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Medical studies: Evidence you can trust?

January 29, 2013 By 4 Comments

Evidence-based Living is built around the idea that scientific study should guide our lives – in decisions we make for our families, in community initiatives, and of course in choosing medical treatments.

A new review this month is the Journal of Oncology raises important questions about the validity of medical studies.  The report reviewed 164 trials of treatments for breast cancer including chemotherapy, radiation and surgery conducted from 1995 to 2011.

It concluded that: most of the studies were clouded by overemphasizing the benefits of the treatment, or minimizing potential side effects.

For example, they reported on 92 trials which had a negative primary endpoint – which essentially means the treatment was not found to be effective for the main goal of the study. In 59 percent of those trials, a secondary end point – another goal – was used to suggest the experimental therapy was actually beneficial.

And only 32 percent of the studies reported severe or life-threatening side effects in the abstract – where medical professionals who are scanning the report might miss them. Studies that reported a positive primary endpoint – meaning the treatment was effective for the problem that researchers were targeting – were less likely to report serious side effects.

What does all of this mean?

Elaine Wethington, a medical sociologist at the College of Human Ecology, says the review reveals some important findings about medical studies.

“I would speculate that the findings are due to at least three processes,” she explained.

“First, trial results should be published even if the primary outcome findings are negative, but it can be difficult to find a journal that will publish negative findings,” she said. “As a result, there is a tendency to focus on other outcomes that are secondary in order to justify the work and effort.

“Second, presentation of findings can be influenced by a variety of conflicts of interest. There is a lot of published evidence – and controversy — that scientific data collection and analysis can be affected by the source of funding, private versus public.

“Third, this could also be explained as a problem in scientific peer review.  Reviewers and editors could insist that this type of bias in reporting be controlled,” Wethington said.

In short, she sees the publication of this review as an important step in improving the scientific review process.

Filed Under: Evidence-Based Living, Health and Wellness, The Learning Center Tagged With: , ,

Hand sanitizer? Not to prevent norovirus

January 23, 2013 By 1 Comment

With all the recent reports about the flu, it’s not surprising that you find hand sanitizer everywhere these days – the supermarket, doctor’s offices, and in many homes. But is it as effective as regular old hand washing?

The New York Times Well blog recently provided a great evidence-based summary of why hand sanitizer is not as effective as hand washing with soap and water.

Essentially, studies show that hand sanitizer is not effective against all germs. One study of long-term care facilities found that facilities where staff members used hand sanitizer instead of hand washing were six times more likely to have an outbreak of norovirus – a stomach bug – compared with facilities where hand-washing was the norm.  That’s because hand sanitizer has been found to be  ineffective against the norovirus.

The take-home message: Hand sanitizer is better than nothing, but washing your hands is the best way to prevent the spread of germs.  For more information, the CDC offers an evidence-based guide to hand-washing.

Filed Under: Evidence-Based Living

The evidence on preventing weight gain

January 18, 2013 By 1 Comment

We’ve all heard extensively about the obesity epidemic that impacts millions of Americans, leading to heart disease, stroke and cancer, among other problems. And, of course, it’s the time of year when many of us make new year’s resolutions to lose weight, exercise more and generally improve our health.  But what methods work the best?

To answer that question, I dug up a systematic review of lifestyle changes to help prevent weight gain in people who were normal weight, overweight and obese. The researchers looked at 40 studies on a wide array of interventions including low-calorie diets, Weight Watchers, meal replacement, behavior therapy by trained nutritionists, low-fat diets, exercise programs and others.

The conclusion?  There are many effective ways to lose weight and prevent weight gain. Eight interventions yielded significant improvement in weight control .  These included low-fat diets with and without meal replacements, low calorie diets, Weight Watchers,  and diets with behavior therapy.

The review did not find enough evidence to support lifestyle interventions to prevent weight gain in normal-weight adults. It called for better study design as well as improved reporting of participant characteristics and outcomes in weight loss studies.”

The take-home message here: To lose or prevent gaining weight, your best move is to do something. Whether it’s diet, exercise, behavior therapy, or a combination of the three, it’s likely to yield results.

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: , , ,

Shocking evidence: Young Americans die at high rates

January 15, 2013 By 2 Comments

Young Americans are dying at higher rates than young people in any other country in the world – primarily as a result of gun violence, car accidents and drug addiction.  This startling piece of evidence comes from a sweeping new study sponsored by the Institute of Medicine and the National Research Council and conducted by a panel of experts.

The report – titled U.S. Health in International Perspective: Shorter Lives, Poorer Health – examines the body of research on life expectancy and health in America and 16 other “high-income democracies” including the United Kingdom, Germany, Canada, Australia and Japan.

The analysis found that Americans perform the worst in the world on nine health indicators including:

  • infant mortality and low birth weight
  • injuries and homicides
  • adolescent pregnancy and sexually transmitted disease
  • HIV and AIDS
  • drug-related deaths
  • obesity and diabetes
  • heart disease
  • chronic lung disease
  • disability

In fact, the U.S. ranked at the bottom on nearly every health indicator the panel reviewed with the exception of deaths from cancer that can be detected by tests, and blood pressure and cholesterol levels.

While the report offered some potential explanations for Americans’ poor health, there is no clear-cut evidence on how to fix the problem. The panel found that Americans have less access to health care compared to people in other countries, and that they suffer from higher rates of poverty and income inequality.

The panel also found that health behaviors are a contributing factor. Americans are more likely to abuse drugs, get involved in traffic accidents involving alcohol, use firearms in an act of violence, fail to wear a seat belt and consume high levels of calories.

This disturbing news should serve as a walk up call.  Clearly eating well and exercise are important, but there are economic and cultural issues at work that require a broader response.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , , ,

The case for taking aspirin

January 10, 2013 By 2 Comments

It’s always a pleasure to see a mainstream media outlet providing the big picture on medical therapies. So I was fascinated by a recent opinion piece in the New York Times which called for the increased use of aspirin.

In the article, cancer-researcher Dr. David Agus makes a clear case of the health benefits of aspirin. For years, the evidence has clearly established that aspirin reduced the risk of cardiovascular disease. In fact, he points out, the U.S. Preventative Services Task Force – an independent panel of health care experts – recommended aspirin for people up to 80 years old to prevent heart disease.

Now there is a growing body of solid evidence that aspirin also helps reduce the risk of cancer.  Several major systematic reviews found that people who take an aspirin a day over the period of several years reduce their risk of developing cancer.

One major systematic review published by British researchers pulled together data on more than 77,000 patients from 51 separate clinical trials. It found some striking results: people who took aspirin daily were 15 percent  less likely to die from cancer compared with those who didn’t take aspirin. They also had a 38 percent reduction in the risk of colorectal and gastrointestinal cancer. And for aspirin-takers who did get cancer, it was 38 percent less likely to spread to other parts of their bodies.

Other reviews have found that aspirin use not only reduces the risk of colorectal and gastrointestinal cancer but also decreases distant metastasis, the spreading of cancer to new regions of the body.

The take-home message: While people have been using aspirin for thousands of years, it was likely to be providing more health benefits than were ever realized.

Filed Under: Evidence-Based Living, Health and Wellness, policy Tagged With: , ,

The consequences of child abuse and neglect

January 8, 2013 By 1 Comment

Here at EBL, we’ve written before about the horrible consequences of child abuse and neglect.  The statement we made before remains true: No one needs an academic study to understand that abuse and neglect take a terrible toll on young people, their families, and our society.  But it is helpful to understand the specific effects this behavior causes.

A new systematic review examines the long term impacts of  physical abuse, emotional abuse, and neglect in childhood on later mental and physical health.  The review synthesized data from 124 studies that followed victims of child maltreatment later in life.

The findings demonstrate  significant associations between physical abuse, emotional abuse, and neglect with mental health conditions including depression, anxiety, and suicide attempts. The researchers estimate that all three forms of maltreatment double the risk of developing a mental health disorder later in life.

Adults who were victims of child maltreatment were also more likely to use drugs, to engage in risky sexual behavior, and to contract sexually transmitted infections. Additionally, research has found a possible relationship with chronic diseases and other physical health outcomes, but the evidence is sparse and not consistent across types of maltreatment. The authors said more research is needed to better understand these consequences.

At Cornell’s College of Human Ecology, researchers manage a project called the National Data Archive on Child Abuse and Neglect (NDACAN). The project, which is housed in the Bronfenbrenner Center for Translational Research, makes existing child maltreatment data available to qualified researchers so that they can conduct their own original research and learn more about the costs, consequences, and prevention of child maltreatment. Datasets at NDACAN include large-scale surveys and annual federal efforts collect data from official child abuse and neglect reports and about maltreated children living in foster care.

“The Archive is an important tool that allows social scientists to replicate and expand on our scientific knowledge base,” said Elliott Smith, Associate Director of NDACAN.

The take home message: All forms of child abuse and neglect have serious ramifications that last throughout the life-span.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , ,

Exciting Changes at Evidence-Based Living

January 4, 2013 By Leave a Comment

It’s hard to believe that it has been four years since we started this blog! Over that time, we’ve seen our number of readers grow astronomically. We now have more than 8,000 visitors per month. It’s wonderful to see so much interest in how research can help us understand and enhance our everyday lives.

As our audience grows, we are looking for ways to bring in more expert opinions and include evidence on an even broader range of topics. So we’re pleased to announce that he Bronfenbrenner Center for Translational Research – an exciting new center at Cornell – will be sponsoring the blog.

Known as the BCTR, the center was created to advance research that helps solve human problems across the lifespan, from young children to older people. A host of projects look at ways to promote optimal human development throughout life. With a staff of over 60, the expertise available in the BCTR covers the areas you have come to expect from Evidence-Based Living: health, psychological well-being, child-rearing, nutrition, and many others. [Read more…]

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Evidence-based fitness tips from the Olympics

January 2, 2013 By 4 Comments

It’s that time a year again when so many of us pledge to lose weight, get fit and generally improve our health.  Advice about dieting and exercise abounds.  Here on EBL, we’ve written about the evidence on diet and exercise many times before.  But there is always something new to learn. Last month, the British Medical Journal published two new studies on the long term health of Olympic athletes that sheds some light on fitness for the rest of us.

The first study examined more than 15,000 Olympic medalists from nine countries who competed in the Summer or Winter Olympics since 1896, when the modern Olympics began. The study compared the athletes to similar groups of people in the general population to determine which group of people lived longer.  The study found that medalists lived an average of 2.8 years longer than their peers in the general population. But the interesting part came when the researchers divided the Olympians into groups by sport.

Olympians in endurance sports – such as running, cycling and rowing – and technique-based sports – such as golf, table tennis and even croquet –  has the longest lifespans – about 13 percent more of them were alive 30 years after the Olympics compared with the general population.  On the other hand, Olympians in power sports – such as weight-lifting and discus – has shorter lifespans, with only 5 percent more living longer than their counterparts.

The second study examined nearly 10,000 Olympians  —participants as well as medalists — to compare the lifespans of athletes in sports with low, moderate or high cardiovascular intensity.   The study found that athletes in more strenuous sports had no longer lifespans than athletes in less strenuous sports. It did find that those who competed in contact sports or sports with frequent crashes –  think rugby, bobsledding and boxing – had shorter lifespans compared to other Olympians.

There are a few take-home messages from these studies that you can apply to your own New Year’s resolution:

  • Power exercises such as weight-lifting don’t appear to be as beneficial as cardiovascular exercise.
  • The intensity of cardiovascular exercise doesn’t seem to matter. Walking is as good for you as running.
  • Sports that involve heavy contact or crashes are not as beneficial.

Happy New Year, and good luck with your own resolution!

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: ,

How to talk to your kids about violence

December 17, 2012 By 5 Comments

The tragic school shooting in Newtown, Connecticut last week has ignited emotions in people across the nation. Many feel sorrow at the loss of so many young lives and such dedicated educators. Some feel angry at the reoccurrence of this type of violence and angry about the proposed solutions to prevent future tragedies. And many parents are worried about the safety of their own children and wondering about the best ways to talk with their children about this kind of violence.

Most of the broader issues surrounding the shooting – e.g., gun regulations, school security measures and mental health care – are incredibly complex and too politically-charged for EBL to unravel at this point. We can weigh in on what the evidence says about helping children understand and cope with traumatic events.

We have compiled a list of tips and evidence-based advice about explaining trauma and violence to children. Here are some of the highlights:

· Find times when children are most likely to talk, such as during a car ride or dinnertime.

· Start the conversation by letting them know you’re interested in how they are coping.

· Listen to their thoughts and point of view without interrupting before you respond.

· Tell them you are there to provide safety, comfort and support.

You can find more comprehensive advice at:

· The American Academy of Child and Adolescent Psychology

· The American Psychological Association

· The National Center for Toddlers, Infants and Families provides great advice for younger children.

· The Kaiser Family Foundationoffers advice for helping school-aged children cope.

· The National Association of School Psychologists offers advice on discussing school violence specifically.

It is sad that parents need to explain such horrific events to their children. But because this kind of violence does happen in our society, the best action parents can take is to consider the evidence when having these difficult discussions with their children.

Filed Under: Evidence-Based Living

A flexible work schedule: It’s good for you!

December 11, 2012 By Leave a Comment

Although working a 9 to 5 schedule used to be the norm, more people than ever before are able to choose the hours they’d like to work, at least to some extent. Personally, I have a flexible working schedule, and I find immensely helpful for balancing work and family life. But do flexible schedules make a tangible difference in people’s lives?

According to the evidence, the answer is yes. A systematic review published by the Cochrane Public Health Group found tangible benefits for workers who have choices about and control over their own schedules.

The researchers searched 12 databases and found 10 studies that evaluated the effects of flexible working arrangements on employee health and well-being.

The review found that workers who were able to schedule their own shifts or had the option for partial or early retirement were healthier and reported a stronger sense of community. They fared better on a wide range of health indicators including systolic blood pressure and heart rate, tiredness, mental health, and sleep quality and alertness.

The studies of other working arrangements – including overtime and fixed-term contracts – found no significant effects on physical, mental or general health.

The review concluded, on the whole, that having flexible schedules is likely to have positive effects on the health and wellbeing of workers. That said, the review only included a small number of studies, and many of them had methodological limitations.

While flexible working schedules appear to make a real difference, researchers need to continue studying the topic to find out for sure.

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The evidence shows preschool matters!

December 6, 2012 By 1 Comment

We have heard educators and politicians alike tout the virtues of early childhood education, and how it prepares kids for a lifetime of learning. With one of my own children in preschool and another one headed there shortly, I’m always interested in the evidence on this stage learning. Do activities like playing with blocks and paints, sitting through circle time and learning to share really impact a child for the rest of his life?

So I was fascinated to follow a series of reports on National Public Radio that detail some interesting evidence about preschool programs. While these reports didn’t include a systematic review, they did include several different longitudinal studies that make an interesting case about the importance of preschool.

On the show This American Life, host Ira Glass talks with a range of experts – a journalist, an Nobel-prize winning economist and a pediatrician – about the evidence on what researchers call “non-cognitive skills” like self-discipline, curiosity and paying attention.

One of the leading experts in this field is an economist at the University of Chicago named James Heckman. His work has found that these soft skills are essential in succeeding in school, securing a good job, and even building a successful marriage. Heckman found that children learn these skills in preschool.

One well-known longitudinal study followed a group of low-income 3- and 4-year-olds in Ypsilanti, MichiganThese children were randomly assigned to attend preschool five days a week, or not attend any preschool.  After preschool, all of the children went to the Ypsilanti public school system.

The study found  that children who attend preschool were more successful adults. They were half as likely to be arrested and earned 50 percent more in salary. Girls who attended preschool were 50 percent more likely to have a savings account and 20 percent more likely to have a car.

Another similar project conducted in North Carolina found that comparable results: Individuals who had attended preschool as children were four times more likely to have earned college degrees, less likely to use public assistance, and more likely to delay child-bearing.

There is more evidence too.  NPR’s Planet Money aired a show  earlier this year demonstrating further evidence about the benefits of preschool.  And researchers at the University of Texas in Austin found that preschool reduces the inequalities in early academic achievement.

The take-home message seems to be: Preschool matters!

Filed Under: Evidence-Based Living, Youth Development Tagged With: , , , , ,

HIV screening is essential

November 30, 2012 By 1 Comment

A new report from the U.S. Centers for Disease Control this week gave me pause: There are 60,000 new HIV infections in the U.S. each year. Nearly 25 percent of new HIV cases occur in people ages 13 to 24, and more than half of them don’t know they are infected. That means each year, more than 7,000 teen-agers and young adults contract a chronic, fatal disease without realizing it.

The good news is, researchers are uncovering new evidence on the best ways to help those newly-infected with HIV. Two new systematic reviews found broad-based routine screenings for HIV can help reduce the spread of the virus, and that screening during pregnancy helps reduce the chance the HIV virus will be transmitted from mother to child. Both were published in the Annals of Internal Medicine.

The first review included randomized trials and observational studies that compared HIV screening strategies, evaluated the effects of starting anti-retroviral therapy at different stages of the disease or reported how these kinds of interventions impacted the risk of transmission.

It concluded that only screening groups of people with a high risk of contracting HIV misses a substantial proportion of cases. Broad-based routine screening for HIV allows more people to start anti-retroviral therapies early in the course of HIV infection. This reduces their risk of sickness and death, and also reduces transmission of the virus to others.

The second review focused specifically on HIV-positive pregnant women. It included randomized trials and longitudinal studies that investigated the risks for a mother transmitting HIV to her unborn child, and the effects of prenatal HIV screening or antiretroviral therapy during pregnancy.

The review found that women who take antiretroviral therapy, avoid breastfeeding and elect to have a cesarean section reduce their risk of transmitting HIV to their child.

The bottom line: Contracting the HIV virus is still a real risk today, but routine screening and early treatment can make a positive impact on the health of HIV-positive patients and reduce the spread of the disease.

Editor’s note: Cornell’s Bronfenbrenner Center on Translational Research will offer streaming sessions from the 2012 International AIDS Conference.

What: Turning the Tide on HIV/AIDS: 2012 International AIDS Conference
When: 8:30 a.m . to 4:45 p.m. on Friday, December 7, 2012
Where: 102 Mann Library
Topics: Preventing mother-to-child transmission; structural inequalities and their impact on the HIV epidemic; strategies for “turning the tide together.
Visit the BCTR web site for more information.

Filed Under: Evidence-Based Living, Health and Wellness, policy Tagged With: , , ,
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