TIME medicine

Here’s What Experts Say About the Advice on Dr. Oz and The Doctors

Experts evaluated the advice given on medical talk shows, and the results were surprising

Many Americans get their health advice not from their doctor, but from daytime television. But how good are those recommendations?

Reporting in the BMJ, Canadian researchers analyzed two medical TV talk shows—The Dr. Oz Show and The Doctors—and found that only 46% of the recommendations on The Dr. Oz Show and 63% on The Doctors were supported by evidence. 15% of advice given on Oz and 14% of advice on The Doctors contradicted the available published evidence in journals.

“The bottom line message is for people to be really skeptical about the recommendations made on these medical television shows,” says study co-author Christina Korowynk, associate professor of family medicine at the University of Alberta. “They should look for more balanced information to be presented, and understand that they need all of that information in order to make an informed decision.”

They measured 80 major recommendations made on the two shows from January to May 2013 against evidence gleaned from published studies in medical databases. They looked at both consistency—how much the conclusion was supported by the studies—and believability, which included the quality, number and type of study.

On average, Korownyk’s group found that both shows mentioned how the advice might specifically help a person in only about 40% of the recommendations, and they mentioned the amount of benefit, another aspect of useful health advice, in less than 20% of recommendations. (Harms were mentioned in less than 10% of the recommendations, and costs in less than 15%). She says that without such information on how much benefit and harm a particular recommendation might have, it’s hard for people to make informed choices about whether the advice is right for them.

Korownyk and her colleagues aren’t the first to cast doubt on the quality of advice given on the shows. In June a Senate subcommittee heard testimony from Oz on false advertising of weight loss claims and Sen. Claire McCaskill queried the doctor about the statements he made on the show. “I do personally believe in the items that I talk about on the show,” he said at the hearing. “We have to simplify complicated information. We have to make the material seem interesting and focus on the ‘wow’ factor.”

Representatives for The Doctors said in a written statement to TIME: “The Doctors was never contacted about the study or the article. Our producers and doctors all do their due diligence to make sure information provided on the show is sound, relevant and timely—often debunking the myriad of medical myths that abound in the media and across the internet.”

Members of The Dr. Oz Show wrote: “The Dr. Oz Show has always endeavored to challenge the so-called conventional wisdom, reveal multiple points of view and question the status quo. The observation that some of the topics discussed on the show may differ from popular opinion or various academic analyses affirms that we are furthering a constructive dialogue about health and wellness.”

Korownyk acknowledges that the exact impact of television health advice isn’t clear, since the study didn’t investigate how many of the recommendations people adopted and whether they had an effect on their health. But the advice is clearly reaching people. “What we’d love to see is a process on these shows where the evidence is reviewed in a critical manner, and presented in a balanced, objective way so the audience can understand,” she says. “As physicians, we are moving toward that, and we’d love to see the broader television personalities doing the same sort of thing.”

TIME Innovation

Five Best Ideas of the Day: December 17

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Independent and third party candidates could break D.C. gridlock — if they can get to Washington.

By Tom Squitieri in the Hill

2. A new software project has surgeons keeping score as a way to improve performance and save lives.

By James Somers in Medium

3. The New American Workforce: In Miami, local business are helping legal immigrants take the final steps to citizenship.

By Wendy Kallergis in Miami Herald

4. Policies exist to avoid the worst results of head injuries in sports. We must follow them to save athletes’ lives.

By Christine Baugh in the Chronicle of Higher Education

5. Sal Khan: Use portfolios instead of transcripts to reflect student achievement.

By Gregory Ferenstein at VentureBeat

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Whooping Cough Outbreak Strikes Undervaccinated Michigan County

Grand Traverse County has the state’s highest rates of parents choosing not have their children vaccinated

A major outbreak of whooping cough has struck a Michigan area where many people opted out of vaccinations against the disease.

At a single school in Grand Traverse County, which has the state’s highest rates of parents choosing not have their children vaccinated, there have been 151 confirmed and probable cases of whooping cough, reports local news outlet MLive.com.

“Nobody likes to be the person who says, ‘I told you so,’ but what’s unfolding now is exactly the scenario feared by those worried about the region’s low immunization numbers,” Bradley Goodwin, the president of the Grand Traverse County Medical Society, said.

Cases of whooping cough have been reported at more than 14 school buildings in the area, which has also reported several cases of the highly contagious measles.

Read more at MLive.com

TIME medicine

This New Kind of Stem Cell May Revolutionize How We Treat Diseases

Scientists have created a new type of stem cell that could speed treatments for diseases and make them safer

Ever since Japanese researcher Shinya Yamanaka found a way to treat skin cells with four genes and reprogram them back to their embryonic state, scientists have been buzzing over the promise of stem cell therapies. Stem cells can be coaxed to become any of the body’s cell types, so they could potentially replace diseased or missing cells in conditions such as diabetes or Alzheimer’s. And Yamanaka’s method also meant that these cells could be made from patients themselves, so they wouldn’t trigger dangerous immune rejections.

Now scientists led by Dr. Andras Nagy at Mount Sinai Hospital Lunenfeld-Tanenbaum Research Institute in Toronto report an exciting new advance that could push stem cells even closer to the clinic. In a series of papers in the journals Nature and Nature Communications, the group describes a new class of stem cell, which they called F class, that they generated in the lab.

The F class cells, says Nagy, have a few advantages over the Yamanaka-generated induced pluripotent stem cells, or iPS cells. While the iPS cells are created by using viruses to introduce four genes that reprogram the cells, Nagy’s team relied on a technique they developed several years ago using transposons—small pieces of DNA that can insert themselves into different parts of a genome. Unlike viruses, these transposons can be popped out of the genome if they’re no longer needed, and they don’t carry the potential risk of viral infection.

MORE: Stem-Cell Research: The Quest Resumes

Nagy’s team found that the transposons were much more reliable vehicles for delivering the reprogramming genes exactly where they were needed to efficiently turn the clock back on the skin cells. What’s more, they could use the common antibiotic doxycycline to turn the four genes on and off; adding doxycycline to the cell culture would trigger the transposons to activate, thus turning on the genes, while removing the antibiotic would turn them off.

In this way, says Nagy, he was able to pump up the efficiency of the reprogramming process. Using the Yamanaka method, it was hit-or-miss whether the viruses would find their proper place in a cell’s genome, and more uncertainty over how effectively it could direct the cell to activate the four reprogramming genes. “F class cells are much more similar [in the culture dish], like monozygotic twins while iPS cells are more like brothers and sisters,” he says.

That consistency is a potential advantage of the transposon method, since any stem cell-based treatment would require a robust population of stem cells which can then be treated with the proper compounds to develop into insulin-making pancreatic cells to treat diabetes, or new nerve cells to replace dying ones in Alzheimer’s, or fresh heart muscle to substitute for scarred tissue after a heart attack.

MORE: Stem Cell Miracle? New Therapies May Cure Chronic Conditions like Alzheimer’s

Nagy’s team also described, with the most detail to date, exactly how mature cells like skin cells perform the ultimate molecular feat and become forever young again when exposed to the four genes. They analyzed the changes in the cells’ DNA, the proteins they made, and more. “It’s similar to high definition TV,” he says. “We see things much better with much more detail. We expect that having that high resolution characterization will allow us to better understand what is happening during this process at the molecular level. And obviously that better understanding is going to affect what we can do with these cells to make them better, safer and more efficient in cell-based treatments in the future.”

That may be years away yet, especially since some experts say that transposons may pose their own risk of wreaking DNA havoc on a cell’s genome. But having another type of stem cell that could potentially churn out healthy cells and tissues to replaced diseased ones is a welcome development.

TIME health

Until 2014, This Man Was TIME’s Only Medical Person of the Year

1996: Dr. David Ho TIME

For 2014, the Ebola Fighters have been selected. In 1996, the Man of the Year was AIDS researcher Dr. David Ho

“Some ages are defined by their epidemics,” wrote Philip Elmer-De Witt in TIME’s 1996 Man of the Year issue. The 14th century was the time of the bubonic plague. The 16th brought smallpox to the new world. In the early 20th century, influenza rampaged. “Today,” he wrote back then, “we live in the shadow of AIDS–the terrifyingly modern epidemic that travels by jet and zeros in on the body’s own disease-fighting immune system.”

The idea that a virus or bacterium can change the world — and that the men and women who fight them can too — is no less true now than it was then. On Wednesday, TIME announced that the Ebola Fighters have been named the Person of the Year for 2014.

As TIME’s Editor Nancy Gibbs notes, this year’s Ebola outbreak has brought forward heroes while raising the question of how the world can turn their personal sacrifices into new ways to fight the virus, to respond to epidemics and to care for those who need it most.

And though AIDS and Ebola remain two of the most frightening diseases on earth, looking back at 1996’s Man of the Year cover story can bring at least a little hope that those questions stand a chance of being answered. (There were theoretical medical researchers included in the 1960 Men of the Year issue, honoring U.S. scientists, but their work as doctors was not the focus of the story; Dr. Ho is the only Man of the Year prior to 2014 selected specifically for his work with a disease.) At the time, AIDS was a death sentence — but Ho, by successfully lowering the virus count in patients who received a combination of new and powerful drugs when they’d only just been infected, helped change the way the medical community looked at HIV and AIDS.

Nearly two decades later, though an AIDS vaccine is still not a reality, progress has been substantial. AIDS researchers have found their answers to many of the questions Ebola fighters face today. Treatment protocols are well established (if not applied equally all over the world). Survival is no longer miraculous. It’s possible to prevent transmission. And, just this winter, TIME took a look at the state of AIDS in San Francisco and found that, against what would have once seemed impossible odds, the city has the elimination of the disease in its sights.

Dr. Ho continues to direct the Aaron Diamond AIDS Research Center; in 2010, TIME profiled him again and found that he was still pioneering new ways of treating the disease. That tireless work by Ho and his colleagues is one of the reasons AIDS is no longer a defining disease of our time — and if he demonstrates that devotion and dedication can make a difference, that’s just one more reason to honor the Ebola fighters.

Read the full story about Dr. David Ho, here in the TIME Vault: Man of the Year, Dr. David Ho

TIME health

How the Mystery of AIDS Created Dangerous Myths

SIDA
Microscope view of HIV, 1985 Michel Setboun—Gamma-Rapho / Getty Images

Dec. 10, 1981: The New England Journal of Medicine publishes a series of articles about a new disease that appears to target gay men

The early days of the AIDS epidemic were dangerous not just because a killer virus was sweeping across America, but because the mysterious syndrome spawned its own damaging myths.

On this day, Dec. 10, in 1981, the New England Journal of Medicine published three landmark articles and an editorial attempting to make sense of the deadly immune deficiency, which had been identified a scant six months earlier. By December, according to the BBC, the condition had been found in 180 Americans and killed 75, nearly all of them gay men.

Doctor Michael Gottlieb was among the first to recognize the chilling threat the crisis posed. When the epidemic began, 33 years ago, Gottlieb himself was 33 and an assistant professor of immunology at the UCLA Medical Center, eagerly searching for interesting “teaching cases,” according to a profile in the American Journal of Public Health.

One case that caught his attention was a harbinger of the devastation to come: a young gay man with an array of serious health problems more common to organ transplant patients than otherwise robust young people. Gottlieb and his fellow immunologists found that the man had virtually none of the “helper” cells that fight infection. After coming across several similar cases, the doctor suspected that some new, unknown virus was responsible. He told the editor of the New England Journal of Medicine that it might be “a bigger story than Legionnaire’s disease.”

To warn the medical community, Gottlieb put out his preliminary findings in the weekly report issued by the U.S. Centers for Disease Control and Prevention. By the time the journal article came out in December, other doctors from around the country had reported similar cases and were hunting for a cause.

One early theory pegged the spread of the disease — which the CDC named AIDS — to a club drug called “poppers,” although the correlation quickly broke down. New evidence that the virus was transmitted through bodily fluids emerged when heterosexual drug users began reporting symptoms, apparently after sharing dirty needles.

By then, however, hysteria over the agonizing illness had led to a proliferation of myths about its transmission. Those myths lingered long after they were disproved, adding another layer of stigma for the syndrome’s victims.

For example, in 1988 — by which time AIDS was well enough understood to make such claims preposterous — a sensationalistic book, Crisis: Heterosexual Behavior in the Age of AIDS, stirred new panic with old assertions about how the syndrome was spread. According to TIME’s review of the book, the authors suggested that contracting AIDS was as easy as using the toilet after someone with the virus, being bitten by the same mosquito or even getting to second base. This last was meant as a literal warning to baseball players, not a metaphor for heavy petting: a player could catch the virus by sliding onto the base “if, by chance, an infected player has bled onto it,” the book warned.

When confused — and terrified — callers jammed AIDS hotlines, one epidemiologist fumed, “This is the AIDS equivalent of shouting ‘Fire!’ in a crowded theater.”

Read more about the early search for the HIV virus, here in TIME’s archives: Hunting for the Hidden Killers

TIME medicine

Genetic Screening Saved This Baby’s Life

Researchers say sequencing genomes can lead to quicker diagnoses and effective treatments for more than half of children affected by brain disorders

Mya Burkhart was only six months old when she went into cardiac arrest. Fortunately, she was in the hospital when it happened, brought there by her parents because she had trouble breathing. It was her eighth or ninth visit to the emergency room for her respiratory problems, but each time the doctors had sent the Burkharts home with more questions than answers.

Mya wasn’t developing at the normal rate. She couldn’t lift her head and wasn’t responding to people and things around her. Doctors thought she might have a muscle disorder, but her other symptoms did not fit with that diagnosis.

After her heart scare, Mya spent three weeks, including her first Christmas, in the ICU on a ventilator. “I couldn’t pick her up or anything,” says her mother Holly. Still unable to solve the mystery of what was ailing her, the doctors finally suggested she have her genome tested. Maybe, they hoped, her DNA would offer some clues about why she wasn’t growing normally.

MORE: The DNA Dilemma: A Test That Could Change Your Life

Holly knew the test was still in the research stages, and that there was a chance that even it might not yield any more answers about her daughter’s condition. “At that point, I just wanted to try anything to find out what was wrong with her,” she says. It boiled down to balancing a chance that their baby would live or die.

Genetic screening, especially whole-genome screening in which people can learn about their possible risk for certain diseases, remains controversial, since the information is neither definitive nor always accurate. In most cases, genes can only predict, with a limited amount of certainty, whether a disease such as breast cancer or Alzheimer’s looms in a person’s future. As the Food and Drug Administration (FDA) contemplates the merits and efficacy of such screening, some doctors and researchers are using it with great success, according to a new study published in the journal Science Translational Medicine.

Researchers at Children’s Mercy Hospital in Kansas City, where Mya was treated, say that for 100 families, including the Burkharts, with children affected by either unknown disorders or brain abnormalities, genome screening helped 45% receive a new diagnosis, and guided 55% to a different treatment for their child’s disorder. Of the 100 families, 85 had been going from doctor to doctor in search of a diagnosis for an average of six and a half years.

“I was surprised by how many cases we found where a specific intervention can make a difference,” says Sarah Soden from the Center for Pediatric Genomic Medicine at Children’s Mercy and the study’s lead author. “For me it’s compelling enough to push the envelope and get younger kids diagnosed.”

MORE: Faster DNA Testing Helps Diagnose Disease in NICU Babies

In Mya’s case, her genome revealed a mutation in a gene responsible for transporting citrate; without it, her cells could not get the energy they needed. So far, only 13 babies have been confirmed with the condition, and all died before their first birthday after having seizures and respiratory infections. Once the genetic analysis revealed the deficiency, however, Mya was started on citrate supplements. She’s now 18 months old, having already lived nearly twice as long as the other confirmed cases. She has some developmental delays but she has not had any seizures and managed to avoid getting any serious respiratory infections.

Their success at Children’s Mercy are encouraging Soden and the study’s senior author, Dr. Stephen Kingsmore, to push ahead and determine how such screening can benefit more babies. About 5% of the 4 million babies born in the U.S. each year are admitted to the neonatal intensive care unit (NICU), and between those who are born with a genetic disorder and those who may have adverse drug interactions, he and his team anticipate that about 30%, or 60,000, may benefit from the personalized screening they offer.

For now, he and his team are targeting babies like Mya who are sick almost from the minute they enter the world, with symptoms and abnormalities that doctors simply cannot explain. For them, the screening can save families from uncertainty as well as the financial burden of having many different experts perform many different tests looking for a diagnosis. The average genetic sequencing for newborns costs around $5,000, but the average cost of a night’s stay in the Neonatal Intensive Care Unit (NICU) hovers around $8,000, and most babies spend days, if not weeks, in the units awaiting a diagnosis.

Kingsmore received a $1.5 million grant from the NIH to expand the screening program to other institutes, and he has reached out to hospitals in Florida, at the University of Maryland and in Oklahoma City to test the strategy in more babies. “If we can decrease the length of stay in the NICU it could certainly lead to huge potential cost savings,” says Dr. Alan Shuldiner, associate dean of personalized medicine at the University of Maryland.

In the latest study, Soden says that on average, families spent more than $30,000 on genetic testing alone to figure out what was ailing their babies; those who had their genomes screened paid about $3,000 for an answer.

The key to Kingsmore’s success is a system that starts with a doctor punching in a newborn’s baffling symptoms and ends with a genetic readout. The “magic juice,” as he calls it, is a database of 10,000 symptoms that typically affect infants, from simple coughs and fevers and enlarged hearts to all manner of abnormal lab readings. The baby’s unique combination of these symptoms is mapped onto the 3,000 genes that experts have so far connected to about 4,000 diseases. “No physician on the planet earth could carry that database around in his head,” says Kingsmore. But that’s what desperate parents, whose babies’ lives are at stake, expect them to do. So Kingsmore’s program accomplishes the feat, spitting out, in rank order, a list of potential genetic diagnoses. That targeted tally of diseases then directs doctors to focus on a much more manageable list of 10 or, at the most, 50 genes (from a possible 20,000 or so) that could be mutated and responsible for the baby’s condition.

While there is no argument that such testing can save lives, the more challenging question is who should be tested, and when. There is also still debate among those in the genetics and medical communities about how to interpret genomic data. “Some people would argue that he is still reporting his experimental findings, and moving too soon from the research arena into the clinical arena,” says Dr. Edward McCabe, chief medical officer of the March of Dimes.

Ethicists are concerned about the coerciveness inherent in any hand extended to parents whose babies would otherwise die; no matter how carefully and comprehensively doctors word their request, parents in that situation may not fully process the risks and benefits and be unable to provide a truly informed consent. What if the baby falls into the minority for whom the testing doesn’t yield a diagnosis or treatment? When faced with inevitable death on the one hand, and a chance, however, small, of avoiding that death on the other, can there ever really be a choice?

The stakes are especially high since in some cases, the disorders won’t lead to established and approved treatments, but experimental ones without known risks and benefits. But as the value of such testing becomes more obvious, more centers may consider sequencing more newborns’ genes. “These babies, because they are brand new, are salvageable,” says Kingsmore. “Many patients we see with genetic illnesses already have ravaged organs. In contrast, with newborn babies we have the opportunity to halt a disease early in its progression,” he says.

“I think this testing is definitely something that everybody should consider,” Holly Burkhart says. “Without it, we probably never would have figured out what was wrong with Mya. We probably would be in the same place we were a few months ago.” Instead, Mya is now smiling at her mom and making progress. “The testing helped us find answers, and tell us where we need to go from here,” she says.

TIME Innovation

Five Best Ideas of the Day: December 8

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A new crowdfunded software tool for reporting sexual assault can reduce stigma and protect survivors.

By Shafaq Hasan in Nonprofit Quarterly

2. Millions of discarded laptop batteries could light homes in the developing world.

By David Talbot in the MIT Technology Review

3. A long overdue transparency plan for clinical trials will finally open results to the medical community and the public.

By Julia Belluz in Vox

4. Without role models or a road map through the upper ranks, women are leaving the tech industry at the mid-career point in droves.

By Sue Gardner in the Los Angeles Times

5. A new plan to drop strips of prairie into cropland helps preserve soil and battle climate change.

By Dylan Roth in Iowa State Daily

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

That Flu Shot You Had May Not Work This Year

Flu vaccines
David Cheskin—PA Wire/AP

You should still get vaccinated

The Centers of Disease Control and Prevention (CDC) have warned doctors that flu vaccines may not be effective against the most common strain of flu circulating in the U.S..

According to Reuters, the U.S. health agency issued an advisory to doctors Wednesday saying that of the flu samples they had taken between October 1 and November 22, less than half were good matches for the current flu shots.

The flu shots will still protect against certain strains of the flu, and can help reduce the risk of complications even among the strains that have mutated.

[Reuters]

 

TIME health

Plastic and Permanent: The Artificial Heart’s Debut

First Artificial Heart Implantation
Barney Clark receives the first artificial heart implant Dec. 2, 1982, in Salt Lake City Ravell Call—Getty Images

Dec. 2, 1982: Doctors implant the first permanent artificial heart in a human, Barney Clark, who lives 112 days with it

Barney Clark’s heart was made of plastic — and instead of beating, it whooshed.

The 61-year-old retired dentist was in an advanced stage of cardiomyopathy, a progressive weakening of the heart muscle, when he became the first recipient of a permanent artificial heart on this day, Dec. 2, in 1982.

Heart transplants were already being done to prolong lives, but in a limited, last-resort way. Surgeons accomplished the first human-to-human transplant in South Africa in 1967, when a man with severe heart damage received the heart of a 25-year-old woman who had died in a car crash. He survived 18 days. In 1977, after new immunosuppressant drugs dramatically increased the odds of survival, the first recipient of a heart transplant at Columbia University’s Medical Center — one of only three institutions in the country performing the surgery at the time — survived 14 months.

But Clark was 11 years too old to be a candidate for a heart transplant, according to the criteria U.S. surgeons had by then agreed on. His only shot at survival was Dr. Robert Jarvik’s pneumatically-powered heart. The Jarvik 7, as it was called, comprised two plastic pumps powered by compressed air, which required the patient to be hooked up at all times to a rolling console the size and weight of a refrigerator. The artificial heart could pump blood through the body at 40 to 120 pulses per minute, but it replaced the telltale heartbeat with a soft clicking sound followed by a whoosh.

Clark knew what he was in for: before agreeing to the operation, he first toured a facility where Jarvik’s hearts were keeping several sheep and calves alive, including a calf named Tennyson who set the survival record of 268 days, according to TIME.

He met the requirements for the surgery by having a fatal heart condition, with no other treatment alternatives, as well as a strong will to live. By the time of the surgery, he was nearly dead already: his heart was pumping a liter of blood per minute, or a fifth the normal rate.

The surgery was considered a success, since Clark went on to live another 112 days. A surgeon told TIME that his color had changed, from blue to pink, after more oxygen infused his blood. There were hitches, however. A week after the surgery, he suffered a series of seizures his doctors blamed on an imbalance of fluids and salts. Following the seizures, he was often disoriented, and sometimes believed he was still a dentist in Seattle.

He never left the hospital after his transplant, and ultimately died of “circulatory collapse and secondary multi-organ system failure” triggered by an infection that was likely the result of a blood transfusion, according to his obituary in the New York Times.

Later recipients fared somewhat better with the Jarvik 7. William Schroeder lived a record 620 days with one, although his quality of life was poor after he suffered serious strokes within the first three weeks. Another recipient, Leif Stenberg, made remarkable progress with his new heart, and lived 229 days before suffering a fatal stroke.

Stenberg’s renewed vigor was a triumph fraught with unexpected philosophical considerations. Long suspected of being a powerful Swedish crime boss, he was never convicted of any crime, partly because his health problems delayed a trial on charges of tax evasion. But the transplant led to a new delay, since Swedish law defined death as the moment when one’s heart stopped beating. Stenberg’s attorneys, therefore, argued that he should not have to stand trial, since he was already dead.

Read the full report on Barney Clark’s operation from 1982, here in the TIME Vault: Living on Borrowed Time

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