What we talk about when we talk about research findings in the news

What happens when journalists report the findings of a scientific study to the general public? Often, the findings are stated out of context, broadly interpreted, and stripped of the nuance and uncertainty that characterize much of scientific research.  Should this scare us back from publicizing findings to a wider audience than you might typically find in a scientific journal? Or is publicity critical to uptake?

What is our responsibility as scientists to communicate our findings, not only through dedicated dissemination and implementation planning, but also through the popular press?

Here’s a recent example. JAMA published the findings of a study by Mandager et al.  on the association of cardiorespiratory fitness (CRF) with long-term mortality. CRF was measured by exercise treadmill testing in a sample of over 120,000 patients who were having this test done anyway as part of their care (that means these people were mostly being evaluated for symptoms potentially related to cardiovascular disease). The investigators quantified CRF as peak estimated METs. They separated by sex and age to calculate percentiles and then stratified CRF based on those percentiles. They used public and hospital records to determine mortality. Median follow-up was 8.4 years. The investigators concluded that CRF was significantly inversely associated with all-cause mortality (i.e., the fitter you are, the less likely you are to die). They went on to state that low CRF was as risky as or riskier than diabetes, CAD, or smoking. They also noted, importantly, that “there does not appear to be an upper limit of aerobic fitness above which a survival benefit is no longer observed”, but “there continues to be uncertainty regarding the relative benefit or potential risk of extreme levels of exercise and fitness”. They go on to offer several other sensible caveats, including that the study population may not be representative of the general population, and there are potentially significant unmeasured factors in this retrospective study. All things considered, though, this seems to represent very good news: a modifiable factor is strongly associated with increased longevity in a large sample with a long follow-up.  Bravo!

So how did this get reported in the popular press? Gizmodo’s headline reads “No Such Thing As Too Much Exercise, Study Finds”.

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What happens when a plant-loving scientist watches What the Health

I’m not a diet absolutist or a purist, but if I had to join a diet camp and stay there, it would be with the vegans, and specifically the whole-foods, plant-based vegans. My experience and common sense tell me that this is a good way to eat. There’s some evidence that it’s healthy. There’s a lot of evidence that it’s economically and environmentally sound. Mostly vegetables, fruits, whole grains, nuts and seeds, all that good stuff. I’m for it. IMG_1435

So this week, I watched the much-discussed What the Health, since when my partner’s out of town, all I do is watch documentaries about fitness and stuff. As a person who is personally and professionally invested in health, I wanted to like it. But alas, I was thoroughly disappointed, and even a little pissed off.  Yes, I’m late to the party. But whatever. The thing is, I think the overall message is probably right– processed meat is bad for you, industrial production of  animal foods creates major health hazards, animal agriculture is an ethical and environmental abomination, and major health advocacy groups take money from corporations that promote unhealthy products, thereby creating a colossal conflict of interest. So why package this message in a bunch of evangelism, cheap tricks, and scientific misrepresentation? It’s bad for the message.

whatthehealth

indeed.

Let’s take a moment to discuss crimes against science: no credible scientific paper would ever say something like “this definitely shows beyond the shadow of a doubt that a always causes b no matter what, and this is 100% true beyond the shadow of a doubt.” Science doesn’t work that way. Evidence accumulates– with nuanced approaches and varied findings, and over time, it may start to become clear what’s likely going on. Scientists study the studies and look at patterns and trends. They create meta-analyses and systematic reviews. They build a body of credible evidence. They don’t pull a handful of individual studies out and ask why they haven’t been made into policy.

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Women’s Health: Beyond the Bikini

Health is complex. Women are complex. Women’s health is complex. So why does “women’s health” so often refer to reproductive issues alone?

The American Heart Association and the American College of Obsetricians and Gynecologists did something smart. They looked at the past few decades of progress in women’s cardiovascular health and asked “why are women still under-informed about their risk of heart disease. . . and why are we still not better at lowering risk?”

Those of us who practice primary care day-in, day-out could probably tell you a lot of reasons: competing priorities, limited time, siloed care— leaving a void for a big-picture assessment of health and health risks. This is a problem for all kind of patients and providers, but it’s particularly acute in women’s health, where issues of reproductive health often take center stage (especially in younger women). A well-woman visit is an opportunity for more than pap smears and birth control! This might be in a primary care practice or a gynecologist’s office (where many young women get their only care). What are we telling women when they come for a well woman visit, and what are they telling us? Are we communicating well, or are we checking boxes on the EHR and making sure we get reimbursed fully? I had a well woman visit myself this year, and I heard a lot about pap tests and nothing about blood pressure or depression.  This is not unusual, but it’s not good.

There’s mounting evidence about sex (biological and physicological) and gender (sociocultural) influences on cardiovascular health and disease. Cardiovascular disease was first identified, studied, and treated in men. Our entire paradigm of the disease is based on men. Yet women’s disease is different, women’s response to disease is different, and the healthcare system’s treatment of women is different. Still, we too often fail to appreciate how these differences matter, and that undermines our efforts as health professionals to address risk.


The million dollar question: How do we identify, communicate, and mitigate women’s cardiovascular risk effectively?

One approach? Treat women’s health as a holistic issue rather than just focusing on the parts covered by a bikini.

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Kinesio taping: yea nor nay?

I’ve had a minor niggling calf pain for a week or so. Should I kinesio tape that sucker? Kinesio tape (also called KT tape, though technically that’s a brand name): it was a hot ticket at the olympics a few years ago (London, maybe?). I’ve used it before, for minor tweaks and sore spots. I see others at the gym doing it. Patients of mine ask about it. Professionals (hi PTs!) do it. Theoretically, kinesio taping is supposted to increase blood and lymph flow by lifting the skin— this isn’t the same as traditional athletic taping, which is meant to create stability. Because I’m a science person, I’m immediately skeptical of a claim without evidence, even if it seems generally sane.

So, let’s ask: Kinesio tape. Is it safe? Does it do anything? Should I cover myself in multi-colored tape before my next workout?
taped up and ready to run.

why yes, my KT tape does match my skoras, than you for noticing.

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How not to be an idiot (or at least not to sound like one) when talking about health & fitness topics

Have you ever listened to a podcast or overheard a bro-trainer at the gym and heard something so profoundly idiotic that you did a spit-take while trying not to break your form on the rowing machine? Here’s how not to be the guy that makes that embarrassing situation happen:

  1. If you are going to use scientific (or anatomical, or otherwise technical) terminology, learn how to spell it and how to pronounce it. Creatine is not the same as creatinine. Hemoglobin is not the same as hemoglobin A1C.
  2. Learn what it means, too.
  3. A single study does not a body of evidence make. And use common sense— a study with an n of 10 isn’t impressing anyone.
  4. Don’t cherry pick. Anyone can go into PubMed and find an article that sounds good for his or her point. But it’s stupid at best and deceitful at worst to ignore evidence that hurts your position.
  5. I can’t believe I have to say this, but if you are going to cite a study, friggin’ read it. No, I don’t mean skim the abstract.
  6. Be open to opposing viewpoints and be willing to change your mind.
  7. If you have an agenda, or an angle, be clear about it. Do you have a paleo podcast? Cool. Make sure your description says that, and be willing to talk about what it means and why you do it.
  8. Be very, very careful when you are stating something as fact. Particularly something that is controversial. It can make you sound a little brainwashed. Try it: “Butter is good for your brain.” “Ketosis is healthy.” Do you still trust me when I tell you that penicillin can cure strep throat, or hand-washing prevents the spread of disease?
  9. It is absolutely OK to give your opinion or relate your personal experience, as long as you are clear that that is what you are doing.

So there you have it, kids. Go forth and discuss the science without sounding like an idiot or a quack!

What’s for dinner?

Food Blog Roundup!

 

There is no health topic more confounding and controversial than nutrition. People care, and they care a lot, but finding sensible and trustworthy information is a full-time job. Searching “diet” in books on amazon returns almost 100,000 hits. Doctors have their name on every kind of eating plan you can think of, from Atkins to Ornish. Popular-press health magazines report the findings of tiny, specialized research studies as if they’re The Answer (see rant).

 

So what’s a girl/boy/man/woman/non-gender-idenfitied person to do? My advice is to stick to the Michael Pollan  method: Eat food. Not too much. Mostly plants. 

greens

I like it because it’s easy, and it cuts through bullshit, and it’s very, very good advice. Of course, it’s not specific. “Eat food” is subjective, but it means, mostly, that what you eat should be clearly recognizable as food to your grandmother— and not created in a lab. Another way to say this is to eat close to nature, or eat whole foods. “Not too much” isn’t as easy as it looks, either, but basically, it means eat the right amount to support the energy you expend. So, if you are Michael Phelps, eat more. If you are Mr. Potato head, eat less. “Mostly plants”? This one might be more controversial, but I believe, and the science supports, that this is the healthiest approach to eating (I won’t review the scientific literature here, but I’ve read a lot of it and am happy to discuss it more fully in the future!). Plants tend to be nutrient-dense foods, and they tend to have more “good” and less “bad”. Plant-based diets are also generally more efficient and environmentally friendly.

 

To to get from “OK, great, I get it” to “what’s for dinner?” creates some challenges. The truth is, you have to cook. You just do. You can’t eat an overall healthy diet if you rely entirely on others to prepare your food. When I started eating along these principles, it took some legwork. I don’t eat a completely vegan or even vegetarian diet, but I do eat “mostly plants.” I tend to find a lot my recipes on vegan blogs, and I am famous in my family for the recipe collection I store in an evernote library that we can all peek at. So where do I find these recipes that I make, tweak, and save? The internet, duh. Now, one caveat: Just because a recipe is vegan doesn’t mean it’s healthy, and just because it calls for parmesan cheese doens’t mean you can’t make a vegan version. So use your common sense, and be creative! Here are some great suggestions for places to start, or places to go when you are feeling uninspired:

 

http://ohsheglows.com/

http://veganyackattack.com/

http://kblog.lunchboxbunch.com/

http://www.nomeatathlete.com/vegetarian-recipes-for-athletes/

http://www.theppk.com/blog/

http://blog.fatfreevegan.com/

http://www.cleanwellness.ca/

http://thugkitchen.com/

http://www.greenkitchenstories.com/

http://golubkakitchen.com/

http://www.alexandracooks.com/

http://thesimpleveganista.blogspot.com/

http://www.mynewroots.org/site/

 

These are just a few! The internet is full of them. Are there favorites that I didn’t put here?