Becky Siame

WebMD headline: “Vitamin D linked to lower heart risk.”

OR

Reuters headline: “Calcium, Vitamin D pills don’t help heart.”

Same study. Quite different stories.

Look at how the evidence was analyzed differently.

WebMD:

“Researchers found six studies (five of which involved people on dialysis and one which included the general population) showed a consistent reduction in heart-related deaths among people who took vitamin D supplements. But four studies of initially healthy individuals found no differences in development of heart disease between those who received calcium supplements and those who did not.

A second analysis of eight studies showed a slight, but statistically insignificant 10% reduction in heart disease risk among those who took moderate to high doses of vitamin D supplements.”

Reuters:

“Some studies did show that vitamin D supplements cut the risk of dying from heart disease and stroke. However, most of these involved patients with severe kidney disease who were on dialysis, a vast difference from healthy individuals, (the senior author) noted.

The remaining studies failed to show any meaningful benefits of vitamin D, calcium, or a combination of the two.”

The WebMD piece seemed to keep trying to make the case for there being some heart benefit from vitamin D when that isn’t what the results they presented indicate. No matter how you cut it, the evidence in favor of vitamin D having heart benefit is not robust, so how did they decide on the definitive headline, “Vitamin D linked to lower heart risk”?

The Reuters story helped people understand that more vitamins isn’t necessarily better – with the editorial writer’s quote, “We’ve learned in the past that things can go really, really wrong” when people start taking vitamin pills.

Psychiatrist Daniel Carlat, on his terrific blog, raises questions – just as Senator Chuck Grassley is doing – about a WebMD TV commercial that leads viewers to take an online depression screening test. The test was funded by Eli Lilly–information that was apparently omitted from the TV commercial.

Carlat says the WebMD test takes the DSM-4 list of nine possible symptoms of depression, but adds a tenth:

“I’m having frequent headaches, stomach problems, muscle pain, or back problems.Yes or No”

Carlat believes that happens, as he writes:

“Because Lilly markets Cymbalta as the “go to” antidepressant for patients who have both depression and physical pain. This is not really a “depression screening test” at all. Instead, it is a “Cymbalta-requester” screening test.

WebMD is telling the public a big lie. The say that “this content is selected and controlled by WebMD’s editorial staff” when in fact the crucial aches and pains questions was selected by Eli Lilly’s marketing team to encourage patients to ask their doctors for Cymbalta.”

What a great idea for a blog – with a focus solely on the practice of embargoes in the management of the flow of health/medical/science news and information.

Reuters Health executive editor Ivan Oransky just launched his Embargo Watch blog last week but already has a faithful following. It’s evidence, I think, of what a sore subject embargoes are and have been with so many who have toiled in these fields for so (too?) long.

In his initial post, Oransky wrote:

“You’ve probably noticed that every major news organization — including mine, Reuters — seems to publish stories on particular studies all at once. Embargoes are why.

A lot of journals, using services such as Eurekalert.org, release material to journalists before it’s officially published. Reporters agree not to publish anything based on those studies until that date, and in return they get more time to read the studies and obtain comments.

That would seem to be a good thing for science and health journalism, much of which is reliant on journals for news because it’s peer-reviewed — in other words, it’s not just a researcher shouting from a mountaintop — and punctuates the scientific process with “news events.”

Vincent Kiernan doesn’t agree. In his book, Embargoed Science, Kiernan argues that embargoes make journalists lazy, always chasing that week’s big studies. They become addicted to the journal hit, afraid to divert their attention to more original and enterprising reporting because their editors will give them grief for not covering that study everyone else seems to have covered.

But even if embargoes are a necessary evil, they’re not uniform, and how each organization deals with them provides case studies in some of the chinks in embargoes’ armor.”

Ironically (or was this a test case?), Reuters itself lost its advance notice “privileges” from the American Heart Association last week for jumping an embargo by a whopping 43 minutes. (Correction added 12:21 pm Central time, March 1: They jumped the embargo by 1 hour and 43 minutes. A bit more whopping.)

The Embargo Watch blog is a great concept. It becomes a repository for embargo-related issues. It provides a social media platform for all parties involved in the dissemination of health/medical/science (and other) news and information to weigh in on the issue. Who knows? It may even lead to a better system.

We’ve written before about some of the headlines praising robotic surgery:

• Robot doctor – surgery of tomorrow

• Da Vinci puts magical touch on the prostate

• Cancer survivors meet lifesaving surgical robot

• Robotic surgeon’s hands never tremble

• Da Vinci is code for faster recovery

• Surgical Maestro

• DA VINCI ROBOT IS SURGERY WORK OF ART

Now even the news that a company is testing a couple of robotic-surgery-training-simulators “and expects the units to go on sale for about $100,000 by early 2011″ makes news.

The AP reported it (this is their photo at left of the news conference) and the story was picked up by ABC News.com, CNBC, the Los Angeles Times and elsewhere.

Granted, a simulator that might help train docs in what seems to be the inevitable spread of this technology might be an important quality/safety improvement.

But the AP story that spread across the country didn’t mention any concerns about the medical arms race involving robotic devices, nor any questions about evidence.

• Hold news conference.

• Demonstrate gizmo.

• Get nationwide news.

How easy it can be to get free publicity, without ever having people focus on some of the important policy questions at stake. But after this week, who cares about health care policy, anyway?

There’s now a website that actually tracks The Daily Mail of London to categorize its stories as either “kill or cure” stories. The site quotes British physician-author Ben Goldacre: “The Daily Mail, as you know, is engaged in a philosophical project of mythic proportions: for many years now it has diligently been sifting through all the inanimate objects in the world, soberly dividing them into the ones which either cause – or cure – cancer.”

Visitors to the site can vote on the stories.

So far, the following things cause cancer: age, air pollution, air travel, aluminum, artificial flavors, artificial light…. You get the picture. That’s only in the A alphabetical listing.

So far, the following things prevent cancer: bananas, Brazil nuts, breakfast, etc. Beer, it should be noted, both causes and prevents cancer!

Hmmm. I may have just received inspiration for a new health news review project in this country!

Dr. Harlan Krumholz, in a Forbes column:

“I want to believe in America’s pharmaceutical companies. I want to believe that people in these companies believe that the best strategy for success is to do what is best for patients. I want to believe that they are interested in scientific truth and eager to know of any safety issues and ready to share that information with the public.

This week I was disappointed again.

Over the years GlaxoSmithKline has repeatedly reassured the public about the safety of its blockbuster diabetes drug Avandia. But this weekend the Senate Finance Committee released a report revealing that inside the company Glaxo’s own experts and advisors were raising concerns about whether the drug could cause heart problems all along. …

The report, based on more than 250,000 internal documents, provides a rare and unsettling glimpse into the decision by company executives to deflect safety issues–even as their own experts agreed with conclusions of outside researchers who were warning the public about possible harms.

This type of behavior is eroding the public trust in the pharmaceutical industry. The fix is simple: Once a drug is approved, all data relevant to drug safety should be placed in the public domain and independent investigators across the country should be able to use it. There should be big financial penalties for withholding relevant information. Drug studies sponsored by industry must be truly independent–outside of company control. Companies should give outside investigators independence over every aspect of the study. There are too many examples of companies wresting control of clinical studies from their consultant investigators for reasons that seem more related to product promotion than clinical science.”