Winter 2014 - The Ehlers Danlos Society

Transcription

L O O S E CONNECTIONS
Board of Directors Retreat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Orphan Age Georgianne S. Ginder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Silver Ring Splint Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
My Story Alexandra Barbier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
From the Editor’s Desk Mark C. Martino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
YouScript . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
EDNF Thanks Our 2014 Donors: Corporate Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Individual Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Tribute Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
EDNF Board of Directors, Professional Advisory Network, and Publisher’s Information . . . . . . 25
Special Addendum: Televised talk shows — what they recommend and the evidence
to support the recommendations: a prospective observational study
Christina Korownyk, Michael R. Kolber, James McCormack, Vanessa Lam, Kate Overbo,
Candra Cotton, Caitlin Finley, Ricky D. Turgeon, Scott Garrison, Adrienne J. Lindblad,
Hoan Linh Banh, Denise Campbell-Scherer, Ben Vandermeer, G. Michael Allan . . . . . . . . . . . . . . . . 27
Your Magazine About Living With EDS
Winter 2014
WINTER 2014
PAGE 2
EDNF Board of Directors Meet for Retreat
T
HIS YEAR FOR THE FIRST TIME, THE EDNF BOARD OF DIRECTORS
gathered for a two-day retreat to plot a course for the EDNF. The board
teleconferences regularly, but traditionally, they only met face-to-face
for a few hours at the conference. Given how quickly EDNF is growing and the
momentum following the opening of the EDNF Center this year, those few hours
proved inadequate to manage everything our dynamic group of directors wanted
to discuss.
At this summer’s meeting, the Board of Directors agreed to hold the retreat. Almost
the entire board gathered at the EDNF offices in McLean, Virginia on November
14 and 15 (at their own expense, as our board is comprised of volunteers). The two
days proved to be an effective session that will be repeated next year, and will likely
be an annual event.
Pictured at retreat (left to right): Clair Francomano, MD; Richie Taffet, MPH, Secretary; Lara Bloom, International Liaison; Susan
Hawkins, Vice Chair; Linda Neumann-Potash, RN, MN, CBN; Sandra Aiken Chack, Chair; Richard Malenfant, MBA, MPH Treasurer;
Heidi Collins, MD, Professional Advisory Network Chair; Jane Mitakides and John Mitakides, DDS, FAACP; John Zonarich, Esq.
WINTER 2014
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Orphan Age
Hope and confidence to restore—
Orphans no more!
I
WANT YOU TO KNOW THAT I LIVE
with what is called an “Orphan Illness.”
Many of us who are ill suffer dearly and
very often with little acknowledgment, support
or recognition. There is scant awareness and
little understanding regarding some of these
perplexing and life-altering illnesses. The nature
of such a life can render one feeling helpless,
in pain, afraid, and profoundly compromised.
There may appear for us little hope at all on many
days and there remains little by way of research
given to these chronic, problematic, perilous and
painful diseases.
These are just words unless you or a loved one
has suffered this way.
I have a very difficult form of Ehlers-Danlos
syndrome. Or more as though, it has me. Thanks
to the Web, those of us who are ill and suffer
with problems that are so often undiagnosed,
misdiagnosed, misunderstood, or deemed “all
in one’s head” (which so often feels so very
patronizing and dismissive) are able to locate
information and find support. However, it
pains those of us who are ill and often so very
challenged to understand that there are few who
choose to devote time and monetary resources to
assist those who are dealing with such pernicious
and persistent life situations. I have no proof but
I often imagine that many of these “orphans”
may become a gateway to other and additional
powerful and formidable illnesses and diseases.
I believe that it is imperative, educational, and
therapeutic that one share what he or she learns
and experiences with others so that all can find
ways to understand and lend support. Perhaps
they, too, have an illness that is chronic and has
gone undiagnosed, and this condition has gone
on a very long time. This is not necessarily the
case, however.
I am sharing this because one of my goals before
I depart this life is to open eyes, doors, windows,
and yes, wallets so that many of us who suffer
(often in silence), feeling isolated and ignored,
may find hope, healing, and a solution. One can
only speak up and share what a life with such an
illness entails.
There are many of us who live such lives — and you
may be one of us. No one need suffer in isolation.
There goes forth a renewed call for prevention
and self-care as we accept more and more
responsibility for our wellbeing. Thus we are
afforded the opportunity to learn, grow and
too to benefit from such awareness and positive
action.
Georgianne S. Ginder
Pals Around™
WINTER 2014
PAGE 4
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WINTER 2014
PAGE 5
My Story
I
MOVED TO AMERICA FROM ENGLAND
around four years ago and recall being
struck every day by our different cultures. It
was refreshing to encounter a different way of
life and each day presented me with another
anomaly or amusing tale of our many differences.
I kept promising myself I was going to commit it
all to paper “one of these days.”
I muse upon how Life often ends up being
“one of those days.” Our work, our busy lives,
our sometimes mundane life takes on a whole
new meaning when your health is called into
question. I long for that mundane, normal life
again, yet feel an incentive to do all of the things
that I promised myself I always would. How
many times have we read how a life-altering
event shaped the course of someone’s life or
radically changed their future? I guess it is always
different when it happens to you or to a loved
one. It’s hard to truly grasp a situation until you
are living it. As they say, “Never judge a person
until you have walked a mile in their shoes.”
Being diagnosed with EDS also makes me want
to be part of a collective. Now that I have walked
these steps to a diagnosis, I am eager to hear
other people’s tales, to understand this illness, to
have someone to talk to who will understand our
challenges. We all need to belong in this world.
I recall talking to a taxi driver here in the US,
who was ruminating on the subject of tribes and
how we, as humans, need to be part of a tribe
whether through religious or spiritual beliefs or
professional associations, that people ultimately
group into clans. It resonated with me because
part of identifying, what I see as a new life in
many ways for me, is to find others like myself. I
realized that EDS is a little-known and sometimes
little-understood disease of the connective
tissues, and as we know tissues make up 90% of
our bodies, so that means literally anything can
happen. To know others are there to experience
it with us and to support each other can make all
the difference. After all, the true way to soften
one’s troubles is to solace those of others.
Nearly everyone I have spoken to has reported
a particularly stressful or traumatic build up
to their diagnosis, a time when they were
really pushing themselves and their body was
physically reaching a limit. It is almost as if the
disease is activated or taken to a new level. Stress
definitely exacerbates the issue. Then all the
pieces to the mysterious jigsaw start to slot
together. Getting a diagnosis seemed to me to be
both a blessing and a curse. It’s great for your
hypochondria to have some validity assigned to
it, but suddenly you are set apart from everyone
else. The hardest part is first acceptance, and
then fear of how you might end up.
Eight weeks ago my neck, which I had
been pulling for years and always resolved within
a week, caused me pain again. I had started
doing Insanity® weight classes, then spent one
Sunday trying to lift heavy garden furniture
alone. I had radiating pain down my right arm,
but I seemed to have always had a high pain
tolerance: for instance, last year I was slightly
breathless and went to hospital only to find
I had a pleural effusion in my lung. So I went
for a spinal MRI and found eight bulging discs
in my thoracic mid spine, annular tears, and
prolapsed and bulging discs in my neck. There
was movement of the odontoid peg in my skull
and a Chiari Malformation. Now all the pressure
headaches were starting to make sense.
WINTER 2014
PAGE 6
The wrist weakness and ganglion cysts come up
while I think of it, and my knees hurt too and
often feel like they are going to give way. I used to
click my knees into place as a child when riding
my bike but thought nothing of it. When I look
back, I always felt very protective of my body. I
hated injections to the point of a phobia, would
bruise easily and generally felt a strange anger if
people tried to prescribe me drugs or wanted to
take blood or hurt my body in any way. My best
friend commented that maybe my body had a
strange intuition that something was not quite
right and it instinctively wanted to protect itself.
While devouring a host of medical papers, I
read that our brains may be wired differently. It has been noted that while emotional/
behavioral distress is quite common in various
EDS and significantly contribute to disability,
the relevance of psychologic/psychiatric features
and their likely relationships with the underlying
pathophysiology are “generally overlooked in
the management of these patients.” There was
a study undertaken of 48 EDS patients; Lumley
et al. detected a high rate of anxiety, depression,
anger, and interpersonal concerns. They found
that although psychological difficulties may
be secondary to chronic pain and disability,
ostracism or avoidance of relationships and social
activities, an organic contributor may coexist.
In other words, our brains really are structured
differently and that it is not just about being
overly emotional because we are distressed by
our illness. Correspondingly, Eccles et al. described greater
amygdala volumes in hypermobile subjects, as
well as decreased volume of anterior cingulate
and parietal lobe. So I looked up the anterior
cingulate part of the brain and found that if you
have less grey matter in this area of the brain,
it may translate into an over-emotional state
and anxiety and often OCD. I don’t know
about other EDS patients but I certainly have
OCD! Higher amygdala volumes can present
with an increased emotional state and more
social connectedness. It also demonstrate higher
emotional intelligence. Interestingly, I found
that patients suffering from bipolar disorders
often present lower amygdala volumes:
“Amygdala volume correlates positively with both
the size (the number of contacts a person has) and
the complexity (the number of different groups
to which a person belongs) of social networks. Individuals with larger amygdalae had larger and
more complex social networks. They were also
better able to make accurate social judgments
about other persons’ faces. It is hypothesized
that larger amygdalae allow for greater emotional
intelligence, enabling greater societal integration
and cooperation with others.”
Another interesting fact about EDS is that
proprioception is permanently impaired in
patients that suffer from joint hypermobility
or EDS — something as simple as our ability to
balance. So keep practising those tree poses with
your eyes closed!
Last, dysautonomia is a condition in which the
autonomic nervous system malfunctions. You
can expect a whole variety of things from this,
as I know I have; for instance, increased thirst
and excessive sweating, or the opposite. Irritable
bowel syndrome is possible as well. I am also convinced that high testosterone saved
me for all these years. In another medical treatise
I read, EDS presents less in male subjects due to
the level of sex hormones and, therefore, greater
joint strength and muscle tone. I was diagnosed
with polyovarian syndrome when I was in
my twenties and had unusually high levels of
testosterone as part of this. It was lowered when I
underwent in vitro fertilisation (IVF); then the
weakness and the issues commenced. My mother
also reported a large decline after giving birth
WINTER 2014
PAGE 7
to me and my sister; and pregnancy is known
to sometimes eradicate polyovarian syndrome
through hormonal changes. My mother had
never heard of EDS and just thought she had
a bad back, needed knee replacements, went
deaf five years ago, and had weak wrists due to
general ill health. Unwittingly, she may have
lowered her testosterone levels as her back issues
got notably worse. This ties in with the EDNF Conference
presentation by Dr. Derek Nielson from Cincinnati
Children’s Hospital, Proving the Obvious: Next
Steps for the Demystification of Ehlers-Danlos
Hypermobility Type, noting a similar finding
which has not yet been proven. I was given high
levels of estradiol (estrogen) during IVF, was
unfortunately hyper-stimulated, and my estrogen
levels reached a critical point. This is when the
pleural effusion occurred: weaker tissues resulted
in destabilization. I was driving long distances to
New York each day for work, four hours a day), and
would arrive home with terrible neck and back
strain. I have read studies that prolonged driving
and the vibrating movement against the joints
for prolonged periods can cause spondylitis of the
spine. I believe my issues were triggered by the
weakened tissues and crazily long car trips. Could
testosterone therapy provide relief for fellow EDS
sufferers if administered after puberty when the
hormone levels change? I was diagnosed with Ehlers-Danlos Hypermobility
type in the UK. My odontoid peg movement was
not discovered in the US; a supine MRI can mask
any movement, and my Chiari malformation
presented differently when lying down. How
many more people might have indicators that
are being missed because they did not have an
upright or dynamic upright scan, the techniques
UK doctors used?
Vitamin D deficiency is another symptom which
was found during my IVF blood counts. There is
scarring on my face, lax skin on knees. I would
wonder how many other people also carry the
cystic fibrosis gene. Apparently asthma sufferers
are prime candidates for carrying this gene; I am
an asthma sufferer. When you list off all these signs I almost feel
like a hypochondriac again, but I just want to
be educated and informed. If Ehlers-Danlos is as
misunderstood as it seems to be and we can help
to change this, then we give value to ourselves
everyday by helping others. There is always research underway in England in
terms of this illness. In the National Health Service
EDS is better understood with a team approach:
rheumatologists, geneticists, endocrinologists,
and neurosurgeons would come together. If
you pay privately in the UK then the support
structure changes, and you need to bring the
team together yourself. Patients need a holistic
approach. It is one thing trying to deal with this
illness alone, but also having to navigate and
find your team of specialists is a minefield and a
job in itself. We need to be taking it easy! I see time and time again that we are a
community of fighters and kind people who
are hard-working, eager to share their stories
and help others; and in this world, however
kindness and compassion blossoms, they are
always wonderful virtues to cultivate.
There is a quote from William Shakespeare’s As
You Like It which I think is particularly apt when
we are fed up with our bodies:
Sweet are the uses of adversity;
Which, like the toad, ugly and venomous,
Wears yet a precious jewel in his head….
Alexandra Barbier
WINTER 2014
PAGE 8
From the Editor’s Desk:
How Do I Tell the Story of This Year?
T
HERE ARE MANY WAYS TO TELL A
story. What my life means depends on
the way I tell the story of my life—and
this year has been a really telling example.
It was a great year!
It was a horrible year.
It started with the protracted death of Lenny, a
truly great white beast of a cat, one of the longest
I’ve ever known. He first went blind, then slowly
wasted away before our eyes from aggressive
cancer in the dead of one of the coldest winters on
record in Houston. I still miss him on my shoulder
at night, holding me in place and being my sleepdisturbance early warning system.
My partner’s parents have faced enormous struggles.
His stepfather has lost most of his memory to a
neurological cognitive disorder his doctors refuse
to call Alzheimer’s because, thankfully, there’s no
dementia, and was consequently forced to give up
the work that gave his life meaning, as well as kept
them housed and fed—as well as his hobby as a
whistler. They have downsized into a complex that
provides some, but not really enough, support. His
mother faces a constant battle against a variety of
heart difficulties, along with taking care of her
frequently lost husband.
My father has drastically deteriorated from
Alzheimer’s with vascular dementia. Days before
Christmas this year, just hours after being fully
himself at a holiday party, he abruptly stopped a
few steps away from the top landing in his home,
and my stepmother couldn’t get any response from
him. He simply wasn’t there anymore. He is now
locked in a psychiatric unit, as doctors try to get
his paranoia under control. He will never go home
again; he has since somewhat returned, knows his
family occasionally for a few minutes at a time, but
he still isn’t eating or walking.
I’ve developed psoriasis. I’ve almost lost the use
of my left shoulder. I suspect the syrinx is causing
trouble finally after ten years, but I have no avenue
to deal with these as my partner now has a hernia
and is unable to do the lifting and work he kept
out of my hands for years.
None of this really matters, though.
There are many ways to tell the story of this year.
I’ve discovered despite all the problems, I can
mow and maintain three-quarters of an acre of
yard. The smaller apartment means the cleaning
is easy. When we moved here the beginning of
the year, the first move in almost thirty years,
I wasn’t sure I’d ever feel at home again. I do; I
have a sense of the year now in this bit of land,
it knows me a little, and that’s satisfying. Two
blocks away the circus came and a month later
went, and we endured. The fireworks were more
extreme in our first Christmas and New Year’s in
this neighborhood, but even the cats survived,
albeit a bit nervously.
I discovered astonishing new music. I found joyous
recordings of pieces I thought I’d known my entire
life but found were brand new, and experienced
some life-memorable performances, some by
friends whose careers I influenced a very long
time ago. I read new books and rediscovered old
favorites. I found art that gave me surprising views
on the universe. There were causes that drew my
passion. For all the times I say to myself, “I can’t
do this,” somehow I keep managing, and all of it
distracted me from my body.
WINTER 2014
PAGE 9
I try to live in a world bigger than this garage
apartment. In that bigger world, EDNF has
thrived. It was not only a great year, it was one of
the foundation’s best.
EDS Awareness Month was the most rewarding to
date. Widespread attention to EDS brought tens
of thousands to daily posts on Facebook, and
thousands more were diagnosed this year.
The annual conference in Houston brought
together experts who have been friends for years,
and some rising stars for their first visits. Videos
of the general sessions on YouTube have reached
several times more people than attended the
conference; subsequent videos are drawing new
attention to EDS.
The EDNF Center for Clinical Care and Research
at the Greater Baltimore Medical Center opened
and is treating patients, involved in research, and
conducting educational sessions. We launched our
first one-day Physicians’ Conference with nearly
100 participants, and hosted our first educational
webinar, Connecting the Dots Between EDS and
POTS, which had over 1,200 registrants.
Our fundraising growth, which makes all of the
work we do as a nonprofit public charity possible,
has been astonishing. EDNF’s first active Giving
Tuesday campaign brought in more than $5,000.
Participation in the Amazon Smile program is
exciting. More and more third-party campaigns
and fundraisers are wonderfully joining in. For
the first year ever, EDNF has crossed over $500,000
in donations., and as we head into our 30th
anniversary year, how could we be happier?
Perhaps only with the announcement of the next
International Symposium, to be hosted in 2016 by
EDNF. The last time EDNF hosted an international
conference in Villefranche the result was the
1997 diagnostic criteria. Who knows what may
happen this time when the world’s leading EDS
organization, in the strongest position we’ve ever
been, helps bring the world’s greatest EDS experts
together?
So this was the story of my life in 2014: A Story of
Triumphs. I hope your story is told that way, too.
Mark C. Martino
“For me, breathing is
its own reward.”
“How can you laugh?”
“What, should I cry?
Would that make
more sense?”
Matthew Woodring Stover
Blade of Tyshalle
WINTER 2014
PAGE 10
EHLERS-DANLOS NATIONAL FOUNDATION GRATEFULLY ACKNOWLEDGES
THE INVALUABLE SUPPORT OF OUR DONORS IN 2014.
WINTER 2014
PAGE 11
ompa Gifts
$100,000+
Amerector Inc.
$25,000+
IOMAXIS, LLC
$10,000+
Skyline Steel
$1,000–$2,499
CRC Charity Fund
Darald and Julie Libby Foundation
Houston Jewish Community Foundation
North Scott Community School District
Theodore W. Batterman Family Foundation
$500–$999
Alabama EDSers, Inc.
BlackRock Foundation
Community Foundation for Southeast
Michigan
DDJ Capital Management
Eastside Mission Interdenominational
Church
Nuclear Electric Insurance
On The Rocks Restaurants
Stonewall Jackson Senior High School
The Blanchard Foundation
Teespring, LLC
Zengo Fitness LLC
$250–$499
Atwood Guns
Lucky’s Exhaust, Inc.
United Way of Greater Philadelphia and SNJ
$100–$249
Bravelets, LLC
DBA Discount Fashion Warehouse
Jewish Community Federation
LexisNexus Cares
Moonan Family Fund of the Greater Lowell
Community Foundation
NBT Bank
Pfizer Foundation
Shell Oil Company
Silicon Valley Community Foundation
Solebury Township Police Benevolent
Association, Inc.
TERC
Vicki Adelman Salon, Inc.
$50–$99
Evergreen
Hazel G. Scott Middle School
Insurance Auto Auctions
Kaneland Blackberry Creek Elementary
Post University
SureWest Foundation
United Way of Greater Philadelphia and SNJ
West Michigan Hockey
$25–$49
Ball State University Libraries
Cascade Communications
Hilltop Quilters
San Juan Diego Academy
$1–$25
Jamberry
United Way of Metropolitan Dallas, Inc.
WINTER 2014
PAGE 12
Inividul Gifts
$50,000+
Rochelle Bain
$25,000+
Jaimee Eckert-Griffin
$10,000+
Diane Cresci Tee
Linda Neumann-Potash
$5,000–$9,999
Robert Caspar
Adam Lawrence
Cyndi Ratcliffe
Deborah Winsor
$2,500–$4,999
Sandra Chack
Susan Garza
Louella Jane Mitakides
Richard Taffet
$1,000–$2,499
Michael Broder
Charles Ehrlich
Stephen Feder
Elise G. Kaplan
Nancy Krueger
Philip Weinberg
$500–$999
David Baunoch
Rosemary Carroll
Courtnie Choate
Leah Cohen
Maja Wessels and
Charles Covington
Clair Francomano
Christopher Hartman
Brent Hofmann
Stephanie Jobe
Gordon Lafer
Matt Liptak
Richard Malenfant
Daniel Paulson
Sarah Rowe
Carrie and Robert Sawicki
Austin Tupler
AnnMarie Walsh
$250–$499
Megan Black
Anne Breslin
Laura Davis-Robeson
Lisa Dugger
Marie Brown Etris
Shira Goldenberg
Jeff Goldenberg
Rodney Grahame
John Hackett
Carl Hagerling
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Terri Keyes
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Clara Klap
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Waller Walker
Courtney Zifkin
$100–$249
Michael Abrams
Harvey Abrams
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Sara Adams
Sharon and Richard Allen
D. Allen
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Lori Altman
Sally J. Anyan
Amy Augustyn
Heather Battaglia
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Katherine Berg
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Rebecca Binkley
Sharon Bradley
Dianne Brown
Chris Bueter
Dulcie Bull
Heather Burris
Danielle Carlin
Gisele Chaghouri
John Chiocca
David Christopher
Rebecca Clement
Holly Clowers
Shaul Cohen
Peggy Coleman
Alan Coltri
Richard Connors
Larry Constant
Cynthia deLeon
Kate Doyon Buckovitch
Heidi Emam
Behrooz Emam
George Evans
Zachery Ferenczy
Simon Forster
Gerry Galgon
Maureen Gallagher
Martin Gallo
Frances Gelman
Jane Gibbons
Georgianne Ginder
Donna Gleason
Deryl Goldenberg
Margaret Gontrum
Gale Gors
Xx Gourevitch
Christopher Hager
Mary Hays-Pierce
Vern Hines
Julian Johannesen
Janet Jordan
Marsha Karrass
Robyn Kelly
Clyde Kometer
Christine Kulikowski
Benjamin LeCompte
Joyce Liddle
Sara Lowe
Lois Luallin
Deb Mailander
Patricia Marshall
Colleen McCoy
Elaine Milbrodt
Jonnee Mitchell
Shellie Molina
Allison Muth
Chris Nicholson
Beth O’Donnell
Donna Olivero, PT
Cheryl Palmersheim
Cathy Pardiny
Sherry Paulhamus
Karen Pedroza
Margie Priestle
Diane Raimer
William Reel
Nicholas Ridgely
Laurie Robinson
Eugenia Rooth
Lois Sacks
Stephen Shain
Paul Shain
Ronald Simmons
Sue St. Laurent
George Stanley
Anne Star
Joanne Stringer
Michael Tan
Jason and Jessica Thibeault
Karen Tippins
Rondi Tuten
Ronnie Uberman
Wendy Urban
Kody Varahramyan
Roberta Voegele
Sally H. Weber
Rosetta Wester
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Sarah Willoughby
Darren Wright
Sue Yeatts
$50–$99
Gabrielle Adam
Donnie Akers
Wendi A. Amos
Sherina Anderson
Janet Theresa Anderson
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Catalina Arboleda
Paul Bechly
Nancy Berna
Diann Botelho
Jo Braley
Ellen Brick
Tania Caillouet
Betsy Carlson
Manuel Carreras
Raina Chamish
WINTER 2014
PAGE 13
Sharon Collins
Brianne Connizzo
William Cormier
Catherine Crytzer
Donald Cummins
Robin Dassinger
Susan Delgardo
Laura Dore
Rabbi Shosh Dworsky
Lydia Edmunds
Susan Edwards
Lisa Ehrman
Trish Eichenberger
Roberta Einziger
Taraneh Emam
Parisa Emam
Robert Favuzza
Gerald Fein
Patrick Giacomini
Jay A. Goldberg
Dan Golden
Heather Goodell
Brenda Guyton
Patricia Guzikowski
Diane Hackett
Elizabeth Hardy
David Harris
Kristine Hastings
Nicole Herlands
Elizabeth Herndon
Patricia Hilt
Richard Hoff
Mary Ellen Holden
Juli Howdeshell
Jessica Jameson
Lynne Karanfil
Tammy Kosbab
Barbara Lafer
Janice Lang
Susan Langston
David Larkin
William Levine
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L O O S E CONNECTIONS
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PAGE 27
BMJ 2014;349:g7346 doi: 10.1136/bmj.g7346 (Published 17 December 2014)
Page 1 of 9
Research
RESEARCH
CHRISTMAS 2014: MEDIA STUDIES
Televised medical talk shows—what they recommend
and the evidence to support their recommendations:
a prospective observational study
OPEN ACCESS
1
Christina Korownyk associate professor of family medicine , Michael R Kolber associate professor
1
3
2
of family medicine , James McCormack professor of pharmacy , Vanessa Lam research assistant ,
2
1
1
Kate Overbo research assistant , Candra Cotton pharmacist , Caitlin Finley research assistant ,
3
1
Ricky D Turgeon pharmacist , Scott Garrison associate professor of family medicine , Adrienne J
1
Lindblad associate clinical professor of family medicine , Hoan Linh Banh associate professor of
1
1
family medicine , Denise Campbell-Scherer associate professor of family medicine , Ben Vandermeer
4
1
biostatistician , G Michael Allan professor of family medicine
1
Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4; 2Faculty of Medicine and
Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2R7; 3Faculty of Pharmaceutical
Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3; 4Alberta Research Centre for Health Evidence,
University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, Canada T6G 1C9
Abstract
Objective To determine the quality of health recommendations and
claims made on popular medical talk shows.
Design Prospective observational study.
Setting Mainstream television media.
Sources Internationally syndicated medical television talk shows that
air daily (The Dr Oz Show and The Doctors).
Interventions Investigators randomly selected 40 episodes of each of
The Dr Oz Show and The Doctors from early 2013 and identified and
evaluated all recommendations made on each program. A group of
experienced evidence reviewers independently searched for, and
evaluated as a team, evidence to support 80 randomly selected
recommendations from each show.
Main outcomes measures Percentage of recommendations that are
supported by evidence as determined by a team of experienced evidence
reviewers. Secondary outcomes included topics discussed, the number
of recommendations made on the shows, and the types and details of
recommendations that were made.
Results We could find at least a case study or better evidence to support
54% (95% confidence interval 47% to 62%) of the 160 recommendations
(80 from each show). For recommendations in The Dr Oz Show, evidence
supported 46%, contradicted 15%, and was not found for 39%. For
recommendations in The Doctors, evidence supported 63%, contradicted
14%, and was not found for 24%. Believable or somewhat believable
evidence supported 33% of the recommendations on The Dr Oz Show
and 53% on The Doctors. On average, The Dr Oz Show had 12
recommendations per episode and The Doctors 11. The most common
recommendation category on The Dr Oz Show was dietary advice (39%)
and on The Doctors was to consult a healthcare provider (18%). A
specific benefit was described for 43% and 41% of the recommendations
made on the shows respectively. The magnitude of benefit was described
for 17% of the recommendations on The Dr Oz Show and 11% on The
Doctors. Disclosure of potential conflicts of interest accompanied 0.4%
of recommendations.
Conclusions Recommendations made on medical talk shows often lack
adequate information on specific benefits or the magnitude of the effects
of these benefits. Approximately half of the recommendations have either
no evidence or are contradicted by the best available evidence. Potential
conflicts of interest are rarely addressed. The public should be skeptical
about recommendations made on medical talk shows.
Additional details of methods used and changes made to study protocol
Correspondence to: C Korownyk [email protected]
Extra material supplied by the author (see http://www.bmj.com/content/349/bmj.g7346?tab=related#datasupp)
No commercial reuse: See rights and reprints http://www.bmj.com/permissions
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Introduction
Mass media in the form of television, radio and printed material
are frequently used to deliver medical information to the public.
Research suggests that mass media can improve public
knowledge1 and potentially improve health behaviors.2
Television is one of the most important mass media sources of
health information.3 4 However, concerns have been raised about
the quality, completeness and accuracy of medical information
covered in the news media,5-8 and television news media is no
exception.7 8 The quality of information outside of the news
media has not been examined.
According to Nielsen’s report, American citizens spend an
average of over five hours a day watching television.9
International health information programs, such as The Dr Oz
Show and The Doctors have become a regular part of television
broadcasting. In the 2012-13 season, The Dr Oz Show was
consistently ranked in the top five talk shows in America with
an average of 2.9 million viewers per day, while The Doctors
had a high of 2.3 million viewers.10 11 In the 2012 Greatist report,
Dr Mehmet Oz and Dr Travis Stork (one of the hosts of The
Doctors) were both included in the top 100 health and fitness
influencers.12
Popular television talk shows such as The Dr Oz Show often
engender skepticism and criticism from medical
professionals.13-15 However, no research has systematically
examined the content of the medical information provided on
these talk shows. Our objective was to review the most popular
medical talk shows on television, to (1) determine the type of
recommendations and claims given and the details provided,
and (2) search for and evaluate the evidence behind these
recommendations.
Methods
Programs
We searched for internationally syndicated medical or health
television talk shows that aired daily (weekdays). Two
internationally syndicated medical or health television talk
shows (The Dr Oz Show and The Doctors) were identified by
internet search. We prospectively recorded all episodes of The
Doctors from 11 January to 1 May 2013 (79 episodes) and The
Dr Oz Show from 7 January to 1 May 2013 (78 episodes).
Data collection and outcome measures
Three members of the research group (GMA, MRK, CK)
reviewed two episodes of each show from the previous year
(2012) to help inform the development of a data collection
spreadsheet.
The primary outcome was the percentage of recommendations
and claims (henceforth referred to as recommendations)
supported by evidence as determined by a team of experienced
evidence reviewers. Secondary outcomes included topics
discussed, the number of recommendations made, the types and
details of the recommendations, and general episode
characteristics.
We had no previous information on which to base an estimation
of the needed sample size to make a reasonable estimate of the
number of recommendations that were evidence based. Based
on direct observation of two of each of the shows, we
hypothesized that 50% of the recommendations would be
supported by evidence, then calculated that 158
recommendations would give an 80% chance that the 95%
confidence interval would have a precision within ±10%. We
estimated there would be at least two definitive or stronger
recommendations per episode. Therefore, to attain 158
recommendations, we needed to review 80 episodes. Using a
random number generator, 40 of the recorded episodes for each
of The Dr Oz Show and The Doctors were randomly selected
for analysis.
Being unfamiliar with broadcast health information, we were
unaware of the non-specific nature of many statements and
recommendations given on medical television talk shows. In
addition, the content of the medical information provided on
talk shows has not previously been assessed systematically.
This required us to use an iterative approach to the study design,
ultimately resulting in three small changes to the protocol and
one larger change (see data supplement for full details). A flow
chart of the final study is presented in figure 1⇓.
Classification and content of
recommendations
Two reviewers (VL, KO) independently watched each randomly
selected episode to document the topics discussed and the
specific details surrounding recommendations. Further
information on data extraction is included in the data
supplement. To focus on stronger or clearer recommendations
for the evidence review portion of the analysis, the reviewers
attempted to delineate the more definitive recommendations.
This was based on both the strength of the wording (for example,
“Get your kids vaccinated” was considered a strong
recommendation, whereas “Prescription retin-A helps with ear
and other types of acne” was not) and the context in which the
recommendation was made (for example, a recommendation
may have been classified as strong if it was repeated multiple
times). After independent review, data extraction was compared,
disagreement of coding and classification was resolved by
consensus or third party adjudication (CK, MRK, or GMA),
and overall agreement was calculated. We found some of the
initial classification of topics and recommendations included
categories that were too broad. Therefore, two investigators
(CK, JMcC) reclassified all topics and recommendations, again
with a third investigator (GMA) resolving any uncertainties.
After preliminary review of the data, it was determined that
more specific detail was needed to better quantify the type of
information provided for all recommendations. Two new
reviewers (CC, CF) independently watched the same randomly
selected episodes and focused on the recommendations to
identify if a benefit was described (such as “heart healthy”), if
the benefit was specific (such as “reduces heart attacks”), if a
magnitude of benefit was given (such as “reduced 5%”), if costs
were mentioned (such as “this supplement costs $5 a month”),
and if potential risks or harms were mentioned. In addition, the
observers recorded any mention of potential conflict of interest
with each recommendation or acknowledgement of potential
conflicts of interest at any point during the show. After
independent review, data extraction was compared, disagreement
was resolved by consensus or third party adjudication (CK,
MRK, or GMA), and overall agreement was calculated.
Development of searchable questions and
the evidence behind the recommendations
We randomly selected 80 of the stronger recommendations from
each show and developed a searchable question for each. Two
healthcare providers from the group with medical literature
searching skills (GMA, MRK, CK, JMcC, SG, AJL, HLB, DCS,
RDT) independently searched for evidence supporting each
recommendation. The searchable resources included the
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RESEARCH
Format of a typical medical talk show
Shows are typically divided into 3-4 topics (range about 1-5), each topic runs about 12-15 minutes, often divided by commercial breaks
Each topic may have 4-5 recommendations within it (range about 0-10)
Recommendations may come from the host, guest, or rarely audience members
databases Pubmed/Medline, Embase, Cochrane Database of
Systematic Reviews, Natural Standard Database, and Google.
Maximum search time allotted was 1 hour per recommendation.
If reviewers found high level evidence (a systematic review of
randomized controlled trials or large randomized controlled
trials) addressing the question or recommendation, the search
was concluded. Original research that addressed patient oriented
outcomes (such as mortality or quality of life) was assigned
higher priority over surrogate markers or in vitro data. If several
papers were available, reviewers selected the highest level
evidence pertaining to the target audience of the shows (such
as middle age adults versus pediatrics, and North American
data). Reviewers recorded citations of all papers that were
considered relevant and were encouraged to make notes
regarding their search and evaluation of the evidence.
Originally each reviewer was also going to independently judge
if the evidence was of sufficient consistency and believability
to support the recommendations. However, challenges occurred
with the non-specific nature of the recommendations and wide
diversity of reviewer interpretation of the evidence (see data
supplement). Therefore, the protocol was modified and four
investigators (CK, MRK, JMcC, GMA) reviewed the evidence
for each recommendation as a team. The investigators reviewed
the recommendation and determined the ideal study design to
answer the question but considered sources of evidence ranging
from case reports to systematic reviews. While expert opinion
is considered a level of evidence, these were excluded because
all recommendations in the programs were, by definition, being
made by experts. In cases where the answer remained unclear,
an additional search was performed until the group was satisfied
that a reasonable answer was found or that no evidence was
readily available.
The evidence was evaluated for consistency and believability.
Consistency was defined as both internal (within the study) and
external (between studies). Believability was based on the
quality, quantity, and type of evidence available. The group
discussed each recommendation and voted on how believable
(believable, somewhat believable, or not believable) the
evidence was. When reviewing evidence, investigators used a
relatively broad definition of support in an attempt to be as fair
as possible (for example, see data supplement). The group also
recorded how frequently “consult a healthcare provider” was
mentioned in the 160 randomly selected stronger
recommendations. All data are presented descriptively without
statistical comparison. The 95% confidence intervals for the
primary outcome were computed using the normal scores
method.
Results
Program topics
Topic categorizations from the 80 randomly selected episodes
(40 of The Dr Oz Show and 40 of The Doctors) are shown in
figure 2⇓. The most common show topic discussed on both The
Dr Oz Show and The Doctors was general medical
advice—32.0% (40/125) and 65.5% (74/113) respectively. The
second most common topic on both shows, 24.8% (31/125) and
8.8% (10/113) respectively, was non-weight loss dietary advice
(such as immune boosting diets). The combination of dietary
advice and weight loss accounted for 43.2% (54/125) of all
topics discussed on The Dr Oz Show and 16.8% (19/113) for
The Doctors.
Program recommendations
We identified 479 recommendations for The Dr Oz Show (291
stronger recommendations) and 445 recommendations for The
Doctors, (219 stronger recommendations). On average, each
episode of The Dr Oz Show had 12 recommendations, while
each episode of The Doctors had 11 recommendations.
Recommendation categories
The categories of the recommendations for both shows are
shown in figure 3⇓. The most common recommendation in The
Dr Oz Show (39.2%, 188/479) was dietary advice (such as “Carb
load your plate at breakfast”), while in The Doctors (17.8%,
79/445) it was to consult a healthcare provider (such as “Go to
your primary care doctor or talk to their nurse before going to
the ER to help relieve the load in the ER”). For the 160
recommendations that were randomized for evidence review,
The Dr Oz Show recommended consulting a healthcare
professional 9% (7/80) of the time compared with 33% (26/80)
of the time on The Doctors.
Recommendation details
The details of benefits, harms, and costs around the
recommendations are shown in table 1⇓. The benefit of the
recommendation was not specific 57.4-58.7% of the time. For
example, a recommendation from The Dr Oz Show that vitamin
E improves brainpower would be considered a benefit but not
considered specific or measurable, and the magnitude of the
increase in brainpower was not discussed. Magnitude of the
potential benefit was mentioned in 11.0-16.5% of the
recommendations, often in relative rather than absolute terms
(for example, vitamin E in foods cuts risk of Alzheimer’s disease
by 25-70%). Recommendations were made by the host(s) 26%
(125/479) of the time on The Dr Oz Show and 65% (290/445)
of the time on The Doctors. Guests made 65% (310/479) of the
recommendations on The Dr Oz Show and 33% (146/445) on
The Doctors.
Both the host(s) and guests made the recommendations 9%
(44/479) of the time on The Dr Oz Show and 2% (7/445) of the
time on The Doctors. Acknowledgment of a potential conflict
of interest was identified four times over the 924
recommendations.
Evidence base for the stronger
recommendations
Evidence assessment for 160 randomly selected
recommendations is presented in table 2⇓. Overall, we found
that 87 of the 160 recommendations (54%, 95% confidence
interval 47% to 62%) had some level of published evidence to
support them. Believable or somewhat believable evidence
supported 33% of the recommendations on The Dr Oz Show
and 53% on The Doctors. We found believable or somewhat
believable evidence against 11% and 13% of the
WINTER 2014
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RESEARCH
recommendations on the The Dr Oz Show and The Doctors,
respectively.
Clinical outcomes (versus surrogate) were used for 85% of The
Dr Oz Show and 98% of The Doctors recommendations. At
times these recommendations were justified via an intermediate
or surrogate outcome that in turn would result in clinical
outcome. For example, flossing every day decreases
inflammation of the gums, and this inflammation causes aging.
Discussion
Principal findings
In our review of the two most popular medical talk shows, we
found that general medical advice was the most common topic
addressed on both shows. This broad category includes advice
that could not otherwise be categorized into dietary, weight loss,
exercise, cosmetic or counseling. The most common
recommendations differed between the shows. On The Dr Oz
Show the most common recommendations were dietary advice,
while the most common recommendation on The Doctors was
to consult a healthcare professional. Dietary recommendations
were almost four times more common (39% v 10%) on The Dr
Oz Show than on The Doctors. Dietary recommendations on
The Dr Oz Show were close to eight times more common (39%
v 5%) than exercise recommendations. Similarly, dietary
recommendations were twice as common as exercise
recommendations (10% v 5%) on The Doctors.
For both shows, a specific benefit was mentioned for only about
40% of the recommendations. The magnitude of benefit (<20%),
potential harms (<10%), and costs (<15%) were less commonly
mentioned. Thus, anyone who followed the advice provided
would be doing so on the basis of a trust in the host or guest
rather than through a balanced explanation of benefits, harms,
and costs. The near absence of potential conflict of interest
reporting (<1%) further challenges viewers’ ability to balance
the information provided.
Roughly a third of the recommendations on The Dr Oz Show
and half of the recommendations on The Doctors were based
on believable or somewhat believable evidence. Evidence was
believable or somewhat believable against a recommendation
for 1 in 8-10 recommendations. For slightly over 1 in 3 and 1
in 4 of the recommendations for The Dr Oz Show and The
Doctors respectively, no evidence could be found. This is despite
us being quite liberal in the type and amount of evidence we
required. The percentage of medical practice in the real world
that is evidence based is difficult to ascertain, although one
review reported an average of 78% of medical interventions
were based on some form of “compelling” evidence.16
Comparisons are difficult, however, because the types of
evidence that was required to determine this is considerably
varied.
Strengths and limitations of study
Limitations of this study include the inherent complexity of the
shows, including the subjective nature of the recommendations
such as distinguishing between what was said and what was
implied. To our knowledge, a detailed analysis like this has not
been attempted before, and thus determining the best approach
to gathering and quantifying the information was iterative.
Although the protocol was planned ahead, it was adapted due
to unanticipated challenges in data collection and interpretation.
While this was a limitation, it also represents a lack of
pre-disposition bias.
Developing searchable questions for each recommendation was
difficult because less than 50% of recommendations were
associated with a specific benefit. Again, we were liberal with
our question development and search for evidence. Our original
approach of having two independent experienced evidence
reviewers (out of a pool of nine) review and categorize the
evidence for each recommendation led to too much
inconsistency due to the variability of the recommendations and
the type of evidence required for each recommendation. Our
adapted approach of four reviewers examining and discussing
the evidence for recommendations was also imperfect, but we
believe this method was the best way to provide a consistent
review of the evidence for these highly subjective
recommendations. During evidence review, some of the
recommendations may have been standard or commonly
recommended medical care or public health advice (such as
“sneezing into your elbow prevents the spread of germs”), but
we could not find evidence to support the recommendation.
Although these were uncommon, it increased somewhat the
proportion of recommendations with no evidence.
Finally, the time period selected for recording may not be
reflective of the shows over multiple years, although it is
unlikely that sampling episodes over a different time would
change the results meaningfully. This is the first study to assess
recommendations made on popular medical television talk shows
from an evidence based perspective, and the strengths of the
study include dual review at all levels, detailed data extraction,
committee discussion for evidence assessment, and an iterative
methodology.
Conclusions
Consumers should be skeptical about any recommendations
provided on television medical talk shows, as details are limited
and only a third to one half of recommendations are based on
believable or somewhat believable evidence. An interesting
question is whether we should expect medical talk shows to
provide more than entertainment. Future studies may be directed
at determining what viewers hope to obtain from watching these
shows, and if the airing of these shows results in behavior
changes related to specific recommendations. If the shows are
perceived as providing medical information or advice, viewers
need to realize that the recommendations may not be supported
by higher evidence or presented with enough balanced
information to adequately inform decision making. Decisions
around healthcare issues are often challenging and require much
more than non-specific recommendations based on little or no
evidence from media health professionals. Patients would do
well to ask healthcare providers specific questions about the
benefits and harms, along with the magnitude of the effect (in
absolute numbers), and the costs and inconveniences of any
recommendation.
Contributors: CK, GMA, MRK, JMcC conceived and designed the study.
CK, GMA, MRK, JMcC, VL, KO, CC, CF, RDT, AJL, HLB, SG, DC-S,
BV acquired, analysed, or interpreted data. CK, GMA, JMcC drafted
the manuscript. CK, GMA, MRK, JMcC, VL, KO, CC, CF, RDT, AJL,
HLB, SG, DC-S, BV critically revised the manuscript for important
intellectual content. BV, GMA conducted statistical analysis. CK, GMA
obtained funding. GMA provided administrative, technical, and material
support. GMA, JMcC, MRK, CK supervised the study.
Funding: This study was supported in part by the David and Beatrice
Reidford Research Scholarship through the University of Alberta (valued
at $2400). The sponsors had no role in the design and conduct of the
study; collection, management, analysis, and interpretation of the data;
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RESEARCH
What is known on this topic
Television is an important source of health information for the general public
Popular medical television talk shows frequently engender skepticism and criticism from medical professionals
No research has systematically examined the content of the medical information provided on these talk shows
What this study adds
Recommendations made on popular medical television talk shows often lack adequate information on specific benefits, magnitude of
benefits, and harms, and do not facilitate informed decision making
Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts
of interest are rarely addressed
The public should be skeptical about recommendations made on medical talk shows
preparation, review, or approval of the manuscript; and decision to
submit the manuscript for publication.
4
Competing interests: All authors have completed the ICMJE uniform
disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no
support from any organisation for the submitted work; no financial
relationships with any organisations that might have an interest in the
submitted work in the previous three years; no other relationships or
activities that could appear to have influenced the submitted work.
5
Ethical approval: Not required.
9
Transparency: CK affirms that the manuscript is an honest, accurate,
and transparent account of the study being reported; that no important
aspects of the study have been omitted; and that any discrepancies
from the study as planned have been explained.
11
Data sharing: For further information on the dataset, please contact the
corresponding author at [email protected]
6
7
8
10
12
13
Chew F, Palmer S, Slonska Z, Subbiah K. Enhancing health knowledge, health beliefs,
and health behavior in Poland through a health promoting television program series. J
Health Commun 2002;7:179-96.
Cassels A, Hughes MA, Cole C, Mintzes B, Lexchin J, McCormack JP. Drugs in the news:
an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ
2003;168:1133-7.
Milazzo S, Ernst E. Newspaper coverage of complementary and alternative therapies for
cancer—UK 2002-2004. Support Care Cancer 2006;14:885-9.
Tong A, Chapman S, Sainsbury P, Craig JC. An analysis of media coverage on the
prevention and early detection of CKD in Australia. Am J Kidney Dis 2008;52:159-70.
Moynihan R, Bero L, Ross-Degnan D, Henry D, Lee K, Watkins J, et al. Coverage by the
news media of the benefits and risks of medications. N Engl J Med 2000;342:1645-50.
Statistic Brain. Television watching statistics. 2012. www.statisticbrain.com/televisionwatching-statistics/.
The Hollywood Reporter. ‘Dr. Oz’ and ‘Ellen’ see ratings growth, ‘Kelly & Michael’ topping
2011 in demo. 2012. www.hollywoodreporter.com/news/dr-oz-ellen-see-ratings-387407.
The Hollywood Reporter. Updated: TV ratings: ‘Dr. Phil’ tops talkers during February
sweep, ‘Dr. Oz’ sees steep declines. 2013. www.hollywoodreporter.com/news/updatedtv-ratings-dr-phil-427733.
Greatist. 2012. The 100 most influential people in health and fitness. http://greatist.com/
health/most-influential-health-fitness-people.
Inoue-Choi M, Oppeneer SJ, Robien K. Reality check: there is no such thing as a miracle
food. Nutr Cancer 2013;65:165-8.
Hagenbruch JF. Dr. Oz sells out the Hippocratic Oath. CDS Rev 2013;106:5.
Cifu AS. Why Dr. Oz makes us crazy. J Gen Intern Med 2014;29:417-8.
Imrie R, Ramey DW. The evidence for evidence-based medicine. Complement Ther Med
2000;8:123-6.
Compliance with reporting guidelines: As we are unaware of other similar
studies, there is not a template with which to perform this type of study.
We used STROBE guidelines where possible but could not adhere to
it rigidly.
14
15
16
1
Cite this as: BMJ 2014;349:g7346
2
3
Marx JJ, Nedelmann M, Haertle B, Dieterich M, Eicke BM. An educational multimedia
campaign has differential effects on public stroke knowledge and care-seeking behavior.
J Neurol 2008;255:378-84.
Bala MM, Strzeszynski L, Topor-Madry R, Cahill K. Mass media interventions for smoking
cessation in adults. Cochrane Database Syst Rev 2013;6:CD004704.
Oakley A, Bendelow G, Barnes J, Buchanan M, Husain OA. Health and cancer prevention:
knowledge and beliefs of children and young people. BMJ 1995;310:1029-33.
Accepted: 19 November 2014
This is an Open Access article distributed in accordance with the Creative Commons
Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute,
remix, adapt, build upon this work non-commercially, and license their derivative works
on different terms, provided the original work is properly cited and the use is
non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
WINTER 2014
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RESEARCH
Tables
Table 1| Details of benefits, harms, and costs associated with each recommendation made in samples of medical television talk shows
The Dr Oz Show and The Doctors
No (%) of recommendations
The Dr Oz Show (n=479) The Doctors (n=445)
Benefit of recommendation mentioned
453 (94.6)
402 (90.3)
Benefit was specific
204 (42.6)
184 (41.3)
Magnitude of benefit mentioned
79 (16.5)
49 (11.0)
Possible harms mentioned
47 (9.8)
34 (7.6)
Cost mentioned
60 (12.5)
14 (3.1)
1 time
3 times
Potential conflict of interest declared or mentioned
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RESEARCH
Table 2| Evidence for 80 randomly selected recommendations from each of the medical television talk shows The Dr Oz Show and The
Doctors
Number (%) of recommendations (n=80)
Evidence believable
By believability
Overall
47 (46.3)
The Dr Oz Show
Evidence agrees
Evidence disagrees
No evidence
Yes
17 (21.3)
Intermediate
9 (11.3)
No
11 (13.8)
Yes
4 (5.0)
Intermediate
5 (6.3)
12 (15.0)
No
3 (3.8)
—
—
31 (38.8)
50 (62.5)
The Doctors
Evidence agrees
Evidence disagrees
No evidence
Yes
26 (32.5)
Intermediate
16 (20.0)
No
8 (10.0)
Yes
3 (3.8)
Intermediate
7 (8.8)
No
1 (1.3)
—
—
11 (13.8)
19 (23.8)
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RESEARCH
Figures
Fig 1 Flow chart of study design
Fig 2 Prevalence of topic categories in 40 episodes of each of The Dr Oz Show (125 topics) and The Doctors (113 topics)
WINTER 2014
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RESEARCH
Fig 3 Prevalence of recommendation categories in 40 episodes of each of The Dr Oz Show (479 recommendations) and
The Doctors (445 recommendations).

Winter 2014 - The Ehlers Danlos Society

Transcription

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