Costly New Prostate Cancer Drug Works In Mysterious Ways

Explanation: The story had a primary focus of evaluating the evidence, raising some of the "mysterious ways" this drug works even in the headline. And saying "It does work, sort of" – in the third paragraph. But its strength is in how it educates readers about what confuses researchers about what they’ve seen, what it means, and how to explain it. Pithy quotes:  "It’s not a home run…this is not going to cure prostate cancer." Cutting to the core of the editorial writer’s issue: "The way the study was done, he says, ‘does not allow one to conclude’ that Provenge is working because it mobilizes the immune system specifically against prostate cancer." Writing that doesn’t beat around the bush:  "Deep in the data is further mystery…Nobody yet knows just how to explain these results." Put this one on a shelf and pull it down anytime you need proof that journalists can scrutinize evidence (and get a 5-star score from us) in less than 500 words. Show this to journalism students.

The story itself only says "it’s pretty pricey." But those words provide a hyperlink to another NPR story that discloses the drug cost as $93,000. It would have taken the same amount of space to just state the cost in the current story. Why make people click away to get the cost in another story? Is the need to improve click rates driving this? Regardless, we’ll give the story the benefit of the doubt on this. In a broad overview comment, it’s sufficient for the story to have stated "men with prostate cancer that no longer responds to hormone therapy (basically, chemical castration) lived about four months longer if they took Provenge than if they got placebo treatment." No discussion of any potential harms found in the studies. Excellent, understandable evaluation of the evidence. Thorough. Raises many important questions we haven’t seen in other stories. There are many angles one could take with the Provenge story. For example, ABC News chose a cost angle (but in so doing, still injected a glowing personal anecdote, something the NPR story thankfully didn’t.) Both of these angles are important. But the cost angle is low-hanging fruit – an easy target. Evaluating the evidence, as NPR did in this tight little story, can be difficult but is really important. Big props! No disease-mongering. The story makes it clear the drug was tested in men with prostate cancer who no longer respond to hormone therapy. Solid quotes from the written editorial accompanying the study in the New England Journal of Medicine and even an appropriately cautious quote from the lead author of the study. The story says the drug performed "better than the only other approved treatment for such advanced cancers" and that "Other immunotherapy approaches are in the pipeline, along with fancier versions of drugs to block the hormones that feed prostate cancer." The story is clear the drug was just approved by the FDA and that "Dendreon, the Seattle-based company that makes Provenge, says there’s a waiting list for the drug. The company estimates 100,000 American men have the kind of hormone-resistant, metastatic cancer the drug is approved to treat. But the company can only make enough at this point for 2,000 patients in the first year." The story leads with: "After decades of dreaming about getting patients’ immune systems to fight cancer, immunotherapy is finally here." And later: "…after all, Provenge is just the first cancer immunotherapy on the market." It’s clear this story didn’t rely on a news release.


A couple sued Planned Parenthood for child support over a failed abortion.

Explanation: What's true: A couple sued Planned Parenthood over a failed abortion that resulted in the birth of a third child. What's false: The lawsuit was not a child support claim, but rather one seeking compensatory damages.

On 11 February 2019, Bianca Coons and Christopher Ruiz of Idaho filed a lawsuit in Albuquerque, New Mexico, against Planned Parenthood over a failed abortion that resulted in the birth of a baby boy. According to court documents, the couple, who were already parents to two small children, cited “extreme poverty” as a reason for their seeking a “medically assisted” (or non-surgical) abortion in an effort to limit the size of their family. The story was soon picked up by a number of partisan websites such as LifeSiteNews, who reported the story in emotional terms: Imagine the following scenario. You are a happy boy, growing up in a middle-class home with your two siblings. You enjoy playing outdoors with them, school is going well, and you think the world of your parents. Your dad is your hero, and you love your mom more than anyone in the world. But one day, you Google your family’s name for a school assignment. Your teacher has assigned the class a project that has each student researching their family tree. And that is when you discover a series of news articles that appear to discuss your family. It seems a man and a woman with the same names as your father and your mother sued an abortion clinic after giving birth to a baby they had tried, unsuccessfully, to abort. The articles mention that there were already two children in the family, and it was the third baby they had tried to get rid of. With horror, you try to fight off an inescapable realization: You are the third and youngest child. These hypothetical details may have inspired some readers to question whether the underlying event itself was true, and a review of court documents shows that Coons and Ruiz did indeed file suit against Planned Parenthood for damages over a failed abortion that resulted in the birth of their third child. According to the lawsuit filed in New Mexico, the couple felt they could not afford to add another child to their family, so on 12 February 2016, when Coons was about five or six weeks pregnant, they traveled from their home in Idaho to a Planned Parenthood clinic in Albuquerque in hopes that an abortion procedure could be performed quickly before the fetus developed any further. The couple made the journey, court records said, in order to avoid a state-mandated waiting period. (In Idaho, a woman must wait 24 hours after receiving “state-directed counseling that includes information designed to discourage her from having an abortion” before undergoing the procedure.) Coons wanted the procedure done expeditiously before the fetus developed any further. Coons and her family used “all economic resources available to them at the time to pay the $400 fee for the abortion and make the trip,” according to court documents. She took the first pill in the two-pill regimen at Planned Parenthood, was given instruction for “further oral administration,” and then returned home to Boise. The next day Coons visited a hospital emergency room complaining of nausea and dizziness. She was treated for dehydration, and medical staff there told her that her fetus had a strong heartbeat. The doctor caring for her called the Albuquerque clinic asking whether she should continue with the second abortion pill and received an affirmative answer. According to court documents, even after taking both doses of the abortion-inducing drugs, Coons was still pregnant with a viable fetus, but she didn’t have the financial means to pay for another procedure in Idaho or return to New Mexico to follow up with the clinic that gave her the medication. Coons contacted the Planned Parenthood facility in Albuquerque in early March 2016 to inform them she was still pregnant, but by that time she felt morally opposed to continuing the effort to undergo an abortion due to the more advanced stage of development of the fetus. The couple was notified that the abortion medication could result in birth defects, causing them to live with the fear their son could develop resulting health issues later in life. Coons gave birth to a premature baby boy who had jaundice and blood-sugar problems, according to court documents. Coons and Ruiz are suing for $765,000 in compensatory damages for alleged negligence and breach of contract, according to court documents. We reached out to Planned Parenthood for comment and have not received a response, but a spokesperson for the organization told the Albuquerque Journal they could not comment on pending litigation or discuss specific patients due to privacy concerns.


If voters are turned away from polls on election day, they can ask for a provisional ballot.

Explanation: According to the North Dakota Secretary of State’s office, voters whose identifications don’t include their residential address can bring the following supplemental documents to the polls if they show a residential address: A current utility bill; a current bank statement; a check issued by a federal, state, local, or tribal government (including those issued by BIA for a tribe located in North Dakota, any other tribal agency or entity, or any other document that sets forth the tribal member’s name, date of birth, and current North Dakota residential address); a paycheck; or a document issued by a federal, state, local, or tribal government (including those issued by BIA for a tribe located in North Dakota, any other tribal agency or entity, or any other document that sets forth the tribal member’s name, date of birth, and current North Dakota residential address).

Thousands of American citizens have been purged from voting registries or will face new obstacles to voting in several states, a situation which has drawn attention to a fail safe mechanism put in place by federal law to help ensure all eligible voters are counted: provisional ballots. In response to reports that states (including Indiana, Georgia, and North Dakota) had thrown up roadblocks to potential voters in the lead-up to the 6 November 2018 midterm elections, social media users sought to spread awareness to their fellow Americans about the back-up plan for those who believed themselves to be registered and eligible to vote but were turned away at the polls nevertheless: “Give me a provisional ballot with a receipt as required by law when requested”: Memorize, take a screen shot, write in sharpie on your arm these magic words to use IF YOU ARE TURNED AWAY AT THE POLLS: https://t.co/FsQq5Icfol — Carrie L. Kruck (@KruckCarrie) October 12, 2018  In most states, provisional ballots are for voters who believe they are registered but their registration can’t be found. States that have same-day voter registration (SDR) have little need for them while states that have voter identification laws such as Wisconsin, North Dakota, and Virginia use them for those who go to the polls but don’t have the proper ID on hand. In those cases the voter has a certain amount of time to present a local election official with the required identification in order for the provisional ballot to be counted. Most states don’t have same-day registration, and federal law requires election officials provide voters who do not appear on registries or whose eligibility has been challenged by officials at the polls to be given provisional ballots, according to Section 302 of the Help America Vote Act (HAVA). “The deal with the provisional ballots is that so long as you believe yourself to be registered, you have the right to a provisional ballot. Polling workers are supposed to offer this to you,” said Allegra Chapman, senior counsel and director of voting and elections for the government accountability organization Common Cause. If voters must use provisional ballots, Chapman added that they absolutely should request receipts if they aren’t automatically offered. The provisional ballot receipts provide voters the necessary information to follow up and find out if their votes were counted. Common Cause officials urge voters who encounter any problems on election day to call 866-OUR-VOTE to speak to trained volunteers or text the words “election protection” to 97779 for voting assistance. In SDR states like Wisconsin, North Carolina, New Hampshire, Iowa and Idaho, voters can register on the spot. Maine, Minnesota, Montana, Wyoming and Washington, D.C. also have same-day voter registration. North Dakota doesn’t have voter registration but it does have voter identification laws. “Wisconsin voters who are not on the poll list can register on election day. In Wisconsin, provisional ballots are used primarily for voters who do not have an acceptable photo identification,” said Reid Magney, public information officer for the Wisconsin Elections Commission. Voters in Wisconsin have until 4 p.m. the Friday after the election to present their local election official with required identification in order for their vote to be counted. North Dakota voters without required identification who cast provisional ballots must present an acceptable form of identification to local election officials within six days in order for their votes to be counted. Sen. Heidi Hietkamp also introduced a bill that would, among other things, enable voting precincts to treat the state’s large minority Native American residents’ tribal ID cards like state and local-issued forms of identification for purposes of voting. Provisional ballot voting has gotten wide attention because of highly-publicized cases in which state officials have either purged voter roles and/or enacted legislation that critics fear will disenfranchise minority communities. In Georgia, a 2017 “exact match” law allowed the registration of voters to be suspended and then cancelled if the information on their government-issued identification varied even slightly from the information on their voter registration forms. According to court documents, “Under this ‘exact match’ protocol, the transposition of a single letter or number, deletion or addition of a hyphen or apostrophe, the accidental entry of an extra character or space, and the use of a familiar name like “Tom” instead of ‘Thomas’ will cause a no match result.” And the burden of rectifying the issue falls on voters. Georgia secretary of state and gubernatorial candidate Brian Kemp is currently being sued by a coalition of civil rights groups who claim the “exact match” law has hampered the registration of 51,111 voters, 80.15% of whom are black, Latino, or Asian, and some critics have called on Kemp to resign. Also in 2017, Indiana Secretary of State Connie Lawson dropped roughly half a million entries from voter registries in what she called an effort to clean up an outdated list. In June 2018, a federal court blocked the state from implementing a 2017 law that would have allowed election officials to cancel registrations without notice if voters’ names appeared on an interstate database meant to flag potential double voting. The database, Interstate Voter Registration Crosscheck, has been criticized as being unreliable, while the court ruled the Indiana law violated federal law. Indiana officials have been accused of violating that court order and did not respond to our questions about it. In North Dakota, the U.S. Supreme Court on 9 October 2018 let stand a state law requiring voters to present identification listing their residential addresses. Because many among the state’s large Native American minority use post office (P.O.) boxes and not street addresses on reservations, the Supreme Court decision that allowing the voter ID requirements to remain in place through the November 2018 election has caused many to fear that tribal members will be collectively disenfranchised on election day.


Explanation: The results were announced at a medical meeting, which usually means the data has not been through the level of peer review used by leading medical journals and that key information may have been withheld pending journal publication. Also the trial was halted early, which may increase the odds that the results were a fluke and that if the trial had continued as intended the final results might be different than the interim numbers presented.The early trial stoppage was mentioned, but not the possible significance of that. Medical meeting presentations often fail to include enough detail to allow solid judgments about the real significance of highlighted results.

The story does not include any estimate of the cost of the drug, but the treatment is still experimental, so it is not surprising that there is no firm estimate of the drug’s price. The story does note the high costs of other recently approved drugs to treat advanced prostate cancer… and that cost may be an issue for this product as well. This story reports the absolute survival numbers of 15 months for advanced prostate cancer patients who received the new drug and a steroid vs. 11 months for those given a placebo and a steroid. However, it reports only the average survival figures. With many new cancer drugs, it appears that certain patients get most of the benefit, while most patients get little or no benefit, perhaps because of genetic or metabolic differences. The story should have addressed this issue. Also, while the story notes that the drug has been tested only in patients with advanced disease who have run out of treatment options, it goes on to dangle the hope that the drug “will lead to much longer survival when studied in patients with early-stage disease.” Will it? The statement is premature. No one knows if other types of patients will benefit from this treatment because it has not been tested in them. Some harms were mentioned, but oddly the story then referred to this hormone therapy not causing harms associated with chemotherapy. The story does not mention other harms linked to hormone therapy, such as osteoporosis, fractures, diabetes, and heart disease. We aren’t provided any information on these outcomes or cause of death. Since these results were presented at a medical meeting (which means it is likely the full data have not been reviewed by independent experts) and because the trial was halted early, there is much that remains unknown. Although the story tells readers that the trial results were presented at a medical meeting, it does not make clear that such presentations are not peer-reviewed in the same way that articles in leading journals are, nor does the story tell readers how much information was provided about the trial methods and results. Presentations at meetings tend to include only fragmentary information, which often makes it difficult to know whether there were limitations, harms or other important details that were not revealed. The story only briefly mentioned a red flag about the trial: it was halted earlier than originally planned after an interim check of the results showed a statistically significant survival advantage for patients receiving the experimental drug. The story would have been better if it had pointed out that such early termination can increase the risk of a statistical fluke. In a way, it can be like ending a race early when you see that the horse you bet on is in the lead, without knowing whether that lead would be sustained. Similarly, drugs sometimes appear to show a benefit at one point in time, but then do not show the same benefit when studied longer. A notorious case is Vioxx. It was approved in part based on data from a trial that was ended early. Longer follow up (along with the release of some withheld data) revealed a higher number of serious harms that altered the risk-benefit balance. Readers are not told about the duration of follow-up or whether any patients were dropped from the study or could not be found for follow-up. The omissions could also affect the validity of the conclusions.


Antibiotics could dramatically reduce STIs, study says, raising tough new questions

Explanation: Getty Images This is a story about a test of using antibiotics right after sex to reduce the spread of sexually transmitted diseases in men who have sex with men and use no condoms. On the plus side, readers who stick with the story to the end are given many warnings from the researchers and independent sources about the risks of deploying such a strategy. In that respect this is a very thoroughly reported story. However, the story implies the results may be relevant to the general population even though the people included in the study have a risk of syphilis, for example, that is more then 1,000 times higher than the general population. All men in the study were also taking antiviral prophylaxis against HIV infection. Much of our concern about the story stems from the overly broad headline, and we’re the first to acknowledge that reporters often have little control over that key aspect of their work. Nevertheless, we think it’s something that needs to be addressed if readers are to receive an accurate picture of the research and its relevance. This is an important topic because rates of sexually transmitted infections remain high, especially among high-risk populations, and a safe and effective means of preventing them would be big news. News stories such as this, however, should be very clear about the potential relevance of studies to general readers. A more complete description of the study population (and of the long history of other studies that have looked at using antibiotics to prevent sexually transmitted diseases) would have helped readers understand just how specific and limited the results of this study are.

The story does not address the cost of preventative use of doxycycline. Based on the average use in this study of about seven pills per month, the cost of the drug might be about $30/month. But that cost does not include regular lab testing, which the study authors said should be mandatory in this sort of high-risk group. The cost of clinic visits also was not addressed in the story. Even though doxycycline is not an expensive drug by itself, any plan for widespread, routine use would entail much more than just paying for pills. We also think it would be interesting to consider the cost-effectiveness–does the reduced disease burden reduce costs, too? The story gives some relative reductions, but doesn’t provide enough comparative data to give readers the scope of the benefits. For example, overall, without the antibiotic, the rate of new infection, given that condoms were not used, was 42% (45 men), and with the antibiotic, 22% (28 men). Also, the story implies that there might be a benefit for anyone who is sexually active. Although it notes that the study participants were “men who had frequent unprotected sex with a number of male sex partners,” the story does not make clear just how unusual the men in the study were. For example, while the story reports that syphilis rates for the general US population have risen to almost 9 per 100,000 during a year, the syphilis infection rate in the control group was 11 percent (that is, 11 per 100, not 100,000) over 9 months; a rate that is more than 1,000 times the rate in the general population. The story should have made the point that the men in the study do not resemble the general population. The body of the story spells out many of the potential harms, but the story would have been stronger if warnings had been included in the headline and lead paragraphs. The headline refers to “raising tough new questions” and the second sentence in the story says the strategy “could spark a controversy.” The potential harms would have been clearer to readers if the headline and lead had bluntly stated that routine use of doxycycline could undermine the effectiveness of antibiotics for a range of infections, not just the sexually transmitted diseases these researchers looked at. The story reports that it was a short-term, open-label randomized trial (participants knew whether or not they were taking antibiotics) that included 232 men who had frequent unprotected sex with a number of male sex partners. The story includes several comments from the researchers and others warning that this sort of strategy should be considered only for short-term use in special circumstances. However, that message follows a headline and lead that imply a more general relevance. A strength of the story is that it includes multiple independent sources. It reports funding from the Bill & Melinda Gates Foundation. However, the story does not report funding from a French government agency, nor does it refer to the lengthy list of industry financial ties that many of the researchers disclosed. But we will give the story a satisfactory rating because doxycycline is available as a generic drug produced by a number of companies, not just those the researchers have ties to. The story should have noted that this study did not compare the approach of routinely taking a pill after sex to a more conventional approach of regular testing followed by treatment when an infection is found. The story makes clear that doxycycline is widely available and that it is used to treat other diseases, including acne. A summary box in the journal article states that what is new about this study is that it tested an antibiotic in a group of very high-risk men who have sex with men and who were already enrolled in a trial of a drug that may reduce the risk of HIV infection. This very narrow scope is largely lost in the story. The story includes quotes with researchers and independent sources that appear to be from original reporting.


Patients should avoid taking ibuprofen to relieve pain and fever associated with COVID-19 infections.

Explanation: But other experts suggested that Véran’s advice is in line with some countries’ general guidance on anti-inflammatory painkillers such as ibuprofen, even if their specific connection to the coronavirus is not clear.

Adding to the extant confusion swirling about the COVID-19 coronavirus disease pandemic in March 2020, the French government, including Health Minister Olivier Véran, issued warnings advising that infected persons should avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen:  Serious adverse events related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported in patients with COVID19, possible or confirmed cases. We remind you that the treatment of a poorly tolerated fever or pain in the context of COVID19 or any other respiratory virosis is based on paracetamol, without exceeding the dose of 60 mg/kg/day and 3g/day. NSAIDs should be banned. COVID-19 — Taking anti-inflammatory drugs (ibuprofen, cortisone, …) could be a factor in worsening the infection. If you have a fever, take paracetamol [also known as acetaminophen]. If you are already on anti-inflammatory drugs or in doubt, ask your doctor for advice. Dr. Amir Khan, a National Health Service (NHS) doctor and a senior university lecturer in the U.K., offered the following explanation about why taking anti-inflammatory drugs might have a deleterious effect on persons dealing with a COVID-19 infection: Despite all of their beneficial effects, it has long been known that anti-inflammatories can have a depressive effect on parts of our immune systems. When it comes to taking them to help ease the symptoms of the common cold, we do not really have to worry about this slight but important reduction in the strength of our immune systems: We are very unlikely to develop complications from the common cold, let alone die from it. But we need our immune system in top working order in order to battle the coronavirus and win. When the virus enters the human body, it induces mild to severe respiratory problems, a high fever, cough and, potentially, multi-organ dysfunction, which can lead to death. An early part of our body’s immune response to a virus of this sort is to release cells called mast cells, which form our first line of defense against the virus. These [mast cells] are released very quickly from our respiratory tract — the nasal passageway and linings of the lungs. When the mast cells come into contact with the virus, they then trigger a much bigger immune response, which involves inflammatory chemicals being released. We need these inflammatory chemicals to help tackle the virus in the medium to long term. It is the effectiveness of these chemicals that decides whether a person develops complications from the coronavirus or makes a full recovery. If we take medicines that dampen this immune response, such as ibuprofen, this can lead to us not fighting off the infection as effectively, potentially leading to a longer illness with a higher risk of complications. These warnings to avoid ibuprofen (commonly known by the brand name Advil) generated mixed reactions among the medical community, with some asserting that scientific evidence to support it was lacking, and others maintaining that it was generally good advice: “Deeply concerned about this bold statement,” Muge Cevik, a researcher at the University of St Andrews Infection and Global Health Division, said on Twitter. “There’s no scientific evidence I am aware of that ibuprofen [causes worse] outcomes in #COVID19.”


Antibiotics speed up recovery from ear infections in young children, studies show

Explanation: Of four stories we reviewed on this study (Washington Post blog, NPR, Los Angeles Times as well), two were blog pieces – this one and the Washington Post entry. This CNN effort was better in most ways than the opinionated blog from the Washington Post. It earned points for sticking to the evidence and providing independent perspectives about the value of antibiotics for treating childhood ear infections. We also applaud the story’s focus on shared decision-making between doctors and parents when managing ear infections. A bit more detail on costs and harms would have added value to this excellent story. Wanting the best for a child with an ear infection doesn’t necessarily mean opting for the most aggressive treatment. As Dr Richard Rosenfeld  puts it in this story: “Medicine is about gray zones and balancing the risks and benefits. Parents and doctors need to understand what the benefits and what the downside of treatments are.” While the research discussed here confirms that antibiotics are likely to be beneficial for certain children with ear infections, no study can take the place of a careful consideration of individual circumstances. According to Rosenfeld: “It’s an opportunity for a conversation with your pediatrician.”

This story did not discuss the costs of antibiotic prescriptions to the individual or costs of policies on our health care system and society. We think it should have. Although a bit more detail would have been useful on the findings from both studies, the story does provide an account of the absolute rate of symptom relief after 7 days for antibiotic (80%) and placebo-treated (74%) patients, which is the expectation for this criterion. It also provides valuable expert commentary on how parents can put these benefits into context vs. the risk of harm and the likelihood of spontaneous recovery in children who don’t receive antibiotics. Although we’re tempted to give this story a pass for providing a detailed list of potential harms and a better explanation of why limiting antibiotic use can be beneficial (it can “increase the chance the future use of antibiotics will be effective”), the expectation here is that the story will provide a quantitative estimate if available. These figures were easily obtainable from the original studies, and should have been provided. This story takes a much more careful approach to examining the evidence than the competing Washington Post blog. Examples: No disease-mongering in this story. The prominence of the independent voices in this story is a real strength of the coverage. It was nice to see lengthy comments from Dr. Richard Rosenfeld, who literally wrote the book (or at least edited it) on evidence-based treatment of ear infections. There’s also input from a doctor who is a stronger proponent of early antibiotic use. The story adequately describes the rationale supporting watchful waiting, which is the primary alternative to antibiotics for an acute ear infection. The availability of antibiotics to treat ear infections is not in question. The story correctly characterized the novelty of the research: it establishes that antibiotics are more effective for infants and toddlers with a conclusive ear infection diagnosis, and supports current U.S. guidelines for providing immediate antibiotics to such children. The story features comments from two independent experts, so we can be sure it’s not based on a news release.


A man caught in the explosion of one of the World Trade Center towers rode bits of the falling building down to safety.

Explanation: What's true: Pasquale Buzzelli, a survivor who claims to have been on the 22nd floor of one of the collapsing towers, lived through the fall with only minor injuries. Genelle Guzman-McMillan, another survivor who was with Buzzelli when the tower collapsed, claimed to have been on the 13th floor. What's false: Possibly by using a piece of debris as a makeshift boogie board to surf the air currents, a man who fell some 80 stories or more in the collapsing WTC survived relatively unharmed.

Not all rumors hurriedly spread in the wake of a tragedy are exaggerations of the horror that was or vocalizations of fears of things potentially to come — some are expressions of hope. The “building surfer” is one such rumor in that it celebrates the miraculous survival of an otherwise doomed man and thus by implication imparts hope that others too will have been found to have lived through the destruction. In a larger sense, such rumors reaffirm belief that man will always pull through no matter what disaster is visited upon him. According to widely dispersed bit of gossip, a man trapped high in one of the falling World Trade Towers managed to ride parts of the collapsing building down to safety. In some accounts, he is said to have “curled himself into a ball,” in others, to have ridden the swirling air currents and cascade of debris like a surfer, a piece of wood his boogie board to survival. Shaken but proud, he emerges from his wild ride with only minor injuries amounting to no more than scratches and a broken ankle. Often the rumor specifies the floor the man fell from, placing it as the 71st, 82nd, 92nd, or some other so high that no one could reasonably have lived through a fall from it. Many accounts assert the mystery man was a firefighter, one of the countless brave souls who deliberately risked their lives to help others. Because this is a rumor of man triumphing over mayhem, lore remakes one of the cherished but doomed heroes of the day into a survivor, changing his real fate into one that not only spares his life, but leaves him triumphant in the face of utter devastation. Our sense of justice is thus appeased. Sadly, there isn’t any credible evidence of the existence of such a man, firefighter or otherwise. He’s a figment of our wishful imaginations, a fictional icon of indomitability we are quick to turn to in times of disaster. We picture his incredible ride down the side of collapsing building and delight in this confirmation that man will always find a way. In our minds, we see his ride as a giant thumbing-off to the destruction raining down about him. Needed icon or not, could he be real? Is there at least some small shred of truth to this story? There is — and there is even a true tale of actual miraculous survival — but there are also confusion, misinformation, and exaggeration. Some news outlets have reported tales from the scene involving interviews with those who’ve rescued victims from the fallen building. One such report came from two members of the Passaic County Sheriff’s Department who pulled a trapped Port Authority police officer from a crater a day after the disaster. “He must have just rode the building as it came down,” one of them said. The rescued officer goes unnamed even at this late date, leading us to believe he’s a conflation of rumor with hope or just a garden variety misremembering of things read and heard with things experienced. Or he could have been Sgt. John McLoughlin, and in the manner of all gossip, his story widened to make him two men instead of just one. McLoughlin is a 21-year veteran of the Port Authority police force who was pulled from the rubble of the World Trade Center on 12 September 2001. He sustained kidney damage and was in critical condition, but his prognosis was good. Confusion over his story has fueled the rumor. According to a New York Times article written the day he was found:  No one knows how Sergeant McLoughlin survived Tuesday’s collapse, or even where he was when the buildings fell. His colleagues said he was probably outside the south tower when it came down, but a battalion chief at the rescue said that Sergeant McLoughlin was on the 82nd floor of the building when it came down. McLoughlin’s whereabouts at the time of the building’s collapse were in dispute — his boss (who would have been interviewed by the press and whose comments would have been taken as definitive) thought he was one place, and his colleagues knew him to be another. The injured man and his family have been refusing to talk to the press, but after close to two weeks of being battered with inquiries, a senior press officer for the Port Authority spoke up about what he knew. Sgt. McLoughlin’s brother said the officers were on the ground floor when the tower fell. This version was confirmed by another hospital visitor to the injured officer. Further complicating the matter, some recall seeing an interview with David Lim, another Port Authority worker who was pulled from the rubble. Lim’s story could lead those who listened less than carefully to believe he’d fallen from a great height, because he was on the 44th floor of the first damaged tower where he was aiding in the rescue efforts when he saw United Airlines Flight 175 hit the second tower. But he did not come down with the collapsing building — he and others with him turned back at that point. Lim had made it back to the fourth floor when the building gave way. He was pulled from the wreckage on 11 September about five hours after the collapse of the World Trade Center towers, making him one of the last people to be rescued alive. Adding to the belief in this tale was a lengthy article titled “Ground Zero” which ran in the 24 September 2001 issue of Newsweek. In it, the story of rescue workers hearing from an unnamed detective about a Port Authority police officer fell with the building from above the 80th floor and survived with just a broken leg was aired. Also, Dr. Kenneth Tesla, a surgeon who had treated two Port Authority workers, was quoted as saying both of these men had survived falls from the 86th floor. Newsweek has retracted this part of the story. A correction that ran on 1 October 2001, reads:  In “Ground Zero,” we reported that two Port Authority police officers fell more than 80 floors and survived in the World Trade Center collapse. The Port Authority now believes that the officers reached the ground floor by foot before the towers fell. Yet with all the misinformation and confusion surrounding rumors about miraculous survival, some stories do appear to hold up, such as that of Pasquale Buzzelli. This 34-year-old Port Authority worker had begun the descent from his office on the 64th floor of the North Tower via Stairwell B and had reached what he believed was the 22nd floor when the building collapsed. (Genelle Guzman-McMillan, a clerk who was with him when the building went down, recalled they were on the 13th floor when everything came apart, so there still remains controversy as to where they were in the building at that critical moment, and thus how far they fell.) Buzzelli was knocked unconscious but came to a few hours later, was discovered atop a high pile of rubble by firemen, and rescued. His right foot was fractured and he had suffered a few scrapes and bruises, but was otherwise unharmed. Guzman-McMillan suffered a crushed right leg and was not pulled from the wreckage until a day after the disaster. Sixteen people in all survived the collapse of the North Tower. Even among this handful who lived, folks standing immediately to the right or left of them at that critical moment died, leaving many of the survivors haunted with unanswerable questions of “Why me?”


Study: Safe hormone therapy after hysterectomy

Explanation: This story provides a brief overview of the results of the Estrogen-Alone study, which was a large, randomized, blinded trial and part of the Women’s Health Initiative study of hormone replacement therapy (HRT). The story accurately notes that estrogen-alone therapy is only for postmenopausal women who have had a hysterectomy. The story provides some balance on the risks and benefits of taking estrogen alone to relieve symptoms of menopause, and there is caution that it is not right for certain women. There is discussion of some of the established benefits of HRT, such as relieving hot flashes and helping to prevent osteoporosis. However, there is no quantitative data from the study on how great a benefit HRT would provide. For example, in the estrogen alone study, there were only 6 fewer hip fractures (11 cases in estrogen alone and 17 cases in placebo group) out of tens of thousands of women enrolled. There is no discussion of other medications which are effectively used to prevent osteoporosis and have fewer health risks. The most erroneous portion of the story is the claim that “women can take this form of HRT with worrying about breast cancer.” It is true that there were fewer cases of breast cancer in the estrogen alone group: 28 per 10,000 in the estrogen group vs. 34 per 10,000 in the placebo group, and the difference was not statistically significant. However, there were more abnormal mammograms that required follow-up and 33% more breast biopsies in the estrogen alone group (747 vs. 549), which does not necessarily mean more breast cancer, but can signal changes in breast cells and tissue. Also, women at a higher risk of developing breast cancer in the estrogen-alone group had larger tumors that spread to the lymph nodes, which can mean a poorer prognosis and more breast cancer treatment. Lastly, there is no discussion that menopause is a natural part of aging and not a condition which necessitates medical intervention. Unless symptoms are very bothersome, many women do not need to take hormone therapy medications to ease symptoms common in menopause such as hot flashes, cold sweats and vaginal dryness and discomfort. The report does not talk about less invasive alternative treatments for relieving symptoms of menopause such as exercise, vaginal creams, and wearing loose, cool clothing to prevent discomfort from hot flashes and cold sweats.

The story doesn’t mention the cost of taking estrogen alone. There is also no discussion of the additional cost of screening for breast cancer via mammograms and breast biopsies, or follow-up visits that might be required for women at higher risk of developing breast cancer from taking estrogen-alone HRT. The story mentions some of the established benefits of HRT, such as relieving hot flashes and helping to prevent osteoporosis. However, there is no quantitative data from the study on how great a benefit. There is also no comparison between the two groups regarding the relative or absolute risk reduction of experiencing hot flashes or developing osteoporosis due to taking estrogen alone. In the estrogen alone study there were only 6 fewer hip fractures (11 cases in those on estrogen alone and 17 cases in those on placebo). For a woman considering this therapy, these are important distinctions. Mentions some harms of treatment such as an increased risk of blood clots and strokes, but the interpretation of increased breast cancer risk for a subgroup of the study in omitted and misinterpreted. Also, there is no mention that the study found a slight increased risk of dementia in the estrogen-alone group. There were about 12 extra cases of dementia in every 10,000 women using estrogen alone each year. This increased risk was not statistically significant. Estrogen therapy is also associated with an increased risk of symptomatic gallstones. No quantitative evidence presented from estrogen-alone study of the Women’s Health Initiative. The claim that “women can take this form of HRT with worrying about breast cancer is not correct. Breast cancer was diagnosed in 28 per 10,000 in the estrogen group and 34 per 10,000 in the placebo group; however, this was not statistically significant. Additionally, there were more abnormal mammograms and breast biopsies in the estrogen group than in the placebo group. Women at a higher risk of developing breast cancer in the estrogen therapy group had larger tumors that spread to the lymph nodes. This is critically important information for women and their physicians as they consider estrogen therapy. There is no discussion here that menopause is a natural part of aging and not a condition which necessitates medical intervention. Unless symptoms are very bothersome, many women do not need to take hormone therapy medications to ease symptoms common in menopause such as hot flashes, cold sweats and vaginal dryness and discomfort. No attempt to interview other sources, but we realize this is a TV story providing a brief overview of the results of the estrogen-alone portion of the Women’s Health Initiative HRT trial. There is discussion of the risks and benefits of taking estrogen alone and that it should be tailored to an individual woman’s health and familial risks. There is some caution about taking estrogen-alone hormone therapy. The story does not talk about alternative treatments for relieving symptoms of menopause such as exercise, vaginal creams, and wearing loose, cool clothing to prevent discomfort from hot flashes and cold sweats. Also, there is no talk of other (less risky) medications which are used to prevent osteoporosis. It is fairly clear from this story that this is not a new therapy – this treatment is available to women from a primary care provider or gynecologist. Mentions hormone replacement therapy (HRT) as part Women’s Health Initiative estrogen-alone study for women who have had hysterectomies. The story does not present HRT as a new treatment for bothersome menopausal symptoms such as hot flashes and vaginal discomfort. It is clear that HRT is not proven to prevent heart disease or cancer. There is no attempt to discuss the finding of the WHI with researchers in women’s health not affiliated with the study. However, this is a time-limited science report on the evening news. There is an explanation of the results of the WHI and caution about taking estrogen-alone hormone therapy. This appears to be a somewhat balanced report and not taken from press release.


Jackson Laboratory grant to help understand addiction, genes.

Explanation: Maine’s two U.S. senators say a laboratory in Maine is receiving a federal grant to advance its research of drug addiction and the role genetics play in it.

Genetics, Susan Collins, Maine, Angus King, U.S. Department of Health and Human Services

Republican Sen. Susan Collins and independent Sen. Angus King say Jackson Laboratory is getting $255,000 from the U.S. Department of Health and Human Services. Jackson Laboratory vice president LuAnn Ballesteros says the grant is “an important step in propelling our work forward to help Mainers, and people around the world impacted by addiction.” The senators say researchers at the lab are working on projects to improve understanding of genetic factors that play a role in vulnerability to substance use disorders. The federal money was awarded via the DHHS National Institute on Drug Abuse.


Disability, Health Care, Retirement, Florida, Rosemary Laird,

A Florida physician who specializes in geriatrics and memory care warned a Florida Senate committee that Alzheimer’s disease is both a present and a looming problem for the state. "Please make no mistake -- we are in the midst of an epidemic of Alzheimer’s disease," Rosemary Laird, a geriatrician at the Centre for Senior Health in Winter Park, told the Senate Health Policy Committee on March 14. "Currently, half a million Floridians have Alzheimer’s disease, and in less than 10 years, a 40 percent growth rate means that another 200,000 Floridians will develop this devastating illness." Laird was testifying in favor of SB 1050, a bill sponsored by Sen. David Simmons, R-Longwood, to establish a memory disorder clinic at Florida Hospital in Orange County. Laird’s office did not return a call, but we were able to find statistics that closely matched what she told the committee. They were cited in "2017 Alzheimer’s Disease Facts and Figures," a report by the Alzheimer’s Association, the leading advocacy group for patients with the severe memory-loss condition and their families and caregivers. The report, in Table 4, offers projections for state-by-state numbers of residents with Alzheimer’s in 2017 and 2025. For Florida, it lists 520,000 people with the disease in 2017 and 720,000 for 2025, a growth rate of 38.5 percent. Rounded off, those are essentially identical to the figures Laird cited. However, it’s worth noting that the table cites these figures as "estimates" (for 2017) and "projected" (for 2025). The numbers in the report are footnoted to a study published in the academic journal Neurology in May 2013. The authors used Alzheimer’s diagnosis statistics from 2010 to create estimates of how many cases would be expected in future years as far out as 2050. Given the margins of error in estimates and projections, and given the difficulty of diagnosing Alzheimer’s disease in patients, it’s a slight overreach for Laird to frame these as hard numbers of Floridians who have the disease today. They are a useful yardstick and were published in a respected scientific journal, but her phrasing suggests too high a degree of certainty about the numbers who have the disease today. "It is accurate to say that the numbers are estimates, or as we put it in the report, ‘projections,’ " said Laura Cilmi, a spokeswoman for the Alzheimer’s Association. Our ruling Laird said, "Currently, half a million Floridians have Alzheimer’s disease, and in less than 10 years, a 40 percent growth rate means that another 200,000 Floridians will develop this devastating illness." These numbers are sourced to a credible scientific paper, though it’s worth noting that the paper deals in estimates and projections, rather than hard, verifiable numbers. We rate this statement .


Explanation: This news story was based on a report of two double-blind randomized studies comparing the newer drug, varenicline, with bupropion and placebo as aids to smoking cessation. This newer drug may help quell nicotine cravings by binding to receptors in the brain that control the release of dopamine, which is often stimulated by nicotine. More sustained levels of dopamine may help with cravings and withdrawal from nicotine. The studies discussed were both funded by Pfizer and reports of side effects were limited, as only nausea was listed and qualified as “mild” by the primary researcher. Despite the headline (“Drug effective in smoking cessation studies”), which we know is usually not written by the reporter, the journalists are appropriately cautious about the findings and provide information about the funding source and potential conflicts of interest. Abstinence rates at one year for each smoking cessation drug and placebo are presented; however, the news story lacks a comparison with abstinence rates for alternative (non-drug) methods of smoking cessation and does not provide enough information about the long-term risks of the newer drug or side effects. Longer-term data, larger controlled studies and more information on the safety of varenicline (vs. the more studied bupropion) are necessary before this drug is presented as a viable option for smoking cessation. Given that the drug has not yet been approved for smoking cessation in the U.S., the storyâ€™s generally positive tone fails to remind readers of hurdles still to be passed on the road to approval. For example, the drug’s performance is not much better than published rates for bupropion (Zyban) in other randomized clinical trials designed to test the latter versus placebo.

No mention of the cost of varenicline. Numbers are framed appropriately. Only mention of harm was nausea. The issue is that 1) rate of nausea was not mentioned, rather rate of quitting due to nausea was; 2) this might be significantly more common in the active drug group than the placebo group, but we can’t know. Brief mention of clinical evidence, but this is incomplete. The numbers were from 2 fairly well-designed randomized, double-blind trials (N=2000 total). Abstinence was evaluated between varenicline, bupropion and placebo groups at 12 weeks, then continuous abstinence for another 40 weeks. During weeks 9-52 carbon monoxide (CM) levels were taken to confirm quit rates. The numbers presented are the continuous abstinence rates from weeks 9-52, based on these CM measurements. The only person interviewed was the lead investigator of the Pfizer-sponsored trial. She downplayed side effects. Mentions other drug treatment, which was used as a comparison in this double-blind study; however, no quantitative comparison of non-drug methods of smoking cessation (e.g. behavioral interventions, support groups, nicotine replacement) with regards to abstinence rates. No discussion of side effects of bupropion. No comparison of tolerability of side effects between valenicline and bupropion. Importantly, the study may not have provided, or the story omitted, the important counseling component that is recommended as a complement to drug therapy. Mentions that the drug is not yet approved. Nicotine receptor agonist: new drug with old mechanism (nicotine replacement).


New Therapy Delivers Long-Term Relief for Chronic Back, Leg Pain, Study Finds

Explanation: The release reports on a study that tested a new type of implanted device for the treatment of chronic back and leg pain. It uses high-frequency electrical pulses, delivered directly to the spinal cord via implanted leads. The study compared this high-frequency form of spinal cord stimulation (SCS) to a more traditional approach that uses lower-frequency pulses. The main advantage of the new approach, according to the release, is that patients don’t feel an annoying tingling or buzzing sensation that’s associated with the traditional approach. The release faithfully reports the outlines of the study in broad strokes and provides some of the outcomes in user-friendly terms. But there a lot of missing context that any reporter relying on the release should have been given. Notably, this was a company funded study run by investigators with close ties to the manufacturer of the device. The surgery required to implant the device can cause harms that weren’t mentioned. Finally, it’s not clear if this device is approved for use and if so, how much would it cost to have it implanted and would insurance cover that cost? Many people have chronic pain that isn’t satisfactorily addressed with existing approaches. If a new device can improve on those existing therapies as is claimed in this release, many people would be interested to know about it. But along with offering the good news about potential benefits, release writers have an obligation to provide context that cuts the other way — whether that’s possible harms from the device, conflicts of interest among the researchers, or limitations to the study design. They also owe it to readers to present a full array of potential alternatives. This release sets up what seems to be a false choice between SCS and either surgery or narcotics. Patient can also try yoga, exercise, NSAIDS, and behavioral modifications — treatments that can work and have little cost and risk.

Association/Society news release,Conflict of interest,medical devices

The news release doesn’t address the costs of newer, high-frequency SCS vs. traditional SCS. Since traditional SCS seems to be commonly used, it should be possible to provide some estimate of what the device and the implantation procedure cost. It would be nice if the release had also addressed potential insurance coverage for either device. The release does a good job of putting some numbers on the potential benefits. For example, the release gives us the absolute number of pain patients in each group who experienced a 50% or greater reduction in symptoms. “At three months, 85 percent of back pain and 83 percent of leg pain patients in the HF10 therapy group experienced a 50 percent reduction in pain or greater. Conversely, only 44 percent of back pain and 56 percent of leg pain patients in the traditional SCS group experienced a 50 percent reduction in pain.” Of course, it’s worth noting that these are the findings after 3 months, and the study lasted for 12 months. However, it doesn’t look like the benefits were diminished too greatly with longer-term use of the device, so we’ll award a Satisfactory grade — even though it would have been preferable to also see the findings after a full year of use. The story doesn’t address harms except to note that the high-frequency group had no paresthesia. The study that’s the basis for the release noted that “non-serious” study-related adverse events occurred in about 30% of patients in both groups. These included implant site pain and lead migration resulting in “surgical revision” (i.e. a second operation). But that begs the question: How can a second surgery be considered “non-serious”? The release provides some details, noting that the researchers examined 171 patients with chronic back or leg pain who were implanted at 10 comprehensive pain treatment centers. We’re also told the study was the first long-term comparison of the two approaches. But the release skimps on some important information. On the one hand, the release never tells us that this was a randomized study — one of the strongest study designs for comparing the effectiveness of two treatments. But on the other, the release doesn’t acknowledge the fact that the study wasn’t blinded, which is a very serious limitation in a study to assess pain. The patients knew which treatment they were getting and the study researchers also knew which patients were getting high-frequency vs. traditional SCS. This knowledge has the potential to bias the results of the study. Moreover, the non-blinded researchers were free to change patient pain medicines as they saw fit, and neither the release nor the study gives data on these changes: this sort of thing is very likely to lead to spurious results. We’re not saying the release needed to go into detail on every possible limitation of this study, but readers need some sense that there are limitations and drawbacks to a study such as this. The release didn’t provide that context. The release succumbs to exaggeration, noting that “More than 1.5 billion people worldwide suffer from chronic pain, with lower back pain being the most frequent condition affecting 23 to 26 percent of the population.” The release should’ve kept the discussion limited to back and leg pain and the specific kind of patients who would be candidates for this device — not every person in the world who suffers from chronic pain. By throwing out such numbers, the release takes on a promotional tone — as if its purpose is to increase interest in the procedure from anyone with chronic back pain. The release does not tell readers that the study was funded by the Nevro Corporation, which makes the device that was studied, nor that the study authors had ties to the company and other medical device makers. The release mentions traditional SCS, opioids, and back surgery as other approaches to back pain, and notes that they have “limited effectiveness and commonly known side effects.” But we don’t think this is enough for a Satisfactory grade here. The options for treatment of back pain are much more diverse than just surgery, narcotics, and an implanted spinal cord stimulator, and so in a sense the release is offering a false choice. Other less invasive components of multimodal pain management strategy include exercise, physical therapy, yoga, NSAIDS (e.g. ibuprofen), and behavioral counseling. It’s not clear from the release if this device is approved and available. It appears that it is. The release says, “This is the first long-term study to compare the safety and effectiveness of high frequency and traditional SCS therapy for back and leg pain.” Nothing over-the-top here. We’ve already commented on exaggeration in the Disease Mongering criterion above.


Bolsonaro to send army to fight huge fires in the Amazon.

Explanation: Under international pressure to contain fires sweeping parts of Brazil’s Amazon, President Jair Bolsonaro on Friday authorized use of the military to battle the huge blazes while thousands took to the streets to protest his environmental policies.

Brazil, Deforestation, Global trade, AP Top News, International News, General News, Forests, Latin America, Environment, Jair Bolsonaro

Brazilian forces will deploy starting Saturday to border areas, indigenous territories and other affected regions in the Amazon to assist in putting out fires for a month, according to a presidential decree authorizing use of the army. The military will “act strongly” to control the wildfires, Bolsonaro promised as he signed the decree. The armed forces will collaborate with public security and environmental protection agencies, the decree says. “The protection of the forest is our duty,” the president said. “We are aware of that and will act to combat deforestation and criminal activities that put people at risk in the Amazon. We are a government of zero tolerance for crime, and in the environmental field it will not be different.” Bolsonaro has previously described rainforest protections as an obstacle to Brazil’s economic development, sparring with critics who note that the Amazon produces vast amounts of oxygen and is considered crucial for efforts to contain climate change. As the president spoke, thousands of Brazilians demonstrated in Rio de Janeiro, Sao Paulo and the capital of Brasilia demanding the government announce concrete actions to curb the fires. People also banged pots from their homes, a traditional mode of protest in South America. An Associated Press journalist who traveled to the Amazon region Friday saw many already deforested areas that had been burned. Charred trees and fallen branches were seen around Porto Velho, the capital of Rondonia state, which borders Bolivia. In some instances, the burned fields were adjacent to intact livestock ranches and other farms, suggesting the fires had been managed as part of a land-clearing policy. A large column of smoke billowed from one fire, and smoke rose from a couple of nearby wooded areas. Life appeared normal in Porto Velho. However, visibility from the windows of an arriving airplane was poor because of smog enveloping the region. Small numbers of demonstrators gathered outside Brazilian diplomatic missions in Paris, London, Geneva and Bogota, Colombia, to urge Brazil to do more to fight the fires. Larger protests were held in Uruguay and Argentina. Hundreds also protested in Chile, Ecuador and Peru. Neighboring Bolivia and Paraguay have also struggled to contain fires that swept through woods and fields, in many cases set to clear land for farming. About 7,500 square kilometers (2,900 square miles) of land has been affected in Bolivia, Defense Minister Javier Zavaleta said. A B747-400 SuperTanker arrived in Bolivia and began flying over devastated areas to help put out the fires and protect forests. The U.S.-based aircraft can carry nearly 76,000 liters (20,000 gallons) of retardant, a substance used to stop fires. Some 370 square kilometers (140 square miles) have burned in northern Paraguay, near the borders with Brazil and Bolivia, said Joaquín Roa, a Paraguayan state emergency official. He said the situation had stabilized. Close to 20% of the Amazon has already been deforested, said Thomas Lovejoy, a George Mason University environmental scientist. “I worry that the current deforestation will push past the tipping point leading to massive loss of forest and biodiversity,” Lovejoy wrote in an email to The Associated Press. He said Brazil is “turning its back” on past environmental achievements, including the 1992 Earth Summit, and has proposed infrastructure projects that will accelerate the challenge of climate change. “Fires are directly burning into the Amazon rainforest and that releases the carbon stored in those trees,” said Doug Morton, a NASA scientist. “The carbon then enters the atmosphere as carbon dioxide or methane, where it contributes to the greenhouse gases that are causing climate change, bringing us a warmer and a drier planet.” Morton said there is now “an uptick in the pressure against the remaining Amazon forest, to expand agriculture production in areas that are the leading edge in the deforestation frontier.” Fires are common in Brazil in the annual dry season, but they are much more widespread this year. Brazilian state experts reported nearly 77,000 wildfires across the country so far this year, up 85% over the same period in 2018. Just over half of those fires have occurred in the Amazon region. Brazil contains about 60% of the Amazon rainforest. U.S. President Donald Trump said Friday that he spoke with Bolsonaro. “Our future Trade prospects are very exciting and our relationship is strong, perhaps stronger than ever before,” Trump tweeted. “I told him if the United States can help with the Amazon Rainforest fires, we stand ready to assist!” In escalating tension over the fires, France accused Bolsonaro of having lied to French leader Emmanuel Macron and threatened to block a European Union trade deal with several South American states, including Brazil. Ireland joined in the threat. The specter of possible economic repercussions for Brazil and its South American neighbors show how the Amazon is becoming a battleground between Bolsonaro and Western governments alarmed that vast swaths of the region are going up in smoke on his watch. Ahead of a Group of Seven summit in France this weekend, Macron’s office questioned Bolsonaro’s trustworthiness. Brazilian statements and decisions indicate Bolsonaro “has decided to not respect his commitments on the climate, nor to involve himself on the issue of biodiversity,” Macron’s office said. It added that France now opposes the EU’s trade deal “in its current state” with the Mercosur bloc of South American nations that includes Brazil, Argentina, Paraguay and Uruguay. In Germany, Chancellor Angela Merkel views the fires as “shocking and threatening,” government spokesman Steffen Seibert said. Argentina, which is struggling with rising poverty and austerity measures, has offered to send emergency workers to Brazil and Bolivia to help battle the fires. Chile also offered aid. The Brazilian government has said European countries are exaggerating Brazil’s environmental problems in order to disrupt its commercial interests. Bolsonaro, who has said he wants to convert land for cattle pastures and soybean farms, said it was difficult to curb increasing deforestation with limited resources. “It’s not easy to fight deforestation, our Amazon area is bigger than all of Europe,” he said. “We’ll do what we can to fight this crime.” ___ Associated Press journalists John Leicester in Paris; Science Writer Seth Borenstein in Washington; Marcelo Silva de Sousa in Rio de Janeiro; Juan Karita in Santa Cruz, Bolivia; Pedro Servin in Asunción, Paraguay; and Christopher Torchia in Caracas, Venezuela, contributed to this report.


Study suggests sildenafil may relieve severe form of edema in swimmers

Explanation: This news release describes a small study of individuals prone to swimming-induced pulmonary edema (SIPE, fluid in the lung) that found that giving them a dose of sildenafil (sold under the brand name Viagra) dilated blood vessels and prevented the cold water-induced constriction that may cause the problem. The study involved 10 individuals with a history of SIPE and 20 control subjects. The news release, based on the study published in the journal Circulation, describes the condition and the study parameters nicely but then overwhelms the cautionary comments appropriate for such a modest design with an enthusiastic testimonial from a participant who felt the medicine was a life-changer. The release would be stronger if it had added some quantification of the benefits and relied less on a patient testimonial to make its case. A treatment for swimming-induced pulmonary edema likely won’t matter to most of us recreational swimmers since the incidence of the condition seems low and confined to serious, competitive swimmers and divers. However, the subset of individuals diagnosed with the problem may find the availability of a medication attractive — if it stands up to the rigor of larger studies.

Cost is not mentioned in the release. Although the press release indicates that measures of pulmonary arterial pressure “were no longer as elevated” in individuals who received sildenafil, the document got no more specific than that. The author described the benefit very vaguely in this statement: “It appears that the drug, which dilates the blood vessels, could be creating more capacity in the blood vessels in the arms and legs, reducing the tendency for blood to redistribute to the thorax, and therefore reducing the high pressure in the pulmonary vessels.” We’re also concerned with the glowing anecdote that the release uses to illustrate the drug’s benefits. The study itself looked at pulmonary arterial pressure and had nothing to say about sildenafil’s ability to prevent bouts of SIPE during competition. Nevertheless, this study participant gushes, “I have successfully raced in 20 triathlons since I started taking sildenafil, including five ultra events that require 10-kilometer swims,” Calder-Becker said. “I have not had an incident since then. I didn’t want to give up racing — this is something my husband and I do together, and we travel together to competitions — so it has meant everything to me to continue.” The anecdote goes well beyond the limited parameters of the study and overwhelms any cautions regarding the limitations of current evidence. Although the study itself is silent on the potential harms seen in the subjects treated with sildenafil, we think that the story should have noted that explicitly. Are four-hour erections an issue that swimmers need to be concerned about? Harmful side effects of ingesting sildenafil certainly exist but are not broached here. The news release describes the published study in some detail, and the first author goes on record calling for larger studies “to replicate the results and learn more about possible adverse side effects of the drug.” The release offers no information about the incidence of this condition among swimmers and divers and, because this condition is rare, it could unnecessarily raise some alarms. And while it makes clear that the symptoms of swimming-induced pulmonary edema “often” disappear over the course of 24 hours in the subset of swimmers and divers who have the condition, it also notes that the problem can be fatal, again without providing any incidence data. The reader will likely be more concerned than she or he should be. The funders are mentioned, although the release makes no effort to clarify possible conflicts of interest. The study on which this news release is based states that the principle investigators have no conflicts of interest. Information about possible treatment alternatives (for example, diuretics or oxygen) is not provided. The very first sentence of the release characterizes sildenafil as “readily available.” Indeed it is. It is Viagra ™. The release notes that the drug is already used as a treatment for another lung condition — pulmonary arterial hypertension — so this application would be an extension of sildenafil to another lung condition. Health professionals have speculated in the past on the ability of drugs such as sildenafil to help individuals cope with swimming-induced pulmonary edema. The published research notes that this study tested that hypothesis. We found no language in the release that was clearly out of bounds. As noted above, however, we’re concerned that cautionary language is overwhelmed by an enthusiastic testimonial from a swimmer who believes she has benefited from using the drug.


Hallmark greeting cards are made in China.

Explanation: What's true: Certain Hallmark greeting cards and keepsake ornaments that require handwork such as beads or tassels are made in China. What's false: However, the majority of Hallmark greeting cards are made in Lawrence, Kansas, U.S.A.

In 2020 an old rumor started to recirculate on social media claiming that Hallmark greeting cards were made in China and that citizens of the United States should spend their money on products made in America. It frequently spread via text-only posts on Facebook that lacked any supporting information. The claim that Hallmark makes its cards in China has been circulated for years by those urging people to buy American, but it saw a resurgence in 2020 as some Americans became critical of China for its handling of the COVID-19 coronavirus disease pandemic and as anti-Chinese sentiment grew. Regardless of how long this rumor has been around, there is little truth to this claim. The majority of Hallmark cards sold in the United States are made in Lawrence, Kansas. Hallmark explains on its website: Most Hallmark greeting cards sold in the United States are produced here by Hallmark employees in our greeting card production center in Lawrence, Kansas. Hallmark cards with specialized processes, such as die cut, glitter, flock and foil stamp are produced in Lawrence. Most of Hallmark wrapping paper, ribbons and bows are made at our manufacturing plant in Leavenworth, Kansas. Some Hallmark products, however, are produced overseas:


Genetic tests detect new way to fight war on breast cancer

Explanation: The story discusses new genetic tests that may help some women with early-stage breast cancer determine their risk of recurrence, and thus help with decisions about chemotherapy. More tailored (often less) chemotherapy is a newer idea for women who may not benefit as much from more aggressive treatment. A favorable score on a genetic test does not mean a woman at lower risk will not benefit at all from chemotherapy; she may, in fact, benefit some over the long term, but not as much as a woman with a higher chance of cancer recurring. Also, a woman's values and ability to live with a certain amount of risk, though small, is still part of the decision to have chemotherapy or forgo this treatment. The story presented no quantitative evidence for the Oncotype Dx test, which was the main focus of the story. It only said the test had been independently validated via a peer-reviewed process, and that it had been used on over 17,000 women. This test is validated only for women with node-negative breast cancer whose tumors are estrogen receptor-positive. The story does not mention that the test is time-sensitive and must be used within six months of diagnosis. The story emphasizes the cost of Oncotype Dx and notes that this may make it prohibitive for some women whose health insurance does not cover the test. The story is balanced and does not appear to be taken from a press release. A breast cancer specialist, a public health researcher, breast cancer patients and the CEO of Genomic Health, makers of Oncotype Dx, provide perspective on genetic testing as an aid in decision-making for breast cancer treatment .

The story mentions the cost of this genetic test, as well as the issue of insurance coverage. The story didn't quantify any benefit from the use of the test. The story does not mention potential harms of genetic testing. A favorable score does not mean an individual woman at lower risk will not benefit at all from chemotherapy; she may benefit some over the long term, but not as much as a woman with a higher chance of cancer recurring. Also, a woman's values and ability to live with a certain amount of risk, though small, is still part of the decision to have chemotherapy or no chemotherapy. Decisions for chemotherapy are not based solely on the results of Oncotype Dx. Most of the story is devoted to the Oncotype DX test. The story only mentions that the test has been independently validated via a peer-reviewed process and it has been used on over 17,000 women. But it doesn't quantify any of the evidence for the test or from the use of the test. The story does not engage in disease mongering. The story provides accurate American Cancer Society statistics on breast cancer incidence and mortality. The story is balanced. A breast cancer specialist, a public health researcher, breast cancer patients and the CEO of Genomic Health, makers of Oncotype Dx, provide perspective on genetic testing as an aid in decision making for breast cancer treatment. The story explains that the Oncotype DX test "is among the tools making their way into doctors' hands and patients' lives as new technology emerges from genetics research. The tools, which include screening tests and targeted drugs, help doctors tailor treatments for breast and other cancers." It also mentions the BRCA blood test and another test under development, OncoVue. The story explains that "The test's manufacturer says Oncotype DX has been performed on about 17,000 women. It is among the tools making their way into doctors' hands and patients' lives." The story mentions that the cost of Oncotype Dx may make it prohibitive for women whose health insurance does not cover the test. This test is validated for women with node-negative breast cancers that are estrogen receptor-positive, and when Oncotype DX is used within six months of diagnosis. The story does not mention that it is time-limited. The story mentions a new genetic test that can help some women with early-stage breast cancer determine their risk of recurrence and thus help with decisions about chemotherapy. More tailored (often less or forgoing) chemotherapy is a newer idea for women who may not benefit as much from more aggressive treatment. There are several sources cited who provide prospective on genetic tests such as Oncotype Dx. Information does not appear to be taken directly from a press release.


Stem Cells May Safely Restore Motor Function In Patients Suffering From Disabilities After Stroke

Explanation: Drawn substantially from a feature-style news release issued by Stanford University’s School of Medicine, this story describes results of a trial in which modified human stem cells were injected into the brains of so-called “chronic” stroke patients. The results, which study authors called promising, showed the injections were safe. The stem cells–as expected–survived only briefly, but the researchers report that there were “clinically meaningful results” in which some patients (it’s unclear how many) recovered “significant” motor function. The story states the total number of patients (18), their age range (average age was 61), but it’s missing hard information about the range of specific improvements, along with any interviews from researchers independent of this study or medical center. An estimated 800,000 people in the U.S. experience an ischemic stroke each year, and most of them have permanent motor deficits unless treated with drugs within a few hours of the stroke. Given that this pilot safety study showed improvements in patients whose first-ever strokes occurred from six months to three years before treatment with mesenchymal stem cell injections, millions of people with stroke disability could potentially realize some restored function if the current research is borne out in further studies.

Because this story involved an experimental therapy in an early phase trial, formulating a probable cost of the treatment is premature. The story would have been strengthened, perhaps, by some indication of what stroke care and disability costs in lost productivity and health care expenses in the U.S. The story is clearly upbeat about the promise of the therapy and uses a great deal of positive language from the news release. But the story did not really quantify the results in a way that would give readers a sensible picture of just how many of the 18 could “walk again” and what exactly the metrics used to assess results consist of. The article duly noted side effects. It’s worth pointing out that the study only followed patients for about a year, and long-term effects are unknown and could be more severe. The article does not adequately describe the quality of evidence. We’re told there was a trial, but not that it was done on a small number of patients chiefly to establish safety. The story would have been stronger on this criteria if it had, for example, used this researcher’s quote from the news release: “This was just a single trial, and a small one. It was designed primarily to test the procedure’s safety.” No mongering here. As noted above, this article appears to have been drawn substantially if not exclusively from the news release, although the writer appears to have interviewed the principal investigator; but it offers not a single source outside of the investigators who presumably approved the news release issued by Stanford. There is disclosure about industry funding in the news release, but none at all in the article. The article would have gone a long way to put credibility and context into a genuinely promising experimental therapy if it had sought comment from an independent stem cell therapy researcher. Although the article mentions there are “therapies” that help after a stroke, it does not mention what these are, how often they succeed, how often they fail, or their costs. The article notes that the investigators are planning a larger trial of the procedure. We’ll give this a Satisfactory rating here because the article does make the point that the stem cell therapy trial in question does demonstrate safety and some efficacy; and it also notes that the benefits were detected regardless of the severity, duration, or location of the stroke in the test population. And it does well by mentioning that previous research showed the stem cells used can “treat” brain cell damage caused by loss of oxygen, essentially what happens in an ischemic stroke. The article could have done better by saying whether that past research was done in lab-grown cells or in animals. Because the story includes an interview with the lead researcher–with quotes not found in the news release–this is Satisfactory. However, that’s about the only information in the story not found in the news release, so this is a barely passing scenario.


We’ve doubled the production of clean energy.

America’s recovery from the Great Recession is slow but steady, President Barack Obama said in a recent speech, and the country is headed in the right direction, thanks in part to his energy initiatives. He told students at Pellissippi State Community College in Knoxville, Tenn., on Jan. 9, 2015, the United States is now the world’s No. 1 producer in oil and gas -- a statement we’ve researched in the past and rated True -- and touted a move to more renewable resources. "We’ve doubled the production of clean energy," Obama told the crowd. There was no time frame given or any indication of what he considered clean energy, but PolitiFact wondered whether that was true. And if it was, could he take credit for it? Generating interest The White House specified Obama was referring to solar, wind and geothermal (harnessing power from heat generated under the Earth’s crust), but omitted any specific time frame. We can go ahead and assume they mean since the beginning of Obama’s first term, but the definition of renewables needs some explaining. The U.S. Energy Information Administration considers renewable energy as coming from any source that is "naturally replenishing but flow-limited," meaning there are limits on how much energy can be derived from the source at once. This also includes biomass fuels, like burning wood and solid waste, and hydroelectric power. States often don’t classify hydroelectric as renewable for several reasons, including substantial infrastructure requirements and the disruption of water ecosystems. Many states also don’t count hydroelectric in order to pressure utilities to increase renewable energy resources beyond existing hydroelectric facilities. It’s important to note that promoting renewable energy was a major focus of the American Recovery and Reinvestment Act passed by the Democrat-controlled Congress in February 2009 to help spur the economy in the wake of the recession. Obama signed the bill, which contained some $90 billion for energy-related investment, reimbursements for installations, a reauthorized loan guarantee program and tax credits. One of the goals was to double renewable energy generation by 2012. Since the administration mentioned those three energy sources as their definition of "clean energy," they are the ones we asked the Energy Information Administration about. Spokesperson John Cogan provided this information for the existing net summer capacity of energy production types in megawatts: Year Wind Solar, Thermal and Photovoltaic Geothermal Total 2007 16,515 502 2,214 19,231 2008 24,651 536 2,229 27,416 2009 34,296 619 2,382 37,297 2010 39,135 866 2,405 42,406 2011 45,676 1,524 2,409 49,609 2012 59,075 3,170 2,592 65,377 Now, don’t go thinking we’re all suddenly living emission-free and the specter of global warming due to greenhouse gases is a thing of the past. The country still uses fossil fuels like coal, petroleum and natural gas for most of its electricity needs, about 68 percent as of June 2014 (the EIA says wind, solar and geothermal generated less than 5 percent in that time frame, up from about 1.5 percent in 2008). Still, that’s a marked decrease in fossil fuel use, which was around 85 percent in 2008. Also, we can’t completely ignore hydroelectric and biomass sources. Those sources are considered renewable even if they weren’t named by the White House, but their use has not doubled since 2008. Both have remained basically flat in that time period. So can Obama take credit for this spike in renewable energy resource use? Joseph Aldy, former special assistant to the president for energy and environment in 2009-10 and currently an assistant public policy professor at Harvard, says yes, arguing the combination of tax credits, grants and guaranteed loans for renewable energy projects helped boost providers through tight credit and labor markets. Current production far exceeds Energy Information Administration projections from 2009, he told PolitiFact. Susan Glickman, the Florida director of the pro-renewables Southern Alliance for Clean Energy said some expansion would have happened anyway, since costs have gone down, particularly for wind and solar. But not only did the Recovery Act spur growth for renewable energy, the residual effects have continued. The 2013 National Renewable Energy Laboratory report bears out these growth trends, which have been fueled by federal incentives, she said. Our ruling Obama said, "we’ve doubled the production of clean energy." The White House said he was referring to wind, solar and geothermal, which are three types of renewable resources promoted in the American Recovery and Reinvestment Act of 2009. The Energy Information Administration confirmed that capacity had basically doubled between 2009 and 2012, accomplishing Obama’s goals. Renewable resource advocates also agreed that the Recovery Act contributed to that growth. Obama didn’t mention, however, that so-called "clean energy" still accounts for a sliver of U.S. energy production, which overwhelmingly relies on fossil fuels. Nor does it include other kinds of renewable energy, such as biomass and hydroelectric, which have remained relatively flat. We rate the statement .


In 1983, US children got 10 vaccines and the autism rate was 1 in 10,000.

Explanation: We don’t know exactly how prevalent autism was in 1983. There were around five vaccines involving 11 doses recommended for children in the US back then.

In 2008, US children got 36 vaccines and the autism rate was 1 in 150. US children were recommended to get around 13 vaccines, which involved about 39 doses, in 2008. It was estimated that about 1 in 88 children has autism disorders. In 2013, US children got 46 vaccines and the autism rate was 1 in 88. US children were recommended to get around 13 vaccines, which involved about 53 doses, in 2013. In 2012, 1 in 69 were estimated to have autism disorders and in 2014, it was 1 in 59 (we found no figures for 2013). Increasing numbers of vaccines are associated with increasing rates of autism. Dozens of scientific studies have shown there is no link between autism or autism spectrum disorders and vaccines. Claim 1 of 4


Bayer, Novartis clash with UK doctors over use of cheap eye drug.

Explanation: Bayer is weighing legal action and Novartis has expressed concern at plans by doctors in the north of England to defy official guidance by using a cancer medicine as a cheap eye drug.

Doctors from 12 clinical commissioning groups (CCG) plan to make Roche’s cancer therapy Avastin the preferred option for wet age-related macular degeneration (AMD), even though it is not licensed for this use. AMD, which occurs when the macula is unable to function properly, is a common cause of sight loss. David Hambleton, head of the South Tyneside CCG, said the policy of using Avastin rather than Bayer’s Eylea or Novartis’s Lucentis could save the regional National Health Service (NHS) 13.5 million pounds ($18 million) a year. “Clinical safety and effectiveness are paramount but, as the legal guardians of finite NHS resources, we commissioners also have a duty to act efficiently, effectively, and economically,” he wrote in the British Medical Journal on Wednesday. “This is one choice that is morally, ethically palatable.”  Across England, savings from using Avastin could total more than 500 million pounds, the journal reported. The new policy from the North East and North Cumbria CCG Forum means doctors will tell patients that Avastin is the preferred choice, although they are still free to choose Eylea or Lucentis if they want. However, doctors prescribing Avastin for AMD will be using the medicine “off label”, which goes against guidance from the General Medical Council that a licensed product should be used when available. While Avastin works in a similar way to Eylea and Lucentis, for a fraction of the price, Bayer and Novartis said it had not undergone the same rigorous regulatory scrutiny for use in AMD as their products. “Bayer feels it has to act to challenge the decision taken by these CCGs. Bayer is currently considering its position including the possibility of legal proceedings,” the German company said in an emailed statement. Novartis said the move was “not in line with the current UK and EU legal and regulatory framework”. The issue of whether Avastin should be used as a cheap alternative in AMD has long been controversial in Europe. In 2014 in Italy, Roche and Novartis were accused of collusion in trying to impose the use of Lucentis in AMD - a charge the two companies denied.


Of the 98 top oxycodone-dispensing doctors who used to live in Florida, "today, there are none.

Criminal Justice, Drugs, Public Safety, Florida, Pam Bondi,

Attorney General Pam Bondi has launched her re-election advertising campaign with a major milestone in Florida law enforcement: The death of the state’s infamous "pill mills." In a Sept. 8 TV commercial, the incumbent touts her record of overseeing the demise of rampant prescription drug abuse enabled by Florida doctors. "With our amazing law enforcement, we closed down the pill mills," Bondi said. "Of the top 100 oxycodone-dispensing doctors in this country, 98 of them lived in Florida. Today, there are none." That statistic implies Bondi was tough on crime, but PolitiFact Florida wanted to know if it was accurate. Closing the clinics The pill mill epidemic was a nationwide problem in 2010, driven by doctors who would write prescriptions and sell drugs out of clinics they owned themselves. Florida’s lax laws gave the Sunshine State a reputation for easy access to the drug, so much so that billboards advertised to "narco tourists" -- buyers from out of state who would come to Florida to buy the drug. With more than 1,000 pain clinics in operation across the state, Florida became known as the "Oxy Express." Bondi, who was elected in 2010, was a staunch supporter of HB 7095, a 2011 law that increased penalties for doctors who abused prescription privileges, banned them from prescribing drugs like oxycodone and strengthened state regulatory power over prescription pill trafficking. The bill passed both houses of the Legislature unanimously on May 6, 2011, and was signed by Gov. Rick Scott on June 3, 2011. Bondi’s camp told PolitiFact Florida the stat in the commercial came from the Statewide Task Force on Prescription Drug Abuse & Newborns 2014 Progress Report, which specifically dealt with the effects of opiate abuse by pregnant women on their children. The report credited changes in Florida law that shut down many clinics. "In 2010, 98 of the top 100 oxycodone pill dispensing physicians nationally resided in Florida," the report read. "In 2011, after the passage of HB 7095, only 13 of the top 100 resided in Florida, and by the end of 2012, not one Florida doctor appeared on the top 100 list." The report, which used figures that also were widely reported by the media, cited U.S. Drug Enforcement Administration data accessed January 2013. Bondi’s office also gave us a DEA press release from April 5, 2013, to back up that claim -- although that release said "90 of the top 100 oxycodone purchasing physicians in the nation were located in Florida." When we asked the attorney general’s office why there was a discrepancy in the numbers, they insisted the number was 98. The DEA stood firm, however: In 2010, the number was 90 of the top 100 oxycodone-purchasing doctors. The federal agency also told us the number of doctors in Florida in 2011, after HB 7095 passed, was down to 10 and not 13. But wait, Bondi’s commercial says "oxycodone-dispensing doctors," not "purchasing," as the DEA measured in 2010. That’s because the 2011 law no longer allowed physicians to simply buy the drug to resell, DEA public information officer Mia Ro told PolitiFact Florida. "When the Florida law changed, it prevented physicians from dispensing pills out of their clinics," Ro said. The agency doesn’t track "what’s filled or prescribed," she said. That means the DEA numbers weren’t tracking whether or not actual abuse had happened, just that Florida doctors were buying lots of oxycodone. Some physicians are still allowed to buy hydrocodone in large quantities, Ro said -- emergency room personnel, for example -- but private doctors could no longer buy the drug and sell it on their own. There was one unnamed DEA registrant from Florida who was in the top 100 oxycodone buyers in 2014, Ro said: A purchaser for a fleet of cruise ships, to use the drug in the fleet’s sick bays. That’s not to say pill mills weren’t a problem, or that the 2011 law didn’t make a difference. By the time HB 7095 was enacted, it was estimated as many as 11 people per day were dying from prescription drug abuse. From 2010 to 2012, overdose deaths from prescription drugs, illicit drugs and alcohol dropped nearly 17 percent, and overall prescription drug fatalities fell 23 percent, according to a Centers for Disease Control and Prevention report. About 52 percent of that decrease was in deaths from oxycodone. Our ruling Bondi said that of the top 100 oxycodone-dispensing doctors, 98 were in Florida, and "today, there are none." She cited DEA numbers that since 2010, the number of physicians who dispensed the most oxycodone in the nation and also lived in Florida had dropped from 98 of the top 100 to zero. The DEA told us there are a few problems with that stat. First, it was for the biggest purchasers of oxycodone, not dispensers -- the DEA said the list didn't track dispensation. Second, the number in 2010 was 90 and not 98, although the 98 figure was widely reported by the state and the media in the past few years. Third, in 2014 there was one top 100 oxycodone purchaser in Florida, a buyer for a cruise ship fleet. The DEA data only tracks top purchasers, not whether actual drug use decreased, but other sources confirmed oxycodone abuse is on a downward trend in the state, although there’s debate over whether a 2011 law Bondi supported is the sole factor. While the specifics are a bit off, the gist and context of what Bondi is saying is accurate: There are no more Florida pill mill doctors in the DEA’s top 100. We rate the statement .