The CDC is telling doctors to prescribe more antiviral flu medications, because, “If you get them early, they could keep you out of the hospital and might even save your life.” But the FDA explicitly prohibits the drugs’ makers from making claims that these drugs can reduce hospitalizations or deaths, and scientists who’ve reviewed the evidence on these flu drugs say they’ve only been shown to reduce the duration of symptoms. Who’s right? Read more in my latest FiveThirtyEight story here, then listen to an audio discussion about the story.
Category: Columns
The Case Against Early Cancer Detection
In November, I joined Nate Silver’s data journalism site, FiveThirtyEight, as the lead writer for science. My first feature for FiveThirtyEight was on a familiar topic, cancer screening. Specifically, I made the case against early detection of cancer. I realize it might seem crazy, but once you take a close look at the data, it doesn’t seem so irrational.
In a similar vein, this week, in JAMA Internal Medicine, I explain why I’ve opted out of mammography. The JAMA piece is a more detailed version of a story I first told in a Washington Post column. Click here to read the full text version and get through the paywall.
Mental Health: Recovery is Possible
In my latest Washington Post column, I answer questions about how to find help for mental health problems such as: Where can you find a mental health professional? What’s the difference between a psychiatrist, a psychologist and a social worker? The piece also explains what to look for in a provider and outlines the factors that best predict successful treatment. Read it here.
Platelet-rich plasma and the power of belief-based medicine
I recently wrote a Washington Post column about platelet-rich plasma, a treatment highly touted for sports injuries but without much clear evidence. As I later wrote at Last Word On Nothing, PRP provides a case study in why it’s so important to track outcomes in medicine. If you don’t measure your outcomes, you have no way to really know how you’re doing. Humans are notoriously bad at self-evaluating. A 2006 study published in JAMA found that, “physicians have a limited ability to accurately self-assess,” and a 2012 study found that doctors overestimate the value of the care they provide. And if you have an incentive (money?) to keep doing something, results be damned, then if you’re not careful, an ineffective practice can become fixed as the standard of care. Once that happens, it’s very, very difficult to walk it back.
Giving suicide attempt survivors a voice
While researching military suicides, I came across a new movement to give a voice to suicide attempt survivors. I was shocked to learn the extent to which they’d been isolated and shut out of the conversation about suicide prevention. I wrote two stories, for NPR and Dame Magazine about the remarkable people who are standing up to give suicide attempt survivors a voice and the rights they deserve.
Read the stories here:
NPR: Suicide Attempt Survivors Seek A Voice In Helping Others At Risk
Dame Magazine: People Who Attempt Suicide Are Not Criminals
It’s Time to Revamp Our Goals for Cancer Screening
Since the 1980s, “Early detection is your best protection” has been a mantra of the cancer-awareness community, spurring an insistence on frequent screenings to catch ever-smaller abnormalities. But this approach to cancer screening loses sight of the real goal — saving lives. And it turns out that finding more and more smaller and smaller abnormalities churns out more cancer patients, but this doesn’t necessarily translate into lives saved.
Read the rest of my opinion piece at Popular Science.
Kids who aspire to pro sports need more play, less practice
Expensive sports camps and intensive practices and team competitions for young kids are becoming more and more common. Efforts to corral children into highly focused sports programs often arise from good intentions, yet research suggests that kids who specialize in a single sport when they’re young risk injury and burnout but don’t improve their odds of attaining an elite sports career. In most cases, giving kids more time for unstructured play and a chance to sample a wide array of athletic pursuits provides a better recipe for success.
Read more of my latest Washington Post, column: Too much practice and specialization can hurt instead of help child athletes.
This column has a sidebar: Is 10,000 hours magic or not?
Does CrossFit push people too hard?
It seems as though nearly everyone who has heard of CrossFit has an opinion about it — even people who have never tried it. Aficionados claim that this brand of high-intensity workouts is a fast and fun way to get fit. Critics say that it’s a fast track to injury.
Read more of my latest Washington Post column here.
Understanding suicide, which is surprisingly common in spring
Washington Post, April 7, 2014
Spring, with its longer days, blooming flowers and rising temperatures might seem like a time of peak happiness, but some studies indicate that suicides are more common in the spring and summer months than in December. Researchers don’t know why they’re higher in these seasons, but they say that friends and loved ones should not be lulled into thinking a brighter season necessarily means a brighter mood for someone who is struggling with mental health issues. Intervention is important no matter the month.
Read the rest at The Washington Post: Understanding suicide, which is surprisingly common in spring.
Is your doctor in good standing?
Recently a reader wrote me to ask how patients can perform background checks on their doctors, to make sure that they’re in good standing. He had a reason for asking: A few years ago, he said, he’d agreed to have a spinal fusion performed by an apparently well-regarded surgeon. The operation left him worse off than when he started, and he later discovered that there were numerous malpractice lawsuits pending against the surgeon.
How do you make sure this doesn’t happen to you? My latest Washington Post column offers ways to check your MD’s background.
Why you may want to avoid a dementia test
Washington Post, December 13, 2013
Excerpt:
Early dementia is difficult to distinguish from mild cognitive impairment, those minor memory blips that sneak up as we age. About one in five people older than 75 have such blips, and most cases never progress to dementia or Alzheimer’s, Spence says. Some memory lapses that may seem like dementia are actually something else. In a study published last year, Danish researchers revisited the records of nearly 900 patients thought to have dementia and discovered that 41 percent of them had received faulty diagnoses.
Read the rest at The Washington Post: Why you may want to avoid a dementia test
I’m just saying no to mammography: Why the numbers are in my favor
Washington Post, October 7, 2013
Excerpt:
What my doctor neglected to tell me is that a mammogram was, in my case, more likely to hurt than help me. Few doctors take the time to mention the risks of mammography — especially, the danger of overdiagnosis —that a mammogram might lead a patient to get needled, sliced, zapped with radiation and possibly treated with tamoxifen, a drug that increases risk of uterine cancer, for a breast lesion that wasn’t life-threatening in the first place.
Most people believe that breast cancer is inevitably a progressive disease that will kill you if you don’t remove it in time. According to this idea, which I call the relentless progression model, every big cancer is harmful, every small one is less so and every cancer is curable if only you catch it in time. It’s an appealing, intuitive idea — except that a growing body of research suggests that it’s wrong.
Read the rest at The Washington Post: I’m just saying no to mammography: Why the numbers are in my favor
Washington Post: Do Bike Helmet Laws Really Save People?
Do bike helmet laws really save people?
Washington Post, June 3, 2013
Excerpt:
Mandatory helmet laws, like one brought up in the Maryland legislature this winter, might seem like a no-brainer. Yet when the medical journal BMJ polled its readers in 2011, 68 percent of the respondents opposed mandatory helmet laws. The Washington Area Bicyclist Association (WABA) also opposes mandatory helmet laws, and its members testified againstMaryland House Bill 339, which never made it out of committee before the legislative session ended in April.
Proponents of helmet laws say that they reduce injuries. But evidence for this claim remains mixed.
Read the rest at the Washington Post: Do bike helmet laws really save people?
Christie Aschwanden 