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Category: Medicine

Another example of lousy health reporting

I saw the AP version of this article yesterday*, and I was immediately struck by what was missing. Sad to say, the Times version isn’t any better:

Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

The study was done in Australia, on patients who had had lap-band surgery (more popular there than gastric bypass). Lap-band surgery involves putting a band around the stomach to create a small pouch rather than removing parts of the stomach and intestine. In theory, it’s less invasive and risky than gastric bypass, and reversible. In reality, it carries a number of risks, such as erosion of the stomach (rendering the procedure irreversible) and death.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. (Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.)

What’s interesting about this bit is that the AP article mentioned that the diabetes often went into remission within days of the surgery.** Which tells me that maybe the effects are due not to weight loss itself but to some other factor. One not mentioned in the article, perhaps. What could it be?

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The BBC says: humour “comes from testosterone.”
Holly says: bad reporting “comes from the BBC.”

If you’ve kept track of the scant number of posts I’ve contributed to Feministe over the past half-year, you may have realized that I get very irritated when I come across blatantly misleading “science” reporting. (I guess it must come from being raised by scientists, then working in the media.) So my eyeballs bulged and turned a hilarious shade of pink when I came across this lead for a “Health” story on the BBC News site courtesty of Feministing:

Humour ‘comes from testosterone’
Men are naturally more comedic than women because of the male hormone testosterone, an expert claims.

Men make more gags than women and their jokes tend to be more aggressive, Professor Sam Shuster, of Norfolk and Norwich University Hospital, says.

The unicycling doctor observed how the genders reacted to his “amusing” hobby.

Women tended to make encouraging, praising comments, while men jeered. The most aggressive were young men, he told the British Medical Journal.

Previous findings have suggested women and men differ in how they use and appreciate humour.

Women tend to tell fewer jokes than men and male comedians outnumber female ones.

What we really need to do is find out the gender of whoever research and wrote this story for the BBC, because few things are funnier than someone who’s supposed to be a journalist, working for the largest broadcasting company in the world, making a complete ass out of themselves. Not to mention spreading the story to all sorts of other news services that seem to be taking the story seriously.

So, the first thing I always do with these science stories is find the original study: Sex, aggression, and humour: responses to unicycling. It turns out that Sam Shuster is a retired professor of dermatology. (Note to BBC researchers: this means he studied skin, not hormones or psychology.) Shuster wrote about reactions to his unicycle for the traditional end-of-year issue of the British Medical Journal. This season, the BMJ also features densely written scientific papers on which brand chocolate bar doctors ought to use to demonstrate bone fractures and whether magical powers are heritable, based on an analysis of Harry Potter novels. In short, it’s clearly a joke. I would blame the notoriously dry wits of the British for the confusion, but it seems all too likely that the BBC reporter is… also British, albeit maybe not a doctor with enough time on hand to write witty, self-referential papers about the statistical mistreatment of orthopedic surgeons in medical journals.

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The default option

I just created a new chart on my electronic medical record. I typed in the patient’s name, her date of birth and her phone number, and then I chose from the dropdown menus for sex and marital status. The blanks are automatically filled in, but this patient is a married woman so I had to change both, because the default option is male, single. And I can’t change the defaults.

Why do I have a feeling that the people who designed this program are male, single? It’s a small thing, but every time I create a new chart I am reminded that “female” is considered an aberrant state of being.

Thank the AMA

Live in the US? Uninsured? Underinsured? In the Medicare donut hole? Stuck in a job you hate because you need the benefits? Thank the AMA.

Medicare was proposed in the 1930s when Social Security was enacted. You may have noticed that Medicare didn’t actually exist until the 1960s.  That’s in large part because the AMA spent millions of dollars fighting it. Can’t have the government telling doctors what to do, or how much they can charge. It’s an article of faith with the AMA that doctors must be allowed to do their work without any pesky oversight at all.

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Is this a good enough reason? If not, what is?

Kat passed along this story from CNN that brings up all kinds of disturbing questions about bodily autonomy and disability and medical interventions:

LONDON, England — A mother is seeking to have the womb of her severely disabled daughter removed to prevent the 15-year-old from feeling the pain and discomfort of menstruation.

Doctors in Britain are now taking legal advice to see if they are permitted to carry out the hysterectomy on Katie Thorpe, who suffers from cerebral palsy.

But a charity campaigning for the disabled said on Monday the move could infringe human rights and would set a “disturbing precedent.”

Andy Rickell, executive director of disability charity Scope, told the Press Association: “It is very difficult to see how this kind of invasive surgery, which is not medically necessary and which will be very painful and traumatic, can be in Katie’s best interests.

Painful, invasive surgery on a disabled teenage girl to spare her from the “pain and discomfort of menstruation.” That, to me, sets a terrible precedent. There’s not much in the article that indicates that her periods are unusually heavy or painful, or that she’s got fibroids, or that she’s unable to take any sort of hormonal birth control. In any event, there are nonsurgical alternatives, or even less-invasive surgical interventions, like uterine cauterization.

I’m not really sure, in fact, what’s going on here. The mother swears it’s not about her:

Katie’s mother Alison Thorpe, who lives in Billericay, southern England, said the operation was in her daughter’s best interests.

“First of all, this is not about me. If it was about me, I would have given up caring for Katie a long, long while ago,” she told GMTV.

“It is about quality of life and for Katie to not have the associated problems of menstruation adds to her quality of life. It means she can continue with the quality of life we can give her now.

“Katie wouldn’t understand menstruation at all. She has no comprehension about what will be happening to her body. All she would feel is the discomfort, the stomach cramps and the headaches, the mood swings, the tears, and wonder what is going on.”

Thorpe said an operation would be best for Katie, despite the initial pain it would cause.

She added: “The short-term pain and discomfort we can manage with painkillers. We will be able to manage that pain much better than menstruation once a month, when Katie cannot tell us ‘I’m in pain.'”

So the solution is to put her through severe pain now to spare her cramping later? Can’t you give her painkillers once a month later, or Depo shots, or what have you? Something just seems sort of off to me with this whole thing.

I don’t want to minimize the burden that Allison Thorpe will have in caring for Katie over a lifetime, nor her awareness of Katie’s limited ability to comprehend and communicate that she’s in pain. However, given a range of alternatives, I can’t help but think that there’s a pretty big factor of not wanting to deal with the mess every month here.

The question, of course, is whether this decision will be for Katie’s benefit. And I just can’t say for sure, with such limited information. But I can say for sure that this case raises a lot of red flags for me. There’s also the issue of bodily autonomy, which is a particularly fraught subject in the disability-rights context, one that was argued with a great deal of intensity in the case of Ashley, a Seattle girl referred to as a “pillow angel,” whose growth was stunted surgically (which included the removal of her uterus and breast tissue so that they would not interfere with the hormone therapy or cause her discomfort) so that she could remain a size that would allow her parents to care for her at home and be able to transport her easily so she could be included in family activities. (For some perspectives on the ethics of this choice, see Blue and Planet of the Blind and Lindsay Beyerstein).

Thoughts?