Same-day hip replacements get patients back on their feet

Explanation: This is a story about “same-day” hip replacement surgery. The story gives readers the impression that a few pioneering institutions are offering patients a superior procedure, when the reality is that hospital stays after hip replacement have been steadily shortening for many years, to the point that it is not unusual for some otherwise healthy patients to go home without spending a night in the hospital. The story includes important cautions from a skeptical surgeon, but the prominence of the surgeon and institution that are actively marketing this procedure results in a story that implies greater benefits and fewer risks than there is evidence to support. The same surgeon and hospital were featured in a Wall Street Journal story that we reviewed in February. There are more than 300,000 hip replacement procedures performed in the United States each year. The many hundreds of thousands of people who have hip pain and are considering hip replacement need news stories that clearly and precisely state the benefits and harms of the various procedures.

There is no discussion of the costs of hip replacement, even though it is a common procedure and its costs are widely discussed. For example, a Blue Cross Blue Shield report noted an average cost of about $30,000, but with wide variations, ranging between “$11,327 in Birmingham, Alabama, and $73,987 in Boston.” The basic premise of the story is that “same-day” hip replacement offers important advantages to patients, but the only benefit specifically noted in the story is that people who opt for this procedure are less likely to spend a night in the hospital. Even then, there are only vague references and quotes from the surgeon on how many patients really go home the same day. Indeed, the one patient named in the story did not go home the same day. The story does note that studies following hip replacement patients for at least six months find no important differences in how they fare depending on which sort of procedure they had. Still, the overall thrust of the story is that “same-day” is superior, without critically evaluating the differences between going home that day or the next. We will give the story a Satisfactory rating on this criterion because it includes comments from a surgeon who warns about the risk of serious complications during the first night after surgery. However, the most prominent voice in the story is a surgeon who dismisses those concerns by saying, “if the pain is controlled and the patient is healthy and medically completely stable there is no reason for them to be in the hospital. It really doesn’t make sense.” We’re not given any information or data that proves this “doesn’t make sense,” though. We also think potential harms that could have been included are falling at home due to dizziness, or otherwise not being adequately prepared for managing under major surgery. The story does mention one study that found no difference in longer term outcomes of two types of hip replacement procedures. However, it fails to note that there are few good studies comparing outcomes of different types of hip replacement procedures and that the choice may rest largely on the personal experiences and preferences of individual surgeons, rather than robust scientific evidence. The story does not exaggerate the extent of hip problems or the relevance of replacement surgery to people with chronic hip pain. This does appear to target younger, healthier people, and surgery for them comes with special considerations–a hip replacement has a 20 to 25 year life span, less when put into a more physically active person. So, younger people may face a second procedure at an older age. When deciding on the timing of the first procedure, this should be considered since second surgeries are more involved and higher risk. This story does include a surgeon who is skeptical of the benefits of “same-day” hip replacements. However, as noted above, the surgeon advocating the “same-day” procedure is featured far more prominently, likely creating an imbalance in reader perceptions. But the main reason for marking down the story on this criterion is that it fails to tell readers that NYU Langone has a marketing campaign tied to “same-day” hip surgery. The result is that the story supports the promotional efforts of the hospital and its surgeons without alerting readers to the commercial aspects of the matter. The hospital tweeted an image of an earlier story on “same-day” hip replacement, indicating the marketing department understands the value of friendly coverage. HealthNewsReview.org also reviewed that Wall Street Journal story. As noted above, the story exaggerates the differences between hip replacements billed as “same-day” and those that give patients more conservative timelines. The story offers examples of hospitals currently offering “same-day” hip replacements. If anything the story understates the availability of the procedure. However, the story could have been more clear about who this procedure is most available to, since this won’t be the right option for some people. For example, if they don’t have help at home, or if they live far from the hospital. The story implies “same-day” hip replacement is new. While the practice is becoming more common, it is part of a long-term gradual trend toward shorter hospital stays, rather than a sudden break with past practice. In fact, reports on the technique note that over a decade ago some hip replacement patients were discharged the same day. The impression that NYU Langone Medical Center has a new type of procedure appears to be more marketing spin than medical fact. The story includes original interviews and other reporting.


New transplant research aims to salvage infected donated organs.

Explanation: Retired subway and bus driver Stanley De Freitas had just celebrated his 70th birthday when he started coughing, tiring easily and feeling short of breath. He was diagnosed with pulmonary fibrosis, a severe scarring of the lungs, and put on the wait list for a transplant.

“Life became unbearable. From the time I got up in the morning until when I went to bed at night, I struggled through every breath of air,” De Freitas, now 74, told Reuters by phone from his home in Toronto. After two years, De Freitas was offered a lung, with one significant downside: The donor had hepatitis C.  In October 2017, he became the first patient enrolled in a just published study conducted at Toronto General Hospital testing a technique that aimed to flush out and inactivate the hepatitis C virus from donor lungs before a transplant. The research comes amid a spike in available organs linked to the opioid overdose crisis, meaning many are contaminated by hepatitis C as the virus is commonly spread by sharing needles. Since it can easily infect an organ recipient, those organs are usually discarded despite the urgent need. Data from the United Network for Organ Sharing (UNOS), which matches donors with recipients, shows that 97 percent of people  waiting for a lung in the United States last year were unwilling to accept an organ from a donor who tested positive for hepatitis C.  While hepatitis C causes serious liver disease, the virus can be present in the blood in other organs. Researchers are testing different approaches to salvage infected organs. A study published in April showed that giving patients antiviral therapy just hours after transplant surgery can successfully attack the virus before it gains a foothold in the recipient. Eliminating the virus prior to transplant would simplify the procedure for patients, said UNOS Chief Medical Officer David Klassen. It could also significantly cut down on wasted donor organs. The technique used in Toronto, known as ex vivo lung perfusion, keeps organs “alive” outside the body by pumping them with a bloodless oxygenated liquid. They used ultraviolet C light to irradiate the solution, aiming to deactivate the hepatitis C virus and make it non-infectious. Perfusion allows doctors to evaluate and potentially rehabilitate organs for transplant, and buys them more time than  storage in ice boxes, which can cause tissue damage. Toronto researchers used a solution from Sweden’s Xvivo Perfusion AB with the hospital’s own ex vivo lung perfusion system, a bubble-like machine made from off-the-shelf components and an intensive care ventilator. The study of 22 patients, published in The Lancet Respiratory Medicine on Wednesday, had mixed results. Adding light therapy significantly decreased the amount of virus, but all but two of the patients contracted hepatitis C, which is now curable. Infected patients, including De Freitas, were treated with a 12-week course of antiviral drugs that rendered the virus undetectable in all of them. Two of those patients relapsed but were retreated and cured. One patient in the study died due to complications from lung transplantation. “All of the patients were in a very sick condition,” said Marcelo Cypel, surgical director at University Health Network in Toronto and co-author of The Lancet Respiratory Medicine study. “Perhaps some of them wouldn’t have made it to the transplant in time if they were not offered these type of organs.”  The researchers are planning another study combining perfusion with a photodynamic therapy, a type of light they believe could be more effective against the virus than ultraviolet because it can penetrate the organ as well as the solution. For a graphic on U.S. organ donors by mechanism of death:  here  In the United States alone, almost 113,000 people are on organ transplant lists, including more than 1,400 awaiting a new lung. Hundreds die each year while on the list or after becoming too sick to endure a transplant. A tragic public health crisis has led to an unexpected opportunity. With the jump in deaths from opioids such as heroin and fentanyl, overdose victims now account for 13% of U.S. organ donations, up from less than 4% a decade ago, according to UNOS. Many of those organs are going to waste. For example, last year less than 4% of hepatitis C positive donors in the United States had lungs used for transplantation, the study’s authors said in the paper. Other researchers are working with perfusion technology to improve the function of donated lungs, hearts and livers. Scientists at the University of Oxford were able to improve the quality of 16 donated livers with signs of a fatty liver disease. They treated donated organs outside the body with drugs and captured fat that was washed out of the liver through a filter on a transportable perfusion device developed by Britain-based OrganOx, according to a study presented last year. OrganOx has European Union clearance to use its device on livers and hopes to gain U.S. approval by the end of 2020. Perfusion device use currently is limited by cost, which can stretch to hundreds of thousands of dollars, and by lack of expertise and training. De Freitas, though, is grateful the Toronto researchers are testing perfusion to salvage organs. “Every day I get up and I thank the Lord, I thank the doctors because I am not supposed to be here,” he said. “I am supposed to be on the other side.”      (This story adds dropped words to name of medical journal)


I'm all ears: fossils reveal human ancestors' hearing abilities.

Explanation: Two-million-year-old fossils including the three tiny bones of the middle ear are helping scientists figure out the auditory abilities of early human ancestors at a time when they were beginning to hear more like a person and less like a chimpanzee.

A study published on Friday involving two species from South Africa, Australopithecus africanus and Paranthropus robustus, showed they boasted better hearing than either chimps or people in a frequency range that may have facilitated vocal communication in a savanna habitat. Both species featured a mixture of ape-like and human-like anatomical traits and inhabited grassland ecosystems with widely spaced trees and shrubs, as opposed to the forests of earlier members of human lineage. In both species, maximum hearing sensitivity was shifted toward slightly higher frequencies compared to chimpanzees, and both had better hearing than chimps or humans in the range from about 1.0-3.0 kilohertz, paleoanthropologist Rolf Quam of Binghamton University in New York said. Sounds in that range include vowels and some consonants, Quam said. “It turns out that this auditory pattern may have been particularly favorable for living on the savanna. In more open environments, sound waves don’t travel as far as in the rainforest canopy, so short-range communication is favored on the savanna,” Quam said. The human lineage split from chimps roughly 5 to 7 million years ago, Quam said, and our ancestors’ hearing abilities began to adapt to lifestyle changes. To assess the two species’ hearing abilities, the researchers studied fossils including tiny middle-ear bones called the ossicles (the malleus, incus and stapes) and created virtual computer reconstructions of the ear’s internal anatomy. Our species, Homo sapiens, which arose about 200,000 years ago, is distinct from most other primates in having better hearing across a wider range of frequencies, generally from 1.0 to 6.0 kilohertz. This range encompasses many sounds emitted during spoken language. “I want to be clear that we are not arguing that these early humans had language, which implies a symbolic content,” Quam said. “Certainly they could communicate vocally. All primates do. But human language emerged during our evolutionary history at some time after the existence of these early humans.”  Paleontologist Juan Luis Arsuaga of Spain’s Universidad Complutense de Madrid said their hearing abilities indicate their voices “would sound strange, half chimp-like, half human, to us. Or in other terms, not completely human.”  The research appears in the journal Science Advances,


Reince Priebus Says Hillary Clinton took "money from kings of Saudi Arabia and Morocco and Oman and Yemen.

Explanation: Priebus said Clinton took "money from kings of Saudi Arabia and Morocco and Oman and Yemen." The monarchies of Saudi Arabia, Morocco and Oman have contributed to the Clinton Foundation, but Yemen, which does not have a king, has not. And although Priebus’ claim was made during a discussion of the foundation as well as contributions to political candidates, his phrasing could have left the impression that Clinton herself, rather than the foundation, received the money. For a statement that is partially accurate, our rating is Half True. To comment on this article, go to the Milwaukee Journal Sentinel's web page.

Campaign Finance, Candidate Biography, Foreign Policy, Military, Negative Campaigning, Wisconsin, Reince Priebus,

For probably as long as Democrats anticipated Hillary Clinton announcing for president, Republicans anticipated attacking her. On April 12, 2015, the day Clinton’s run became official, Republican National Committee chairman Reince Priebus disparaged her on CBS' "Face the Nation." The former chairman of the Wisconsin GOP appeared on the program after U.S. Sen. Rand Paul, R-Ky., who declared for president several days before Clinton did. Paul told host Bob Schieffer that Clinton will have a problem with women voters because "she has taken money from countries that abuse the rights of women," and he referred to Saudi Arabia. Schieffer later noted that Saudi Arabia had given money to Clinton’s foundation, and then while interviewing Priebus, said Clinton couldn’t use that money personally. Schieffer added: "But it also occurs to me, a lot of your candidates and the Democrats as well, are going to be taking campaign contributions that we are never going to know where they come from -- but now you can give these unbelievable amounts of money without any accounting of where the money comes from." Priebus replied with a claim about kings and cash: "But the difference is, all those other entities -- Super PACs, parties, individual candidates -- they can't take money from kings of Saudi Arabia and Morocco and Oman and Yemen, and that's what Hillary Clinton did. And so she's going to have to account for this money." Priebus' statement goes beyond foreign government contributions to the Clinton Foundation, leaving the impression Clinton herself may have benefitted from money donated by the four countries -- including Yemen, which is the home of one of al-Qaida’s most active branches, and where the United States has conducted airstrikes since 2009. Let's sort it all out. Clinton Foundation Not only Republicans are raising questions about whether the Clinton Foundation is taking millions of dollars a year from governments and other donors that want political influence. The Wall Street Journal, the Washington Post, Politico and CBS News have run stories about the questions, with a Journal analysis noting that the number of governments contributing to the foundation in 2014 appeared to have doubled from the previous year. Responding to Priebus’ claim, the foundation emailed us a statement saying: "Like other global charities, the Clinton Foundation receives support from individuals, organizations and governments from all over the world because the foundation's programs improve the lives of millions of people around the globe." The charity, originally named the William J. Clinton Foundation, was launched in 2001 by former President Bill Clinton. Its aim is to partner with government and non-government organizations to tackle issues such as AIDS and poverty. The foundation has received millions of dollars from foreign governments, as PolitiFact National found in February 2015 when it rated that claim by a conservative group as True. When Hillary Clinton became secretary of state in 2009, under President Barack Obama, the foundation agreed to disclose its donors at the request of the White House. When she left the Cabinet post, in February 2013, the foundation became the Bill, Hillary & Chelsea Clinton Foundation, with Hillary Clinton taking an active role in fundraising. Clinton resigned from the foundation’s board just before announcing her candidacy. And a few days later, the foundation announced it would modify its policies while she is a candidate for president, limiting which governments can give directly to the foundation. An important note: Candidates for office are prohibited by law from accepting campaign contributions from foreign governments, but foundations have no such restriction. Here’s what we know about the four countries cited by Priebus: Saudi Arabia The kingdom gave between $10 million and $25 million to the Clinton Foundation between the time the foundation was created through 2014, and some portion of the funds was contributed in 2014, according to the foundation’s searchable database. (The database only reports ranges of the total amounts given and does not provide a breakdown by year, except that it notes which donors made a contribution in 2014.) According to a February 2015 news article by the Washington Post, Saudi Arabia was among some foreign governments that had been supporting the foundation before Clinton was appointed secretary of state, did not give while she was in office and then resumed giving. Saudi Arabia has long been regarded by the United States as a friend and a "strong partner in regional security and counterterrorism efforts," according to the State Department. Oman The Sultanate of Oman gave the foundation between $1 million and $5 million through 2014, including contributions given in 2014, according to the foundation database. The U.S. and Oman have been parties to a military cooperation agreement since 1980. Oman "plays an important role in helping the United States realize its regional stability goals" in the Middle East, the State Department says. Morocco Four days before Clinton announced her run, Politico reported that the foundation was accepting at least $1 million from a Moroccan government-owned company to hold a high-profile conference in May 2015 in Marrakech with the king of Morocco. The article noted that in 2011, Clinton’s State Department had accused the Moroccan government of "arbitrary arrests and corruption in all branches of government," but that when she announced the conference in September 2014, she praised Morocco as "a vital hub for economic and cultural exchange." The U.S. regards Morocco as a "strong partner in counterterrorism efforts," according to the State Department. Yemen Neither the Post nor the Politico articles, which were cited to us by Priebus’ office, reported any donations to the foundation from Yemen. And a spokesman for the foundation told us the country has never been a donor. Yemen borders Saudi Arabia and Oman, but unlike those countries and Morocco, is not a monarchy. American drones have been conducting strikes in Yemen since 2009. On April 14, 2015, the al-Qaida terrorist group announced that one of its top spokesmen for its branch in Yemen had been killed the previous day by an American drone strike. Our rating Priebus said Clinton took "money from kings of Saudi Arabia and Morocco and Oman and Yemen." The monarchies of Saudi Arabia, Morocco and Oman have contributed to the Clinton Foundation, but Yemen, which does not have a king, has not. And although Priebus’ claim was made during a discussion of the foundation as well as contributions to political candidates, his phrasing could have left the impression that Clinton herself, rather than the foundation, received the money. For a statement that is partially accurate, our rating is . To comment on this article, go to the Milwaukee Journal Sentinel's web page.


Problems spur FDA caution on insulin pump

Explanation: First, let’s be clear that this is a review of an Associated Press story as shortened by the St. Paul Pioneer Press. Some of the flaws commented on were not present in the original AP story. The story was about a 10-year retrospective study of adverse events resulting from adolescent use of insulin pumps conducted by the FDA and published in the May issue of the journal Pediatrics. Insulin pumps are being used more often to deliver insulin to the body through a plastic tube with a small tip that inserts under the skin. The article provides a good description of the pumps, indicating that they are approximately the size of a cell phone and can be worn on a belt or kept in a pocket. Insulin pumps have been primarily used by adults but are now being used more often by adolescents because it allows them to lead more normal lives by eliminating the need for them to give themselves insulin injections in public. The results of adverse events reported by in the FDA study, including 13 deaths and more than 1,500 pump-related injuries over the past decade, were accurately presented. However, no denominator was given so the numbers lose context and meaning. Estimated causes of these adverse events – patient misuse, lack of education, and device malfunction – were also described. A notable omission from the story was the importance of parental supervision as three of the 13 deaths occurred when there was no adult supervision. The original AP story provided a good overall summary of the health concerns related to insulin pump use among adolescents and the need for for more study to address safety concerns. But all for the sake of cutting 290 words, the St. Paul Pioneer Press version lost:    any discussion of cost – something lacking in about 75% of all stories we review. (And at a time when the US devotes 16% of the GDP to health care spending!) the emphasis on the parental oversight issue the perspectives of two other knowledgeable sources  Yet it left in a defensive comment from the Medtronic company "which makes the top-selling insulin pump." Why cut out independent perspectives and leave in the Medtronic comment? Is it because it’s a local Twin Cities company? Not a good reason in our estimation.

The original AP story told readers the cost of devices, approximately $6,000, and monthly supplies, approximately $250. The St. Paul Pioneer Press, in its shortened version of the AP story, left this information out. So our grade is for the Pioneer Press effort, not the original AP story. This article fairly communicates the risks and benefits of insulin pump use among adolescents. It does not overstate the main benefit of allowing young people to live more normal lives by eliminating the need for multiple daily insulin injections. The overall focus of the original research and this article was on the potential harms of insulin pump use by adolescents and the need to address safety concerns. Potential causes of adverse events related to patient use and education and device malfunction were appropriately described. This article could have been improved by including the importance of parental oversight in preventing adverse events, particularly since three of the five deaths occurred at times when there was no parental supervision. This article includes the key findings and conclusions reported in the Pediatrics study. Some of the study methodology, e.g. the 10-year time period of the investigation, was provided. But there is no mention that this was a retrospective study and what limitations such a study may have. The story mentions 13 deaths and > 1,500 injuries over 10 years, but fails to give the denominator of subjects involved. In addition, the research study also examined the use of analgesia pump use in adolescents which was not covered in the story. Why not? This article accurately summarizes the prevalence of adverse events related to insulin pump usage in adolescents and presents this information without sensationalism. The brief amount of background information on Type 1 diabetes was useful for context. The original AP story included the perspective of an independent expert, the American Diabetes Association’s president for medicine and science. It also included input from the editor of a patient newsletter. But the Pioneer Press deleted these perspectives. Instead, the St. Paul story included a quote from the manufacturer of the top-selling insulin pump. Why? Because it’s a local Twin Cities company? Multiple daily insulin injections, the standard most widely used treatment option for Type I diabetes, is appropriately referenced. The story establishes availability in its lead sentence when it clearly states that insulin pumps are used by tens of thousands of teenagers worldwide. This article accurately indicates that insulin pumps have been available and used for many years. There is no evidence that the AP story relied solely or largely on a news release.


NASA twins study explores space, the final genetic frontier.

Explanation: From his eyes to his immune system, astronaut Scott Kelly’s body sometimes reacted strangely to nearly a year in orbit, at least compared to his Earth-bound identical twin — but newly published research shows nothing that would cancel even longer space treks, like to Mars.

Genomics, Genetics, Health, Science, Mars, U.S. News

The good news: Kelly largely bounced back after returning home, say scientists who released final results from NASA’s “twins study,” a never-before opportunity to track the biological consequences of spaceflight in genetic doubles. It marks “the dawn of human genomics in space,” said Dr. Andrew Feinberg of Johns Hopkins University. He led one of 10 teams of researchers that scrutinized the twins’ health down to the molecular level before, during and after Kelly’s 340-day stay at the International Space Station. More importantly, the study “represents more than one small step for mankind” by pointing out potential risks of longer-duration spaceflight that need study in more astronauts, said Markus Lobrich of Germany’s Darmstadt University and Penny Jeggo of the University of Sussex, who weren’t involved in the work. The findings were published in Friday’s edition of the journal Science, on some notable space anniversaries — when Soviet cosmonaut Yuri Gagarin became the first person in space in 1961, and the first launch of the space shuttle in 1981. KEY FINDINGS NASA already knew some of the toll of space travel, such as bone loss that requires exercise to counter. This time, NASA-funded scientists looked for a gamut of physiologic and genomic changes that Scott Kelly experienced in space, comparing them to his DNA double on the ground, former astronaut Mark Kelly. Some results had been reported in February. Possibly the weirdest finding had to do with something called telomeres, the protective ends of chromosomes. Those tips gradually shorten as we get older, and are thought to be linked to age-related diseases including some cancers. But in space, Scott Kelly’s telomeres got longer. “We were surprised,” said Colorado State University telomere expert Susan Bailey. She can’t explain it although it doesn’t mean Kelly got younger. Back on Earth, his telomeres mostly returned to preflight average although he did have more short telomeres than before. Next, Kelly’s DNA wasn’t mutated in space but the activity of many of his genes — how they switch on and off — did change, especially in the last half of the voyage, which ended in March 2016. Immune system genes especially were affected, putting it “almost on high alert as a way to try and understand this new environment,” said study co-author Christopher Mason, a Weill Cornell Medicine geneticist in New York. Again, most gene expression returned to normal back home, but some of the immune-related genes were hyperactive six months later. “We learned that the human body is pretty resilient and we can survive and to some extent maybe even thrive on these long-duration flights,” Mark Kelly said. Other findings: —Some changes in the structure of Kelly’s eye and thickening of his retina suggested that, like about 40% of astronauts, he experienced symptoms of “spaceflight-associated neuro-ocular syndrome.” It may be caused by fluids shifting in the absence of gravity. —He experienced some chromosomal instability that might reflect radiation exposure in space. —A flu shot given in space worked as well as one on Earth. —Kelly aced cognitive tests in space but slowed down after his return, maybe as more things competed for his attention. WHAT THE KELLYS SAY “It was a real privilege to be part of this study,” said Scott Kelly, who spent the year in space along with Russia’s Mikhail Kornienko. Kelly retired from NASA soon after his return. He said it probably took him six months once back on Earth before he felt 100% again, but acknowledged his wife said it seemed more like eight months. What was particularly hard, he said, was getting used to not having a schedule dictating his life in five-minute increments every single day, like there was in space. During a teleconference he joked with his twin, “I got all the glory and you got a lot of work.” “I got people coming to my house, right, for tubes of blood,” responded Mark Kelly. “But it’s great we saw and we learned that the human body is pretty resilient and we can survive and to some extent maybe even thrive on these long-duration flights,” he added. As for trips to Mars, Mark Kelly said: “I hope it’s sooner rather than later, and hopefully, our participation in this study will help us get closer to making a mission like that a success.” ULTRA LONG-DISTANCE TESTING Researchers needed months’ worth of blood, urine and fecal samples, along with cognitive and physical tests and ultrasound scans. That meant getting creative: Some blood samples required analysis so rapidly that Kelly would time collection so the blood could travel on Russian Soyuz capsules carrying other astronauts back to Earth. That wouldn’t be an option on a three-year trip to Mars. One of the study’s technological advances: Portable DNA-sequencing equipment that will let astronauts run some of their own genomic analyses on future missions, said Weill Cornell’s Mason. WHAT’S NEXT? Studying one pair of twins can’t prove risks of spaceflight, researchers cautioned. And longer missions, to the moon or Mars, will mean greater stress and radiation exposure. Colorado State’s Bailey plans to study 10 additional astronauts on yearlong missions, using the twin findings as a road map. More one-year missions are planned by NASA, officials said, but no details were given Thursday. “We need to get outside of low-Earth orbit and we need for the astronauts to spend longer periods of time to really evaluate some of these health effects,” she said. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.


Crohn’s patients respond to J&J’s Stelara in study.

Explanation: Without evaluating the evidence, it becomes one of those classic stories of a new therapy spun in the most favorable light possible based on a limited presentation at a medical meeting. Crohn’s disease is a terrible condition and more treatment options are needed. Thus this new research is welcome and we hope ustekinumab proves successful in phase 3 research. But in order to understand what the current study means, readers must know that data presented at conferences are preliminary and how independent experts assess it.

While we’re given the size of the market, we don’t get the costs of the drug itself. It’s a biologic treatment and it ain’t cheap. Even if this story is targeted at a business audience, patient costs are extremely relevant. The study presented lots of numbers and defined the scales. We appreciated the Crohn’s Disease Activity Index (CDAI) thresholds for clinical response and remission, the subjects’ baseline CDAI scores, and the explanation of what a 100-point drop feels like to patients. Bravo for including these points and for mentioning that the study met its ‘primary goal.’ Great facts for readers to consider that are often left out of news coverage.


Ohio committee rejects medical marijuana for anxiety, autism.

Explanation: A State Medical Board of Ohio committee has decided not to recommend adding anxiety and autism spectrum disorder to the state’s list of qualifying conditions for purchasing medical marijuana.

Anxiety, Medical marijuana, Marijuana, Ohio

The committee made its decision Wednesday after hearing testimony that included concerns from several physicians about using marijuana for those conditions. They said the drug offers momentary relief from anxiety but can lead to panic attacks or worsening anxiety for some patients. The physicians also noted concerns about marijuana’s effects on children’s developing brains. The full board could make a final decision at its September or October meetings, but it’s not clear whether it would vote against a recommendation from the committee. The board voted earlier this year against adding opioid use disorder, depression and insomnia as qualifying conditions,


The number of mental health nurses has fallen from 46,155 to 39,358 [since 2009]. This is the difference in the number of mental health and learning disabilities nurses between two different months which isn’t the best way to compare the figures. Comparing the figures in September 2009 and 2017 shows the drop has been larger. The number of doctors in specialist psychiatry training fell from 3,187 in 2009 to 2,588 in the first quarter of this year. This 20% drop was between September 2009 and March 2018, which isn’t a fair comparison. Comparing September 2009 and 2017 there was a 15% decrease. Claim 1 of 3


Grocery store chain H-E-B's "hurricane emergency supplies" included a limit of two on brisket, due to projected storms in Texas.

Explanation: U.S. President Donald Trump said on Monday he will be meeting with vaping industry representatives as his administration considers tightening e-cigarette regulations amid a nationwide outbreak of vaping-related injuries and deaths.

“Will be meeting with representatives of the Vaping industry, together with medical professionals and individual state representatives, to come up with an acceptable solution to the Vaping and E-cigarette dilemma. Children’s health & safety, together with jobs, will be a focus!” he wrote on Twitter. Trump did not give a time for the meeting or offer any other details. He said on Friday that his administration would come out with “an important position” on vaping this week. On Thursday, the CDC reported there have been 2,051 confirmed and probable U.S. lung injury cases and 39 deaths associated with use of e-cigarettes, or vaping products. Nearly 85 percent of lung injury patients in the nationwide outbreak have reported using products containing THC, the component of marijuana that gets people high. In the CDC analysis, THC was detected in 23 of 28 patient samples of lung cells, including from three patients who said they did not use THC products. Nicotine was detected in 16 of 26 patient samples. U.S. public health officials have recommended that people avoid using e-cigarettes that contain THC or any products that come from illicit sources. The Trump administration in September said the Food and Drug Administration was working on a “guidance document” that would lead to a ban of all e-cigarette flavors, aside from tobacco flavoring. Health and Human Services Secretary Alex Azar told reporters that once the guidance was finalized, enforcement actions would begin to remove the products from store shelves. In his remarks on Friday, Trump indicated that a flavor ban was still under consideration, but that other actions were as well, including raising the age limit for e-cigarette purchases. Asked if Juul Labs Inc, which dominates the U.S. e-cigarette market, would participate in the discussions, a Juul spokesperson said the company was not lobbying on the issue. “We are continuing to refrain from lobbying the administration on its draft flavor guidance while we take significant actions to combat underage use and convert adult smokers,” the spokesperson said. The White House did not immediately respond to a request for comment on Trump’s tweet.


Teen eating habits may help cut breast cancer risk

Explanation: This story focuses on a recent study from the journal Pediatrics, which found that women who ate more dietary fiber during adolescence and young adulthood had a lower risk of developing breast cancer. The story does a nice job of addressing the strengths and weaknesses of the study — as does a competing story we reviewed from NPR. However, as with the NPR story, this story would have been even better if it had explained that the 16% lower risk of cancer was a relative risk reduction, and that the absolute difference was a mere 0.2 percentage point. Moreover, the story would have been improved by the use of more appropriate language in the headline — this type of study can’t tell us whether fiber “may help cut breast cancer risk,” and the story should’ve reflected that uncertainty in its headline description. According to the CDC, breast cancer is the most common cancer in women in the United States, with more than 224,000 new cases reported in 2012 alone. Findings that early life experiences (diet and behavior) affect later chance of malignancy and heart disease are beginning to emerge. This should be intuitive, but is hard to show in studies because of the very long periods between the early life experiences and later health outcomes.

breast cancer,Fiber,relative vs. absolute risk

There are a lot of foods you can eat to increase your dietary intake of fiber, and the story lists apples, pears, raspberries, artichokes, green peas, broccoli, split peas, lentils, beans, whole wheat pasta, whole grain bread, brown rice, bran flakes, and oatmeal. We’ll rate the story Not Applicable since most people are aware of the cost of the foods mentioned. However, we wish the story had discussed the fact that many of these healthy sources of dietary fiber are either unaffordable or unavailable to many young women, particularly those from low-income backgrounds who live in food deserts. As we noted with the NPR story, we recognize that this is a story about breast cancer risk, not about food availability. However, if a story focuses on the importance of a healthy diet, there should ideally be at least a brief acknowledgment that many people do not have access to the foods that make up a healthy diet. We recognize that it would be challenging for any journalist covering this story to report on the absolute risks seen in the study. The study does not report absolute risks, although it is possible to calculate them based on the data provided. One could look at the number of cases in each quintile of dietary fiber (found in Table 2) and divide that by the number of people in each quintile (which is found in Table 1). There are several steps involved, but for the example of early adulthood dietary fiber and breast cancer risk in this cohort, you could do the following calculation: – 613 cases in quintile 1 / 18,364 women in quintile 1 = 3.3% later developed breast cancer (pre or post menopause) .– 567 cases in quintile 5/ 18,167 women in quintile 5 = 3.1% later developed breast cancer (pre or post menopause). – The difference is 0.2 percentage point, which is quite a small absolute risk reduction. When absolute risk numbers aren’t reported in a study, we think journalists should press their sources to provide these numbers so that they can be disseminated to the public. The issue of absolute risk reduction is key to helping readers understand the impact of changing dietary behaviors. We think it’s important enough to rate any story Not Satisfactory when these numbers aren’t provided. We’re not aware of any harms from incorporating additional fiber into one’s diet by eating more fruits and vegetables. We’ll rate this Not Applicable. The story offers a brief description of the study, and notes that it is an observational study rather than a clinical study. It also gets high marks for highlighting the fact that the study required women to “recall details about their adolescent diet when they were in their 30s and 40s.” (Though, worth noting, that sentence should say “…in their 30s, 40s and 50s.”) No disease mongering here. The story incorporates input from multiple independent sources who provide valuable perspective on the research. We particularly liked this line from Dr. Deanna Attai. (Full disclosure: Dr. Attai is also a reviewer for HealthNewsReview.org.) “The sexy headline is eat this and you’ll have a lower risk of breast cancer, but I’d shift the focus to, eat more fiber because it’s better for you and you’ll be a healthier person and you’re less likely to be obese and have chronic inflammation and other things that will reduce your risk for heart disease and cancer along the way,” And while the story does not address conflicts of interest, there do not appear to be any conflicts of interest to report. The story does note that increasing dietary fiber consumption “is just one mechanism by which we can reduce risk,” but it doesn’t mention any of the other mechanisms. Exercise, maintaining a healthy weight, getting sufficient sleep and limiting alcohol consumption can also help reduce breast cancer risk. There are no new products or services at issue in this story, and we addressed access to healthy foods under “Cost,” so we’ll rate this not applicable. This study is not the first to examine the possible link between dietary fiber and breast cancer risk. For example, a 2012 paper in the Annals of Oncology looked at 16 earlier studies on dietary fiber and breast cancer risk. There is no discussion of this earlier work, or how the new paper builds on or diverges from the previous research. The story definitely incorporated original reporting.


More lives are lost from violence against women, sex-selective abortion, female infanticide, suicide, egregious maternal mortality, and other sex-linked causes than were lost during all of the wars and civil strife of the 20th century.

Global News Service, Women, Emma Watson,

Violence against women resulted in more deaths than all the wars and conflicts of the past century combined, according to actress Emma Watson. As part of her work as an United Nations Women Goodwill ambassador, Watson recently launched a feminist book club, Our Shared Self, and spoke with feminist icon Gloria Steinem in London. Beyond revelations about Watson’s similarity to Hermione, her new hairdo and her research into female sexual pleasure, the Harry Potter star also shared a statistic that "blindsided" her from the book, Sex & World Peace. ("The two things we want, right?" quipped Steinem.) "There are now 101.3 men to every 100 women on the planet. So women are no longer half of humanity," Watson said on Feb. 24. "I’m quoting the book here but it says, ‘More lives are lost from violence against women, sex-selective abortion, female infanticide, suicide, egregious maternal mortality, and other sex-linked causes than were lost during all of the wars and civil strife of 20th century.’ " "So from this perspective," she continued, "The greatest security dilemma then is systematic, social devaluation of female life. I’d never come across a statistic like this. I had not understood that we were literally affecting the balance of the population of the world." That’s a startling statistic, and we wondered if it was grounded in fact. Looking at the available data, Watson has a point that the devaluation of female life leads to a staggering amount of lost lives. However, it’s not clear that those lost lives are higher than the number of war and conflict deaths in the 20th century. The numbers are comparable, but some estimates find the number of war deaths as slightly higher. The comparison We didn’t hear back from Watson or UN Women, but we did speak with Sex & World Peace’s author, Valerie Hudson, who’s a professor of international affairs at Texas A&M University. Hudson walked us through how she crunched the numbers and shared a chart from her 2009 study comparing the deaths due to conflict and deaths due to sex-selective causes:  Hudson told us she tallied up the death tolls of 53 wars, conflicts and authoritarian regimes for a total of 152.75 million lives. She then compared that number to the number of "missing women." This concept, developed by Nobel-winning economist and philosopher Amartya Sen in 1990s, uses abnormal male-to-female ratios to determine how many women would be alive in a specific year or time period if they weren’t aborted, neglected or victims of inequality. For example, in 2005, the sex ratio in India was 107.5 males per 100 females. The normal sex ratio for a stable population is about 98 to 100.3 males per 100 females. (Women tend to live longer under equal circumstances.) This means that there was a 6.7 percent to 9 percent shortfall in India’s female population, equal to roughly 36 million to 49 million missing women. Hudson used the UN Population Fund’s estimate of 163 million missing women in Asia in 2005 — 10 million more than lives lost to 20th century conflicts. But these figures aren’t the only estimates out there. Conflict deaths Let’s state off the bat that there are many difficulties with tallying up both how many women should exist but don’t, as well as how many lives were lost in all of the last century’s civil strife and wars. Any estimate of missing women only works on the assumption that the skewed sex ratio is a result of discrimination. Similarly, while the specific number of casualties in World War I or under Khmer Rouge are reported, estimates for deaths in little-known conflicts like the one between Islamic separatists in the Philippines and the government are murky or nonexistent. That being said, the estimates we found besides Hudson’s do not show female deaths eclipsing the conflict death of the 20th century. Nonetheless, the numbers for sex-linked deaths are still considerable. Hudson’s number for conflict deaths (153 million) is a bit low. Most other tallies pin the total death toll somewhere around 200 million: Source Death toll Rummel, 2011 At least 169.2 million* White, 2010 203 million Brzezinski, 2010 170 million Leitenberg, 2006 225.5 to 237.5 million Bassiouni, 1996 203 million Average 201.9 million (*We did not include Rummel’s 169.2 million estimate in calculating the average, because the figure refers only to democides, or government-inflicted deaths, and does not include war casualties or famines associated with regime mismanagement.) Hudson’s missing women figure, meanwhile, appears to be an outlier when compared to other estimates: Source Number of missing women Year Bongaarts and Guilmoto, 2015 150 million worldwide 2035 Bongaarts and Guilmoto, 2015 126 million worldwide 2010 UN Population Fund, 2012 117 million worldwide 2010 Anderson and Ray, 2010 86 million in China, India and sub-Saharan Africa 2000s UN Population Fund, 2005 (Hudson’s source) 163 million worldwide in Asia 2005 Hesketh and Zhu, 2006 67 million to 92 million in 8 Asian countries 2001 Klasen and Wink, 2003 102 million to 113 million worldwide 1990s Klasen and Wink, 2001 65 million to 107 million worldwide 1990s The war on women Experts we spoke with expressed the toll of gendercide with more tempered, and more accurate, comparisons than Hudson’s and Watson’s. "The number of missing females is undoubtedly of a larger order than recent demographic catastrophes such as World War II, the Chinese Famine, the HIV-aids epidemics, etc.," said Christophe Guilmoto, a demographer and author of several UN reports on the issue. "There are more missing women today than died in the two World Wars of the 20th century," said Stephan Klasen, a professor of development economics at the University of Göttingen. While none of the missing women estimates top the 20th century’s conflict death toll, they’re a "stock measure," which quantifies the impact of gender inequality in survival for generations that are currently alive, according to Klasen. "(A missing women estimate) does not count those women and girls who died from discrimination decades ago and would have, by now, died from other causes," Klasen said. If you tallied up all the missing women of the 20th century, "the number would be well over 200 million," said Siwan Anderson, a University of British Columbia professor who specializes in development and gender economics. Since the 1970s, the number of missing women has risen and is expected to peak in 2035. There are no signs that skewed sex ratios have normalized even as we’ve normalized violence against women, Hudson told us. "We silo it off as ‘stuff that happens between men and women’ and do not count it as ‘stuff that happens to human beings," she said. "What an incredible level of impunity for a crime committed against a human being, just because that human being has two X chromosomes." Our ruling Watson said, "More lives are lost from violence against women, sex-selective abortion, female infanticide, suicide, egregious maternal mortality, and other sex-linked causes than were lost during all of the wars and civil strife of 20th century." The claim comes from the book Sex and World Peace by Valerie Hudson, who was citing a UN figure of 163 million missing women in 2005. That’s 10 million more than her estimate of lives lost in all of last century’s strife, 153 million. But this is using a high estimate for the first measure and a low estimate for the second. The number of sex-related deaths, which varies from year to year, typically falls within 100 million to 130 million range. The number of deaths due to war, according to most other estimates, is about 200 million. Both numbers are disturbingly high, but it’s not clear that one is definitively higher than the other.


“Boil some orange peels wit cayenne pepper in it stand over the pot breathe in the steam so all that mucus can release from yo nasal… MUCUS is the problem its where THE VIRUS LIVES!!!”

Explanation: Orange peels and cayenne are not proven to treat COVID-19, and neither is boiling them. Even if you swap out cayenne for salt or orange peels for lemon peels, this remedy won't do the trick.

Public Health, Facebook Fact-checks, Coronavirus, Facebook posts,

While boiling water can be used to disinfect medical equipment during a pandemic, using boiling water and seasoning to clear your nose is not proven to protect you from COVID-19. One post on Facebook claimed that if you "boil some orange peels wit cayenne pepper in it" and "stand over the pot breathe in the steam so all that mucus can release from yo nasal" you can get rid of all the mucus because that is "where THE VIRUS LIVES." The spelling errors may have tipped you off that this isn’t sound advice. The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.) We've also seen plenty posts suggesting that boiling orange peels or lemon peels with sea salt and inhaling that steam is a treatment. The World Health Organization has a page on false COVID-19 "cures," which lists lemon and turmeric as unproven cures for COVID-19. In that same vein, there is no evidence that oranges, another citrus, or cayenne, another spice, can cure COVID-19. Mucus is actually the body’s first defense against virus microbes that could enter airways, and blowing it out may not be the best way to protect yourself against COVID-19. A study published in the journal Cell Host & Microbe found that the "mucus layer... can prevent pathogen invasion and subsequent infection." Currently, there is no specific treatment for people with COVID-19. Cough medicine, pain relievers, rest and fluids are all recommended because they alleviate the typical symptoms of COVID-19: cough, shortness of breath and fever. So clearing out your sinuses will definitely not make you less likely to catch COVID-19 or cure you if you are sick, and there’s no evidence that orange peels, lemon peels or cayenne contain any healing properties, either. We rate this .


Wrist replacement surgery is a last resort for those who wish to save hand’s range of motion

Explanation: Patients who suffer with hand and wrist arthritis face a number of treatment options, none of them especially good ones. This article attempts to show how one surgical procedure—the replacement of the wrist joint—fits into the spectrum of treatment choices. It notes that the “seldom-used” operation has been around for decades, and accurately reflects the complexity of the operation. Although the story mentions some of the alternatives to joint replacement (e.g. medications, physical therapy, and fusion)—and briefly sketches their advantages and disadvantages, it does not attempt to evaluate the quality of the evidence to support any of them. The story provides no data on whether the operation is appropriate in some people and not others, no measure or list of potential complications or costs, and no quantification of the procedure's absolute benefit or its relative worth compared to other treatments. The heart of the story is essentially a collection of anecdotes from one patient and one surgeon in one city in Texas. The article provides no news and little analysis, and largely reflects the story line of a recently issued press release from the institution where the surgeon performs these operations.

The article fails to mention the cost of treatment or whether it is covered by Medicare or other insurers. There is no quantification of benefits. The story reports ony the anecdotal experience on one patient with one surgeon. The article mentions a single disadvantage of the operation—that patients can’t lift heavy objects. But any patient undergoing joint replacement faces potential complications such as infection. In one recent study, 52% of patients had a complication after wrist replacement and 44% reported pain one to five years after surgery. (J Hand Surg [Am]. 2003;28:570-6). There is also the possibility of undergoing a second operation for fusion if the implant fails—a risk that persists with newer implant designs as well as old ones. The article does not cite a source for the projected 10- to 15-year life of the device. There is no discussion of evidence, a major lapse. Readers should know that there is scant high-quality literature on wrist replacement. Some experts consider the procedure experimental. The story’s “evidence” is comprised mostly of testimonials of one patient who underwent the operation and one doctor who performs about 10 of the operations every year. There are no obvious elements of disease mongering. It is clear that wrist replacement surgery is a treatment of "last resort." The story relies on one patient and one “expert,” a surgeon who performs wrist replacements. It provides no information on potential conflicts of interest and no conflicting points of view. Input from experts outside of this institution would provide balance and potentially clarify the risks and benefits of this procedure. The article outlines some alternatives to wrist replacement surgery (e.g. medications, physical therapy, and fusion)—and briefly sketches their advantages and disadvantages. There are other surgical treatments for wrist arthritis as well, though the evidence to support them is also sparse. The article explains that wrist replacement has been available for decades. But why is the procedure “seldom used”? Is the device FDA-approved? Is the operation widely available in the U.S., offered in the local community hospital, or mostly consigned to large or academic medical centers? The article does not say. The story points out that wrist replacement surgery has been around for decades. The story’s single source of medical information—a surgeon–suggests that newer versions of the implants enable surgeons to retain more of the patient’s native bone. Two weeks before this story was published, the Texas Medical Center issued a press release about wrist replacement surgery, covering much of the same information in the Houston Chronicle article. The Medical Center is named in the second sentence of the article, and the story’s expert source is the same surgeon that is quoted in the press release. The story fulfills every public relations department’s dream, and does not stray far from the hospital’s and surgeon’s story line. But we can't be sure if the story relied solely or largely on the press release.


New psoriasis drug is more effective than current treatment

Explanation: The news release announces the results of a phase II clinical trial published in the New England Journal of Medicine, which found that an experimental drug called guselkumab was more effective than a drug already on the market (called adalimumab) at controlling the symptoms of psoriasis. However, the release leaves some significant gaps, not giving readers any information about potential harms or costs associated with guselkumab. The release falls victim to the common practice of hyperbole in its headline. This was a phase II trial in a relatively small number of subjects. Suggesting that guselkumab is both more effective and less toxic than adalimumab is nothing more than speculation at this juncture. A more appropriate title would have been, “Early phase II trial suggests that new psoriasis drug may be more effective and has the potential to leave more of normal immune system intact.”  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, more than 5 million people in the U.S. have psoriasis. The disease can have a significant impact on quality of life, and treatment can be extraordinarily expensive, so information about new, effective treatment options is certainly worth noting. Psoriasis is an autoimmune disease that affects the skin. While psoriasis itself is not life-threatening, because it is an autoimmune disease, some pharmaceutical treatment options affect the immune system and can increase a patient’s risk of infections — and those infections may pose a significant health risk of their own. This makes it particularly important for readers to be aware of potential health risks associated with new treatment options.

Academic medical center news release,psoriasis

The release does not address cost at all. While guselkumab is not yet on the market, HealthNewsReview.org has long argued that if it is worth discussing a drug’s treatment potential, it’s worth discussing what that treatment might cost — even if it is only in general terms. Certainly, readers of this release would be interested to know that the comparison drug, adalimumab (brand name Humira), costs almost $50,000/year. Considering the similarities between adalimumab and guselkumab, the release should have warned that if this experimental drug is approved, it might well also command a hefty price. The release is fairly clear in this regard, reporting that 81 percent of patients taking a 200-milligram dose of guselkumab reported “minimal” or no psoriasis symptoms after 40 weeks of treatment, compared to 49 percent of patients taking adalimumab. The release doesn’t note that patients taking 200-mg doses of guselkumab did only slightly better than patients taking a 100-mg dose, and that the 100-mg dose fared slightly better at various points during the first 40 weeks of treatment. But that’s a level of detail that perhaps we can’t expect. The release would have been better if it specifically noted that further study will be needed in order to find out if the observed benefits last longer than a year. The release also could have noted that the patients in this study were overwhelmingly white (91%) and male (71%), so it remains to be seen if a more diverse patient population would get similar benefits. The release does not discuss harms at all, which is problematic. The authors of the paper noted the difficulty in identifying true rates of adverse events in the study given the discrepancy in the number of subjects in each treatment group. There was a 6:1 ratio of guselkumab subjects compared to adalimumab in the post placebo phase of the trial. While the true incidence of harm is unclear at the moment, some comment is necessary even in a press release. For example, according to the paper, 20 percent of patients who received guselkumab experienced “adverse events of infection” during the first 16 weeks of the trial, as compared to 14 percent among patients receiving a placebo and 12 percent of patients who received adalimumab. A higher rate of infection is certainly worth mentioning. Heck, even a comparable rate of infection is worth mentioning. Overall, patients who received guselkumab had lower rates of all “adverse events” compared to adalimumab over the first 16 weeks of treatment (50 percent versus 56 percent), and over weeks 16 through 52 of the study (49 percent versus 61 percent). But the rates of adverse events were still noteworthy, and the release should have addressed them. This was a close one. The release does do a fairly good job of describing the overall study, but it fails to mention some important limitations. It explains that it was a multi-center study of 293 adults, it describes the symptoms of the adults, and it describes the study design: some study participants got guselkumab, some got adalimumab, and some got a placebo. It also explains how the study evaluated the effectiveness of the drugs. However, the release does not mention that the number of participants who received guselkumab was relatively small at each dosage level. The press release notes, “…293 adult patients with moderate-to-severe psoriasis (defined as covering 10 percent or more of the body) were randomly assigned to receive varying doses of one of the two drugs or a placebo over 52 weeks.”  This suggests that the three cohorts (placebo, guselkumab and adulimumab) were equal in size. Clearly this is not the case. So, when the story notes, “At week 40, for example, 81 percent of patients taking a 200-mg dose of guselkumab had a score of 0 or 1, compared to 49 percent of patients taking adalimumab,” it should have noted that this is in a sample of 42 and 43 subjects respectively. The release should have noted that the results for specific doses of drugs are based on just a few dozen patients. The release should have highlighted a limitation that is noted in the journal article: “Furthermore, some elements of the study design limited the ability to assess uncommon adverse events or adverse events that might have developed during long-term treatment.” And as we already noted, the study is based on a skewed patient population (91% white, 71% male), so it can’t be said that all sorts of psoriasis patients could expect similar results. Psoriasis is a serious health condition, but this release takes it a bit too far. For example, in the fourth paragraph, the release states that psoriasis “also increases a patient’s risk for depression, heart disease and diabetes, among other conditions.” It would have been more accurate to say that it has been associated with, or is linked to, these other conditions. While psoriasis is correlated with an increased risk of multiple adverse health outcomes, it is not known to be the cause of any of them. In most, if not all, cases we know very little about the relationship between psoriasis and those health outcomes. The release also quotes the study’s lead author as saying that “the concept that psoriasis is ‘just something you live with’ is no longer appropriate.” But that source is also cited as saying that about half of all patients with psoriasis do not get any treatment. Whether that is by choice, or because the patients don’t have access to treatments or can’t afford the newer, very expensive drugs, it’s clear that many patients with psoriasis do live with the condition. Those dealing with psoriasis already know the value of treatment, they don’t need their condition written about in a way that may stir additional concern. Although the release clearly notes that the study was funded by the company that manufactures guselkumab, and that the study’s lead author is a former paid consultant for the company, it fails to tell readers that the company was actively involved in the study. The journal article points out that Janssen Research and Development collected and analyzed the data. What’s more, “All the authors collaborated on writing the manuscript, with the assistance of professional medical writers employed by Janssen, and made the decision to submit the manuscript for publication.” That intimate level of involvement should have been made clear in the release. The release discusses only two potential treatments: the drugs guselkumab and adalimumab. There are many additional options. Other medications include methotrexate, cyclosporine, and retinoids, among others. There are also a number of topical treatments and several forms of light therapy. The release would have been stronger if it had explained why guselkumab (or adalimumab, for that matter) are important treatment options or when physicians may incorporate medications like these into their treatment plans. The release makes clear that the study was a phase II clinical trial, and that a phase III trial is ongoing. In other words, the drug will not be available in the very near future. Ideally, the release would remind journalists – and the public – what a Phase II trial means and what it doesn’t mean. The release explains that guselkumab is novel because of its mode of action (i.e., how it works), compared to other, similar drugs. Specifically, the drug blocks a protein that’s implicated in psoriasis. It would have been nice if the release had included another sentence or two on how blocking that protein disrupts psoriasis (or its symptoms). The release uses fairly cautious language throughout, as exemplified in the headline, which says only that guselkumab is “more effective” than adalimumab. However, readers have to be sophisticated enough to know that a phase II trial is merely an intermediate step in the clinical trial process. The release should have noted in the headline and lead paragraphs that further work is needed in order to reach firm conclusions about the effectiveness and potential side effects of this experimental treatment.


Walter "Blackie" Wetzel, a former leader of the Blackfeet Nation, designed the Indian head logo for the Washington D.C. "Redskins" NFL team.

Explanation: What's true: Walter "Blackie" Wetzel, a former leader of the Blackfeet Nation, helped the NFL develop the Indian head logo for the "Redskins" football team, which players debuted on helmets in 1972. What's false: There's no evidence to prove that he made any art choices regarding colors, lines, or other specifics of the logo's design. Rather, he provided inspiration for it by showing NFL executives photos of Native American leaders that he believed should be part of the Washington team's brand.

After decades of criticism from Native American activists and allies over the offensiveness of the Washington NFL franchise’s “Redskins” name, the team on July 13, 2020, said it would drop the controversial title — as well as its Indian head logo — when leaders select a new brand in the future. The announcement, which the team made via a press release featuring the Redskins name and logo, sparked a new wave of curiosity among social media users over how, exactly, the team’s trademark came to be. Numerous Snopes readers contacted us to determine the legitimacy of the below-displayed meme, which opponents to the name change were circulating online as part of their argument for why the change was not necessary. The viral post alleged that Walter “Blackie” Wetzel, a former leader of the Blackfeet Nation, designed the team’s logo in the early ’70s using inspiration from a photograph of the early 20th-century Blackfeet Nation leader, Chief Two Guns White Calf. This is mostly accurate, aside from the claim that Wetzel had helped create the image. No evidence proves that he made any of the art choices regarding colors, lines, or other specifics of the design. To reach that conclusion, we began by confirming through verifiable evidence that Wetzel, indeed, was a real person and had served in a leadership position for the tribe in northwest Montana. An analysis of archived newspapers uncovered several news stories featuring Wetzel, including one in the Great Falls Tribune on July 9, 1969, in which he was described as the former chairman of the Blackfeet Tribal Council and president of the National Congress of American Indians. (NCAI), which represents tribes across the U.S. A directory for that organization said Wetzel served as president between 1960 and 1964.Next, we considered an obituary in Montana’s Billings Gazette that said Wetzel died at age 88 on November 8, 2003. That profile filled in for us the lesser known details about his life: He was born near Cut Bank Creek on the Blackfeet Indian Reservation, grew up a “star athlete in nearly all sports,” attended the University of Montana, and, at one point, considered a career in professional boxing. The obituary stated: Other special interests and items which highlighted his life were being a drummer for a jazz band, dancing with movie actress Donna Reed and being the Medicine Man in the movie, “Grey Eagle,” which was filmed in the Helena area. Blackie was also very proud of being the force behind the Indian Chief logo of the Washington Redskins pro football team. Blackie and his Washington Redskins’ cap were inseparable. The obituary went on to detail Wetzel’s time in the Army, work to increase housing and employment opportunities for Native Americans, and leadership via the Blackfeet Tribal Council. In that role, the obituary stated, “Chief White Calf gave him a right of passage of the chieftainship of the Blackfeet Nation and named him ‘Siks-a-num,’ ‘Blackfeet man or man of the Blackfeet people. '” He was survived by eight children and dozens of grandchildren. That means, based on evidence so far, it was true to state that Walter “Blackie” Wetzel, a former leader of the Blackfeet Nation, was a “force behind” the Indian head logo for the football team. The exact details of his involvement, however, were unclear. Next, we moved onto review a 2002 news story by The Washington Post in which Wetzel was interviewed about the moniker and logo. The newspaper reported that, after the football team abandoned early references to Native Americans in its brand and launched a new “R” image in the early 60s, Wetzel shared photos of Native American leaders with the team’s top executives, and successfully persuaded them to use them as inspiration for a new design on players’ helmets. While it’s unclear what photos, exactly, Wetzel had used to make his case for the brand overhaul, Montana’s Great Falls Tribune said the gallery included a picture of White Calf. According to the Post, the franchise created the new helmets with Wetzel’s help within weeks, and players debuted them in 1972. Nothing in the news coverage indicates that Wetzel had drafted the details of the logo himself but rather that he provided inspiration for it. Wetzel said in the 2002 interview: It made us all so proud to have an Indian on a big-time team … It’s only a small group of radicals who oppose those names. Indians are proud of Indians. That means the language in the alleged quote from Wetzel in the above-displayed meme is correct; however, its punctuation ( or lack of ellipses between the first two sentences to note that he had said something more in the interview but the reporter chose not to include it) is misleading. The meme makes it seem like Wetzel had made the statement fluidly without pausing or connecting thoughts about his reaction to the logo and who he believed opposed it.


The UK is performing 240,000 Covid-19 tests a day.

Explanation: The U.S. investigation into hundreds of cases of life-threatening lung illnesses related to vaping has turned up a curious abnormality: Many of the victims had pockets of oil clogging up cells responsible for removing impurities in the lungs.

Dr. Dana Meaney-Delman, who has been leading the inquiry at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, wants to know where that oil came from. The answer will help explain whether these cells play a key role in the vaping-related outbreak that has killed seven people and sickened 530 so far. It may also reveal whether some of these cases have been occurring all along, undetected. “We’re looking to partner with any lab that can assist in the identification of what those lipids (fats) are,” Meaney-Delman said in a telephone interview. A group of researchers who have been studying the long-term effects of vaping told Reuters they have taken up the challenge. They have begun to re-examine lung cell samples they have collected in recent years for evidence of these oil-filled immune cells in people who vaped but didn’t get sick. One possibility: The deposits are residue from inhaling vaping oils, such as those containing the marijuana ingredient tetrahydrocannabinol (THC) or vitamin E acetate. Both are considered possible contributors to the current illnesses. Some researchers suspect the oils are formed inside the lungs as part of the body’s natural response to chemicals found in many commercial vaping devices. One theory is that vaping these chemicals may impair the immune system, and make people who vape more vulnerable to respiratory distress, they say. A study published in the Journal of Clinical Investigation earlier this month has fueled the latter theory. It found that mice exposed to aerosols of propylene glycol and vegetable glycerin - common solvents used in conventional nicotine vaping devices - developed these same fat-clogged immune cells even though they were never exposed to vaping oils. These mice also had impaired immune systems compared to mice exposed to room air. The study set off alarm bells for Thomas Eissenberg, co-director of the Center for Tobacco Products at Virginia Commonwealth University. For years, doctors have reported isolated cases of pneumonia-like illnesses in people who vaped. In many cases, patients also had these fat-filled immune cells - called lipid-laden macrophages. Now, these same abnormalities have been found in mice, and in at least some of the people who have fallen ill recently. “For me, the implication is there may be some underlying level of disease, like what we’re seeing in this cluster, that’s been going on all along,” Eissenberg said in a phone interview. Early last week, Eissenberg joined some 25 vaping experts on a hastily arranged conference call. At least three researchers who have already collected lung cell samples from otherwise healthy vapers told Reuters they would see whether these people also had fat-laden pockets within their immune cells. Other researchers, like Eissenberg, are seeking funding to collect new samples of their own. They want to help determine whether these abnormalities have been present for years, and whether they have made vapers generally more vulnerable to severe disease, possibly triggered by some new vaping substance. The group’s members say they have been in regular contact with officials at the CDC and the National Institutes of Health on how they can best help with the multistate investigation. They include Robert Tarran, a physiologist and vaping expert at the University of North Carolina School of Medicine, and Dr. Peter Shields, a lung cancer specialist at The Ohio State University Wexner Medical Center, who has one of the country’s largest sets of lung samples from vapers, smokers and never-smokers. “It could be that we’ll see something in the general, normal population of people who are using e-cigarettes,” Shields said. Investigators at the CDC and the U.S. Food and Drug Administration (FDA) have pointed to THC vaping oils or vitamin E, a substance used in some THC products, as a possible cause of these illnesses. But they have not ruled out anything yet, including conventional nicotine liquids. CDC pathologists are examining hundreds of lung cell samples gathered from patients in the outbreak. Meanwhile, forensic chemists at the FDA are testing more than 150 products to determine whether there is a common ingredient that may help explain the illnesses. “We need to parlay what we’re seeing in product samples with what we’re seeing in lung tissue,” Meaney-Delman said. Dr. Laura Crotty Alexander, a lung specialist at the University of California at San Diego, has been studying vaping’s effect on health since 2013. Two years ago, she treated a patient with the same set of symptoms that are now being described across the country, and is now checking her lung cell samples to look for clues. “It’s possible that everybody who is vaping is at risk,” she said.


What is and isn't a Schedule I narcotic is a job for Congress.

National, Congress, Drugs, Legal Issues, Barack Obama,

The buck may stop at the president, but does the blunt stop at Congress? For the second time in recent weeks, President Barack Obama was asked to publicly weigh in on the debate over decriminalization and legalization of marijuana. During an interview aired Jan. 31, 2014, CNN’s Jake Tapper asked Obama whether he would consider changing marijuana’s status as a Schedule I narcotic, a distinction that bans the substance from sale or use for medicinal or recreational purposes. "Well, first of all," Obama contended, "what is and isn't a Schedule I narcotic is a job for Congress." "I think it's the (Drug Enforcement Administration) that decides," Tapper offered. "It's not something by ourselves that we start changing," Obama replied. "No, there are laws undergirding those determinations." The back and forth was emblematic of the confusion surrounding the federal government's position on cannabis, particularly in Washington and Colorado, where new state laws legalizing marijuana technically run afoul of federal bans. But in this particular case, who is right, Tapper or Obama? Congress, the White House and controlled substances As usual, Obama has chosen his words carefully. He says that determining the classification of marijuana is "a job for Congress," not "the job of Congress." That could mean Obama philosophically believes that Congress should ultimately decide the fate of marijuana, even if his administration has some control over it. And to be clear, it does. But it’s complicated and not without roadblocks. First, a quick history lesson. Congress passed the Controlled Substance Act in 1970, and it was signed by President Richard Nixon later that year. The law set up guidelines to regulate and enforce the usage, production, sale and importation of various drugs and substances. In the law, Congress created five schedules to classify drugs and narcotics by medical use and potential to incite substance abuse. At one end of the scale is Schedule V drugs, which include substances like cough medicines with small amounts of the narcotic codeine. On the other end of the spectrum are Schedule I substances. These drugs have no accepted medical use and "are considered the most dangerous class of drugs with a high potential for abuse and potentially severe psychological and/or physical dependence," according to the Drug Enforcement Administration. Distribution, manufacturing or possession of a Schedule I substance is a federal offense. When Congress passed the Controlled Substance Act, lawmakers singled out several dozen drugs that fall under this category. Among opiates, like heroin, and amphetamines, Congress included marijuana. Congress could amend the law to reschedule marijuana or exempt the substance altogether, as it did for alcohol and tobacco products. But there is another way to lawfully reclassify marijuana and it does involve the executive branch. According to the Controlled Substance Act, the attorney general, through the Drug Enforcement Administration, has the power to change the classification of a substance or remove it entirely, but only if the drug meets certain criteria. First, the attorney general reviews eight factors to determine what schedule to assign a substance, according to the law. The drug's actual or relative potential for abuse Scientific evidence of its pharmacological effect, if known The state of current scientific knowledge regarding the drug Its history and current pattern of abuse The scope, duration, and significance of abuse What, if any, risk there is to the public health The drug's psychic or physiological dependence liability Whether the drug is an immediate precursor of a substance already controlled under the Controlled Substances Act. If the DEA feels a substance should be reclassified, the agency can request a scientific and medical evaluation from the U.S. Department of Health and Human Services to determine if there are safe medical uses for the drug in question. Anyone from a drug company to a local government or even an individual citizen can also petition for review of a drug. Whatever conclusion HHS determines "shall be binding on the attorney general as to such scientific and medical matters," according to the law. That means the DEA cannot change the classification of a drug unless HHS says there are medical uses and it’s safe for consumption. The Food and Drug Administration, the agency under Health and Human Services that handles these reviews, has continually reaffirmed that "the scientific evidence to date is not sufficient for the marijuana plant to gain FDA approval." While research continues, the FDA said because marijuana can be addictive and clinical testing on the benefits of marijuana are not conclusive, it won’t give the DEA the go-ahead to reclassify the drug. In 2001 and 2011 the DEA, citing FDA research, turned down petitions to reclassify marijuana, and in 2006, the FDA upheld that "smoked marijuana has no currently accepted or proven medical use in the United States." Guidelines updated as recently as 2012 reflected that opinion. Many scientists have debated the merits of the FDA’s ruling, but in an email to PolitiFact, the White House reiterated that the agency’s findings serve as the basis for any action from the Justice Department. So basically, there is a mechanism for the executive branch to change the schedules. But it’s an arduous process and not something Obama can change by decree. And while the FDA is an executive agency that includes presidential appointees, the FDA’s recommendations are supposed be based on science, not politics. But Obama has found other ways to get around the FDA’s unwillingness to concede the medical benefits of marijuana to appease states that have gone a different direction. Schedule I substances cannot legally be used for medical purposes; however, 20 states and the District of Columbia have passed laws legalizing medical marijuana. In 2009, the Obama administration told federal law enforcement agencies to stop targeting medical marijuana dispensaries, signaling a change from the approach of President George W. Bush. Similarly, last year the Department of Justice said it would not target new laws in Colorado and Washington legalizing recreational marijuana. So even though marijuana remains a Schedule 1 substance, the current administration, through various memorandums, has not always treated it as one under the law. Our ruling Obama said "what is and isn't a Schedule I narcotic is a job for Congress." While Obama may feel that way philosophically, there is a process by which the executive branch can reclassify marijuana to allow for its medical use or completely remove it from the list of controlled substances. It’s not an easy process, but it’s there. And Obama’s Justice Department has often given tacit approval, or at least turned a blind eye, when states have taken steps to ignore the federal government’s classification.


Researchers produce first widely protective vaccine against chlamydia

Explanation: In many ways, this release provides much of the basic information reporters would need to determine how newsworthy the findings are. Where it was published. The specific antigen being studied and for which disease. A numerical breakdown of the benefits. But nowhere does it mention that this was a study conducted in mice and that, if past experiences with vaccines for other diseases hold true, a true vaccine for humans has a narrow chance of becoming a reality. Chlamydia is the most commonly reported sexually transmitted disease (STD) in the United States, according to the Centers for Disease Control and Prevention. The CDC says the condition is easily treated, but if left untreated, can make it difficult for a woman to become pregnant A further complication of chlamydia is that it often carries no symptoms, so someone who is infected may not even know it. A safe and effective vaccine would certainly be of public health interest. But this research has to far to go before it will be available to the public — if ever.

Academic medical center news release,Animal research

Because the release is presented as if the study were conducted in humans, we would expect to see some explanation of what the vaccine might cost. A better news release might have commented on the potential costs (and time) required for testing a new vaccine and bringing it to market. The release mentions the antigen being studied, BD584, “was able to reduce chlamydial shedding – a symptom of C. trachomatis – by 95 per cent.” Without any context for how many people (or mice in this case) were studied, we have no way of knowing what that means. There is no mention of harms in the release. Did any of the mice die or develop sterility or pelvic inflammatory disease? This is the biggest omission in the release and truly surprising for a university. The study itself discusses in detail how the work was conducted in mice. And yet the release says nothing of the sort and, in fact, is set up in such a way that the strong impression is given that this study was conducted in humans. For example, the release says up high, “Researchers at the Michael G. DeGroote Institute for Infectious Disease Research at McMaster have developed the first widely protective vaccine against chlamydia. This is quickly followed by the first quote in the release, which says: “Vaccine development efforts in the past three decades have been unproductive and there is no vaccine approved for use in humans,” said Bulir, who just finished his PhD in medical sciences at McMaster. Until one read the actual study they’d have assumed that this was a human vaccine trial. All of this makes the comments about the potential benefits for human trachoma infections even more absurd. There is no disease mongering in the story. The release notes that the Canadian Institutes for Health Research funded the study. There is no other pharmacological treatment for preventing the chlamydia infection currently available. However, it might have been noted that most public health experts recommend condoms for preventing this and other sexually transmitted diseases. The release makes no mention of the fact that this vaccine is very far away from a clinical application, assuming it would even pass human trials. Instead, it talks about how easy the vaccine would be to administer and how people wouldn’t even need a lot of training to administer it. (We imagine that administering nasal doses to mice would require some training.) There’s no shortage of claims of novelty in the release, including in the headline. Although the release is misleading about the study cohort, it is a novel study given the absence of any available chlamdyia vaccines. We would say that the entire release is unjustifiable given the lack of a mention of the true nature of the study. We also wonder if the investigators were given the opportunity to review the release before it went out.


A medical examiner's conclusion that Health and Human Services drug pricing adviser Daniel Best died of multiple blunt force injuries contradicts the official ruling that he committed suicide.

Explanation: To date, we aren’t privy to a full account of how Daniel Best sustained his injuries, nor their precise nature, nor any other evidence (such as a suicide note, if one exists) that prompted medical examiners to conclude that he killed himself. But there is clearly nothing contradictory about his having suffered blunt force injuries during the commission of a suicide. Given the facts at hand, there is no reasonable basis for speculation to the contrary.

On 1 November 2018, the Trump administration’s senior adviser on drug pricing reform, Daniel Best, was found “unresponsive” near the garage door exit of a Washington, D.C., apartment building. He was pronounced dead at the scene by first responders. A statement released the same day by Health and Human Services Secretary (HHS) Alex Azar mourned Best as a “friend and colleague” but addressed neither the circumstances nor the cause of his death. No other details were released to the public. Two weeks later, on 15 November, the office of Washington, D.C.’s chief medical examiner announced that Best had died of “multiple blunt force injuries.” His death was ruled a suicide. No other information was provided. Internet conspiracy theorists questioned that ruling. Noting the pharmaceutical industry’s objections to the very task Best was hired to accomplish (i.e., lowering prescription drug costs), not to mention President Trump’s announcement days before Best’s death of a plan to reduce Medicare drug prices and the fact that Best died of blunt force injuries, the theorists took to social media to float the idea that Best was the victim of foul play and not suicide: BREAKING: Death of Trump HHS official, Daniel Best, tasked with getting lower drug prices from pharmaceutical companies is ruled a suicide, even though he died from “multiple blunt force injuries.” Nothing to see here folks. pic.twitter.com/qiWNH0epeQ — Mike Tokes (@MikeTokes) November 17, 2018  Another ‘suicide’ the Media is ignoring. RIP Daniel Best. #ma4t pic.twitter.com/Gt1wojG3eM — Mike Allen (@AMike4761) November 17, 2018  Far-right conspiracist websites followed suit. An 18 November article on Neon Nettle suggested that the the public was being asked to believe that Best had beaten himself to death: The Chief Medical Examiner’s verdict raised questions among the health community, with many people refusing to believe Best killed himself by repeatedly hitting himself with a blunt object until he died. Erin Elizabeth of HNN [Health Nut News] described the ruling of Best’s death as “confusing,” saying: “How does one kill themselves by hitting themselves with a blunt object? Repeatedly?” Another conspiracy-mongering website, Uncle Sam’s Misguided Children, posed the same sarcastic question: So did he lie down under a garage door and let it hit him “multiple times” or did he beat himself to death with a baseball bat? How does that work? Add to the very few actual articles on his death — this man was described as one of Trump’s “senior” HHS officials working with Alex Azar. Things that make you go hmmmm. There’s a fallacious assumption underlying this notion, however: namely, that blunt force injuries can only be sustained in the course of a physical attack by an assailant (or oneself). But that isn’t how forensic pathologists define “blunt force injury.” According to Prahlow and Byard’s Atlas of Forensic Pathology, a blunt force injury is any “resulting from impact with a blunt object, i.e., one that does not possess any sharp edges”: Examples of blunt objects include hammers, baseball bats, fists, the interior surfaces of vehicles, roads, trees, floors, walls, furniture, and even fluid objects such as bodies of water (if the speed of impact is sufficiently high). Medical University of South Carolina pathology professor Nicholas I. Batalis observes in “Forensic Autopsy of Blunt Force Trauma” (Medscape, 2016) that blunt force injuries can be caused in myriad ways that have nothing to with assault and battery (emphasis added): Deaths resulting from blunt force trauma are some of the most common cases encountered by the practicing forensic pathologist. Whereas other forms of traumatic death (e.g., gunshot wounds, sharp force injuries) occur under a relatively limited number of circumstances, deaths resulting from blunt force trauma occur in a variety of scenarios. For instance, almost all transportation fatalities — including those involving motor vehicle collisions, pedestrians being struck by vehicles, airplane crashes, and boating incidents — result from blunt force trauma. Other deaths resulting from blunt force trauma involve jumping or falling from heights, blast injuries, and being struck by a firm object, such as a fist, crowbar, bat, or ball. Bite wounds and chop injuries may be considered variants of blunt force trauma, sharp force trauma, or a class of injuries unto themselves. Blunt force trauma is routinely involved in cases classified as accidents, as well as in cases of suicide and homicide. Finally, we put the known facts of the case to Thomas Sporn, M.D., Chief of the Section of Pulmonary and Thoracic Pathology at Duke University Medical Center, and asked him if a ruling of suicide makes sense. He responded via e-mail to say: Jumping off a building and striking the (blunt) pavement would result in blunt force injuries, as would, say, darting into traffic, and of course most aviation and motor vehicle fatalities are from blunt force injuries. So it’s definitely possible to sustain self-inflicted blunt force injuries, depending on the circumstances.