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The push and pull of medical headlines

By Rhonda Rowland
CNN Medical Correspondent

March 16, 2000
Web posted at: 11:52 a.m. EST (1652 GMT)

This news analysis was written for CNN Interactive.

Some estrogen supplements  

In this story:

The fine print

Scientific Studies 101

The caveats

What to believe

ATLANTA (CNN) -- You may have noticed two recent headlines along these lines:

"Estrogen Therapy Lowers Threat of Heart Disease" and "Estrogen Therapy Reduces Chances of Developing Alzheimer's Disease."

Then, in the past month, there were two new headlines, similar to these:

"Estrogen Therapy Does Not Protect Women from Heart Disease" and "Estrogen Therapy Does Not Slow Alzheimer's Disease."

What is going on?

It is a familiar scenario to anyone who follows medical research results. Just look at the frequently conflicting recommendations on diet and exercise.

The latest studies on estrogen highlight the generally shared frustrations of interpreting this research. Which headlines should the average consumer believe? Should the public be privy to early and often-complex scientific findings?

The competition is intense among medical journals, scientific meetings, pharmaceutical companies and research institutions to get the media's attention. Journalists covering science and medicine are flooded with phone calls, faxes, press kits and medical journals with attached "tip sheets." And media compete to report the significant developments.

Just as the public is bombarded with new medical information, so are doctors. There is so much information, doctors sometimes first hear of developments when a patient brings in a news story or mentions a TV report, which can lead to a more appropriate treatment.

But how to know which story or report is the one to believe?

Making sense of medical headlines
• Read past the headline to examine the specifics of the study.
•  Determine what kind of study was done.
• Notice the demographics of people in the group studied.
• Note how many people were included.
• See how long a time period the study was conducted over.
• Pay attention to who funded and who did the research.
• Research the findings of previous studies that looked at the same therapy for the same condition.
• Evaluate the findings given your personal risk factors, if any.

The fine print

The latest studies on estrogen therapy can be used as examples of how to interpret and evaluate medical studies.

Between the two sets of reports, numerous women and their doctors had interpreted the findings to mean that supplemental estrogen can help prevent heart disease and Alzheimer's disease. These older women weighed the risk of two devastating diseases against possible side effects of estrogen therapy.

But if you read the fine print of the initial studies, those suggesting disease protection from estrogen, you can see the conclusions are not black and white. They are suggestive. They established an "association" between estrogen and heart disease -- that is, estrogen may reduce the risk of heart disease and Alzheimer's.

Although none of these studies established a "cause and effect," many people made the assumption. It is easy to do. Some people change their health habits based on this kind of information. Then they feel let down when they hear about contradictory studies. Or, worse, they tune out all the information, assuming and expecting it to be contradicted.

Instead of tuning out medical news, or adopting it outright, it is better to try to get a handle on what the study set out to find and what it concluded.

Scientific Studies 101

Much of the frustration over health headlines may not be the information's fault. It can be due to the fact that folks do not always fully understand the nuances of the scientific process and to the fact that medical reporters do not always fully explain the study results.

The initial estrogen findings came from what are known as "observational," or population-based, studies. In simple terms, researchers looked at large numbers of women and noticed that many who did not have heart disease or Alzheimer's also happened to take estrogen.

Such an approach is an initial, less rigorous type of study that gives researchers ideas for more in-depth examination.

To prove a definite link, or cause and effect, researchers design what are known as double-blind, placebo-controlled studies. Study participants are randomly given either the drug (or treatment), or a placebo. Neither they nor the researchers know who gets the real therapy and who gets the dummy pill, to prevent bias in the interpretation.

In the latest estrogen and heart disease study, scientists objectively measured constrictions of the arteries that feed the heart muscle, a condition that can cause heart attacks, to determine whether estrogen had an effect. They found it did not.

Understanding the type of study done can help the consumer determine how much weight should be given to the conclusions.

The caveats

There are always caveats behind the headlines. It is a matter of the consumer looking for them and the doctor explaining them.

For instance, the latest set of headlines in the estrogen and heart disease story applies only to older women who have already developed heart disease. It did not close the book on younger, healthy women. It is still possible women with no signs of heart disease could benefit from taking estrogen.

Again, there is more frustration. A major study designed to answer that question will not be completed until 2005.

The latest study on estrogen and Alzheimer's looked at women who already had the disease. The question of whether estrogen can prevent or delay Alzheimer's in healthy women is still open.

What to believe

Sometimes the consumer grabs onto a headline and will not let go. If a person is deriving some tangible benefit, and there is otherwise no harm, that may be fine. Or the person must individually weigh any related risks, such as the possible risk of breast cancer associated with estrogen therapy.

My CNN crew and I delivered one of the latest headlines to a woman who participated in the latest study evaluating estrogen for heart disease. We told her the researchers had found the estrogen she had taken for three years would not help with her heart disease. She was disappointed but said she would continue taking estrogen because it made her feel better.

Researchers agree on several good, proven reasons to take estrogen, despite the conflicting findings regarding heart disease and Alzheimer's. And who is to say these latest estrogen findings will be the last word.

That is how it goes. Contradictory studies are just part of the scientific research process. One study does not solely determine medical practice, but several can influence it. It can be three studies forward, two studies back when it comes to medical headlines.

CNN Interactive: Analysis

CNN Interactive: Health

American Heart Association
Alzheimer's Association
U.S. Department of Health and Human Services
  Office of Research Integrity
  Administration on Aging
U.S. Food and Drug Administration
U.S. Public Health Service

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