Saturday, August 7, 2010

Can you handle the hype? (Marin IJ)

Flesh-eating bacteria, super-viruses, killer E-coli...Bird flu, swine flu, equine flu… Toxic mold, toxic shock, toxic toys, toxic Tylenol…Salmonella in your peanut butter, heavy metals in your salmon…Cancer from phthalates, tumors from your phone…Autism and vaccines, pertussis and vaccines (lack thereof). The media spits out an endless series of scary health stories, many sensationalized for effect. You’re all familiar with these pieces. I feel downright accosted by some of the headlines: “The toxic mold and the hidden room: a homeowner's nightmare,” (, or “The deadly ‘superbug’ that's spreading fast across the country,” ( and “Talk & die syndrome more common that you think” (

With the frenetic heat of media hyperbole, it’s hard to know which health hazards to be concerned about and which to put on the back burner of the worry stove. Not surprisingly, the public is often confused about health matters, and I really believe the media bears a heavy burden of responsibility for this. Medical reporting suffers from a number of ailments, including outbreaks of misinformation, deficits in understanding and context, and, often, a rush to pronounce conclusions.

Take, for example, two stories that sparked a substantial panic this past year. One was the unfortunate death of Natasha Richardson from a seemingly minor head injury and the other was the Food and Drug Administration’s (FDA’s) warning about liver damage due to excessive doses of acetaminophen (Tylenol).
Richardson’s tragic death from an epidural hematoma (bleeding on and around the brain) after falling on a beginner ski slope received widespread media attention, including in this column. The scope of the reporting was varied and from a public health perspective had some beneficial impact. The story reinforced the importance of wearing a helmet during high-risk sports such as biking, skateboarding, and (at least for beginners) skiing. On the flip side, some reports were alarmist and others were dangerously inaccurate. For example, I read an on-line article claiming that clot-busting drugs could have successfully treated Richardson’s brain injury. In actual fact, giving clot-busters to Richardson would almost certainly have hastened her death. Another report recommended that people with head injuries visit their nearest trauma center – which is a good idea for someone who has taken a header off the roof – but not necessary for most minor head impacts. And finally, a rather hysterical blog advised that all patients with head trauma be screened with a CT scan of the head. These and other alarmist stories, such as a Good Morning America feature on a young girl who sustained an epidural hematoma after she was struck with a softball, sent thousands of people to EDs to be checked out for trivial head injuries.
Dr. Brian Walsh from Morristown, New Jersey and colleagues quantified this effect by comparing the number of ED visits for head injury related complaints before and after Natasha Richardson’s death. They discovered that the total number of visits in the ten days after the actress’ death was 73% higher than the number of visits in the ten days prior, while the sum of serious injuries was unchanged. In other words, there was a huge surge in patients with minor head bonks who visited the ED to get checked out. This, of course, is what emergency departments are for, but nonetheless the media let these people down by failing to adequately stress the (well-established) warning signs of serious head injury (such as severe headache and repeated vomiting) and the potential risk of obtaining an unnecessary CT (radiation exposure that is thought to increase lifetime risks for cancer, especially in children). This failure to paint an accurate picture of risks and benefits is one of the five health media deficiencies identified by the American Council on Science and Health (ACSH), an advocacy group dedicated to providing sound health information to consumers.
A second deficiency, recognized by the ACSH and others, is the media’s tendency to gloss over the importance of dose, often altogether ignoring the maxim "the dose makes the poison." An excellent example of this is the media coverage after an FDA advisory panel warned that excessive doses of acetaminophen (Tylenol) could cause liver damage and failure. This statement was intended to raise awareness of the danger of cumulative doses of Tylenol. Truly, it can be hard to keep track of the amount of acetaminophen you’re taking, as it is commonly used as a cocktail ingredient in over-the-counter cold and flu preparations as well as in prescription painkillers such as Vicodin and Percocet. Hence the warning: people taking large doses of these medications, with or without additional Tylenol, are at risk for liver damage. Increased awareness of this risk, as well as changes in physician prescribing patterns (e.g., away from combination medications like Vicodin and towards single drug prescriptions) is desirable. Unfortunately, the message that many patients received, and I heard this many times in the ED, was that Tylenol is a dangerous medication. This could not be farther from the truth – Tylenol is one of the safest pain medications at our disposal and, if used at recommended doses, has far fewer harmful side effects than alternatives such as ibuprofen or naproxen. So please remember – the dose makes the poison. Remember this in regards to Tylenol, lead in children’s toys, mercury in fish, and phthalates in milk. With most environmental or dietary exposures, “everything in moderation” should keep you healthy.
There’s more to write about on the topic of the media and health, and three more ACSH identified deficiencies to cover. But since this column is running out of space and I do not want to violate any principles of responsible health reporting, I will pick up the topic in a couple weeks. In that column, I’ll give tips on how you can become a discerning reader of health news so you can decide for yourself which “scares” to freak out about and which to just forget.