Health beyond the headlines
Extra! Extra!

Overlooked or Overhyped?

10 Medical Research Stories You May Have Read All—Or Nothing—About

By Patches Magarro

Published August 28, 2013

The Truth About Antioxidants!” “FDA Warns of Rare Acetaminophen Risk!” “Pocket-sized Sensor Gives Instant Fat Burning Updates!”

Like a newsboy crying, “Extra! Extra!” health headlines like these beg to be read all about. Some stories warrant a spot on the front page, but at times, the hype of less deserving stories drowns out important public health research. It can then be difficult to suss out what the important bottom line information is from medical news.

Herewith are the most overlooked and overhyped medical stories.

OVERLOOKED

5. Old School Stroke Treatment

Stroke is one of the leading causes of death in the U.S. responsible for killing some 100,000 people annually. The immediate treatment a patient receives is a critical factor determining his or her outcome.

In most cases, stroke is caused by a clot in the brain. The American Stroke Association holds as the “gold standard” an intravenous (IV) medication known as a tissue plasminogen activator (tPA), which dissolves the clot.  Medical personnel deliver tPA to the stroke victim within 3 to 4.5 hours of stroke onset.

In 2004, the U.S. Food and Drug Administration approved the use of catheters for endovascular stroke therapy. In endovascular procedures, a catheter is inserted into the patient’s blood vessel to either remove the clot, or to administer tPA directly into the clot to dissolve it.

The expectations for endovascular treatment, which is more invasive than IV treatment, were high. One study called MR RESCUE had a hard time recruiting participants willing to use the standard IV therapy because it was already expected to be inferior to the newer endovascular options.

It was not.

This year, three studies have come out comparing the two treatments. In the MR RESCUE study, removing the clot was no better than standard care. Lead researcher Dr. Chelsea S. Kidwell, director of the Georgetown University Stroke Center, told the Washington Post, “I think everybody was a little surprised. But mainly disappointed.”

The New England Journal of Medicine published a paper concluding that endovascular therapy was no better than IV tPA. In another trial comparing the two treatments, enrollment was stopped altogether because of safety concerns.

The Mayo Clinic published a commentary in May cautioning that although physicians are currently treating stroke with endovascular therapy, its use should be confined to clinical trials. Dr. Kevin Barrett, an assistant professor of neurology at the Mayo Clinic, points out that “the speed by which these devices can be used is a concern.”

Bottom Line—Newer doesn’t necessarily mean better.

4. Multiple Takes on Multivitamins

Should you take a multivitamin? It depends on whom you ask. The answer is typically, it depends on who you are.

One in three Americans takes a multivitamin, often as “insurance” for a diet that is less than perfect.

Researchers have been studying the relationship between vitamins and disease for decades. While media attention has been focused overwhelmingly on claims that certain vitamins fight disease or prevent poor health, scientific research has been much more ambiguous, and at times has revealed cause for concern that vitamins can be either ineffective, or worse, associated with undesirable outcomes.

Some studies question whether multivitamins are effective.  The National Institutes of Health point to a 2006 study conducted by researchers at the Johns Hopkins University showing that multivitamins had no effect on risk of chronic disease.

Another study, published in the New England Journal of Medicine questioned the safety of vitamins. A group of people with an increased risk of lung cancer were given a combination of beta carotene and vitamin A. The study was halted two years early because those taking the vitamins were 46 percent more likely to die from lung cancer than those taking placebo.

Bottom Line—Population-based studies are not definitive, and individual decisions should be informed. The National Institutes of Health offers suggestions based on specific criteria such as age, gender, and pregnancy. Prevention magazine also offers dietary advice in addition to a recommendation on whether one might benefit from a daily multivitamin.

3. Vegetarian Longevity

If you aspire to get nutrition from food and not a pill, one of the healthiest ways to go about it seems to be eating a vegetarian diet.

A study of over 73,000 people, published in the Archives of Internal Medicine showed that vegetarians of all types were 12 percent less likely to die over the course of the nearly six-year period.  Researchers at Loma Linda University studied Seventh-day Adventist men and women who, for religious beliefs, follow a vegetarian diet much more frequently than most Americans.

The study was published alongside a commentary by Dr. Robert B. Baron which raised the question of whether medical professionals should recommend a vegetarian diet to patients.

It is possible, though uncommon, to follow a vegan diet, a very restrictive form of vegetarianism, and to be unhealthy. Potato chips, for example, are vegan. Baron recommends that dietary advice should emphasize the basic principles of healthy eating common across many “diets”—eating lots of fruits and vegetables. This, he writes, “trumps the more narrow goals of whether to include moderate amounts of dairy, eggs, fish, or even meat.”

Bottom Line—Getting the recommended servings of fruits and vegetables is a healthy goal for meat eaters and vegetarians alike.

2. Trampoline Dangers

If you have a trampoline in your backyard, as approximately three million American households do, you should also have a rider in your insurance policy.

However, trampolines are so risky that most insurance policies do not cover them. In 2011, injuries from trampolines sent 83,000 people to emergency rooms. Falls from trampolines result in the most catastrophic injuries and account for 27 to 39 percent of trampoline accidents.

In 1998, a study in the journal Pediatrics called for a ban on trampolines. However, the whines and squeals of children who yearned for a backyard bounce must have drowned out the warnings against the dangerous devices. In 2012, a policy statement in the same journal began with the following opening, “Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents.”

The Mayo Clinic also discourages the use of trampolines, and published a guide for parents to help diminish the risk of injury. Other than avoiding trampolines, the best practice is to allow only one person on at a time. Most injuries occur when there is more than one jumper on the trampoline.

Bottom Line—Trampolines are relatively unsafe at the population level, but if you must jump around, a bit of harm reduction could keep a good time from flipping.

1. “Annual” Pap Smear

An annual Pap smear has been the status quo. But soon women might be saying, “I have to leave early tomorrow for my once-every-three-to-five-year pap smear.” According to the U.S. Preventive Services Task Force, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology annual pap smears are so 2012.  Other than subtle differences, these groups all recommend that women aged 30-65 get a pap smear every three years, or if the pap smear is accompanied by a human papollomavirus (HPV) screen, every five years.

Why not get a Pap smear every year? The U.S. Preventive Services Task Force points to two considerations: cervical cancer is relatively slow-growing, and unnecessary treatment can have negative outcomes. In their recommendations they warn, “Harms may include anxiety associated with a ‘positive’ cancer screening test, potential stigmatization from the diagnosis of a sexually transmitted infection, discomfort from additional diagnostic and treatment procedures, bleeding from treatment, and longer term, an increased risk of pregnancy complications such as preterm delivery in women previously treated with excisional procedures for precancerous lesions.”

Guidelines began changing back in 1980 when The American Cancer Society recommended less frequent screening for women who are at average risk for cervical cancer. Over thirty years later, many doctors are still not using those guidelines in their own practices. Over half of U.S. obstetrician gynecologists still recommend an annual Pap smear.

Life experiences like that of Miss Malaysia, Genevieve Sambhi, keep some women and their doctors in favor of an annual Pap smear. In her blog, she describes herself as a healthy, 35-year old mother of two when she was diagnosed with cancer that required a hysterectomy, radiation, and chemotherapy. She asked herself, “I went annually for my pap smears, how had I gone from healthy to chemotherapy in one year?”

For now, many insurance plans still cover annual Pap smears. Even without a Pap smear, most women should still see their doctors for a well visit. New Jersey obstetrician gynecologist Dr. Andrea Price told the New York Times, “If (patients) don’t come through the door for their Pap, then they will miss out on their breast exams, mammograms and tests for other gynecological cancers and sexually transmitted diseases. That really concerns me.”

Bottom Line—Pap smear aside, women aged 21-70 should still see their obstetrician gynecologists annually.

OVERHYPED

5. Organic vs. Conventional Food

As reported earlier this year by the 2×2 project, media coverage of a Stanford University study on organic food was quite unbalanced. The research comparing data on organic and conventional produce made its way into newspapers, broadcasts, and online sources. Most coverage focused on the striking absence of nutritional differences between organic and conventional foods. Subsequent stories that looked at the findings in a more balanced way just didn’t get the same attention.

For example, the initial story in the New York Times breaking the news of the Stanford study results appeared on page A20 on September 4, 2012. Reporter Kenneth Chang’s Q and A from the same day raised questions about advantages of organic milk, the downside of pesticide use, and concerns over agricultural antibiotics, but was only published online in the Well blog.

Chang later wrote a news analysis on the same study. This article acknowledges that English scientists looked over the same data as the Stanford study, but found organic produce to be more nutritious than conventional foods. It also explained the corrections that the Stanford researchers made to their paper, including a mistake concerning the disease-fighting flavonoid content in organic produce. Chances are that fewer readers saw this story, which appeared over a month later in the “D” section of the paper.

Bottom Line—Media coverage can be dicey. For those concerned about pesticides and agricultural antibiotics, organic foods are a better choice.

4. Gluten Free-For-All

Time magazine ranked “Gluten-free everything” as the number two food trend of 2012. In another article, the magazine reports that while almost a third of Americans claim to be reducing or avoiding gluten intake, only one in 133 must do so to manage a serious illness called celiac disease, and only one in 16 has a milder sensitivity to gluten.

In a study evaluating the prices of 56 gluten-free foods, every single one was more expensive than the comparable item containing gluten. On average, they were close to three times the price.  CBS News reported that Americans would spend an estimated $7 billion on gluten-free foods in 2012. For the expense of gluten-free foods, consumers may end up with products that are lower in fiber and are unfortified.

Some people are shunning gluten, not for celiac disease or a sensitivity, but for weight loss. However, there is even less evidence that gluten-free products help dieters shed pounds. Consumption of less bread and pasta ,if not replaced with other high-calorie items, may result in lower calorie intake and therefore, weight loss. U.S. News and World Report quotes registered dietician Katherine Tallmadge’s response to gluten-free weight loss as “a terrible idea.”

Bottom Line—Unless you’ve been tested for celiac disease or have an identified gluten sensitivity, there is no reason to avoid gluten.

3. Studies That Cheer the Overweight

Occasionally, readers escalate the hype around certain stories because some evidence seems to tell them what they want to hear. A study published in the Journal of the American Medical Association tied being overweight to lower mortality. Does that mean another cookie might help you to live longer?

The January 2013 study set off a fiery debate among scientists who were quick to disparage the notion that heavier might mean healthier. The controversy centers around what is known as the obesity paradox, although the key weight in question is actually overweight, not obese. A news feature in Nature sums it up this way, “Being overweight increases a person’s risk of diabetes, heart disease, cancer and many other chronic illnesses. But these studies suggest that for some people — particularly those who are middle-aged or older, or already sick — a bit of extra weight is not particularly harmful, and may even be helpful. (Being so overweight as to be classed obese, however, is almost always associated with poor health outcomes.)”

The Harvard School of Public Health convened a panel of experts to discuss the findings. They pointed out methodological errors that Dr. Frank Hu, Harvard School of Public Health professor of nutrition and epidemiology and Harvard Medical School professor of medicine, claims led to an erroneous conclusion that people in the study were dying because they were thin, when they may have been thin because they were dying. For the time being, there is no clear-cut explanation for the obesity paradox.

Bottom Line—The controversy concerning overweight and mortality should not dissuade individuals from eating a well-balanced, moderate diet and getting adequate exercise.

2. Red Wine as Anti-Aging Elixir

Another tale that readers would like to believe is that consuming lots of red wine will boost health and extend life. Most of us would love to find a fountain of youth, and wouldn’t it be lovely if it were flowing with red wine?

Red wine is a good source of a compound called resveratrol, which seems to guard against several age-related diseases.  Since 1992, hundreds of reports have indicated that resveratrol may protect against cancer, cardio vascular disease, vascular dementia, and Alzheimer’s disease. Although those benefits sound desirable, they are not reason enough to start drinking if you are currently a teetotaler.

German-Swiss Renaissance physician Paracelsus offered the wisdom, “Whether wine is a nourishment, medicine, or poison is a matter of dosage.”

The Mayo Clinic has advised similarly. They call the potential benefits of red wine “promising” but caution that “Drinking too much increases your risk of high blood pressure, high triglycerides, liver damage, obesity, certain types of cancer, accidents and other problems. In addition, drinking too much alcohol regularly can cause cardiomyopathy — weakened heart muscle — causing symptoms of heart failure in some people. If you have heart failure or a weak heart, you should avoid alcohol completely. If you take aspirin daily, you should avoid or limit alcohol, depending on your doctor’s advice. You also shouldn’t drink alcohol if you’re pregnant.”

For those who do drink red wine, and would like to strike a balance between the potential benefits of consumption and the potential harms from too much drinking, moderation is key. That means one five-ounce glass of wine for women and two for men each day. One or two servings of wine does not sound like the carte blanche endorsement that some might have been hoping for, but enjoy the notion that you might be protecting your heart while raising your glass.

Bottom Line—If you do not drink, do not start. If you drink red wine, moderation is the key.

1. Andrew Wakefield’s Lancet Study

An elaborate fraud.”

“A costly lie to society.”

“Probably the worst paper that’s ever been published.”

One of Time magazine’s great science frauds of all time.

These are not the kind of reviews one hopes for when publishing a paper. And yet, the amount of coverage and media attention that Andrew Wakefield’s Lancet article on a discredited link between vaccines and autism received, and continues to receive, is enviable. Although Time magazine quotes the Lancet’s own editors saying, “It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false,” there are still people who have not heard about the Lancet’s retraction and Wakefield’s fraud conviction. Maybe some who have heard, are taken with entertainers like Jenny McCarthy who are using their celebrity status to perpetuate “The lie that won’t die.”

The reviews for vaccines are quite to the contrary:

“A great success of preventative medicine.”

“Among the most cost-effective investments in global health.”

One of the most successful public health achievements of the 20th Century.”

The evidence refuting a link between vaccines and autism is abundant. The Autism Science Foundation has links to 28 studies on their website for those who wish to read through some of the findings themselves. A paper published in Clinical Infectious Diseases reviews the science debunking three different theories on how vaccines and autism might be connected. The evidence is so conclusive that the authors recommend a shift in focus to “more promising leads.”

Bottom Line—Vaccination schedules exist for a reason!

Edited by Dana March.

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.