Faith in Statistics

I have some empathy for those who are suspicious of recent recommendations pushing back screening ages for breast and cervical cancer.

Nothing, for example, can stop my pre-flight anxiety. And try as my boyfriend may, he will never convince me to go skydiving. It may be a “calculated risk,” as he says, but it just feels unnatural and, well, “risky.”

So I can sympathize with women who say, ‘that one person saved from breast cancer out of 2,000 others could have been me.’

Highly, highly unlikely. But however unluckily so, it could have been.

Humans tend to see things in 50-50 odds, in terms of this outcome or that. Either my plane lands safely or it doesn’t. My chute opens, or I pummel into the earth. It takes a lot more to think in terms of numbers, odds, risk.

That’s why public health experts do it for us. They’re trained to pit the risks of screening (radiation exposure and anxiety from false-positives for breast cancer, for example) against its benefits (how many lives does it really save?) and calculate sound advice.

It’s called evidence-based medicine, and it’s what doctors like to practice best.

But we don’t see the epidemiologists’ thought processes, their methodology, or their rationale, which could explain why there’s so much skepticism in the general public. As Paul Raeburn jokes in a recent Knight Science Journalism Tracker item, we can’t just consult our healthcare epidemiologist to tell us what to do and why.

But we can try to think like one. It’s as simple as searching the New York Times. These numbers are from a fantastic news analysis by reporter Kevin Sack:

According to their review, the U.S. Preventive Services Task Force found that one cancer death is prevented for about every 2,000 women ages 40 to 49 who are screened for 10 years.

For women ages 50 to 59, one death is prevented for every 1,300 women screened.

Looking very broadly at those numbers, your risk almost doubles when you hit 50. Starting to see their thought process?

The screen works even more efficiently for women ages 60 to 69, preventing one death for every 377 ladies. Based on those numbers, no one would deny screening at that age. That’s a huge difference from 1 in 2,000 — your risk is increased almost five times from when you were 40.

I don’t know the exact statistics, but it would also be worthwhile to factor in your risk of cancer from being exposed to radiation once a year from 40 to 49.

I surely wouldn’t be able to calculate that. As a rookie health reporter, I’m just beginning to understand risk. If I’m around it every day and am still no expert, I can imagine how challenging it must be for the lay reader.

And your doctor may not be able to offer much help, either, as Raeburn notes in his commentary. Physicians learned of the recommendations at the same time we readers did. And they are certainly not epidemiologists. Their last statistics course may have been during their undergraduate training.

So what can you do? Well, know your risks. Know that the new guidelines exempt women who have genetic risks for breast cancer. (And bear in mind that the new guidelines are only one set of recommendations. Other medical organizations, like the American Cancer Society, have not changed their policies yet.)

And do a bit of rationalizing on your own. If you’re not in the at-risk population, but you’re not comfortable relying on the numbers, then compromise. Get screened every three or five years during your 40s if that puts your concerns at ease. It may be statistically unnecessary, but at least you will have peace of mind.

Just like I do when I pray to the deity of statistics before takeoff.

Such is Science

Remember that blog post in which I blasted folks on airplanes and in Broadway theaters for wearing surgical masks to guard against H1N1?

When I said, “the science says that surgical masks do nothing to keep the flu from getting into you — they just keep it from getting out of you.”

Well, a reporter is only as good as her sources, and my sources — and the CDC’s sources — got it wrong.

Last week at the Infectious Diseases Society of America meeting in Philadelphia, the researchers retracted their study that showed N95 respirators were effective against flu transmission, while surgical masks weren’t.

Apparently their statistics were off, and their peer reviewers pointed it out.

So, now, taken altogether, the data show that there’s no difference between N95 respirators and surgical masks in terms of flu protection (a study published in JAMA — that means it was peer-reviewed — already came to this conclusion last month).

Perhaps that’s what we get for taking science reported at meetings for gospel (the study was originally reported at ICAAC). This kind of work tends to be published only as abstracts — which are rarely up-to-date — and seldom scrutinized by anyone other than the study’s authors.

On the other hand, this was a good confirmation that both science and the peer review system work. Science continues to re-evaluate its stance until it comes to an acceptable answer. Peer-reviewers are a big driver in that process.

While the lay person might recoil in having to admit that she is wrong, a scientist is not a scientist if they claim to know everything. Real science is about advancing knowledge — which may sometimes contradict previous knowledge.

As Michael Smith, my colleague who reported the mask stories, so aptly puts it, “science is the only field willing to admit its mistakes.”

I’d gladly buy any scientist a couple rounds to wash down any pride.

Thought We Were Over H1N1 Vaccine Hazards

I got an email from a friend early this morning about how three pediatricians refused to give another friend’s newborn the swine flu vaccine.

“Many doctors are coming out and saying that you have  a much higher risk of dying from the vaccine than from dying from swine flu itself,” she said.

I cringed the way I do when I watch that obviously-faux Fox News report on the cheerleader who got “dystonia” from a seasonal flu vax.

No physician would claim that. I wrote a response-to-all that I want to share here, to allay any kinds of false concerns over the vaccine:

“As a medical reporter, I feel I should weight in on this. I have to say that statistic about risk of death is blatantly wrong. More kids in the U.S. have died from the swine flu — 114 since April — than from the vaccine. Actually, NO kids have died as a result of having the vaccine. We now have almost two months’ worth of data (not to mention data from early, albeit rushed, clinical trials) on the swine flu vaccine and there have been no deaths, no serious adverse events. And that’s among the entire U.S. population (over 500 U.S. adults died from swine flu between April and August, and I don’t know how many more by now).

The swine flu vaccine is nearly identical to the seasonal flu vaccine. It just contains one different protein — DNA from the H1N1 strain, rather than the typical seasonal flu virus. But incorporating new proteins into the vaccine happens every year, since different strains become the “dominant” seasonal flu. Next year, for example, your seasonal vaccine will likely incorporate, or fully become, the swine flu vaccine.”

My friend also had concerns about other ingredients in the vaccine, including formaldehyde. I thought it was just a really terrible rumor, but on further analysis this is what I found and wrote to her:

“This is the FDA’s H1N1 ingredient list:
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm186102.htm

And here is the makeup of Sanofi’s vaccine:
Influenza A (H1N1) 2009 Monovalent Vaccine is formulated to contain 15 mcg hemagglutinin (HA) of influenza A/California/07/2009 (H1N1) v-like virus per 0.5 mL dose. Gelatin 0.05% is added as a stabilizer. Each 0.5 mL dose may contain residual amounts of formaldehyde (not more than 100 mcg), polyethylene glycol p-isooctylphenyl ether (not more than 0.02%), and sucrose (not more than 2.0%).

Apparently formaldehyde is used to kill live virus. If it’s in the vaccine, it’s trace amounts — 100 micrograms is incredibly small. Not something I would personally worry about.”

This is how I signed off the email:

“Apologies if I sound stern about this, but part of my job is to keep abreast of all of this information, and ask hard questions of officials — doctors, government administrators, researchers — if something really is amiss. Since April, I really haven’t had any major reason to do so.”

I also sent her a couple of links. Check them out if you have any other remaining questions:

Here is a good myth-buster piece on the H1N1 vaccine: http://www.nytimes.com/2009/10/12/opinion/12offit.html?_r=1

And here is one with regard to the virus itself: http://www.nytimes.com/2009/09/08/health/08well.html

Also, the FDA and CDC have great swine flu landing pages. I like the FDA’s better: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm150305.htm

And here is the CDC’s: http://www.cdc.gov/H1N1FLU/

A Better ‘Position’ to Deal with Disease

In pop culture, yoga gets a bad rap as a frou-frou hobby of rich housewives or yuppies.

But recently, researchers — mostly psychologists — have been taking a hard look at its potential as a complementary therapy for patients with all kinds of disorders. Cancer. Cardiovascular disease. Asthma. ADHD.

Many have found that it has positive effects on quality of life, and reduces stress and anxiety. Makes sense, since the Ayurvedic therapy is comprised of stretching (read: exercise) and breathing and meditation (relaxation/stress relief).

Studies on possible physiological effects of yoga are still underway. Some say it may reduce levels of cortisol, the body’s stress hormone.

Of course, no researcher would ever ask whether yoga can actually TREAT disease. It’s clear that yoga is a complementary therapy, not an alternative one. Though those terms are often paired, they mean very different things.

I go into more detail in a story I wrote for Good Morning America Weekend on ABC and Medpage Today. We just launched a new monthly segment together called “Doctor’s Orders,” and the yoga story was the first in the new partnership.

After you watch the ABC video, check out our video on MedPage Today, produced by Bjoern Kils.

Healthcare Reform Analogies

Just wanted to point out a couple of great analogies from Dr. Margaret Polaneczky’s blog on healthcare reform.

She writes that having health insurers, big pharma, medical device makers, and lawyers as the leaders in healthcare reform is like “asking Master Card, Walmart, Verizon and Best Buy to help figure out your monthly budget.”

As for big pharma in particular: “Asking them to help us cut healthcare spending is like asking the schoolyard pot salesman what you should do with your lunch money.”

But she doesn’t leave physicians and healthcare consumers blameless. Docs are too busy seeing patients to make enough money to pay their own bills that they don’t have time to put sufficient input into the debate.

And patients’ fears of ‘rationing’ and ‘death panels’ are playing perfectly into the hands of those “whose biggest concern is profit,” she writes.

The entire piece is worth a read, though it makes the outcome of the current “healthcare debate” seem just a bit futile.

Diving with Disease

This post will probably speak to the health concerns of only a small group of people — asthmatics, diabetics, and other chronic disease patients who want to scuba dive.

Yes, if you have any of these conditions, you can venture underwater — despite how counter-intuitive it may sound (if you can’t breathe properly on the surface, why would it be any easier under the sea?).

Obviously, it’s not easier, and you’ll have to get to know your risk factors before donning tanks and fins.

For example, if you have exercise- or cold-induced asthma, you’re disqualified. No doctor will allow you to dive (and yes, a physical is a requirement for anyone thinking of becoming a diver).

A physician will probably give you the seal of approval if you have well-controlled asthma. If you have moderate- or severe-persistent asthma, you’ll have to impress your doc with good results on pulmonary tests before he clears you.

For diabetics, the worst-case scenario would be having a hypoglycemic event underwater. Diving is exercise, so it will use up more glucose for energy than normal. That’s why doctors recommend that patients keep their blood sugar around 150 mg/dL before a dive. Having a bit of extra glucose in reserve could stave off a hypoglycemic episode.

I picked up these tidbits at the Dive Medicine Symposium at Rutgers University two weeks ago. Physicians specializing in dive medicine presented research that found divers with these conditions had no increased risk of adverse events under water.

You can check out the full story, which I wrote for ABC News.

Pink or Green?

Every year our office dons denim and pink shirts for Lee National Denim Day. I’ve always wondered if the “net proceeds” of the clothing-company-sponsored day actually go to cancer research centers — as is claimed on the website. But I pay my $5 and pull my pink blouse from the back of my closet anyway.

This year, denim day was last Friday. Then, on Sunday, I saw football players in pink cleats and gloves, and began to wonder — where is all this pink money really going?

A colleague at ABC News brought the question to light in a great story. One of her sources, Samantha King, an author of a book on pink ribbon mania, noted that not all companies that flaunt their pink are donating to research:

“While some products clearly stated how much money was going toward research, King said other companies simply put pink on their products to ‘raise awareness’ without donating any proceeds toward research.”

So the best thing you can do is try to figure out what the company you’re purchasing pink from is doing with your green. Then hope that they’re donating all the proceeds to a reputable organization that conducts or funds respectable research.

As you can tell, that’s not easy. As skeptical as I am about the “net proceeds” Lee donates, I’ll still be wearing my pink next year.

Overnight Immunity

A few days before reading this column in the NY Times, I had commented to a colleague that when I get a cold now, it doesn’t last quite as long as it did when I was an undergrad.

My theory: I slept less then. Much less. All-nighters were a requirement, at least once a week, for putting out the school paper.

Researchers reporting in the Archives of Internal Medicine did the dirty work of testing my hypothesis for me. In a study, they found that people who slept seven or fewer hours per night were three times more likely to catch a cold when exposed to the rhinovirus.

Much evidence has already pointed to a very intimate relationship between sleep and immunity. This just adds to the literature.

Nowadays I average about eight hours per night. All-nighters are a thing of the past. And my upper respiratory tract is grateful.

Cover Your Mouth — But Not with a Mask

I saw them on the plane from Vancouver to Toronto.

They haunted me in a Broadway theatre.

Those creepy MASKS.

Flimsy, coffee-filteresque surgical masks that people wear thinking they are protecting themselves from flu — particularly H1N1 flu.

Next time you see such a person, run from them. Not just because they are silly and scary-looking. But because the only reason to wear such a mask is to prevent transfer of the wearer’s germs to others.

Thus the only logic could be that these people have germs and are trying not to spread them — because surgical masks do NOTHING to protect the wearer from GETTING disease.

They aren’t designed to keep bugs out. They prevent them from getting out of you — so that the surgeon doesn’t infect his patient.

Credible sources have said this many times over, the most recent being a team of researchers at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco.

If you want to protect yourself, you’ll need to wear an N95 respirator. They’re made to block 95% of particles 0.3 microns or larger from getting into your respiratory pathways (which MAY help — 0.3 microns is 300 nanometers, and most viruses range from 20 nm to 400 nm in size). Have fun trying not to freak people out when you wear it.

The best solution? Don’t wear a mask at all. That’s what the CDC recommends (unless you’re a healthcare worker). Rather, wash your hands, cover your mouth when you sneeze, and all those wonderful tidbits you learned that winter in kindergarten.

A Treatment for Fear

Dear Anti-Healthcare Reform Community,

I don’t understand what you’re so afraid of.

You say you loathe a “government takeover” of healthcare. That Americans won’t have the “choice” of receiving the procedures they need to live.

Yet somehow you put your faith in insurance companies. For-profit insurers with bottom lines to consider in every healthcare decision they make. Who can deny coverage to those with the worst conditions.

Tell me the Ohio man who pays over $2,550 a month for health insurance — because his 8-year-old daughter died of a brain tumor and because his wife has breast cancer — is not before a “death panel.” If he loses his job, he has no other options. What insurer will cover him then?

Or what if you have cancer, and you lose your job, ergo  your health insurance. You get a new job. But the new company’s health insurance won’t cover you because your cancer is a pre-existing condition. How’s that for “death panel?”

You say you don’t want to pay the healthcare of “illegal immigrants.”

I hate to be the one to break it to you, but you’re paying for them right now — via higher insurance premiums, and via taxes if you live in an area with a public hospital.

But you don’t have to worry about that anyway — there is NO proposal mandating that immigrants receive coverage.

If you’re so opposed to the government “running the show,” why are you not appalled by the federal education system? How terrible it is that every child, ages 5 to 16, MUST receive some sort of schooling. Taught by those liberal, college-educated teachers. Ugh!

It’s probably because you know that you have the choice of sending your kids to a private school. Or a charter school. Or a parochial school.

Well, in reality, you’d have similar options with healthcare. Especially when a public plan is a mere option in the wider pool of health insurers.

Every country that provides healthcare to its people ALSO has a market of private plans that you can pay your way into — Denmark. Germany. Italy. Canada. Those are just some of the homelands of people I’ve talked to about healthcare reform and who have such systems in their country.

But you know what they always tell me? They much prefer the public healthcare to the private. It’s just better, they say.

Healthcare reform is not about suppressing your rights to healthcare. It’s about making those rights available to more people. But that really won’t affect YOU personally — because you’ll still be able to keep your current policy if you’re happy with it.

So stop being so … scared.