Health in the media: the good, the bad and the ugly: painkillers, superfoods, and the pill

Posted on 6th June 2013 by David Carroll

Health is commonly reported in the media. Every day consumers of health information, whether they are academics or ordinary punters, are bombarded with information about risk. One thing that is often lacking, especially in the media, is effective communication of all this information. We at Students 4 Best Evidence want to become effective communicators of health information and this weekly blog hopes to provide you with the evidence behind the good, the bad and the ugly of this week’s health news.

This week features news from the BBC, Daily Mail and Daily Express. Time to disable my Kitten Block app, put the kettle on and get stuck in.

The Good

BBC News: Common painkillers ‘pose heart risk’

First up is a headline of ‘Common painkillers pose heart risk’ from BBC News [1] and others. This is a report of a meta-analysis published in the Lancet last week[2], the BBC are delightful in this instance as they hyperlinked the paper in the article. This means I didn’t have to waste time finding it.

A meta-analysis is a type of study in which lots of smaller studies are looked at together. This allows for comparisons and contrasts between the studies and an estimate of the overall effect of something. In this case, a drug. This study took all the individual patient data from trials of nonsteroidal anti-inflammatory drugs (NSAIDs). This came to 124,513 people in trials comparing NSAIDs with a placebo sugar pill and 229,226 people in trials comparing one NSAID versus another NSAID. The outcomes of interest were major coronary events (heart attacks), stroke, heart failure, death or stomach problems.

Wonderfully so, the BBC reported the meta-analysis really well, they reported the results in terms of absolute risks. So good in fact, I’ll leave it up to them. “They showed that for every 1,000 people taking the drugs there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding – every year as a result of taking the drugs. So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drug” [1].

Others can learn from the BBC’s science reporting, referencing and absolute risks. Wonderful.

The Bad

Daily Express: 33p-a-day superfood pill could halt cancer

The Express claimed on Monday [3] that a 33p a day superfood pill is a powerful “cancer buster”. In the first sentence they immediately contradict that statement by stating “The combination of pomegranate, green tea, turmeric and broccoli could help beat several cancer killers” [3] (we don’t want them to beat cancer killers, do we?).

This type of study is a randomised controlled trial, a randomised trial is where you take a group of people and randomly assign them to one treatment or another. Then you follow them up and see what happens. In this case the trial is comparing a pill containing a blend of pomegranate, green tea, broccoli and turmeric with an identical placebo for 6 months.

The Express had a quote that stated that there is “no doubt that the findings were highly statistically significant” [3]. Having no doubt is an extravagant claim, but it may indeed be statistically significant. The important thing is however, do they make a clinical difference? Will this pill impact on the survival and quality of life of the people we know and care about?

This 6 month trial found there was a statistically significant decrease in the rise of prostate specific antigen with the trial pill. There was no difference in the secondary outcomes of the study and no difference in “recorded events” between the groups, although from reading the abstract I’ve no idea what these events are. The Daily Telegraph claimed [4] that those given the capsule had lower PSA levels. This is not true. Those given the capsule had less of a rise in PSA levels compared to those with placebo, this is an important distinction to make.

This trial only measures surrogate outcomes, it has nothing on the real-life clinical outcomes that patients care about. I can imagine the 6 month follow up period of the trial is too short to do that and the size of the trial to is too small also.

The Telegraph also reported this study as a “superfood to fight prostate cancer” [4]. These super foods apparently kill cancer cells by preventing oxidative damage to DNA. From what I can tell this is based on laboratory data, so keep in mind this wonderful xkcd comic when interpreting this information.

This research was presented at the American SocIety of Clinical Oncology [5], however this was presented only in abstract form. We as punters, as consumers of health information, cannot read the full methods and results of this research; we cannot critically appraise it for its worth and therefore cannot make up our own minds. Claims of it being a “scientifically robust study” made on a website are nothing unless we can read the full methods and results. I feel it’s massively unethical to publish this in newspapers when all we have to go on is an abstract or a press release.

Express also claimed [3] that “The pill Pomi-T, available now, was designed by Prof Thomas with the National Cancer Research Institute”, I’ll let you make up your own mind on that claim from the Express.

I wait patiently for the full paper.

Daily Express: High Street pill slashes deaths from heart failure

The Express also reported this week [6] that Coenzyme Q10 (CoQ10) slashes death from heart failure. I don’t know what slashing death is but it sounds painful.

Again, like the previous news article, this is based on an abstract presented at a heart failure conference [7]. Like the previous research, because of this we cannot read the full methods and results of this research. We cannot critically appraise it and make up our own minds about it!

This was another randomised controlled trial that compared 202 patients with heart failure given CoQ10 and 218 with placebo (both on top of standard treatment for heart failure), with follow up for 2 years (more on this later). The patients randomised to the CoQ10 appeared to be less likely to have a major cardiovascular event or to die as a result. Without seeing the full peer-reviewed data we cannot possibly know if we can trust these results.

The patients in this trial appear to have had a lower death rate than is normal for patients with Class III or IV Heart Failure, this combined with the small number of patients in the trial makes me doubt the statistical power of the trial (presuming death was an endpoint). Another really odd thing is that the trial protocol was published in 2003; this trial has taken 10 years to complete, despite follow up only being 2 years.

The trial abstract also fails to mention that the trial was funded by two manufacturers of CoQ10 supplements (Kaneka and Pharma Nord)  as well as the International Coenzyme Q10 Association. This is a potential conflict of interest which wouldn’t matter if the trial was well designed but since it isn’t published yet, I cannot possibly tell you.

The Ugly

Daily Mail: Statins can weaken muscles and joints: Cholesterol drug raises problems by up to 20 per cent

This is a headline from the Daily Mail [8], Britain’s biggest selling daily newspaper, in which they reported that statins raise the risk of musculoskeletal problems.

This research is a retrospective cohort study, this is a study where a large group of people are divided up into groups depending on their exposure to something. In this case the exposure is to statins, a cholesterol lowering group. The group are followed forwards or backwards in time to measure the rate of development of an outcome, in this case musculoskeletal conditions. The authors concluded that musculoskeletal conditions are more common among statin users than non-users. The Daily Mail reported this as a 20% increase in risk for statin users, but is that really the case? This research was published in this week’s JAMA Internal Medicine [9] and it is only there where you see the full picture.

Table 4, which isn’t reported in the Daily Mail article shows (unlike they concluded) that the event rate of musculoskeletal events is higher in the group that doesn’t take statins. This completely contradicts the conclusions drawn in the paper. I emailed the author for clarification of this but as of yet there has been no reply.

In table 4 we get the figure that was reported as the 20% figure in the headline. Table 4 shows us the odds ratio of 1.19, this means that the odds of having musculoskeletal problems with statin use compared to the odds of musculoskeletal problems without statin use is 1.19 times higher. Odds ratios can be misleading, like in this instance, especially if the outcome is common. In this case, it has led to an inappropriate understanding of risk followed by inappropriate communication of this risk in Britain’s biggest selling daily newspaper and the world’s most read news website. That’s a lot of people reading this article, and that’s why it’s so important it should be done right.

The relative risk of developing musculoskeletal problems (the risk of developing problems in statin users divided by the risk in non-users) works out to be 0.87/0.85=1.02. This is a 2% relative risk increase. The absolute risk (the risk of developing problems in statin users minus the risk in non-users) is 0.87-0.85=2%.

How the Daily Mail is allowed to report 20% rather than 2% is beyond me.

This news of statins and musculoskeletal problems is in stark contrast to news in the Daily Mail just 6 days earlier. In which we are told [10] that taking statins could HALVE (not halve, but HALVE) the risk of osteoarthritis.

This type of reporting makes me really sad, but that’s a story for another day.

References:

[1]Common painkillers ‘pose heart risk’. [Internet]. BBC. 2013 May 30 [cited 2013 June 6]. Available at: http://www.bbc.co.uk/news/health-22694858

[2]Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013: http://dx.doi.org/10.1016/S0140-6736(13)60900-9

[3] 33p-a-day superfood pill could halt cancer. [Internet] Daily Express. 2013 June 3 [cited 2013 June 6]. Available at: http://www.express.co.uk/news/health/404557/33p-a-day-superfood-pill-could-halt-cancer

[4] ‘Superfoods’ shown to fight prostate cancer. [Internet] Daily Telegraph. 2013 June 2 [cited 2013 June 6]. Available at: http://www.telegraph.co.uk/health/healthnews/10093092/Superfoods-shown-to-fight-prostate-cancer.html

[5] Thomas Rk, Williams MMA, Sharma H, Chaudry A, Bellamy P. A double-blind, placebo RCT evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer: The U.K. National Cancer Research Network (NCRN) Pomi-T study. J Clin Oncol 31, 2013 (suppl; abstr 5008)

[6] High Street pill slashes deaths from heart failure. [Internet] Daily Express. 2013 May 25 [cited 2013 June 6]. Available at: http://www.express.co.uk/news/health/402408/High-Street-pill-slashes-deaths-from-heart-failure 

[7] Mortenson SA, Kumar A, Dolliner P, Filliapiak KJ, Pella D, Alehagan U, Steurer G, Littarru GP, Rosenfeldt F. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure. Results from the Q-SYMBIO study. European Journal of Heart Failure 2013. 15; S1: S20

[8]Statins can weaken muscles and joints: Cholesterol drug raises risk of problems by up to 20 per cent. [Internet] Daily Mail. 2013 June 4 [cited 2013 June 6]. Available at: http://www.dailymail.co.uk/health/article-2335397/Statins-weaken-muscles-joints-Cholesterol-drug-raises-risk-problems-20-cent.html?ito=feeds-newsxml

[9] Mansi I, Frei CR, Pugh MJ, Makris U, Mortenson EM. Statins and Musculoskeletal Conditions, Arthropathies, and Injuries. JAMA Intern Med 2013: doi:10.1001/jamainternmed.2013.6184

[10] Taking statins could HALVE the risk of osteoarthritis by reducing inflammation in the body. [Internet] Daily Mail. 2013 May 28 [cited 2013 June 6]. Available at: http://www.dailymail.co.uk/health/article-2332016/Taking-statins-HALVE-risk-osteoarthritis-reducing-inflammation-body.html

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