of thumb: when writing about a study that has only two subjects, and the author of that study tells you “I think this is a breakthrough in vitiligo treatment,” at the very least do two things. Don’t just tell people that vitiligo affects 2 percent of the population (a nice inclusion) but also make sure to let your readers know the study involved just two subjects.
Also, let people know that the author of the study has financial ties to the company that makes the drug being studied; in this case, Pfizer makes the tofacitinib that was combined with the ultraviolet-B light therapy and produced (per the author) “results that are impossible to achieve with common therapies.”
And while you’re at it, why not mention the cost of this off-label treatment, the possible side effects & drug interactions, and use data — rather than anecdotes from the study’s two subjects — to help us weigh the risks versus benefits.
This isn’t the first time we’ve wanted to flush and clean the bowl. Here are some other examples.
Anahad O’Connor is a bestselling author and staff reporter for The New York Times. He covers consumer health, writing about topics such as nutrition, chronic disease, obesity, and the food industry. He joined the paper in 2003 and has covered everything from business to politics and culture. His focus since 2011 has been the intersection of food and health. Anahad’s news stories and investigative articles frequently appear on the front page of The New York Times, and he’s been a featured guest on national news programs such as PBS NewsHour, Good Morning America, and NPR’s All Things Considered. A graduate of Yale, he is the author of four books, and currently lives in San Francisco. Follow him on Twitter @anahadoconnor.Courtesy of Anahad O'Connor
What I’m working on:
I’ve been working on a number of investigative stories this year. One series I’ve been working on with my colleagues is a deep dive into the spread of obesity and lifestyle diseases in the developing world and the role of the food industry. It’s called Planet Fat.
Where I work:
I am based in San Francisco, which I love. I was born and raised in New York City and worked there for many years at the Times‘ headquarters. I moved to San Francisco in 2016—where the Times has its third largest office—and plan on being here for a while.
Wake up, check my work email, take a look at the home pages of my favorite newspapers and blogs, and then get up and make coffee. I eat breakfast while I respond to emails. Then I dig into whatever story I’m working on that day. If I’m not on a tight deadline, I’ll sometimes take a 30-minute break in the afternoon to go for a quick run or hit the gym, which helps me think through ideas or conquer writer’s block. I cook dinner around 7:00 p.m. I’m very health conscious, so I like to cook fresh meals. After dinner I get back on my laptop and either write some more or read a bunch of scientific research.