The Guardian’s Polly Curtis writes Alzheimer’s drug could make everyone brainier

The story is about a study on 30 healthy male students:

“..published in the journal Psychopharmacology of the affect of the Alzheimer’s drug Donepezil on 30 healthy male students conducted in Germany last year found that taking the drug for 30 days significantly improved short term memory and some long term memory faculties.”

As a story it offers a balance and includes the side-effects with the sub-lead:

· Smart pills could be on sale within 10 years
· Specialist warns of nausea and dizziness side-effects

And it offers another opinion from Professor Jones from Bath University about the proposed use for healthy persons for these prescription-only medications normally used to treat dementia.

“The general thought is that these substances work by increasing brain metabolism, circulation and introduce antioxidants which protect from damage.”

But is ‘general thought’ Science?

However, not yet licensed in Britain, Jones said:

“It’s much harder to license a drug where there isn’t a disease to treat. It’s going to be a long time before major companies go into that area. There is a growing blackmarket and demand though.”

Interestingly, the drugs are already available on the internet, circumventing prescription controls. Sites based in America advertise a range of prescription-only pills for sale along with one based in the Channel Islands.

Fundamentally as peer-reviewed science I question the study’s right to publication. It sounds like the old LSD studies and where did they get us? This is an example of Wilkes (1997) discussion of peer-review which he defines as “a commonly used phrase in the medical community that to some connotes both truth and high quality.” He notes that importance within the medical community of peer-review is a result of “complex social, historical and economic reasons” which explains how such a study is given any air time, both through academic and popular media channels. Basically you scratch my back and I’ll scratch yours regardless of the need, quality and relevance of your work. The peer-review process will only become accountable and produce relevant studies if the “old boys network” is removed. But if we are slow to realise its destructive influence, at least it should be transparent and the messages promulgated by the media should show more respect for public consumption through intelligent discrimination when selecting stories.

The Australian’s 27 January story Vaccine sparks promiscuity fears is the arena for backchat.

Without going back to Prof Ian Frazer’s study and the findings that 70% of cervical cancer can be prevented by a vaccine – assuming it is true, then how has a debate arisen around Barnaby’s Joyce’s comments:

“don’t you dare put something out there that gives my 12-year-old daughter a licence to be promiscuous”

Barnaby’s response on ABC Radio National, Cancer vaccine comments taken out of context: Joyce has him capturing the limelight in his true form – how is it that only his voice is heard?. His tone doesn’t change no matter the issue – a forceful, opinionated voice – maybe he is just a media pawn. He tried to clarify his position by saying –

“all I’m saying is that the parents should be involved in any vaccination process for young girls” – what is he on about?

Most of Australia’s girls, between 9-15, do not have an independent relationship with the doctor, as medicare is setup via ‘families’.

Then as if he is the only one that knows anything, he goes on with a tireless expanse.

“To jump in on day one and say, ‘this is the best thing since sliced bread without knowing anything more about it, I’m going to recommend it to every child in Australia’, is blatantly ridiculous,” he said.

“Because we’ve had too much of a history of finding things at a later date we thought were wonder drugs at the time but at a later date have had wider ramifications.”

Maybe he has forgotten about fluoride and the like - does he have the power to vote this in or out - it is already in - why does he have the need to be in everybodies’ business.

I think he is ‘ridiculous’ thinking that we all want to listen to his good opinion about “everything” But maybe his ‘talent’ status will diminish very soon, particularly if the Nationals go down!

TOPIC
Discuss medical science’s “politics of knowledge” (Ericson 1989:377) and examine how the ‘pubic interest’ is or isn’t served through health reporting.

This paper will examine medical science in terms of research studies and their transformation into ‘news”. Several examples from the blog ‘connectionsinhealth.blogsome.com’ will be analysed. Health beat’s politics of knowledge will be discussed through a Foucauldian discourse in order to understand how “the experts, the researchers [as] the main voice, or “primary definers” (Cottle 2000) maintain their authority. Both a sociological paradigm (Cottle) and a cultural or mythological approach (Bird & Dardenne 1997) will be used to analyse these blogged case studies. Medical journalism literature and critical analyses of health reporting will be used to show how misrepresentations of science constructs reality for the ‘spectators’. Journals such as Journal of American Medical Association, the British Medical Journal and the Medical Journal of Australia analyse health reporting often using a methodological structured approach. By categories such as ‘disease mongering’, and ‘novelty and availability of treatment’ and the use of ethical guidelines such as reporting adverse effects of treatment, citing of independent sources and of funding source (s) (Smith et.al., 2005) their analysis appears scientific but does not necessarily ultimately serve the public interest.

How the public interest is served, considering an audience that is virtually unknown and silent (Levi 2001), is discussed. Defined therefore as an ‘assumed audience’ whom are entitled to participatory democracy. Democratic principles as espoused by the mass media rely on correct and timely information. The Australian Press Council, print media’s self-regulatory industry body, maintains a mandate to inform the public promptly and with sufficient information that they may make their own judgements but this discussion argues that decisions are eskewed when in matters of health, “Media coverage can fuel demand for new treatments, regardless of their efficacy” (Benelli 2003 in Ooi and Chapman 2003). With such demand for medical/health reporting it is obvious that a daily diet of research studies presented as Bird & Dardene suggest ‘every news story springs anew’ can appear on first glance to be for the public good. That Information is presented as it happens and the public may then make medical health decisions, as they are much better informed than their forbearers, is not disputed but the ‘truthfulness and transparency’ (Schudson 2001) of that information is questionable, along with its true publication purpose.

In conclusion, medical, scientific health journalism models a complex social structure that includes specialists with different knowledge bias’. For example the scientific medical journals’ perspective is regulated by a scientific-medical view of the world and their authority is only part of the ‘truth’. These specialists are most often the originator of medical news, particularly scientists, and should not have the only voice, regardless of their authority, in matters relating to public health. Through ‘news’ the public are offered a plethora of partial information at a harried rate often confusing issues with ideas such as ‘work-stress causes heart disease’ constructing reality and with it life’s direction and choices.

This research article concludes that medical science health reporting offers the audience very little. Ericson et. al. (1997:398) may be closer to reality when they argue that ‘news’ actually prevents the public from knowing, because it “fails to meet the expectations of those who use it, whether members of the public; regular sources, or news-media analysts. … the failure of news to provide adequate knowledge, that it is a means not to know.”

Annotations
Bird & Dardenne(1997)
The pretence is maintained that every news story springs anew from the facts of the event being recorded (p333) even though as a communication process, news can act like myth and folklore with easily understood stories being repeated over and over. The principle of consonance (Galtung & Ruge 1965 In Bird & Dardenne1997:338) ensures that events that may actually be different are encoded into frameworks that are already understood and anticipated. News “conveys an impression of endlessly repeated drama whose themes are familiar and well-understood” (Rock 1981:68). “While news is not fiction, it is a story about reality, not reality itself” (p 346) “Yet because of its privileged status as reality and truth, the seductive powers of its narratives are particularly significant”

Cottle 2000
He argues that “who gets “on” or “in” the news is important …. because it sets society’s structure when news privilege[s] the voices of the powerful and marginalise those of the powerless (p427). That is, how society accepts who/what is on or in the news sets economic and social practice. The sociological paradigm encounters access through a hierarchical power structure and the dominant culture where “media reproduce the voices of the powerful who become the “primary definers” of events” (p 432). The cultural paradigm positions access through a symbolic system. Cottle draws on Bird and Dardenne (1988:438) where the “informational content of particular “stories” becomes less important than the rehearsal of mythic “truths” embodied within the story form itself: News stories, like myths, do not “tell it like it is’, but rather, ‘tell it like it means’.

Ericson et. al.,1989
Discusses news as a product of transactions between journalists and their sources arguing that the process of assigning meaning to “events, processes, or states of affairs” is a serious matter because it creates the knowledge hierarchy. The authorised ‘knowers’ are defined and the news organization cohabits, and not only underpins the ‘knowledge’ but also perpetuates their own authority and together they represent the power/knowledge structure.

They argue that “Sources are painfully aware that news does not mirror reality.” They are equally aware that news does mirror images they help to construct. These images are crucial to the constitution of authority in the knowledge structure of society” p 395-396. News typically fails to meet the expectations of those who use it, whether members of the public; regular sources, or news-media analysts. … the failure of news to provide adequate knowledge, that it is a means not to know” p 398

Hall et. al., 1978
He argues that whether we know it or not the media defines significant events offering “powerful interpretations of how to understand these events. Implicit in those interpretations are orientations towards the events and the people or groups involved in them.” (p57).

The construction of the news itself - presentation of the item to its assumed audience of ‘making an event intelligible’ is a social process – constituted by a number of specific journalistic practices, which embody (often only implicitly) crucial assumptions about what society is and how it works” (p54-55).

In the section “media in action: reproduction and transformation” Hall discusses how items are ‘coded’ and translated into conversational language of the public. The media is two pronged – it gives an easily understood message whilst perpetuating the dominant discourse ( p60).

Levi (2001)
The book is a ‘how-to’ on medical journalism with a focus on scientific issues.
Medical reporting “covers scientific, political, economic and ethical aspects of medicine” in environments where science fights for funding and where powerful commercial interests of the health industry playout. Levi discusses medical journalism with the belief that there are definite benefits to the general public. He discusses ‘barriers to serving the audience’, including ‘limited audience contact’ and ‘conflicting agendas between journalists and scientific researchers.
Journalists can be complicit in ‘scientific fraud’ if they do not practice ‘critical medical reporting’.

Moynihan and Sweet (2000)
Television news and current affairs programs routinely broadcast formulaic “breakthrough” medical stories, and often heavily promote them”, overstating therapy benefits, playing down harms and “failed to disclose the relevant industry ties of cited experts”

The article questions the relationship between scientific research and commercial corporations, and points out that these partnerships are actively encouraged in Australia. They cite examples like GlaxoWellcome’s partner, Biota who produced a reported “wonder drug” with “miraculous results” and whose shares rose by 15%. Television introduced the expert professor as an ‘independent professor’ failing to disclose that his research was supported by GlaxoWellcome. They argue that “overly cosy relationships may be affecting research integrity and professional independence”

REFERENCES

Bird, SE and Dardenne, RW. (1997) ‘Myth, Chronicle and Story: Exploring the narrative qualities of news’ In: Berkowtz, D (ed) Social Meaning of News, Sage p333-349.

Cottle, S. (2000) Rethinking news access. Journalism Studies, 1(3):427-448.

Downie, RS., Tannahil, C. and Tannahill, A. (1996) Health Promotion; Models and Values, New York, OUP, Ch 7 & 9.

Ericson, R.V., Baranek, P.M. and Chan, J.B. (1989) Negotiating Control: A study of news sources, Ch 7 Negotiating Control p377-398.

Hall, S. et al (1978) Policing the Crisis, London, MacMillan, Ch 3 The Social Production of News p53-77.

Levi, R (2001) Medical Journalism: Exposing fact, fiction, fraud. Iowa, State University Press pp1-151.

Moynihan, R and Sweet, M. (2000) Medicine, the media and monetary interests: the need for transparency and professionalism. Medical Journal of Australia, 173:631-634.

Ooi, ES and Chapman S. (2003) An analysis of newspaper reports of cancer breakthroughs: hope or hype? Medical Journal of Australia, 179(1):639-543.

Schlesinger, P. (1990) “Rethinking the sociology of Journalism: source strategies and the limits of media-centerism’ In Ferguson, M. Public Communication: the new imperatives, London, Sage.

Schudson, M. (2001) The objectivity norm in American Journalism, Journalism, 2:149-170.

Wall, M. (2005) “Blog of war” weblogs as news. Journalism 6(2) 153-172.

Continuing the theme of stress, Cresswell picks it up in Bosses at less risk than workers in today’s Australian.

He frames the British study reported yesterday (see below) on BBC news, as a ‘privileged versus under-privileged’ debate. He also throws in a future possible litigious angle by quoting an Australian Cardiologist, Murry Esler who said:

“As medical evidence grew, it also raised the possibility of future litigation against employers who did not try to make workplaces healthier.”

By the way, one of the symptoms of metabolic syndrome is a ‘fat gut’ - now can we really blame the bosses for our overeating? But then again if we are stressed and that makes us eat it might be their fault! Who said we are as happy as we choose to be?

I question the formulaic way ‘news’ is constructed throughout my analyses - it seems a too easy non-thinking approach particularly when you deconstruct what is actually written and look for meaning.

This article mentions the themes of ‘women’ who are five times more likely to develop metabolic syndrome and ‘hormones’ - hooks readers in.

The BBC New’s Work stress Heart disease link

Stress in the workplace is a major factor in the development of heart disease and diabetes, a study says.

The British Medical Journal study claims that they have found the link between work stress and the ‘metabolic syndrome’. This condition is a ’syndrome’ caused by a number of factors including high blood pressure but that it can be reversed by liftstyle changes. Good but others didn’t think that it carried a lot of weight - ie

Experts said the University College London report was “interesting”.

Which experts and what else did they have to say?

“Factors such as social class, smoking, high alcohol consumption and lack of exercise were all recorded as part of the study.

The researchers discovered that there was a link between the amount of stress experienced in their job and the levels of metabolic syndrome symptoms, even when considering the other risk factors.”

STRESS is the culprit - according to the research - its proven! Funny though the cure is physical change - get off your bum.

Professor Peter Weissberg, medical director of the British Heart Foundation, said stress was often linked to having little control over work.

“The good news is that many of the features of the metabolic syndrome can be reversed or improved by lifestyle changes, in particular increasing exercise and losing weight, combined with stopping smoking.”

But maybe everyone should get off their bum - the elite academics studying the ‘’slovenly’ - i don’t see a win-win situation!

Thalidomide makes a comeback as cancer drug by Adam Cresswell

I was horrified when I heard that:

“THALIDOMIDE, the drug that achieved infamy in the 1960s after causing thousands of horrendous birth defects, will pull off a remarkable medical turnaround next month when it wins a taxpayer subsidy for patients with a type of blood cancer - 40 years after it was banned”.

At least Cresswell mentions the downside of its use as a cancer drug:

“Side effects include lethargy and nerve damage in the limbs”.

I think that this drug deserves more notice. The birth defects included partially formed limbs – I remember kids at school with little stumps for arms. How did it get on to the PBS list again?

Diabetics ride for a better life Verity Edwards January 18, 2006

This study suggests that people should do say 20 minutes exercise twice a week – are they waking them up from the dead – what do they do all day? And do you really need a buddy to help you ride your bicycle?

Gee I’d like to do a study entitled “commonsense wouldn’t go astray” – but I suppose being brought up voting labor – studies create jobs!

I know, I know the idea is to be open-minded and not cynical but I guess I don’t like being fed news chaff

DIABETES sufferers over the age of 60 could soon find an ally in the bicycle, with a University of South Australia study expected to show the benefits of cycling in alleviating side effects of the disease.

The Guardian leads their Saturday 14 January 2006 Health & Wellbeing section with:

Drug companies are the most profitable businesses in the world - ever seeking new diseases for which they can provide new ‘miracle’ medicines. But the fact is, Jacky Law reports, a simple sugar pill can often be just as effective

All praise to Jacky Law who reports The fool’s gold that heals.

Law explains the process of how two controlled clinical trials must find proven benefits for a drug to be give governmental approval in most western countries. She discusses the often equally beneficial placebo or sugar pill in a variety of illnesses – depression, ulcers and impotency.

Great information. This is an opportunity for responsible health/medical journalism to provide further regular useful information for public consumption. Understanding how studies are setup and what they mean is not such a difficult task for a journo. For example the use of blinding trials,which can be either single, double of triple blinded is important information.
According to Schulz & Grimes (2002)

“The term blinding refers to keeping trial participants, investigators (usually health-care providers), or assessors (those collecting outcome data) unaware of the assigned intervention, so that they will not be influenced by that knowledge”.

This kind of knowledge, packaged regularly, is useful because pharmaceutical companies have a ‘wonder drug’ marketing mindset that dupes the public. With new accessible medical knowledge people are able to exercise their judgement in terms of their own health and in terms of government health policy and practice. It gives people a critical ‘eye’.

This mornings Sydney Morning Herald’s article by Julie Robotham Early signs hold key to fatal disease looks useful on first glance. It warns:

LEG pain and cold hands and feet are better warning signs of early meningococcal disease in children than the classic rash or light sensitivity, say British doctors who want public health campaigns revised to focus on these clues.

The Oxford University clinical study of 448 children carries weight. It was published in The Lancet which has an impact factor of 21.7 making it one of the world’s top peer-reviewed journals.

The results, published yesterday were strong enough to warrant immediate change in information campaigns, according to the researcher Dr Thompson.

“There would be little risk of harm and considerable potential benefit if these symptoms were to be promoted to both parents and doctors,” he wrote.

But if you read to the rest of the article, and there is a good indication that many readers don’t read the whole article, David Isaacs, Professor of Infectious Diseases at the Children’s Hospital at Westmead, said

“experienced doctors could pick up subtle signs of meningococcal infection, and knew that not all children developed the telltale purple rash. But there was a danger in warning the public to treat leg pains as an emergency, because they also occurred with less serious illnesses.”

But he warns:

“In the flu season you will petrify everyone,” Professor Isaacs said. “You can scare people sideways and swamp emergency departments so that no one can function.”

Another prominent Australian doctor, Dr Chris Hogan, spokesman for the Royal College of General Practitioners, also cautioned and said that

“the British late 1990s data may not reflect patterns of illness in Australia today.

This type of medical communication addresses a serious public concern but leaves parents and health workers worse off and somewhat paniked because they now have three different ‘experts’ in their ear!

The same story in The Australian Vital signs of deadly disease by Health editor Adam Creswell gives a consistent message about the findings of the Oxford University study. It also sets out a panel with WARNING SIGNS for parents and doctors and nurses to follow. The final part of the article is located in Sydney at Westmead’s Children’s Hospital with Professor Robert Booy. Booy enthusiastically supports the study’s outcomes and urges parents to check sick children for

“early signs like cold hands and feet and pain in the legs, then they should seek medical help quickly”

Well Booy had previously worked with the UK researchers for several years according to Creswell and the SMH article. Even though the narrative report is clear, that the Westmead expert was once a collaborator it has the mark of being sold to us as the ‘answer’. The article should have had an independent expert. Although these medical reports seem harmless enough I believe that responsible journalists can be more discerning about how they report on health and science.

Deborah Lupton puts health reporting in a wider context, she writes:

“Medicalisation is evident in the ways in which warnings about health risk have become common events. People are constantly urged to conduct their everyday lives inorder to avoid potential disease or early death” In Foucault Health and Medicine 1997:101 (eds Petersen and Bunton).

Another article on Alzheimer’s in the Sydney Morning Herald Brain size linked to Alzheimer’s follows the pattern of the ‘most popular disease syndrome’.

The article is general and provides piecemeal information but ultimately useless to the general public. what are we going to do with it?

Sixty participants were divided into 3 categories and the group with the smallest ‘hippocampus’ were four times more likely to suffer from dementia or the smallest ‘amygdala’ were at six times more likely to suffer from dementia. Both organs decline in size as one ages.

It is simplistic as it “states that there is no ‘medication’ available but early identification would allow early care”. It doesn’t add up - converting this small piece of research into a clinical outcome is at best 20 years away and as researchers are well aware may come to nothing at the end of the day.

This is an example of news access and control, whose voice is heard, how often and how the ‘news’ is represented? as put forward by Ericson, Baranek & Chan 1989 who state:

News is a product of transaction between journalists and their sources. Scientific researchers vie to have their research published in scientific journals and in the mass media while a journalist can comfortably rely on a steady output where ever there are laboratories or clinical studies. These relationships would be historical and once the formulae works there is no need to change it.

An interview on Today (Channel 9) with Australian Medical Association Vice President, Dr Choong-Siew Long, arose out of an American news item FDA to probe ADHA drug safety

Today was following up on another story on Channel 9 Thursday 5 January, 2006 Australia wont investigate ADHD drugs

When the interviewer suggested that these drugs maybe oversubscribed, Dr Long said that in Australia these drugs can only be prescribed for children by a paediatrician. It was noted that during 1984 and 2000 the use has risen by 31 per cent nationally.

Dr Long said that the increase was due to : “There is better diagnosis of the condition and people are coming to the physician already aware and asking about treatment for their children or themselves.”

Today’s article by Leigh Dayton in The Australian Ovarian cancer therapy boots survival follows a lead format of ‘the who did which research and exactly what they found’. The US study published in the New England Journal of Medicine confirms that the intraperitoneal (IP) treatment that has been around for 40 years which delivers drugs directly to the uterus will enhance women’s lives by more than a 1 year and longer if used in combination with surgery and chemotherapy. To create proximity, a Melbourne specialist in ovarian cancer, Dr Grant was interviewed.

He said “This is very good news. Within the clinical setting in Australia this treatment will become a standard treatment offered to many women.”

SOUNDS LIKE GOOD NEWS or is it readvertising of an old technique – it is hard to tell because you would think that already conventional medicine offers combinations of such treatments.

Grant said that the new data confirmed the belief of many cancer specialists that a combination of surgery followed by IP and conventional chemotherapy would help most women with advanced ovarian cancer.

Because news has an element of currency and immediacy just by being published ‘today’ there is an assumption that it is new.

Earlier in the week the abortion debate received vigorous discussion due to the publication of a link between abortion and mental health. The study reported on SMH’s front page on 3 January, 2006 claimed Abortion linked to mental health problems was timely and newsworthy given the recent Federal Government discussion on the abortion pill RU486. Professor David Fergusson, the leader of the New Zealand study referred to and published this week in the Journal of Child Psychiatry and Psychology said:

“The findings tipped the evidence towards the conclusion that abortion increased psychological distress rather than alleviating it”

“That could make it more difficult for doctors to claim they were performing an abortion on health grounds.”

Although he claims to be apolitical he said

“The aim of our research was never political” but “The science in this are is not good. Let’s add to it”

But surely anything to do with abortion is POLITICAL!

The Australian didn’t report this study on 3 January but chose a political health related article on the Howard Government’s health/pharmaceutical free trade agreement (FTA) with the US on its front page FTA drug safeguard at risk. Apparently this FTA contains a clause to protect drug prices in Australia but Howard is looking at removing it due to pressure from the USA.

The following day the SMH ran a story Findings on abortion ‘credible but inconclusive’ on page 7 (the online version Questions raised over abortion study’s findings while The Australian ran Medic disputes abortion findings on page 3. Both articles pivot on the ‘small number of women’ and interviews with the medical director of Family Planning Health, NSW, Christine Read. Read claims in the Australian article:

“The results do not mean abortion causes depression in young women. … At FPA we don’t believe this study indicates abortion leads to depression.”

Funny though in both articles Read offers social context possibilities as depression trauma influences – that the circumstances in which the decision to have an abortion is made may be traumatic – no-one to talk to, boyfriend not interested, parents opposed to sex before marriage etc. To separate the decision making, regardless of the circumstances, from an abortion is ludicrous – abortions don’t happen in thin air. Post abortion depression is definitely credible – and possible in any circumstances.

There were many followup articles and at least 6 in the SMH with several days of commentary in both papers. This is a case of media doing its job – providing information on an historical and hysterical hot topic in the public interest!