Month: July 2021

Ever read a headline that catches your eye but then found the story itself disappointing? Or worse, did you feel that the dramatic headline was utterly misleading? Yeah, me too.

The impact of a well-crafted headline can be big. We often skim the headlines, then decide whether or not to read on.

Previously, I’ve written about how media coverage of drug research can mislead or confuse. Here I’m zooming in on health headlines, which can be equally deceptive. Watch for these pitfalls.

Overstated study findings

• Were humans studied? If a study finds that a drug is safe and effective for an important disease, that’s big news. But what if all of the study subjects were mice? Leaving out this important detail from the headline exaggerates the study’s importance.
• Too much drama. Dramatic terms such as “breakthrough” or “groundbreaking” are common in headlines about medical research. Yet true breakthroughs are quite rare. That’s the nature of science: knowledge tends to accumulate slowly, with each finding building a bit on what came before.
• Going too far. Headlines often make a leap of faith when summarizing a study’s findings. For example, if researchers identify a new type of cell in the blood that increases when a disease is worsening, they may speculate that treatments to reduce those cells might control the disease. “Researchers discover new approach to treatment!” blares the headline. Sure, that could happen someday (see below), but it’s an overstatement when the study wasn’t even assessing treatment.

• Overlooking the most important outcome. Rather than examining how a treatment affects heart disease, let’s say, studies may assess how it affects a risk factor for it. A good example is cholesterol. It’s great if a drug lowers cholesterol, but much better if it lowers the rate of cardiovascular disease and deaths. Headlines rarely capture the important difference between a “proxy measure” (such as a risk factor) and the most important outcome (such as rates of death).

Faulty logic

• A link for illness is not the same as a cause of illness. The distinction between “causation” and an “association” is important. Observational studies can determine whether there is a link (association) between two health issues, such as a link between a symptom (like a headache) and a disease (like stomach ulcers). But that doesn’t mean one actually caused the other. Imagine an observational study that compared thousands of headache sufferers with thousands of people who rarely had headaches. If more people in the frequent headache group also had more stomach ulcers, the headline might boldly declare “Headaches cause ulcers!” A more likely explanation is that people with a lot of headaches are taking aspirin, ibuprofen, and related drugs, which are known causes of ulcers.

Hazy on key details

• Someday isn’t today. Studies of new drugs or devices may be heralded as life-changing for people or practice-changing for doctors. Yet, a closer look often reveals that the new treatment is years away from reaching the market — or it may never get approved at all.
• A work in progress. “Preliminary” is the missing word in many headlines. Studies presented at medical conferences but not yet published in a peer-reviewed medical journal offer preliminary insights. This research, while promising at the time, may ultimately be a scientific dead end.
• Is it a study, a press release, or an ad? It’s hard to tell with some headlines. Press releases or advertisements typically present a positive spin on new findings or treatments. We expect news stories to be more balanced.

One story, many headlines

Here’s a great example of overhyped headlines. A 2021 study presented findings about a pacemaker that treats abnormal heart rhythms for a period of time and then dissolves. Amazing, right? For people who need a pacemaker only temporarily, a dissolving pacemaker could allow them to avoid a surgical procedure to remove it once it was no longer needed.

Three headlines covering this research spun the story this way:

Coming Soon: An Implanted Pacemaker That Dissolves Away After Use

Could people one day get pacemakers that dissolve into the body?

First-ever transient pacemaker harmlessly dissolves in body

But that dissolving pacemaker had never been tried in living humans — an important fact! To test the dissolving pacemaker, the researchers had performed open-heart surgery in rats and dogs, and lab experiments on heart tissue removed from mice, rabbits, and deceased humans.

The first headline demonstrates the pitfall of overpromising on the findings of preliminary research: yes, a dissolving pacemaker might someday be routine in humans, but it’s unlikely to be “coming soon.” And when a headline says “harmlessly dissolves in body,” we might reasonably think this refers to a livinghuman body. Not so.

The bottom line

Why are we constantly bombarded with misleading headlines? A major reason is that headlines attract attention, clicks, reads, subscriptions, and influence essential to media sites. Some writers and editors lean into hype, knowing it attracts more attention. Others may not be trained to read or present medical news carefully enough.

In a world full of misleading health news headlines, here’s my advice: be skeptical. Consider the source and read past the headline before buying in. And if your go-to media often serves up misleading headlines, consider changing channels or crossing that news source off your list.

You’ve been trying to get your point across, but it’s not getting through. It’s getting you frustrated, maybe a little offended, so you go for a different approach.

You yell.

Now, concert-level volume has its place, like for saying, “There’s a bear behind you” or “Power line down.” But the big question is, how often do those situations come up? The answer is, rarely.

Next question: How often do you reach that intensity? “Too often” is that answer. You know that it doesn’t work. It never feels good. It never makes the situation better. You would just like to stop doing it.

It’s good to have that desire, but you need more to make it happen. What helps is to play detective to uncover your triggers, then set reasonable expectations, because underlying the yelling is stress, something that isn’t disappearing. The question, as Dr. Antonia Chronopoulos, clinical psychologist at Massachusetts General Hospital, asks, is “How do you regulate yourself in a tense situation?”

Start with the basics

Before you can stop, it helps to understand why we yell in the first place.

We could be in a debate and feel like we’re not being heard. We take it as an insult, get frustrated, and the brain’s limbic system sees it as a threat and sets off the fight-or-flight response.

Our blood pressure rises, breathing becomes shallow, and muscles tense up. Since our history factors in, we can start making assumptions. Adrenaline makes everything go faster, and our attention narrows. “When we’re in survival mode, we’re not thinking about creative solutions as effectively,” she says. “The prime directive is to defend, escape, or fight.”

It’s also not a solo act. We’re yelling at someone, and our attempt to control the situation triggers that person, setting off the aforementioned emotional and physiological reactions, and possibly creating a shoutfest (which is anything but festive).

And there’s one more part, which gets overlooked: the flight element. If we decide to not yell and end up holding anger in, the same process is still taking place: the tense muscles, shallow breathing, narrow focus. We might not be making a lot of noise, but we’re far from calm or looking to improve the situation. “It’s almost like a freeze response,” Chronopoulos says.

The goal is to find the middle ground: not fighting, not flighting, and where you can be more in tune with the other person.

How you get there

It’s not impossible to calm down while yelling. You can find a way to break the dynamic with deep breathing, pausing the conversation, and/or walking away from the trigger, but it is difficult. The best course is to practice strategies before you need to call upon them, because fear is a primitive emotion, and once we’re in it, the body becomes hijacked. “You can’t just relax in a heated moment,” she says.

It starts with awareness

Log your behavior over one week, noting what prompted the yelling and rating your anger from zero to 10. Think about everything involved: the people, topics, location, and whether you had eaten or slept well, because self-care affects your ability to handle stress.

When you give your anger a number, it becomes more objective. You can feel the difference between a 1, 4, and 8, and are more able to control something in the early stages. And when you write down your observations, you can see patterns and start thinking about how to prevent trouble spots. It might be carrying food, avoiding certain people, or scheduling a potentially tough interaction for when you’re at your best.

Deep breathing can help

There’s no magic count. People have their own approaches. Chronopoulos suggests to just notice your breathing, or even walk away and count to 10. The result is similar. Your mind is off the stress and onto something practical and concrete. One more exercise is to progressively relax your muscles when you’re calm. You’ll then be better able to distinguish between when your body is at ease and when it’s tense. Chronopoulos calls it “discrimination training.” With this knowledge, you can remind yourself to do something as simple as lower your shoulders or unclench your hands.

Imagery is another tool

Preview your day and play out how you’ll handle the sticky moments. When the real thing happens, it won’t be the first time you’re experiencing it.

In the actual situation, use assertive dialogue over yelling or silently seething. It’s about keeping things in the first person, naming the problem, and avoiding calling out the other person. Clearly say, “When you say X, it really upsets me,” then shift into asking, “What can we do to make this work?” It goes from competition to negotiation. “Our voice can become the tool to resolve the conflict,” she says.

You can aspire to never yelling, but it may still happen

And finally, realize that none of the above is foolproof. You can’t predict every situation or be constantly mindful. You can also have different reactions to the same situation, because each day is different. “We’re never in a static state of mind,” Chronopoulos says. “But by taking these measures, we’re putting ourselves into a position for having more control of our emotions and being able to respond in a way that’s more effective.”

If you have a daily commute, a backup of traffic or road work may delay you, but you’ll eventually reach your destination. Gastroparesis, a digestive condition, can be imagined as a slowed commute through the stomach. But the delay involved can cause uncomfortable symptoms, and may have other health consequences that can affect nutrition and your quality of life. Although gastroparesis affects millions of people worldwide, many people are much more familiar with other gut problems, such as acid reflux and gallstones, that can cause similar symptoms.

What is gastroparesis?

Gastroparesis is a condition that causes delay in the emptying of the stomach. When you swallow food, it travels through your mouth and into a long tube called the esophagus before entering your stomach. Your stomach serves two separate functions: The first is to relax to accommodate food and liquid until you feel full. The second is to churn the food and liquid into a slurry that then passes into your small intestine to be digested. When either function is disturbed, slower-than-normal emptying occurs.

What are the symptoms of gastroparesis?

Nausea and vomiting are two of the most common symptoms of gastroparesis, most likely stemming from the sluggish emptying of the stomach. Typically, these symptoms occur toward the end of meals or soon after meals are finished. A third common symptom is abdominal pain caused by a combination of motor nerve and sensory nerve dysfunction. When motor nerves aren’t working properly, food and liquid can be detained in the stomach. When sensory nerves aren’t working well, signals between the gut and the brain are not communicated effectively, which can cause pain, nausea, and vomiting.

A growing body of evidence suggests that gastroparesis overlaps with a disorder of gut-brain interaction called functional dyspepsia, which is recurring indigestion that has no apparent cause. Other health problems can cause similar symptoms as gastroparesis, such as gastric outlet obstruction and cyclic vomiting syndrome, or even conditions beyond the gut, such as glandular disorders. So it’s important to discuss any symptoms that are bothering you with your doctor to get the correct diagnosis.

Who is more likely to experience gastroparesis?

Many misconceptions exist about the typical person with gastroparesis. For example, it’s not true that people must have diabetes to have gastroparesis: only 25% of people with gastroparesis have diabetes. Most commonly, no clear cause for gastroparesis can be found among people who have the condition.

Additionally, people are more likely to experience gastroparesis if they

• take certain medicines, such as opiate pain medications and some medications for diabetes
• have had surgeries, radiation, or connective tissue disorders that affect the function of the nerves of the gut
• are female, because women are several times more likely than men to have gastroparesis.

Thus far, there is limited information on health disparities among people with gastroparesis, although one study shows that diabetes is more likely to be the cause of gastroparesis among Black and Hispanic patients than white patients. It’s not yet clear why, although socioeconomic inequities that affect health outcomes may be a factor (as is true for many other conditions).

How is it diagnosed?

Diagnosing gastroparesis and deciding on the best treatment strategy requires a careful patient history, blood tests, imaging tests, and sometimes endoscopy. Usually, people first discuss their symptoms with a primary care doctor who can rule out some possible causes and refer them to a specialist to discuss next steps, such as imaging or endoscopy, if necessary.

A common imaging test used in the US is called a gastric emptying scan, which takes four to five hours. The person having the test eats a standardized meal, such as an egg sandwich, that contains safe levels of medical-grade radiation. At certain intervals, images are taken to see how much of the meal remains in the stomach. During normal digestion, about 90% of the stomach is emptied within four hours and 10% is left behind; more than this amount remaining meets a key criterion for gastroparesis.

It’s worth noting that the exact amount of stomach emptying in four hours may fluctuate and may be influenced by other health factors, such as uncontrolled blood sugar, or certain medications, particularly opiate pain medicines.

How is gastroparesis treated?

The main goal of treatment is to address the symptom that bothers you the most. Depending on your diagnosis and symptoms, treatment might involve one or more of the following:

• Medications. Erythromycin and metoclopramide speed up emptying the stomach. A newer medicine called prucalopride may have the same effect. Other medications, particularly for people who are finding pain and nausea more problematic, target disordered gut-brain interaction using neuromodulators, such as older forms of antidepressants and neuropathy medications. These medicines may improve sensation of the gastrointestinal tract.
• Procedures and surgeries. A gastroenterologist may suggest different endoscopy techniques that improve stomach emptying by disrupting a valve between the stomach and the small intestine called the pylorus. One approach, called a per-oral pyloroplasty, does not require surgery. A surgical approach called laparoscopic pyloroplasty reshapes the muscle of the valve between the stomach and small intestine to help the stomach empty more quickly. Less often, surgically implanting a gastric stimulator to help improve the signaling between gut and brain may be considered.

If you have gastroparesis, be sure to discuss all these treatment options to see which one is best for you.

Follow me on Twitter @Chris_Velez_MD