Medicine For People!

July 2019

The Limits of Journalism

News Stand
By Florian Plag from Bretten - Daily News., CC BY 2.0

In The New York Times for July 3 of this year, you will find an article titled "10 Findings That Contradict Medical Wisdom".

We reviewed similar areas of reversal in medical wisdom in a recent newsletter but this NYT list you had best either read with care or ignore.

Yes, medical reversals occur, and they will continue to occur.  Yes, it is good that journalists are paying attention to this and bringing it to your attention.  But for goodness sake, can’t we just get these things correct?

Let’s fix some of the errors in this New York Times article.  Below I quote a few of the NYT headings. Now, in real life no fully-awake doctor reads one medical study and changes her mind about anything without checking to see what else is known on the subject.  But this NYT health specialist claims that the following articles disclose things that should make us change our medical ways.  Please click on each link as I did and see if you agree.

 “Peanut allergies occur whether or not a child is exposed to peanuts before age 3.” 

This headline is true but relatively information free. It also has no bearing on the New England Journal of Medicine study referenced. 

What matters is that we used to dissuade parents from giving children peanuts before the age of one in order to prevent peanut allergy. We now know that this advice is 100% wrong.  Avoiding peanuts before the age of one increases the incidence of peanut allergy. This is the real news about peanuts and completely absent from this NYT summary.

I won’t say more about the NEJM article.  It is complicated and of interest only to allergists.

What is important to remember is that if you give a whole peanut to a child under the age of one and they happen to get that peanut down the wrong pipe, the peanut will usually lodge in a bronchial tube. It will absorb moisture, swell, become mushy, and won’t come out easily even with a skilled bronchoscopist.  The fat in the peanut and the bacteria on it are going to cause inflammation and infection that are tricky to treat. 

Don’t give whole peanuts to infants.  Give them peanut butter.

 “Fish oil does not reduce the risk of heart disease.”

The NYT article references a study in the New England Journal of Medicine in which the authors point out we already know that people who have had a heart attack have fewer repeat heart attacks when given omega-3 fatty acids.  That is not exactly what the NYT says here.

The researchers undertook this study to find out if this beneficial effect also occurred in people who had not had a heart attack. Over a five year period, the fish oil group had no fewer heart attacks than a placebo group. 

This is useful information, but not accurately summarized in The New York Times article.

By the way, read the NEJM article and it’ll also point out that people with heart failure benefit from omega-3 fatty acids, too. 

“To treat emergency room patients in acute pain, a single dose of oral opioids is no better than drugs like aspirin and ibuprofen.” 

This paragraph purports to summarize an article titled “Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department”.

Just look at the title of this article in the Journal of the American Medical Association (JAMA), and you wonder about the journalist’s reading comprehension. The researchers looked at people with pain in an arm or leg and found no difference in pain relief between opioids and non-opioids.   Eighty percent of the people studied suffered from sprains, muscle pain, contusions and other illnesses. Twenty percent had a fracture, in most of whom a splint, cast, or other treatment had been applied. After a period of two hours, this group of folks reported the same amount of pain whether they had received an opioid or something else.

This is actually useful information when treating these specific injuries.  Except the headline rather misses the mark, don’t you think? 

Rest assured that if you show up in the emergency department with pancreatitis, a heart attack or a kidney stone, that the medical staff has read this stuff considerably more carefully than this journalist and that you will be treated with effective pain medication. 

Quiz for advanced students:

One section is headed “To protect against asthma attacks, it won’t help to keep your house free of dust mites, mice and cockroaches.”
Do you agree with this summary of the research referenced? Why or why not?

Click-Bait

Medical studies look at specific types of people, with specific interventions, for specific lengths of time.  They may be written by a conscientious physician or a corporation that has sponsored a medical study designed to obscure the truth rather than clarify it. 

Nature is under no obligation to make herself comprehensible to us.  We frequently repeat studies and get different answers.   Humility about what we know doesn’t hurt.

So remember that of the some 200,000 medical articles published annually, few rate as of earthquake significance.  And few summarize all there is to know about step counters, testosterone, or much else. 
As you peruse this NYT article, let me tell you I don’t see any other glaring errors on the surface. I emphatically agree with the knee meniscus study, as it builds on many similar observations over recent years.  I wonder about the step-counter conclusion—my patients tell me that step-counters do stimulate them to take more steps.  For all of them, we need to recall that medical studies need to be interpreted with care.  There is no substitute for time spent reading and learning.

Let’s put this NYT article in the “click-bait” category, yes?

Answer to quiz:

This article in JAMA points out as an aside that we know from other studies that some children’s asthma is due to exposure to mice and that avoidance of mice and their dander reduces their symptoms.  The journalist’s headline is exactly wrong.

The question asked by the JAMA article was, “does it help to hire professional pest management services for such children?”  The answer to that question, for this group of studied children, was “No.  Telling the parents what to do was just as effective.”  

And where the journalist got “dust mites” I don’t know.  They aren’t mentioned at all.  Cockroaches are mentioned, but not in the way the journalist states.   

It is helpful to reduce dust mite, cockroach, and mouse exposure for people who are allergic to them.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.