Trying to see sense in the drama

The fact is that unfortunately, cancer has been on the rise over the past half century. Macmillan Cancer Research reported that almost half of Britain’s population by 2020 are predicted to have cancer.

As a result, cancer is always a hot topic in the media and with outlets constantly trying to sell us the news some might have the tendency to be dramatic, sensationalist and altogether not so reliable! Virtually every other week something new will save you from cancer or put you at risk.

In this blog, I’m going to make sense of it all by going back to the original scientific papers that news reports are based on. I try to condense it all into cold, hard facts, definitive conclusions, without the thrills and frills you might find in the morning paper. Hopefully you’ll get a snapshot of the pure research rather than the drama we see in the news.

Thanks for visiting!

Sugary Drinks

As we are all well aware, your average daily newspaper would have you believe that drinking sugar free fizzy drinks are going to cut your lifespan down by many, many years (see Aspartame post for more details).

Sugary drinks were the way forward as we were encouraged to trade our poisonous, chemically enhanced Diet Cokes for Coca-Cola.

Last week, however, the Daily Mail and Daily Telegraph expanded the war against fizzy drinks to include the Sugary type. New evidence has come to light effectively consigning us to fruit juices and water if we want to live a healthy, cancer-free life.

The study quoted comes from the University of Minnesota, who are currently looking into the effect that obesity can have on cancer in a series of studied.

It was a study of over 20 000 women over 25 years which found an increase in endometrial cancer, a type of cancer that affects a woman’s uterus, by a whopping 78%.

A large study over a long period of time, all seems pretty sound? Unfortunately not.

For starters, the 78% increase would only occur if women were to drink over 60 fizzy drinks per week. That’s 9 per day. Or one every two waking hours.

Furthermore, the maths simply doesn’t add up.

The study concluded that the reason that sugar filled drinks may cause an increase in cancer is because they increase obesity levels. The effect that sugary drinks have on obesity levels is so minute:

A standard can of Coca-Cola (330 ml), contains 142 calories. The recommended daily allowance (RDA) of calories is 2000 for a female.

So a can of sugary drink contains 142/2000 or 1/15 of the recommended calorie intake. An obese person may be consuming far more calories than this. Probably closer to 3000

In order to be obese, you don’t just need to be a little bit fat- your Body Mass Index (height to weight ratio) needs to be over 30. To put this into context, the average height for a woman is about 5 foot 4 inches or 156cm. In order to be obese you would need to weigh 175 pounds or 80kg.

Furthermore, the researchers themselves admitted that they didn’t take into account the other unhealthy habits that obese people may sometimes have such as lack of exercise and a poor diet.

In other words, an extra couple of sugary drinks is not going to make much of a difference.

The real story here is that obesity is causing the cancer, fizzy drinks are a small contributor. This has already been proven in multiple studies. But you are far more likely to die of heart disease, diabetes or other obesity realted conditions before cancer gets to you!

So in practice obesity’s increase of actual cancer deaths, known as mortality rate,  is in fact a lot smaller.

Verdict: Sugary drinks don’t cause cancer. If you are obese, they might be a small contibuting factor. But you should be far more worried about heart disease which will probably get you first.

Abortion

Usually, it’s the medical journalists who are misleading their readership. But a number of US newspapers have reported that it can be Politicians too.

The House of Representatives in Kansas voted to advance anti-Abortion legislation last week, refusing to allow state money to be used for abortions, even for rape and incest.

One of the most contentious parts of the Bill is the fact that doctors would be required by law to inform their abortion patients that the procedure is linked to breast cancer.

The problem is, that science has proven that there is no link between breast cancer and abortion.

There exist very few studies linking breast cancer and abortion. These studies asked patients with breast cancer and patients without breast cancer whether they had had abortions and found that a higher percentage of abortions was reported in those with breast cancer.

A study of this nature, however, is subject to Recall Bias. Recall Bias is the way in which incidents are reported by those participating in a study:

Having only been legal in Europe and the US since the 1970s, abortions are still a very private, personal and even stigmatised procedure for many women. Particularly considering that those in the breast cancer studies would have been older and possibly from a generation when abortions were illegal.

Studies have shown that those with cancer are more likely to report an abortion since they are looking for closure about their disease. The stigma, however, remains with those who do not, making them less likely to report an abortion.

The overall result is a skewed study, that shows that abortions are linked to breast cancer. Early studies of this nature have been denounced by the American College of Obstetricians and Gynecologists.

Furthermore, there have been multiple studies disproving the link. A Danish Study conducted purely on Medical Records (ie not subject to recall bias) showed no link between abortion and breast cancer in 1.5 million women. A study of 100 000 women by Harvard University in 2007 showed similar results.

Unfortunately, this latest piece of legislation appears to be a thinly veiled attempt by a Republican body to scientifically justify their anti-abortion laws. Although this is an isolated incident, the general point still stands: a society in which politicians dictate what science we have to believe in cannot be right!

As State Rep. Barbara Bollier put it ‘science to dictate policy rather than legislators dictating science.’

Order is everything

Medical studies come in different shapes and sizes but all can be condensed into the same formula: object is tested on subject leading to results. These are the most important components of the study and are contained in the abstract (summary) of all scientific studies.

It would therefore make sense that if the journalists were reporting a study their headline would be for example: New study shows grapes (object) reduce cancer (result) in women (subject).

The first couple of paragraphs would go into further details: the ages of the women, the length of the study, the number of grapes consumed. The final paragraphs may give a bit of background.

Studies have shown that when reading a news story, most people read the top two paragraphs or so, then scan the pictures, then move on. So, when journalists write a news story, it is imperative that they put the most important things at the top.

And what a journalist considers important and what is actually important are two very different things.

A medical journalist puts what (s)he feels will get us to continue reading the story.

So if the grapes has been mixed with human cancer cells in test tubes rather than on humans themselves, leave it till the end. If only 20 women were involved in the study, leave it out.

If the chemical being tested happens to be in the grapes in minutely insignificant quantities (essentially background to the story), shove it to the top, obviously not the insignificant bit- miss that out.

At best, the result is that we are immediately grabbed and are excited by a headline, only to be disappointed after 5 minutes of reading because the superfood that cures cancer is actually an extract of said food that has been mixed with human cells in a test tube and kills one in three thousand cancer cells over a period of five years. (I may be exaggerating but the point still stands).

At worst, we only read the first three lines and move on, and eat nothing but grapes, convinced by a study that clearly showed that they can cure cancer.

So, unless you want to be on a diet of grapes for the rest of your life, don’t believe everything you read!

Nuts

Nuts are one of those super-foods. Packed with vitamins, minerals, cholesterol lowering fats, antioxidants and all sorts of other great things. Now, it seems, nuts can also prevent cancer.

The Daily Telegraph published a joint study this week from the University of Harvard and Brigham and Women’s Hospital that featured in this month’s edition of the British Cancer Journal.

The study was conducted over a period of over 30 years starting in 1976 in which women were asked to inform the study of their average nut consumption every 4 years.

The results showed that eating as few as 2 servings of nuts per week could reduce the risk of pancreatic cancer in women.

Usually at this point, we could break the report apart, show how the study was flawed or misreported, but it seems to be a watertight study- A large number of women over a long period of time.

One possible flaw is that the demographic of people who eat nuts is slightly skewed- nuts are expensive and are therefore eaten more by richer people, whose general diet, health and healthcare access is often better than their poorer counterparts.

However, the study claims to have controlled other risk factors such as diet, alcohol consumption and weight. This means that the average of these other factors was equal in all women, those who consumed nuts and those who didn’t.

Some factors were not accounted for, such as stress. In addition, the questionnaire on the study was very general- women were asked to choose from eating nuts:
never/almost never
1 to 3 times a month,
at least once a week

These, however, are small blots on an altogether well conducted study.

The mechanism of how the nuts reduce pancreatic cancer in women is not understood and since this is the very first study of its kind, no similar data is available for men.

Verdict: Nuts, nuts and more nuts. 2 servings a week has been proven to reduce pancreatic cancer in women

Acrylamide

“What’s odourless, tasteless, invisible, potentially deadly, and lurking in your food?” asks Joanna Blythman of the Daily Mail.

Acrylamide, apparently. I beg to differ.

It is the perfect target though: scary, chemical sounding name, used in cigarettes and is also a major component of weedkiller. And it’s contained in loads of foods: Crisps, chips, cereal, coffee, toast and deep fried products. Could it be a cause of cancer?

Well the Daily Mail seems to think so: it has published 10 different articles over the past 5 years linking acrylamide to cancer, yet still those evil food agencies continue to allow food production companies to keep it in our diets.

The article in question points out (correctly) that acrylamide is classified by the U.S. Environmental Protection Agency as a ‘probable carcinogen’ in humans.

What it failed to mention is that this is only if the acrylamide is pure and contact is through inhalation, skin contact the amount of food you would have to eat in order for it to affect you would kill you first.

Acrylamide was discovered to be in food by Swedish scientists in 2002. Following its discovery, they did a series of trials to see if there was any cancer link and found that acrilamide caused a 10% increase in cancer risk during animal testing.

It was later found, however, that this risk was decreased 900 times in humans, still leaving a minimal risk of under 1 in a million and for this reason, it remains classified as a possible carcinogen by food standards agencies.

A number of studies were conducted on the chemical in Denmark, Sweden, Switzerland, Italy and the USA. This ruled out links to liver, kidney, bowel, mouth, throat and colorectal cancers.

Although the Danish study did find a weak link between breast cancer in women between endometrial (uteral lining) and ovarian cancer, the methodology of this study was criticised by the scientific community.

Verdict: Although technically a carcinogen, levels of acrylamide are far too low in food to cause an increase in cancer risk. This has been proven by multiple studies

Parental Guidance Advised

Anyone been on Huffington Post recently? Its a news website with a bit of personality. It published a cheeky little clip from The Doctors, a health show in the USA about whether masturbation causes or prevents prostate cancer.

TV doctor shows are nothing new and I’m sure many of us have seen these kind of things before. In this particular clip, a man poses the question from behind a screen while three glammed up ‘TV Doctors’ with charming looks and pearly white smiles answer the all important question.

They quote an English Study from which they prove that masturbation is in fact very healthy and can even prevent prostate cancer in over 50s! Unfortunately, it increased the risk in 20-30s, despite having many other benefits.

The study that they refer to was conducted by the Prostate Cancer Research Foundation and Cancer Research UK. It compared a group of 431 under-60s with prostate cancer to a group of 409 without and asked them to record their masturbation habits.

An inherent problem with any study of this nature is the tendency for people to lie to researchers. Scientists can’t start filming people’s sexual activity and have to rely on what they are told. With sex, and particularly masturbation which seen as taboo by many, subjects may deliberately under-estimate.

In addition, this study asked subjects to recall their sexual activities from many decades ago which is extremely difficult to do accurately. The questionnaire from the study was a tickbox (1-3 times per month, once per month, once a week etc.) which can also effect the accuracy of the results.

The study was conducted on men who developed prostate cancer before the age of 60, yet 75% of prostate cancers appear when a man is over 65. In order to get an accurate snapshot of whether masturbation causes cancer a study of all ages, particularly those in the over 65 category, would need to be conducted.

The study brought on TV Doctors was more of a test of whether masturbation is linked to prostate cancer occuring earlier in a man’s life.

Masturbation’s link to cancer is thought to be due to the way in which it alters levels of horomones in the blood. These same hormones circulate in identical amounts in regular sexual intercourse. From a medical point of view, therefore, there is no difference between masturbation and sex.

And there have been many studies into the link between prostate cancer and sexual activity in general, which have produced vastly different results, presumably due to some of the problems mentioned above.

Verdict: This study, like many before it, fails to overcome the pitfalls of getting reliable data on sexual activity. Until a study does, it will be very difficult to assess the link between masturbation and prostate cancer.

 

Dirty Doctors

It was discovered this week that doctors in Colchester Hospital, UK have been falsifying data regarding their cancer patients. It is a shuddering thought that doctors, whose job is based on trust, integrity and transparency, could have been misleading the public. These are people’s lives we are talking about!

Yet, a number of studies have shown doctors in research, the ones who conduct the studies that make it into the morning papers, may not be so squeaky clean either.

A meta analysis in 2009 analysed 18 studies regarding malpractice in research. It found that although serious misconduct may occur in 0.3% of cases (actually making up results) other poor practices, such as overlooking the erroneous interpretation of data and failing to present studies that contradict ones own research, were far more widespread (12.5% and 6% respectively).

The largest study of this type was published in Nature in 2005. It showed that between 15 and 20% of researchers changed the methods of their study and over 10% would overlook flawed data.

What is it that is making supposedly upright and trustworthy doctors lie so much?

Most medical research ends in failure. Getting a drug into the market from the point of conception (when it is first thought out by a scientist) means succeeding in at least 8 different trials, taking a minimum of 25 years.

Each study must be carefully designed, volunteers found, an appropriate length of time for each trial must be met, interpretation of data and refinement of the drugs in light of the results can take months- it all adds up!

Most drugs won’t make it past half of the stages and the vast majority will never make it into the market. So governments are very unwilling to make the millions of pounds of contributions towards these trials (certainly those in their early stages).

Which means that scientists have to turn to private investors (an the word investors is used here deliberately) for funding.

Why should anyone fund science? Although there are many good people in this world, there are very few who would give up millions of their hard earned cash for an early stages trial that might possibly one day do something good in the world, but will most likely end in failure.

More often that not, these funders aren’t doing it because they love science, they’re doing it to make money. Researchers, therefore, face huge pressure to come up with the right results!

A University who sponsored the research can get another paper published and move up the University Rankings. The Drugs Company who funded the scientists is now armed with a study that they can use to gain private investment.The scientists who conducted the research will still get his/her name on the paper and will be better respected in the scientific community.

In short, everybody wins!

And it’s not that difficult to do- it is nearly impossible to navigate a research paper without a decent knowledge of the subject, never mind starting to pick holes in it! This means that only a select few will be able to spot any wrongdoing. It’s not like a regular book or documentary that we can analyse ourselves with a few google searches!

The drug will probably fail spectacularly at the next trial because the results of this one were slightly misrepresented or the method was far from perfect. But if anything, this could make misconduct even more attractive- if ultimately the poorly tested drug will never make it to the market, no-one gets hurt so what’s the problem?

So if there’s an easy way to make money or further your own prestige without any real consequences, it becomes a very attractive option.

And the results speak for themselves: In the 2005 study, 20% of scientists admitted to “changing the design, methodology or results of a study in response to pressures from a funding source”.

Although the majority of data from scientific studies will be true and certain minor changes to study methods may not make that much of a difference, there needs to be a serious review of how the scientific research community operates.

The problem is, that this in itself needs to be rigorous study, with correct methodology, recruitment of paid scientists, paying for access to historical data- the list goes on. Oh and at the end, we may not see any significant results.

Good luck finding anyone without a vested interest who wants to sponsor that!

Fracking

Fracking has been in and out of the news relatively recently. Following the opening of a Fracking Site in Blackpool, UK, a number of small magnitude earthquakes were recorded.

In the USA, fracking has been used for a number of years but a recent Colorado study has linked fracking to an increase in cancer, implying that those living close to fracking sites may be at risk.

Their study is based around the fact that many carcinogenic (cancer causing) chemicals are used in fracking. They are pumped deep into the earth at high speeds, cracking rocks hundreds of feet below the surface. This releases the gas in these rocks which is used for energy. The carcinogenic chemicals remain in the ground and others are released into the air.

And the study seemed to show definite evidence that cancer causing chemicals were present in the air within a small radius of the fracking site. And so, anti-fracking campaigners have jumped on this study and used it against governments and energy companies. How can the government tell us to back fracking when it is so dangerous to everyone’s health?

A closer look at the study gives us the answer: The study was done using a computer model and didn’t involve a single human volunteer! All the study did was assess the levels of certain chemicals in the atmosphere half a mile around the plant.

The connection between fracking and cancer in humans simply cannot be proven off a study that didn’t involve a single person!

And even if you do want to believe this study, all of the fracking sites in the UK are well away from large populations- the study only covered a 0.5 mile radius remember?

Verdict: A Colorado study involving no less than 0 human volunteers can prove anything about whether fracking increases the risk of cancer

IVF Treatment

Louise Brown might sound like your average girl but her birthday marks a huge breakthrough in Medical History. It’s a late January night in Manchester, England when she is finally born, to a crowd of journalists and cheering scientists- the first baby born through successful IVF treatment.

IVF treatment allows mothers with fertility problems to have children by allowing the father’s sperm and mother’s egg to combine outside the body, before re-inserting the formed foetus into the mother’s womb. Since Louise Brown’s birth in 1979, hundreds of thousands of babies have been born this way worldwide.

What would have remained a dream for women became a reality overnight.

Yet, some 30something years later a number of reports surfaced casting a potentially ugly shadow on IVF treatment:

“IVF Babies at Higher Risk of Childhood Cancer” (International Business Times)
“IVF Babies are a Third More Likely to Develop Childhood Cancer” (The Daily Mail)

IVF has hit headlines in light of a metastudy published by Danish researchers. They have analysed 25 studies between 1990 and 2010 and concluded that they have seen a massive 33% increase in childhood cancer in those born through IVF treatment.

The studies included in the analysis were generally well structured to eliminate bias and combining all these studies together amounts to data on some 65 000 people.

End of story? Fortunately not.

The study itself highlights a number of shortcomings that the news decided not to include.

1) Nearly all cancers have been  proven to be genetically linked. How do we know that cancer is higher in those with infertility anyway and these mothers were just passing it on to their children and infertility is not responsible? 

2) Some of the most significant studies were the smallest, often performed on a few hundred people. Their results are less reliable but were considered with equal weight to larger studies.

3) The study highlights parts of the IVF procedure that may give rise to this increased risk of cancer. Yet, the techniques used are becoming more advanced year on year. Perhaps the original more crude methods have been replaced by technology that prevents the risk increase.

Finally, if we look at the numbers in real terms, the figures become far less startling. As mentioned in a previous post, numbers and statistics can be manipulated to sell a story. Although a 33% increase was seen, very few children die of cancer each year.

Whilst each of these is a tragedy and should not be taken lightly under any circumstances an increase of 33% of childhood cancer cases would only see 4.4 more actual cancers per year in Denmark.

Verdict: It would appear that there might be a link between IVF and childhood cancer. However, more research is required to rule out other causes of this link.

 

Making the Jump

As Mark Twain once wrote: ‘Be careful of reading Health Books, you might die of a misprint’.

I have blogged previously about the techniques journalists might use to make the story more dramatic, relevant or sell-able. Once again I refer you to people far cleverer than me who deal with the subject.

But since Dr Rangar Levi’s Medical Journalism Book costs £35.37 on Amazon, perhaps you might want to stick with a cheaper option. Me.

As you may be aware, a lot of reports in the press, particularly those relating to cures and treatments will often come from scientific research papers. These papers are reports of various experiments performed by scientists all over the world and test their hypotheses (informed ideas) about whether there is a link between two variables (factors).

However, between the Scientific paper and the Sunday newspaper, the journalist has a lot of opportunity to present the research in the exact way (s)he wants you to see it- the way in which you are most likely to ‘buy’ the news story.

Often, the journalist will make a ‘jump’ usually involving an assumption or assertion that may be untrue or unfounded in order to make his/her article the one you will read.

Let’s say scientists tested a certain chemical: triterpenoid, as a cancer cure. They mixed it in dish with cancer cells and the cancer cells stopped growing. This ingredient happened to be present in cooking apples.

People don’t care as much if some chemical nobody has heard of stopped cancer cells growing in a dish. But if we find out that something in apples can cure cancer then we sit up and take notice.

So they run with the headline: Apple Chemical Cures Cancer. The article tells us that apples contain loads of triterpenoids and that lab reports show that it can fight off breast cancer. We walk away from the article believing that the more apples we eat, the less likely we are to get breast cancer.

Unfortunately, the scientific research doesn’t tell us that at all. There are so many problems to get past, so many jumps have been made:
1) Who is to say that the chemical is in high enough amounts in the apple to work. You might have to eat 30 apples per day before it has any effect.
2) Perhaps the body breaks down the chemical when it enters the body, so the chemical never reaches your cells.
3) Perhaps the chemical acts differently when inside a fruit with a bunch of other ingredients.
4) Maybe the cells it was tested on react differently to the chemical once they are in the body
5) It might be that apples also contain a carcinogen (cancer causing substance) in equal or greater amounts to the cure.

And I am not making this up or exaggerating- This article was published 3 days ago in The Grio, an Online American Magazine.

Although some of the foods are backed up by scientific evidence, many are based on experiments involving tests of chemicals that are contained in foods rather than the foods themselves.

Unfortunately, scientific studies can be difficult to find on the internet and even more difficult to decipher, so journalists really do have the upper hand on this one. There are many websites out there, particularly charities who offer impartial advice. They aren’t paid or assessed on how much news they sell.

Verdict: Read the headlines very, very carefully. Just because a cure is found in a food, doesn’t mean that the food is the cure!