Archive for the 'Journalism' category

Looking for stronger statements from Sanjay

Jan 06 2011 Published by under Journalism, Medicine

Last night I watched CNN as Sanjay Gupta interviewed accused medical fraudster Andrew Wakefield, and the subsequent discussion with Seth Mnookin, author of The Panic Virus, (along with Anderson Cooper).  Aside from having given a podium to Wakefield, the interview was a good one.  I have nothing to say about Wakefield's performance except that it was hardly exculpatory.   Mnookin was brilliant---knowledgeable, articulate; everything a science journalist should be.  I was less happy with Dr. Gupta.

Sanjay made it clear that he favors vaccines, and that he has had his own children immunized fully and on time, and for that message he deserves kudos.  But as has been his habit, he strayed a bit too far into a "both side-ism" that creates more confusion than  clarity.

Gupta, a very bright and well-respected public figure and physician, has  a lot of influence and his words matter.  He had the opportunity here to speak loudly and clearly about this fraud and its negative effect on public health.   Instead he peppered his remarks with qualifiers.  He reiterated that Wakefield has no credibility in the scientific community, when he might properly have stopped at "no credibility".  He states that it's impossible to prove a negative (sic?), and if we knew "the" cause of autism, the debate would be entirely different.

I'm not so sure.

We know, with as much certainty as is reasonable in science, that vaccines do not cause autism.  The fact that we do not know the cause of most cases of autism is not as relevant as this fact.  I really do appreciate his strong statements in favor of vaccines, but his other statements feel like an attempt at "balance" where none is warranted.

I respect Dr. Gupta (except the execrable John of God report) and I think he has a lot to offer in communicating medicine and science to the public.  He might have used the Wakefield Fraud report to make a strong statement about good science, bad science, and the impact these have on public health.  Instead, he was wishy-washy and for that I'm disappointed.

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Why science reporters should do their homework

Nov 04 2010 Published by under Journalism, Medicine

One of the most significant medical advancements of the last few decades has been the use of cholesterol-lowering medications called statins.  These drugs, when used properly, have been shown over and over to lower the risk of heart attacks, strokes, and death.  But like all drugs, they have many effects, both those we like (preventing heart attacks) and those we don't (in this case, rare liver and muscle problems); the latter we call "side-effects".  Studies done on drugs before they hit the market can identify common side-effects, but it's not until many more people are exposed for a long period of time that rare side-effects show up.

A recent Scientific American article wondered if one of these rare side-effects could be memory problems.  At first glance, the idea seems pretty improbable, but the SI article takes some sketchy anecdotes and runs with the idea, managing to cobble together an interesting hypothesis:

It is not crazy to connect cholesterol-modifying drugs with cognition; after all, one quarter of the body’s cholesterol is found in the brain. Cholesterol is a waxy substance that, among other things, provides structure to the body’s cell membranes. High levels of cholesterol in the blood create a risk for heart disease, because the molecules that transport cholesterol can damage arteries and cause blockages. In the brain, however, cholesterol plays a crucial role in the formation of neuronal connections—the vital links that underlie memory and learning. Quick thinking and rapid reaction times depend on cholesterol, too, because the waxy molecules are the building blocks of the sheaths that insulate neurons and speed up electrical transmissions.

It's not crazy to connect cholesterol-modifying drugs with cognition, but it's quite a stretch.  We do know that statins affect the central nervous system.  They've been proven to reduce the risk of stroke, a devastating central nervous system disease.  If they can prevent brain disease, might they also cause it?  We have some ideas about why statins prevent strokes: they lower cholesterol and stabilize arterial plaques, perhaps by reducing inflammation in these plaques.  They can even cause plaques in some arteries to shrink.  Is there a plausible hypothesis as to why statins might cause memory problems?  What is being posited is that statins actually reduce cholesterol levels so much that cell membranes are damaged and neuronal saltatory conduction* is impaired.  If this were the case, we might also expect to find cognitive differences  when comparing people with high and low cholesterol levels, or to see cognition affected by cholesterol-lowering diets.  This is not the case.

Still, dementia---the most common and severe form of memory loss--- is a devastating disease, so if there is even a chance, maybe we should ask the question.   A large  cohort study published in Archives of Neurology in 2005 looked into whether statins might actually help prevent dementia.  They groups of elderly patient who took statins, and those who did not and compared the incidence of dementia in each group. There found neither a protective effect nor a harmful effect.

The idea that lipids (fat molecules) can affect brain function has been supported by certain epidemiologic studies and some animal models.  Omega-3-fatty acids have been touted for possible use in preventing and treating dementia.  Last week, a randomized controlled trial of a particular omega-3-fatty acid was published in JAMA.  The study design was strong, and the study found no evidence that this particular molecule helped dementia patients.

The two most common types of dementia are vascular dementia and Alzheimer's disease.  The cause of Alzheimer's disease isn't known, making prevention difficult.  Vascular dementia, however,  is to a certain extent preventable.  It is caused by a variety of factors that affect blood vessels such as hypertension, and studies have shown that many of the same interventions that prevent stroke can help prevent vascular dementia.  One of the most potent risks for vascular disease is cigarette smoking, so it would make sense that smoking would be a risk factor for vascular dementia.  A surprising result of a study recently published in Archives of Internal Medicine was that smoking is a risk factor not only for vascular dementia but also for Alzheimer's dementia.

The story of dementia risk is complex, and there is a rich vein of literature to mine.   I was disappointed that the SI article presented anecdotes rather than data, case-reports rather than good studies, and highlighted "experts" who presented fear-mongering testimony rather than the measured caution that we can expect from real experts.


*"Saltatory conduction" describes a way that nerve signals travel quickly.  Nerve cells can function as a sort of wire for electrical signals, and the myelin sheath allows electrical signals to jump from node to node, increasing the speed of conduction when compared to an un-myelinated neuron.  Certain diseases, such as multiple sclerosis, involve destruction of the myelin sheath, decreasing nerve conduction velocity, leading to weakness and other symptoms.    Myelin contains cholesterol, among other things.


Rusanen, M., Kivipelto, M., Quesenberry, C., Zhou, J., & Whitmer, R. (2010). Heavy Smoking in Midlife and Long-term Risk of Alzheimer Disease and Vascular Dementia Archives of Internal Medicine DOI: 10.1001/archinternmed.2010.393

Quinn, J., Raman, R., Thomas, R., Yurko-Mauro, K., Nelson, E., Van Dyck, C., Galvin, J., Emond, J., Jack, C., Weiner, M., Shinto, L., & Aisen, P. (2010). Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease: A Randomized Trial JAMA: The Journal of the American Medical Association, 304 (17), 1903-1911 DOI: 10.1001/jama.2010.1510

Rea, T. (2005). Statin Use and the Risk of Incident Dementia: The Cardiovascular Health Study Archives of Neurology, 62 (7), 1047-1051 DOI: 10.1001/archneur.62.7.1047

Forette F, Seux ML, Staessen JA, Thijs L, Birkenhäger WH, Babarskiene MR, Babeanu S, Bossini A, Gil-Extremera B, Girerd X, Laks T, Lilov E, Moisseyev V, Tuomilehto J, Vanhanen H, Webster J, Yodfat Y, & Fagard R (1998). Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet, 352 (9137), 1347-51 PMID: 9802273

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More crappy reporting from LabSpaces

Oct 22 2010 Published by under Journalism, Medicine

LabSpaces, a newer member of the science blogosphere, has some great bloggers.  But as I recently pointed out, they're failing miserably in one domain.  LabSpace's founder Brian Kreuger has an ambitious vision to create a sort of "facebook for scientists" (not his words).  In his words: is a social network for the scientific community designed to spread scientific news, maintain and create friendships, and harbor collaboration through the internet. The site serves as a web profile for researchers and labs, and is also a community for active communication in the sciences.

Included in his vision is, "a Science News feed updated daily with ~40 news articles."  This is where the problem begins.  LabSpaces bloggers do what good science bloggers do, but the "featured article" section is a travesty.  It is an uncritical regurgitation of institutional press releases and other PR documents.  My interest is in proper reporting of medical information, and the articles consistently fail to deliver un-hyped and accurate medical information.  The article that was the subject of my last critique was removed, along with the critical comment threat.  Today he features another miraculous-sounding headline. How does this one measure up? Continue Reading »

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In which I continue to whine about crappy science journalism blogging

Oct 21 2010 Published by under Journalism, Medicine

Note: Since publication, the referenced article has been removed without note.  Some might argue that a more useful, nuanced, and sophisticated approach to posting a terrible blog post would be to leave the critical discussion intact and perhaps annotate or addend the offending post.  But the memory hole is always tempting, no? --PalMD

From time to time, I write pieces rather critical of the way mainstream media cover science and medicine.  Unfortunately for me, there's nothing terribly unique about that, as there are a number of fine journalists and websites that do that every day, and do it well (see, among others, here, here, here, and here). Last year I had the good fortune to attend an event at USC's Annenberg School of Journalism, and met a number of terrific journalists.  One thing that is clear to me is that I don't know enough about journalism.  For one thing, I'm free of many of the pressures faced by mainstream journalists.  I've broken ties with two media organizations that I've written for in the past (Scienceblogs and Forbes) because of the blurring of advertising and news/editorial content.  As a full-time, practicing physician, I have that luxury.  But many journalists do not.

During the Pepsigate scandal at Scienceblogs, I forced myself to think a bit more about what I want out of my own writing.  I felt that if I am to continue to deliver accurate health information online, I'd better learn  a bit more about journalism and about how reporters think and write.  Blogging has become for me more than a simple hobby, but less than an actual journalism gig.  I've found science writers to be an incredibly generous and approachable lot, and every day I strive to improve my writing, to show that there is no reason that a humble blog like this one cannot be a useful stop for decent writing on science and health.

Some have argued (I think correctly) that it may be impossible to be a practicing doctor and a practicing health care journalist, but I'm arrogant and crazy enough to think that I may be able to pull it off.  Not that I think I can be a good full-time journalist, but I think I have something useful to add to coverage of science and medicine.  I take my writing seriously, even though "it's just a blog."  I would love to spend more time formally studying journalism, but hey, I have disease to stamp out, so I'll just have to do my best.

And while not everyone will look at their own blogging as something delusionally serious, I think that people writing about health and science have to be ready to be taken to task for bad reporting.   LabSpaces, a fairly new network emerging in this second wave of science blogging, has some terrific writers, but one of their projects is a disaster.

Many of us receive daily press releases and other announcements about the latest studies or breakthroughs.  Journalists, with their particular education and experience, usually know how to view these critically.  Usually. But we naive bloggers may succumb to the temptation to treat every press release as conveniently-delivered facts rather than the publicity and PR tools that they are.  The folks at LabSpaces are falling into this trap.

The piece linked above is cribbed directly from a press release (I'm on the same mailing list) and is pure PR, with no supporting data or citations.  It makes very bold claims (such as, "[scientists] have now scientifically demonstrated that strep can lead to brain dysfunction and OCD").  These are just the sort of claims that should lead a writer or journalist to either file away the info for later, or to contact the institution to ask some hard questions.  To do anything else is to serve as a free publicity conduit.

So while you may not take your blog as seriously as some, others may.  More and more, it seems, the mainstream media is blowing it on science coverage.  There is no reason we should make the same mistakes.

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Asking the right questions (retitled)

Sep 29 2010 Published by under Journalism, Medicine

I've been criticized in the past for focusing on criticism of bad health reporting, rather than aiming some positive reinforcement at the good pieces.  Well, here you go.

The story (byline Genevra Pittman) is about lasers used in smoking cessation, an idea with limited plausibility ( suspend tobacco execs over a tank full of sharks with frickin' laser beams attached to their heads, or something).  The idea isn't new (lasers, not shark tanks); ads for laser smoking cessation have been in papers and the internet for years.  Tobacco is a tenacious and deadly addiction, and treatment of this addiction is often unsatisfying.  The use of lasers and other "acupuncture-like techniques" to assist in smoking cessation is popular and profitable. "But does it work?" asks the Reuters piece.

There are a couple of ways to answer this question: a flood of anecdotes, or a systematic evaluation of the plausibility of the claims, and of the data.  Advertising normally focuses on anecdotes.  This approach has the advantage of allowing people to pick the stories they like, highlight them, and use them to promote their business.  Data are much trickier, and more fickle.  They can lead you, as a promoter of lasers, to places you may not want to go.

Does it work?

The Reuters piece gives a good summary of the claims made by a laser smoking cessation clinic.  Laser smoking cessation is basically a variant of acupuncture. Rather than needles, low energy lasers (low enough energy to have no sensible effect on tissue) are aimed at certain "points" believed by practitioners to have some sort of physiologic significance.  The article cites these claims in an objective, rather than promotional tone, then asks the Right Question.  Does it work?

That question is deceptively simple, and often asked and answered improperly in mainstream media pieces. Pittman examines the source cited by the laser promoter, summarizes its findings, but rather than stopping there, she asks the right expert.  She found one of the authors of the Cochrane Collaboration's systematic evaluation of acupuncture techniques for smoking cessation.  She explains his caveats about the single citation supporting laser therapy and problems with the study, including its reliance on patient self-reports.  But one question was left out of both her report, and that of the Cochrane Collaboration.

Can it work?

Cochrane came to the (likely correct) conclusion that the use of acupuncture (including laser therapy) has not been shown to aid in smoking cessation.   The Cochrane Collaboration has been an invaluable resource for evidence-based medicine, but, like most EBM resources, often fails to ask one important question: can this even work?

This is what many of us see as a fundamental flaw in the current approach to evidence-based medicine.  EBM certainly understands the concept of probability, but often fails to use it properly.  While EBM will talk about Bayesian statistics and likelihood ratios, it often fails to take into account what they mean when it comes to implausible claims.

Implausible claims are those that, if confirmed, would cause us to re-examine our fundamental understanding of chemistry, physics, and biology.  The classic example is homeopathy, an 18th century belief system that has become popular among many alternative medicine practitioners.  It relies on a form of vitalism, a made up "Law" of Similars, and if it truly worked, would require us to abandon proved concepts such as the law of mass action (and our understanding of physics as a whole).

The problem with implausible claims (aside from their implausibility) is that when tested, they can, through chance alone, lead to positive results.  This allows supporters to cherry pick favorable data, despite the fact that these data are likely false positives.

If we were to create a hierarchy of implausibility, homeopathy would certainly be near the top.  Acupuncture would be just a bit lower.  It's not inconceivable that sticking needles into someone (or zapping them with lasers) would have some sort of physiologic effect.  According to the owner of the laser clinic, it works like this:

"When you smoke a cigarette, you artificially tell your brain to release endorphins," Frank Pinto, the owner of Innovative Laser Therapy, told Reuters Health. Therefore, quitting leads to a quick drop in endorphin levels, he said.

"The laser basically stimulates the nerve endings to tell the brain to release a flood of endorphins" to boost a patient over that initial 3-5 day hump of withdrawal symptoms, he said.

That sounds superficially plausible (one study in rodents found the neurotransmitter adensoine released after the animals were stuck with needles). But if it's true, then any noxious stimulus could have the same effect, rendering the need for identifying non-existent "meridians" and the use of  expensive equipment moot.  But laser therapy seems to be even less plausible than other acupuncture modalities.  According to Cochrane:

Low level laser therapy produces nosensation, and there is still some uncertainty whether it has a physiological effect on normal tissue. From the researcher’s point ofview, laser therapy has the advantage that both patients and practitioners can remain masked to group allocation by using defunctioned laser apparatus.

In other words, placebo-controlled studies are easy because you can't actually tell if the laser is on or off unless you peek at the switch.

The Reuters article by Pittman is a fine example of how to approach unusual or hyperbolic health claims.  Its primary deficiency is one shared by many scientists examining such claims: a failure to ask "is this even possible".

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Thank you, SEED, for PepsiGate

Aug 16 2010 Published by under [Information&Communication], Journalism, Medicine

I have to thank Seed Media Group. In the month or so since Pepsipocalypse fractured the ScienceBlogs network, there has been a surge of writing on science blogging and science journalism (much of it by Bora Zivkovic, but also quite a lot in in other venues, such as here, here, here, and infamously here).  Science writing continues to diversify, with some networks (such as this one) being "bottom up", independent, and non-commercial, and others (such as Discover and ScienceBlogs) being tied to traditional media, or at least traditional media models.  Discover has used this well, concentrating on supporting a small stable of excellent writers, while others have attracted a diverse group of scientists, writers, and others who simply enjoy writing about science.

I (and others) have complained about the spotty quality of mainstream science journalism, but the real picture is, of course, more complex.  There are many traditional journalists who recognize the potential synergy between science journalists and bloggers, and who are looking to improve both sorts of media.  There are some data that support the idea that when scientists blog about science, they use a more diverse set of sources.  Rarely will the usual suspects in science blogging simply re-hash a press release, something all to common in science journalism (although many science journos are bravely fighting this trend of endumbificaiton).

The fracture of ScienceBlogs has helped to both focus and diversify the discussion of how to best write about science.  This is not a bad thing.

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Another introduction to White Coat Underground

Aug 02 2010 Published by under Journalism, Medicine

Welcome all to my shiny, new blog.  As regular readers will remember, I left ScienceBlogs a few weeks ago after becoming uncomfortable with some of the practices there.  I still read ScienceBlogs regularly, and I'm reasonably confident they will recover from this challenge and continue to be a go-to site for online science reading---but without me.

Many of us in the online science writing community know each other, or are at least familiar with each other's work.  Through these networks, several of us came together to form a new online science writing community run by and for writers and readers.  We are not a monolithic group, as you can see if you browse though who's here, and many of us may disagree on some pretty fundamental issues.   But we have used our commonalities and differences to put together this new community with a great deal of  thought and effort, and hopefully success.  Browse through our "constitution" if you're curious what we have in mind.  Or just read what looks good.

First, a little history.  I started blogging on WordPress in May of 2007.  My writing was bad, but I kept at it, and one or two relatives read it once in a while.  Over time, my writing improved, and other medical writers and skeptics occasionally came by and left comments.  I in turn left comments at their blogs, especially at Respectful Insolence, written by Orac, who was a blog mentor and is now a friend and colleague.  I was eventually invited to co-write denialism blog over at ScienceBlogs, and then struck out on my own with a rebirth of White Coat Underground.

From my platform at ScienceBlogs I was able to continue to improve my writing and my reach, and expanded my writing to Science Business Blog and Science-Based Medicine, for whom I write occasional pieces.  Both of those venues are populated by excellent writers who have given me guidance and mentoring.

And now, a new beginning.  To hear the New York Times tell it, science bloggers are just naive science writers, spewing invective and refusing to accept the mediocre standards of the mainstream media (yes, it really says that: "The bloggers evidently write often enough for ad-free academic journals that they still fume about adjacencies, advertorial and infomercials. Most writers for “legacy” media like newspapers, magazines and TV see brush fires over business-editorial crossings as an occupational hazard. They don’t quit anytime there’s an ad that looks so much like an article it has to be marked “this is an advertisement.”)

But science bloggers and science writers are increasingly intersecting sets, with people like Jonah Lehrer, Carl Zimmer, and Deborah Blum writing books, keeping blogs, and mentoring newer writers.  I've been fortunate to be on the receiving end of this mentoring, even when folks like Ed Yong, Rebecca Skloot, and David Dobbs don't know it.  And I've learned that not all journalists are willing to see ads disguised as news as just "an occupational hazard."

But I'm not here because of what's wrong in other media (or at least not solely for that reason);  I'm here because I love medicine.   And I'm here because of questions like this one:

Dr. Pal,

Tonight, a certain friend of mine stated that she wasn't eating carbs (including sugar) "because i got myself a little under the weather and they say it makes it worse."... So here are my questions/comments/concerns:

1) Let it be known that the phrase "they say" peeves me to no end.
2) Is this accurate? It doesn't seem like something that would be, but what do I know?
3) If this is false, perhaps it is a garbled version of something else? Perhaps someone consumed too many simple carbs once, while sick, and experienced some discomfort unrelated to the original sickness?

Continue Reading »

10 responses so far

Ethics and goals: always a challenge

Jul 19 2010 Published by under Journalism, Uncategorized

My formal ethical training began in medical school with an introduction to the basic concepts of medical ethics. This training continued as I encountered difficult cases and thought through them, often with the help of the hospital ethics committee. While I haven't continued my formal education in ethics, I've continued my own reading, and I enjoy writing on ethical conundrums.

I've been blogging now for over three years, which, in internet time, is quite a while. During that time, I've begun to take the writing itself more and more seriously. I've begun to recognize the implications of the medium itself, especially in conversations with mainstream journalists. We bloggers are, for better or worse, part of "the media".  So I've had to learn something about journalism ethics as well.

This has changed the way I write. When I look back at some of my earliest posts, I cringe. In many ways that's a good thing; as it turns out, I have the ability to learn and improve. My commenters and my colleagues help keep me honest, and without them, I'd write just as poorly as I did five years ago. I've also expanded the type of writing I do. In addition to my always well-reasoned rantings and my discussions of science-based medicine, I've done some more investigative pieces, interviewing sources, and consulting other journalists about ethics and approaches.

Given that much of my writing is very critical of unethical medical practices, I don't have a lot of wiggle room in my own public behavior.  This isn't to say that to be ethical is to be perfect; far from it.  But behaving ethically is hard work that involves hard decisions, and frequent mistakes.

ScienceBlogs has not made such a mistake. With the mishandling of the launch of a commercial ad-blog, Seed Media Group showed incompetence and mismanagement.  They also showed that they do not consider themselves (or we bloggers) to be "media" or journalists.  Whether we like it or not, we are the media, and while we may enjoy a great deal more freedom in style and content than most mainstream media, we cannot claim immunity from their ethics.

It is for these reasons (and others, most of which have been eloquently and completely laid out by Bora Zivkovic) that I'm leaving ScienceBlogs, something I do with great regret.  I have gained immeasurably from my association with Sb and with the people here.  It has given me incredible opportunities.  But despite the advantages in exposure, the fit just isn't good anymore.

This is a personal decision, not one that can be generalized to include anyone writing here.  The bloggers here are some of my favorite science writers, and always will be, whether they remain at Sb or go elsewhere.  I have nothing but respect and admiration for them.

As the science blogosphere has evolved, and as my own writing has, I feel that the risk of leaving is not what it might have been once.  I will continue to write White Coat Underground at my old wordpress site for now, and will announce further plans there.   And I will continue my occasional pieces at and Science-Based Medicine.

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Science journalism pet peeve

Jun 28 2010 Published by under Journalism, Medicine

I frequently read about the latest medical and scientific "breakthroughs" in the mainstream media, and in modern media such as One commonality is lack of citations. If I'm lucky, they may cite the source journal or meeting. If I'm really, really lucky, they may even give a general date (e.g., "JAMA in June"). But I never see an actual citation. That would be one simple way to improve science journalism. A standard citation would give readers the tools to evaluate the primary source. In science, we consider that pretty important.

36 responses so far