Evidence-based energy: What we really know about hydraulic fracturing

A newer method for extracting natural gas from layers of shale deep below the earth’s surface – called hydraulic fracturing or hydrofracking – has ignited debates across the nation. Proponents say that natural gas key to the country’s energy future. (Burning natural gas produces fewer greenhouse gases emissions than coal and oil.) But opponents say this method for extracting it poses risks to ground water supplies.

Over the past several years, Cornell researchers have mounted an unprecedented response to the issue. They’ve stepped up research efforts to collect and develop as much evidence as possible about hydrofracking. And they are reaching out to help individuals and communities across New York to help them make decisions about the benefits and dangers of drilling.

They have created the Cornell Cooperative Extension Natural Gas Resource Center, which is made of a 12 faculty members from a wide array of disciplines—including sociology, environmental sciences, and geology—and 20 extension educators. The group has compiled information for people impacted by hydraulic fracturing including individuals considering leasing their land, community groups, and local governments.

The Resource Center’s web site is a treasure trove of information on the topic including how geologists use seismic data to determine if natural gas is accessible, how to negotiate a lease for gas drilling and the economic impacts of drilling.

If you live in an area where natural gas drilling is a possibility, you’ll definitely want to dig into this resource.

A new federal report: Vaccines and serious side effects

It’s a debate that has raged for decades – whether vaccines lead to serious side effects – and specifically whether the combination vaccine to prevent measles, mumps and rubella causes autism in children.

The federal government has investigated the risk of vaccines a dozen times in the past 25 years to determine what the evidence says on the issue. Their latest report, written by a committee at the Institute of Medicine and released last week, found no evidence that the MMR vaccine causes autism.

The report reviewed eight vaccines in total that are recommended by the U.S. Centers for Disease Control. For each vaccine, a committee of medical experts reviewed adverse events associated with vaccines to evaluate the scientific evidence about whether the event was related to the vaccine.

The committee did find evidence for some adverse events related to vaccines. For example, people who have had the chickenpox vaccine can develop pneumonia, meningitis or hepatitis late in life if they suffer an unrelated illness, such as cancer, that compromises their immune systems. And the HPV vaccine rarely causes a life-threatening allergic reaction.

The committee also found the evidence rejected five adverse relationships related to vaccines, including the link between the MMR vaccine and autism.

But for the majority of adverse events, the committee could not find enough evidence to determine whether vaccines contributed to the problems or not.  Often times, this was because the event was extremely rare, making it difficult to study.

You can read a summary of the report, with information about all of the vaccines studied, by clicking here.  The bottom line is, it’s important to understand the vaccines that you and your children are receiving, and be prepared for potential side effects that could occur based on the evidence.

Wash your hands! And other ways to ward off food poisoning

Following last week’s recall of 36 million pounds of ground turkey, we thought it’d be a good time to review the evidence on Salmonella poisoning.

According to the U.S. Centers for Disease Control, the bacteria Salmonella live in the intestinal tracts of humans and other animals, including birds. People usually contract the bacteria by eating foods contaminated with animal feces, which typically look and smell normal even though they are carrying the bacteria. Salmonella is also be found in the feces of pets, especially, reptiles and young birds.

An estimated 1.4 million people contract Samonella poisoning every year in the U.S.  A total of 107 cases in 31 states have been identified in the most recent outbreak spread by the ground turkey meat. Infection typically results in diarrhea, fever, and abdominal cramps 12 to 72 hours contact with the bacteria. The illness usually runs its course in 4 to 7 days, and most people don’t require treatment.  But severe cases require hospitalization for dehydration.

So what’s the best way to prevent the spread of Samonella?  The evidence shows there are some simple steps you can take to reduce your risk of Samonella poisoning.

  • Cook poultry, ground beef, and eggs thoroughly.
  • Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
  • Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.
  • Avoid direct or even indirect contact between reptiles and infants or immunocompromised persons.

Beyond these common-sense measures, researchers at Cornell are trying to do more. Two Cornell faculty members recently received a grant from the U.S. Department of Agriculture to study how tomato plants interact with the Samonella bacteria, with the hopes of eventually breeding new varieties of produce that suppress Samonella. 

Until then, keep up the hand-washing!

How to promote creativity among kids

Did you know there’s an evidence-based way to measure creativity? 

In the 1950s, a psychologist named Ellis Paul Torrance developed a series of tasks to measure creativity and gave them to 400 Minneapolis children. 

Scholars have followed the children since then and recorded all of their creative accomplishments – patents, research papers, art exhibits, business innovations, books, musical scores, and so on. Sure enough, the children who scored high on the tests showed the more creativity as adults as well. If fact, the correlation of test scores to lifetime creative accomplishment was more than three times stronger for childhood creativity than childhood IQ.

To date, the Torrance test has been taken by millions of people worldwide in 50 languages.  But recently, one researcher identified a disappointing trend. Kyung Hee Kim, a professor of Educational Psychology at the College of William and Mary, analyzed nearly Torrance scores of nearly 300,000 children and adults.  She found the scores had been steadily rising until 1990. Since then, creativity scores have consistently fallen every year. (Her work was famously documented in an article in Newsweek magazine in 2009.)

When Kim says creativity is declining, she’s not just talking about artistic ability, but a range of skills such as the ability to produce original ideas, see things from a different angle, elaborate upon ideas  and synthesize information.  (She explained all of the measures to Encyclopedia Brittanica.)

What does this mean?  Kim is the first to point out there’s more research needed.  But , based on her body of research on creativity, she does suggest some steps that parents and teachers can take to foster creativity among children.

  • Take the time to try to find the answer children’s questions and teach how to find their own answers.
  • Don’t always emphasize getting the “right” answers, but instead encourage inventiveness.
  • Encourage spontaneous and even silly play.
  • Foster independence.
  • Introduce children to different experiences including different places, cultures, food, languages, and people.

Feeling disgust? The evidence shows it matters

Experiencing something icky – the smell of vomit or the sight of maggots, for example – elicits an emotional response from most people.  It’s a feeling we call disgust, likely an emotion that evolved to discourage us from ingesting noxious or dangerous substances.

But a growing body of evidence on disgust shows that it now plays a much broader role in attitudes and judgments about everything in our lives – our food, our politics, even our relationships. David Pizzaro, assistant professor in psychology at Cornell, is making ground-breaking advances in this area.

Pizzaro’s has found evidence that individuals who are more easily disgusted in everyday life tend to have different moral and political views than those who are less easily disgusted. Subtle manipulations of disgust in the laboratory, such as a foul order, can temporarily alter people’s moral and political judgments.

One of his studies showed that people who feel disgust more readily have more unfavorable responses to homosexuals.  Two others demonstrated that individuals who feel disgust more readily are more likely to be conservative.

This research shed lights on how basic differences in emotion leads to variations in social and political ideals that make up the fabric of our society. And provides concrete evidence that emotions play an important role in all of our lives.

You can listen to Pizzaro talk about his work on disgust by clicking on this link.

The royal wedding and the dieting bride

Okay, we admit it. EBL wanted somehow to join in the frenzy over the royal wedding. But where would scientific evidence come in? Maybe: Does research show that two kisses are better than one? Or: What’s the effect of differences in status between two partners on long-term survival of  a marriage? But no evidence-based approach to William and Kate surfaced.

Until I saw reference to the work of Cornell Professor of Nutrition Jeff Sobal in the context of William and Kate’s nuptials! Apparently (as you royal watchers will know), Kate lost a lot of weight prior to her trip down the aisle in Westminster Abbey, raising the eyebrows of the media. Is this common, many asked, or is something up with Kate?

As reported in the Boston Globe and other media outlets, Prof. Sobal has done ground-breaking work on the topic of obesity, and has written extensively on the topic of “weight and weddings” (including this book chapter).

In one widely-read article, Sobal and a colleague conducted a descriptive survey that looked at weight management behaviors among women getting ready for their weddings, as well as their ideals for body weight. Most of the soon-to-be brides were overweight and planned to lose pounds before the big day. Some purchased a smaller-sized wedding dress as a motivator. So Kate is well within the norm by slimming down before tying the knot.

EBL has only one question: Did the new Duchess of Cambridge follow an evidence-based diet? Now that she’s an example to the British and the world, we hope so!

The King’s Speech: What stuttering treatment works?

Many people loved the movie The King’s Speech. But few were more riveted to the screen than current or former stutterers – like myself. At some point in early childhood, I began to stutter when I said certain words. Unlike the King, I was pretty fortunate. For some reason, my playmates were generally supportive rather than tormenting and I don’t recall being teased about my fluency problems.

And I will be forever grateful to Dr. Wolfe, the speech therapist in the college town in which I grew up. I remember Dr. Wolfe as jolly fellow, who reassured us kids that we’d be fine, we’d probably outgrow it, but would we mind just trying this or that technique? He spiced up the lessons with trips into real-world settings, such as ordering in our local candy shop. The best part: I got out of school for the therapy sessions. Dr. Wolfe would have to be well into his 80s by now, so if you’re still around: Thanks!

Like many children who stutter, my speech became more fluent as I got older (possibly because of therapy, but a large proportion of children who stutter get better on their own). But having had an inspirational speech therapist myself, my Evidence-Based Living antennae began to hum, leading to the question:

What is the research evidence on the effectiveness of speech therapy?

In particular, what’s the evidence on behavioral therapy such as that practied by Lionel Logue, who actually was King George VI’s speech therapist? Of course, at EBL we know where to turn: To systematic reviews of the literature. Fortunately, a great review of stuttering treatment research exists – in fact, I suggest you look at it just because it is such a terrific example of systematic review.

Dr. Anne Bothe and colleagues looked at all published studies from 1970 – 2005. Articles had to be original research, they had to have measurable outcomes, and they had to meet a set of critera for good science (described in the article).

One interesting finding right from the start: Only 31 articles met the criteria for sound methods. So even in an area with so much interest as stuttering, very few studies exist that use randomized-controlled designs, have adequate controls for reliability and validity, and look at both short-term and long-term outcomes.  Another review by Nan Bernstein Ratner looks at various forms of treatment from a clinical perspective (2010).

There is so much that’s interesting in these reviews, I suggest you take a look. Scientists are continually finding out new things about why stuttering occurs, from the genetic component to the influence of brain structure and function. But in honor of The King’s Speech, what do the reviews say seems to work best for adults?

For adults, Rhode’s systematic review most strongly endorses what’s called fluency shaping. This treatment works to replace stuttering with more fluent speech (hence the name). And the extensive review Bothe et al. conducted shows that one particular type of fluency shaping really seems to work: prolonged speech. This therapy involves such techniques as managing the stream of breath, creating a more deliberate flow between words, and generally slowing the speech down. One problem with these programs is that speech sometimes doesn’t seem totally natural; the most effective programs use prolonged speech therapy combined with other techniques.

Now, that seems does seem somewhat like what King George VI got from Lionel Logue, after all.

If you have some time to kill, the Stuttering Foundation has some very reassuring information for the approximately 1% of adults who stutter: Lists of famous people who struggled with the problem. Did you know that stutterers include: James Earl Jones, Nicole Kidman, Marilyn Monroe, baseball player Johnny Damon, and writer John Updike?

(And here’s a disclaimer to prevent riled-up comments from the speech therapy world: I know there is a huge debate over what kind of therapy works best for stuttering. For those of you who are interested, the two reviews are a good place to start. Some places to go for descriptions of therapies are the National Institute on Deafness and other Communication Disorders (NIDCD) and the Stuttering Foundation.

Stroke or migraine? Serene Branson’s case makes people wonder

The video of reporter Serene Branson suddenly speaking incomprehensibly as she tried to report on the Grammy Awards brought out a fascinating – in in the digital age, typical – response. The first reaction on the part of many people was to think it was very funny. How often does one see a well-coiffed reporter saying what sounds like: “A very, very heavy birtation tonight, a very derri-derrison.”

But the public response quickly changed from laughter to deep concern. And then, the concern lightened a bit, as new information came in. Comments on these videos followed the public’s reaction. In response to one Youtube “remix” of her garbled speech, viewers wrote in this order:

“Hilarious!”

“Oh man she had a stroke…not funny.”

“She didn’t have a stroke, just a migraine.”

And in fact, the medical diagnosis turned out to be a “complex migraine,” and not a stroke.

All of this probably left many people wondering: How would I know if it’s a stroke or a complex migraine? This is a very important question, because stroke is a huge health problem in the United States: it’s the third leading cause of death and the primary cause of disability among adults. Medical treament of stroke is getting better and better, but all the experts agree that speedy treatment for stroke is extremely important.

A helpful review recently appeared in The Journal of Family Practice called “Is It Stroke, or Something Else?” Drs. Konrad Nau, Todd Corcco, Johanna Biola, and Hollyn Larrabee note that rapid response is crucial in cases of stroke, but it is complicated when people have conditions that mimic stroke.

One of these is complex migraine, which Serene Branson apparently suffered. Complex migraine can mimic stroke symptoms, including hemiparesis (weakness on one side of the body), vision loss, and aphasia (language problems). It’s the latter that was so obvious with reporter Branson. Usually a migraine comes on more slowly than a stroke and there is often a migraine “aura” that occurs prior to the episode. Age is also a factor: The average age for stroke is around 70, whereas complex migraines usually develop before age 40.

An easy-to-read article on the differences between stroke and complex migraine can be found here.

So what should we do? Fortunately, the answer is an easy one: All the experts say that if you have any of these symptoms (weakness on one side of the body, sudden trouble speaking, vision loss), seek medical attention immediately. This is one case where we can’t try to figure it out ourselves – get to your doctor or emergency room right away.

New federal diet guidelines follow the evidence

Here at EBL, we’ve discussed how difficult it is to figure out what nutrition advice to follow, especially when there’s so much health and nutrition advice in the media that refers to anecdotes and simplistic inferences from single studies.

For those looking for real evidence about what to eat, there’s some good news.  The federal government has issued new dietary guidelines based on an extensive evidence-based review.

The U.S. Departments of Agriculture and Health and Human Services appointed 13 nationally-recognized experts in nutrition and health to review the scientific literature on how nutrition impacts health and disease prevention.

The experts worked with a new resource – USDA’s Nutrition Evidence Library, a clearinghouse of systematic reviews designed to inform federal nutrition policy. (You can read more about the process the panel used to create the new nutrition guidelines by clicking here.) The library employs post-graduate level researchers with experience in nutrition or public health to build its content.  The researchers analyze peer-reviewed articles to build bodies of evidence, develop conclusion statements and describe research recommendations.  It’s an EBL dream! 

So what do the new guidelines recommend? 

The entire report from the committee of experts is more than 400 pages long, with specific advice on everything from energy balances to food safety.  Government officials distilled this report into 112 pages of dietary guidelines, and 23 recommendations for the general population. Among them are:

  • Focus on consuming nutrient-dense foods and beverages.
  • Reduce daily sodium intake to less than 2,300 milligrams (about 1 teaspoon).
  • Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars and sodium.
  • Eat a variety of vegetables, especially dark-green and red and orange vegetables, and beans and peas.
  • Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.
  • Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.

As you can imagine, the EBL team is thrilled that the government is using systematic reviews to make national diet recommendations.  They’re worth reading to see if you can improve your own diet.  Even small changes can make a big difference when you consider the evidence.

Does diet soda cause strokes? Nope!

I am guessing that many families reading the paper at breakfast today had this happen: Somebody said to someone else: “See, I told you drinking diet soda was bad for you!”

And that is because of a study reported widely in the media regarding the relationship between consumption of diet soda and stroke. Strokes are very bad things, often devastating the person to whom they occur, so a finding about anything that might increase our risk for stroke is worthy of notice.

 At Evidence-Based Living, one of the most fun things we do is to track back from the media coverage to the actual research findings. In so doing, we hope to help people figure out the nature of the evidence and whether we should immediately change our behavior. This was an unusually big story, and so we ask: Believe it or not?

First, let me say that media coverage was a little more measured than usual. Some news outlets did use headlines like that from Fox News: Diet Soda Drinkers at Increased Risk for Stroke” which make it sound like a firm finding (and probably led to some of the heated breakfast-table conversations). But many other outlets included the all-important “may” in the headline, and the articles themselves included qualifications about the study. 

So let’s take a look at this finding, using some of the key questions EBL recommends you always employ when you are trying to figure out whether a scientific finding should change the way you live. 

1. What kind of a study was this? Was it a good one?

 This is what scientists call an observational study. It was not a randomized, controlled experiment in which some people were asked to drink diet soda and others were not. It uses a longitudinal study called the Northern Manhattan study (or NOMAS). And yes, it is a very good study of its kind. It looks at stroke risk factors across white, black, and Hispanic populations living in the same community (northern Manhattan). It is a large and representative sample, followed up annually to determine if people suffered a stroke (verified by doctors on the research team). Many publications in top referred scientific journals have been published from the study (some of which are available for free on the website). 

2. Where did the information in the media come from? 

Here, in EBL’s opinion, is the first problem. The results were presented at a scientific conference this week (the American Stroke Association). This is not the same as being published in a referred scientific journal. In addition, we cannot follow an EBL cardinal rule: Go to the original article. The only information that is available on the study is from a press release issued by the association and subsequent interviews with the study’s lead author and other experts. So we need to wait until the results are published before we even think of changing our behavior in response to them. 

3. Are the results definitive?

No, no, and again no. There are some good reasons not to drink diet soda (including possible increased risk of diabetes and osteoporosis), but these findings do not “prove” that diet soda leads to strokes.  

Some reasons why this is a very tentative and preliminary finding include the following: 

  • All the data are self-report, so we are dependent on people remembering their diet soda consumption. 

  • It’s the first study to show this association. EBL readers know that we need multiple studies before we even begin to think about recommending behavior change.

  • It’s not all diet soda drinking: It looks like only people drinking diet soda every day show the association with stroke, suggesting that lower consumption may not increase risk. 

  • The study is not representative of the U. S. population. First of all, you had to be over 39 years old in 1990 to get in the study and the average age of the sample now is in the late 60s, so the results can’t be generalized to younger people. Further, the sample for this study included 63% women, 21 % whites, 24 % blacks and 53 % Hispanics. In the U.S as a whole, 51% of the population are women, 77% are white, 23% black, and 16% Hispanic. So it’s a very different group from what a random sample of Americans would get you.

  • We don’t know the reason for the association. The lead author, Hannah Gardener, is open about this: “It’s reasonable to have doubts, because we don’t have a clear mechanism. This needs to be viewed as a preliminary study,” By “clear mechanism,” she means that even if this relationship exists between diet soda and stroke, we don’t know why. 

There’s more we could say, but our main point is this: It doesn’t take very long for you to “deconstruct” what the actual evidence is behind a news story. With a basic understanding of how studies are done and access to the Web, you can often find out as much as you need to know. In this case, the media have reported the first highly tentative findings of an association between two things. Now other scientists need to test it again and again to see if it holds up, as well as finding out why the association exists.

 I go for sparkling water instead of diet soda because of other problems mentioned earlier with diet beverages.  But regarding stroke risk, the data just aren’t there yet. 

   

Weird science reporting: My Saturdays with USA Weekend

On Saturday mornings, my wife and I take turns getting the paper and the morning coffee, and we relax with it for a half hour before starting the weekend routine. My spouse has become used to my reaction when I turn to the magazine that comes with our paper: USA Weekend. Or more accurately, she has become used to covering her ears. When I put my Evidence-Based Living hat on, I believe that USA Weekend’s science reporting could at least enter any “worst of the year” contest.

But then I realized: This may be a “teachable moment” for me and others! On the positive side, it’s nice that relatively heavy coverage is given in USA Weekend to scientific findings. Their health and lifestyle articles are filled with “a recent study shows…” And they make many recommendations regarding nutrition, much of it supposedly based on science. There is even a celebrity panel called “The Doctors” who purport to answer your health questions.

Ah, but the road to you-know-where is paved with good intentions. And what you get from USA Weekend is almost the opposite of good evidence-based advice: It’s a mish-mash of simplistic inferences from individual studies mixed in with folk wisdom and anecdote – and it’s nearly impossible for the lay reader to tell the difference. As such, it’s a great example of exactly the kind of “science journalism” you should avoid taking too seriously. Let me give you a few examples of where the scientific advice provided in USA Weekend should have the label “Let the Reader Beware.”

1. No access to the original research. I am willing to be corrected on this, but nowhere on the USA Weekend site could I find any citations to the original studies. Evidence-Based Living always recommends you go back to the original scientific articles before believing the media, but so little information is given in a typical USA Weekend story that I couldn’t even determine what research was being referred to. If you can’t find the article, how do you know if the finding is real or not?

2. Reliance on a single study (or two). Regular readers of Evidence-Based Living know one cardinal rule: Never believe a single study (or a couple studies). Very often, articles in USA Weekend state: “Swedish scientists have found…” “New Research Shows…” “Two studies found,” “According to research presented at the American Chemical Society.”

What do we really need? All together now, EBL-ers: Systematic reviews of all available research leading to evidence-based practice recommendations. We need to see a finding replicated over and over, using rigorous scientific methods. We want those findings peer-reviewed by other scientists. And we want to know that they work outside of a controlled study. A couple of studies never prove a point, so we should not base our health-related behavior on the findings of a single study (and that’s what almost all scientists tell you at the end of their articles).

Just to give one example, USA Weekend reports that snoring is related to metabolic syndrome. In the closest article to this assertion I could find, the scientists qualify the finding extensively, including that the study is limited by the measures it used, by a small subsample, and by the cross-sectional (one-time) nature of part of the study. Where’s that information, USA Weekend?

3. Quick and confusing generalizations. The Doctors in USA Weekend make the somewhat astonishing recommendation: “Stop counting the calories (if you’re a woman over 65)” and they go on to suggest that it may be better for you stay at your current weight, because “Older women who lose weight can double their risk of hip fracture.” Now try as I might, I couldn’t find the exact reference, although there is research suggesting that weight loss can affect bone density negatively. But this says nothing about the total picture. Should a morbidly obese, diabetic person not lose weight because of a potential increase in hip fracture? Probably not, because the other obesity-related health problems can trump the increase in hip fracture risk.

Here’s a study idea for you: I wonder how many women read that comforting advice and dropped their diet, even if they are very overweight and at no particular risk of hip fracture. That’s why simple generalizations about studies do more harm than good usually.

What’s the lesson here? These snippets of information won’t necessarily do you any good unless you know where they come from, how the study was done, and how it applies to you. Does it fit with other scientific research? We’re told in this week’s issue that we should “sprinkle on the cumin” because “In a scientific study from India, cumin was found to be just as effective as an anti-diabetes drug in controlling diabetes in lab rats.” Does that apply to you? Who knows?

So go to the source whenever you can, and take your Saturday paper’s science reporting with a grain of salt!

Do gun control laws prevent violence?

Gun control laws are in the media spotlight once again in the wake of the Arizona shooting that killed six people and injured 13 including U.S. Rep. Gabrielle Giffords.  Already, the Arizona Legislature has introduced two new bills that would loosen gun controls on college campuses. But what do we really know about gun control laws?  Is there evidence that they reduce violence?

As unsatisfying as it sounds, the answer is that we just don’t know.  One of the only systematic reviews available on this topic was published by the Community Guide, a resource at the U.S. Centers for Disease Control for evidence-based recommendations on improving public health.  It reviewed more than 40 studies on gun control laws ranging from bans to restrictions to waiting periods.  (You can read a summary of the report here.)

The conclusion:  “The evidence available from identified studies was insufficient to determine the effectiveness of any of the firearms laws reviewed singly or in combination.” 

Essentially, the review concludes that there is a lack of high-quality studies that evaluate specific gun control laws.  One challenge is that information about guns and who owns them is limited to protect the privacy of firearms owners.

So what do we know about firearms in the U.S.?

We know that firearms are present in about one-third of U.S. households, and that there are handguns in about half of those homes.

We also have a National Violent Death Reporting System, which collects information from death certificates, medical examiner reports and police reports in 19 states. According to the reporting system, 66 percent of all murders and 51 percent of suicides are committed with guns.  But that doesn’t tell us much – like whether the murders and suicides would occur by other means or, given stricter gun control laws, whether the perpetrators would find a way to obtain guns illegally.

The bottom line is that researchers and government officials need to step up to conduct more research and find a proven way to prevent gun violence from taking the lives of innocent citizens.

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