Marketing and politicize the menopause

The Associated Press reported this week the marketing of a new product line of menopause – "a line of products that target American women 50 million that are or will soon go through menopause. Prices between $ 9.99 and $ 7.99, the line includes lubricant for vaginal dryness, adhesives, socks and feminine cleaning air freshener to the odor and cooling gel roll-on and wipes for women have hot flashes. " Snippet:

Feminine washes are usually not recommended by many doctors, says Dr. Lauren f. Streicher, a gynecologist and Assistant professor of Obstetrics and Gynecology at Feinberg School of medicine in Chicago. And vaginal odor products that mask can cause people to not treat what is causing this symptom in the first place, she added.

"The idea to cover it with an air freshener is an inadequate approach," said Streicher. "I'm very happy people are paying attention, but I don't want to see people harnessed."

And USA Today reports:

But do we really need more products that suggest that women basically stink? The new "daily freshness" products — like all sprays, Douches and cleanser before them — can actually be harmful, doctors say.

"The vaginal odor is not a common symptom that patients come to physicians," or a problem that becomes more common during menopause, says Elisa Ross, an obstetrician/gynecologist at the Cleveland Clinic. When a woman realizes a unusual odor, she may have an infection, Ross says, "very few doctors recommend these products cleaning because they can mask the symptoms that should be brought to the attention of a doctor. They can also cause irritation if. "

Also this week, Liz Scherer, not your Mama Flashfree: menopause, wrote, "Politicizing menopause."   Read the whole post for yourself.  But I wanted to get two excerpts:

"It is possible that menopause has been Government overpoliticized, medicalizada and poorly characterized, a phenomenon not kidnapped by medicine as gradually occupied, [with] the authorities throughout the ages grimly trying and do not set your subject?" "" We are drowning in politics, medicine and industry. And it is difficult to discern the truth from fiction, the data from the data, the risk of benefit

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Epidemiologists call them "absolute risk"; you and I could call them real numbers

In a recent Huffington Post blog post, Gil Welch Dartmouth approached a old topic, our pet, "the problem is relative."  Snippet:

Numerous studies have shown that the general public has exaggerated perceptions of health risks they face — as well as exaggerated expectations of the provision of medical care.

It is because they are stupid? No instead, the problem concerns how various sources of health information — researchers, doctors, reporters, web designers, advertisers, etc. — often frame their messages: using the relative change.

"Forty percent more high" and "low" are 50% more variation on declarations. While they are easy to understand, they are also incomplete. Relative change drastically can overstate the underlying effect. It's a great way to scare people.

For example, survey earlier this year found that women with migraine had a 40 percent greater chance of developing multiple sclerosis. That looks scary.

But the researchers were careful to add some important context: multiple sclerosis is a rare disease. In fact, for women with migraine, the chance of developing multiple sclerosis over 15 years was considerably less than 100 — 1:0 pm each only 0.47%. To be sure, which is about 40% higher than the analogous to women without migraines — 0.32% — but it's much less scary. More importantly, it is a much more complete piece of information.

What makes it more complete is the context of the two additional numbers: the risk of developing multiple sclerosis in women with and without migraine. Epidemiologists call these risks "absolutes". You and I could call them real numbers.

Relative change also exaggerate the effects in the other direction. It's a great way to make people believe that there was a real breakthrough.

When we HealthNewsReview.org, generally grade stories in give them a poor score for the criteria of "quantification of benefits" or "quantification of damages" if they use only values of relative risk.

 

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The news of alcohol-osteoporosis: only 40 women ... just a surrogate marker

In a race to the incomplete news coverage, news about a study published in the journal menopause, "the moderate alcohol consumption reduces the biochemical markers of bone turnover in postmenopausal women," can overcome the news earlier in the week from a BMJ paper on alcohol and arthritis – both in volume and in the absence of key restrictions.

This was a small study of short term in just 40 women.  Still look as final are the statements in this sampling of headlines:

Nightly glass of wine may protect bones female Boomer

Cocktails can prevent bone loss

Ladies drink for health (bone)

DRINK UP FOR STRONG BONES

Bottoms up, ladies! Moderate drinking can be good for your bones

Drink increases bone health: study

Good news for drinkers! A glass of wine per day ' protects women against the fragile ...

Let's drink to that! Two glasses of wine per day ends the misery of menopause

"Although there is substantial evidence that moderate alcohol consumption correlates with higher density of bone mass in postmenopausal women, is far less clear whether drinking alcohol decreases the rate of fracture," the authors write. "So even if drinking had no detrimental effect, it would be imprudent to recommend drinking with the purpose of preventing fractures."

Previously the story took care to explain:

Researchers followed certain blood markers of bone health throughout and thought these markers of bone density positively correlated with alcohol consumption: in other words, the more the Women drank within moderate range, seemed the best of your bone health.

I added the emphasis in red to stress that – in other words – this study looked at only a surrogate marker.  Should women worry with a marker of blood?  Or should they care about real results as fractures? This study did not show anything about the latter.  That doesn't make it unimportant.  Research is intriguing.  But the news coverage generally do not point this important limitation. Exaggerated stories and exaggerated.

Maybe the journalists were seduced by the comments of researchers: "the results presented here have a clear message to public health, as well as for practicing clinicians Advisory and management of patients at risk of osteoporosis."  It seems a little on the top, given the limitations that we have highlighted.

Journalists and consumers must read our little primer, "surrogate markers may not tell the whole story."  Journalists need to ask themselves: what was the result that is being studied?  What was the endpoint? How many people? For how long?  What to say and what we say about the importance of this?

(Photo credit: Thoursie on stock.xchng)

 

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Cocoa as sunscreen? Public relations firm shamelessly Hypes tiny study

the following is a guest post by Kevin Lomangino , one of our analysts in HealthNewsReview.org. He is a medical journalist and independent editor that is currently Editor-in-Chief of clinical nutrition Insight, a monthly newsletter on the basis of evidence that analyzes the scientific literature on nutrition to doctors and nutritionists. He tweets as @ Klomangino.

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With the summer beach season in full swing, it's time to start thinking about ways to reduce your exposure to harmful ultraviolet radiation of the Sun. Fortunately, public relations personnel Draznin is ready to educate you about a new strategy important to protect the skin from sun damage: eat more cocoa!

In a recent press release, Draznin offered to me on the track to the findings of a "featured" experimental adds the "mountain of studies on the benefits of cocoa". The results show that a certain type of antioxidant-rich cocoa "protected the skin from sun damage caused by exposure to UV rays," according the Draznin.

I thought I was above all the latest claims about cocoa-based products, encourage (but far from conclusive) cardiovascular effects of frankly dubious notion that chocolate is some sort of weight loss help. But chocolate as sunscreen? I don't see how this could work unless you were spotting it across your skin like Coppertone. (Not a look that I recommend).

For most of us, cocoa is something that we like to curl up with beside a warm fire on a cold winter night. Draznin now want to pack it in your beach bag along with the floppy hats and parasols.

As you can see, the enthusiastic Draznin claims are based on a study of 6 years of age, involving only 24 women, which was partially funded by the Mars Corporation. The researchers randomly assigned women receive a cocoa drink that was high in certain antioxidants known as flavanols (326 mg/d) or low flavanols (27 mg/d).

At the beginning of the study and after 12 weeks, women were exposed to a solar light Simulator and the redness of the skin was evaluated. Women high-flavanol Group had 25% less redness after 12 weeks than they did on the baseline, while the women in the Group of low-flavanol had no change in redness.

Interesting finding? Absolutely. And I'm not dismissing the idea that your diet can play a role in helping him to resist the adverse effects of exposure to the Sun, but as readers of this blog know, a tiny, short-term study, funded by the manufacturer is not proof of anything when it comes to health outcomes of the real world. And yet that did not prevent the Draznin of blatantly extolling the results.

The "argument" of this study, according to Draznin, is that cocoa consumption "should be part of your daily skin protection strategy and throughout the year."

Not surprisingly, Draznin also volunteered to tell me more about a particular line of supplements that contain cocoa flavanols claimed to be protective.

As far as I'm concerned, the only "takeaway" here is ludicrous lengths to which some public relations companies will promote a product. It is also a reminder that some companies will stretch any shred of evidence to give your product a veneer of scientific credibility.

One more reason for journalists and consumers to look critically for health claims and especially to seek an independent perspective on the importance of supporting research. HealthNewsReview.org has a very useful Toolkit-a great place to start working with this type of analysis.

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Editor's Note: such efforts sometimes PR hit their targets. The Minneapolis Star Tribune is one of the largest newspapers in the country, and they put this piece of fluff in your website in the section "health".

 

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Roundup of the weekend: death panels, superbugs, ads for lung transplants & tumor marker screening

Sorry, I could not read the content fromt this page.

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A glimpse of the Senate make sausage: Hatch & supplements

The following is a guest post by Dr. Bradley Flansbaum, who blogs on The Hospitalist leader, is a Hospitalist Lenox Hill Hospital, in New York City and is active in health policy at local and national levels.

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Given the cost constraints that must be submitted to our healthcare system, it is for our elected officials to oversee expenses with prudence, regardless of Government policy.  Most employees align with this goal, although they may differ with the means to achieve it.  They can try to score political points and finger point on the other side in front of the microphone, but behind closed doors, I think they realize that we have a disaster in waiting.

A common refrain I hear is, "clinical decisions are better for physicians," with the assumption of being, the doctors have all the answers and given the choice between treatment x and y, they will choose correctly.

This is false, as the unseen, often goes beyond the knowable, and quantify the findings of studies available to reach the best decision is beyond the capacity of most doctors.  We need help, and left unchecked, a disorganized system, without an instruction manual, as our current is, it is worse than the alternative.  Inefficient and harmful words come to mind.

Some rail placement against comparative effectiveness research.  I am not sure that it is a posture or a genuine State of certainty derived from a thorough analysis.  Anyway, as the adults in the room — the difficult decisions and how administrators of our limited resources — we can rely on them as the guardians of sound.  This is as relevant to clinical care, such as education and defense.

For example, a fundamental determination process, the sound and the whole, the system must apply the expensive procedure or medical device as well as it does for the simple pill.  Consistency and an approach to "harm versus benefit" should support our care and coverage decisions.

As an illustration, imagine a patient have an adverse reaction to a medication, such as a Statin.  In response, you would expect that the responsible physician prescribe an alternative therapy, such as Coenzyme Q10?  Probably not the first thing that comes to mind and the evidence is instructive:

We can conclude that there is sufficient evidence to prove the etiologic role of CoQ10 in myopathy deficiency associated with Statin and that large and well-designed clinical trials are needed to resolve this problem. The routine use of CoQ10 may not be recommended in patients treated with Statin. However, there are no known risks to this supplement and there is some experimental evidence anecdotal and preliminary effectiveness. Consequently, CoQ10 can be tested in patients requiring Statin Treatment, who develop Statin myalgia, and that cannot be satisfactorily treated with other agents. Some patients may respond, if only through a placebo effect.

Of course, with a scarcity of data — whether CoQ10 and statin therapy or biological treatments in autoimmune disease, the search for evidence is the exercise of the right.  A decision maker would will certainly some process, some channel to facilitate the assessment, and would advocate a mechanism to achieve this objective. In addition, the CER "divergence" and its usefulness in practice are large, as exemplified here and here.

In addition, without evidence, prudence would carry the day and precious as tax dollars — are — it would not deliver an uncertain value treatments:

The family health and retirement Investment Act of 2011 (h.r. 2010, 1098 S) would allow citizens to use their flexible spending arrangement dollars and health savings account (HSA) food supplements and meal replacement products.

On the other hand, maybe our judgment is betraying us.  Here's the Rejoinder.

Click this link and send the video to the 74: 30 mark in the scroll bar below the video.

http://www.Finance.Senate.gov/hearings/Watch/?ID=d77c8f52-5056-A032-52EF-33d9c61fd865

You'll hear Sen. Orrin Hatch of Utah.  The New York Times wrote about Hatch:

“…(he) has spent his career in Washington help the industry US $ 25 billion per year (dietary supplement) thrive.

He was the principal author of a federal law enacted 17 years ago that allows companies to make health claims about their products, but generally exempt them from federal reviews of safety and effectiveness before they go to market. During the Obama administration, Mr. Hatch repeatedly intervened with his colleagues in Congress and federal regulators in Washington to fight against the proposed rules that industry officials consider objectionable. "

In this video, you can hear the Hatch stop Chet Burrell, President and Chief Executive Officer, CareFirst BlueCross BlueShield, Washington, DC.  Hatch asks and then says:

"Doctors Are being educated in all people using dietary supplements? For example, it is my understanding that if you are on Crestor, it would be very wise to take CoQ10-a dietary supplement to compensate for some of the deficits that occur from taking Crestor.  And this is an area that is not really well defined.

Is not well defined, in fact.  This is problematic.  At a public hearing on medical payment reform; given everything that's wrong with health; with all the misallocation of resources; with the need to promote evidence-based practice; and with all disputes in rationing of care and resources conservation, this is the best Congress can do?

Do not know if CoQ10 is effective or not, but knowing what we know, is the national phase, in the corridors of the capital, the right place and time for product promotion (indeterminate value).  More important, again, this is the best of our leadership can put forth, and that's how we can educate the public?  Dampens my confidence that some of these discussions behind closed doors are more than diversions without significant destination.

More here.

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Editor's Note: while we're on the subject of the supplements, we should note the report of the Chicago Tribune, "dietary supplements: widespread problems, FDA inspections show."

And just today, the Tribune reported the other senators "calling the supplement manufacturers account."

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BMJ press release on alcohol & arthritis may have contributed to misleading coverage

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