Tuesday, November 27, 2007

Medical Reporting Gone Bad, Way Bad

Medical reporting requires special skill and vigilance on the part of the journalist. A well-reported medical story helps readers put complex information into perspective. It balances the inevitable attraction of hope and discovery against the inevitable limits of investigation and study.

On the other hand, a poorly done story can lure readers into spending money, investing precious time, and nurturing false expectations for phony baloney medical devices and nostrums. Readers are not always as skeptical as they should be when it comes to hoping there's relief just around the corner for whatever ails them.

In the universe of good medical reporting and bad, the centerpiece of Sunday's medical tab in the Charlotte Sun falls into the bad -- very bad -- categtory.

The topic is a local man's promotion of a device called an interactive metronome. Half a dozen studies have demonstrated that practice with the device can improve some people's ability to concentrate on laboratory tasks. The results suggest learning to mimic rhythms might help some suffers ease the symptoms of some kinds of attention-deficit disorders. This is genuinely interesting news and certainly worth a nice feature story in the local paper.

Unfortunately, the reporter-editor fails to report the relevant who, what, when, where, why, and how-much sorts of information that would help readers understand the device's benefits and limitations. By avoiding journalism's basics, she ends up writing an advertisement for the salesman -- without even including the key element of a good ad: How much does it cost?

Here are the details.

Improving the efficiency of the mind
By Dawn Krebs
Feeling Fit Editor

It helps to improve concentration in autistic children. It also helps to improve overall athletic performance in athletes. It also has been used in a pilot study of Parkinson's patients.

These assertions require attribution. Whose pilot study? Which atheltic performances? Not one of the "teasers" in the lead is addressed in the body of the story.

While it seems that nothing could achieve results in such a broad spectrum of people, ...

(nothing? not asprin, not ice cream, which also achieve results in a broad spectrum of people?)

... the Interactive Metronome program uses a unique device to help reach a variety of people with different needs and goals -- their brains.

What does it mean that the brain is a “different” need or goal? This sentence doesn’t make sense. "Unique" it isn't. Down below the story says the device is a traditional metronome -- hardly unique. And, as anyone with an electronic keyboard knows, computer-generated rhythms are commonplace.

The program is research-based, and utilizes rhythm and timing to improve focus, coordination as well as athletic performance.

The first clause’s assertion that the program is research based is unrelated to the three items in second clause. These assertions echo the lead closely enough that it's time to start coughing up some 5W facts.

And one Nokomis man is not only proof of the program's success, he helps others by coaching them through the program, certified as a program provider.

What regulatory or academic institution issues the certification he claims to hold? There is no professional license issued in the state of Florida to anyone with this name.

"The better our mind and our body work together, the better they perform," said Mike Danski.

And the basis of this assertion is? My body does not work very well, but my mind is pretty sharp.

Danski has traveled from Tampa to Ft. Myers, administering the program to a wide swath of individuals. Because of some of his clients, Danski literally brings the program to them.

Because of some of his clients? Because of what? Why “literally?” What is a “wide swath” of individuals? Swath usually refers to the width of the path cut by a reaper or similar instrument.

"Some of the families I work with involve autistic children," Danski explains. "There's no way they could travel to get to the trainings. So I go to them."

What are his credentials for “training” autistic children?

The Interactive Metronome program typically involves 10-12 sessions lasting about 45 minutes to an hour each.

Attribute this statement. Describe what a session entails.

The program combines the traditional music metronome with computer technology to help with concentration, focusing on tasks, rhythm and timing.

Make the clauses parallel, please. How does this combination occur? Does a "traditional" metronome sit next to the computer?

The program works when a client places the headphones on their head. They will then hear a rhythmic sound through the headphones. They are instructed to respond to the sound by tapping or clapping as closely to the beat they hear as they can. Other sounds direct the client on if they are on the beat, falling behind or responding too quickly. Over a series of sessions, the brain learns to keep rhythm and timing. As these skills improve, so does physical functions such as motor control, coordination, concentration, attention span, and even athletic performance.

FCAT-level grammar faults in every sentence. What makes this “a program,” and not just a bio-feedback session? How is this program different than learning to play drums or other rhythm-percussion instruments?

Danski didn't happen into this field by accident.

This field is what? Using one device hardly constitutes a field.

An elementary school teacher, he was diagnosed with Attention Deficit Hyperactivity Disorder shortly after his son was also diagnosed with the same thing. Other members of his family also tested for ADD and bipolar disorder.

Tested but not diagnosed?

But Danski didn't want to live life like that.

Like what? Living life like any particular thing has not yet been mentioned.

"I didn't like the thought of being on medication the rest of my life," he said. "So I went to the computer and Googled non-medicine alternatives to treat my condition. Interactive Metronome came up.

Close quote. Is Google, a search engine, really a good basis for conducting medical research? The ways its entries are sorted have nothing to do with medical reliability, peer review, types of studies performed or any other criteria usually used to evaluate medical matters.

Even then, Danski took his time -- 10 months in all -- to research all he could find about the program.

Wow. Ten months.

"One of the good things for me is that it was based in Florida," he said. "When I was done reading up on the program, I drove over to their facility with my son, and met everyone involved."

This statement should alert a reporter to suspect Danski’s research skills are rudimentary. What city is “their facility” located in?

He became a program provider soon afterwards.

Was he certified by the manufacturer, or is there an oustide, objective agency involved?

Danski sees the program as a way to help children who have ADHD or are struggling with concentration or focus in a way that doesn't involve medication.

This sentence does not say what the writer thinks it says.

Scientists have found the same results that Danski is now experiencing.

And those scientists are? Those results are?

In a study published in the March 2001 American Journal of Occupational Therapy, a significant pattern of improvement was found in a double-blind study of nine-year-old to 12-year-old boys diagnosed with ADHD. The study found the boys showed improvement in "attention, coordination, motor control, language processing, reading and control of aggression."

The article’s abstract does not describe a “double blind study.” In fact, if the reporter knows what a double-blind study is, she would know it’s nearly impossible to conduct one using a device of this sort. The study described is a randomized study, using a “no intervention” group and a "computer games" group as controls. Here’s the abstract:

[Am J Occup Ther. 2001 Mar-Apr;55(2):155-62. Links
Effect of interactive metronome training
on children with ADHD.
Shaffer RJ, Jacokes LE, Cassily JF, Greenspan SI, Tuchman RF, Stemmer PJ Jr.
College of Human Medicine,
Michigan State University, Ann Arbor, USA.
OBJECTIVE: The purpose of this study was to determine the effects of a specific intervention, the Interactive Metronome, on selected aspects of motor and cognitive skills in a group of children with attention deficit hyperactivity disorder (ADHD). METHOD: The study included 56 boys who were 6 years to 12 years of age and diagnosed before they entered the study as having ADHD. The participants were pretested and randomly assigned to one of three matched groups. A group of 19 participants receiving 15 hrs
of Interactive Metronome training exercises were compared with a group
receiving no intervention and a group receiving training on selected computer video games. RESULTS: A significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronome treatment was found. Additionally, several significant differences were found among the treatment groups and between pretreatment and posttreatment factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior. CONCLUSION: The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD. PMID: 11761130 [PubMed - indexed for MEDLINE]]

The Interactive metronome program was developed in the early 1990s. Now, there are more than 2,500 certified providers in more than 1,700 clinics, hospitals and universities throughout the United States and Canada.

The source of this information? What institution has issued the 2,500 certificates?

One such hospital is HealthSouth Corporation, a nationwide provider of outpatient surgery, diagnostic imaging and rehabilitative health care. In November of 2004, the company announced it will offer Interactive metronome therapy at locations for patients who suffered from neurological and motor impairments such as stroke and Parkinson's Disease, to name a few.

This sounds as if it has been copied from a three-year old press release. How can a hospital be “nationwide?” Where is this hospital based? Is this the same HealthSouth whose board members were accused of stock manipulation and whose CEO was investigated for a billion-dollar fraud a couple of years ago?

In another correlation study, 585 children were found to have a positive correlation between Interactive Metronome scores and academic performance in reading, math, science and study skills.

Why is this “another” correlation study? Where is the first “correlation study?” The alert science reporter knows correlation is not the same as causation and would never report it as such.

The shift from children to adults was seen when the program showed results in the improvement of the brain's ability in motor planning and sequencing.

What shift is referred to? This sentence simply doesn't make any sense. The shift is a definite noun and must refer to something that has already been mentioned. Does a shift from child to adult mean the child grows up?

In a pilot study, the effect of the motor training was observed in patients with mild or moderate Parkinson's Disease.

No cap on “disease,” please. But more important is the pilot study: whose study, what methodology, was used, what duplication of results has occurred?

The severity of the disease was compared before and training sessions that totaled 20 hours.

Is there a word missing? Before and after, perhaps? Knowing what little I do about Parkinson's, I doubt that the disease was mitigated; symptoms perhaps, but not the disease.

The study found that computer-directed movement training improved the motor signs of Parkinson's Disease.

Whose study is this? Where was it conducted? Is computer-directed movement training the same thing as the interactive metronome? There is nothing in the paragraph that says they’re the same.

The patients using the treatment learn to focus for longer and longer periods of time. Danski works one on one with each patient, working off of a lap-top computer he brings with him in order to complete the session.

Are we still reading about Parkinson's patients?

Danski also points out the athletic-training abilities the program has.

"A lot of golfers use it," he said. "I work with a lot of golfers in town. I love helping athletes." Name one.

Danski explains that if your are a athlete [sic] that is struggling, it helps bring your abilities up to par. But if you are already doing well, the program helps take your learning and mental skill to a higher level.

Danski has worked with student athletes in public schools as well as private schools in the Venice area.

Name one.

"More than 50 school districts have the program to help the students academically and athletically," he said.

Name one.

According to Danski, the Interactive Metronome program improves the working memory part of our brains, the part that manages our lives, the part that allows us to walk up a flight of stairs or form a sentence.

Language skills, gross-muscular coordination and balance are not carried out by the same parts of the brain, according to the general sources I’m familiar with. What part of the brain "manages our lives?" These statements are nonsense.

"The sessions can last from 40-50 minutes," Danski said. "The training is not easy."

If it’s not easy, how did studies of young children and Parkinson’s sufferers come about? If it’s difficult to train, explain what the difficulties are.

But being able to qualify for it is.

"Anyone that moves or thinks is a candidate for this training."

Said the salesman. This man is selling something; how much does his service cost? What’s the benefit to “anyone that moves or thinks?”

1 comment:

  1. I am disgusted but not surprised. A good salesman can outwit a bad reporter any time.