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For AIDS, 'Cure' Is Still a Four-Letter Word

November 13, 2008 4:23 PM

By Dan Childs, ABC News Medical Unit

It’s a line that I must have heard in no fewer than a dozen journalism classes -- probably something having to do with headline writing or news placement:

“… So say, for example, that they invent a cure for AIDS.”

For the professor, the idea was to come up with a hypothetical situation that was so earth-shattering that it could be used to illustrate a teaching point -- and at the same time so unlikely and fantastic that we students would not get distracted by pondering the likelihood of whether such a thing could actually come to pass.

The teaching point is this: There are some stories that, when they break, must be given prime placement. They must be shouted to the world.

So when the news rolled across the wires that German doctors report removing all traces of HIV from an American man’s body, perhaps it was little surprise that these headlines followed close behind:

-- AIDS Cured Via Bone Marrow Transplant
-- Patient Gets Accidental AIDS Cure
-- AIDS Cure Found
-- Bone Marrow Transplant Cures Man of HIV Virus
-- German Doc Miraculously Cures AIDS Patient

The list goes on. The reports that carry these headlines come from around the world, from New Zealand to Massachusetts.

But what they all have in common is medical journalism’s most infamous four-letter word -- cure.

Is it a problem in this case? Let’s take a look at the facts. The patient is a 42-year-old man who had been HIV positive for the past decade. He also had leukemia.

Doctors at the Berlin Charite hospital’s Clinic for Gastroenterology, Infections and Rheumatology hoped to treat the man’s leukemia through a bone marrow transplant, in which the patient’s entire immune system is killed off and replaced through an infusion of bone marrow from a donor. In this case, the doctors found a bone marrow donor who also had a rare genetic mutation that made the donor resistant to HIV infection. The procedure got rid of the leukemia. But doctors were also startled to find as well that no traces of HIV remained in the man’s system.

If you are a big fan of happy endings, feel free to stop reading this blog here. Heck, you can call this episode a medical miracle and feel delighted for the unnamed patient, who’s most likely on cloud nine himself at this point.

For those of you who want to stick around, here’s the other side of the coin.

Attempts to treat AIDS using bone marrow transplants are not new; in fact, they have been tried many times -- as early as 1982 and as recently as last year -- usually with little success.

Today, there are perhaps three or so cases in which a bone marrow transplant appears to have sent the disease into remission -- which means that either: 1) The virus is completely gone; or 2) It is still present, but in levels too low to be detected by current means. The safer bet is the latter.

Why might this be? And what happened to the several dozen others who got new bone marrow, but died anyway?

For one thing, AIDS researchers say the changes that the virus makes to the DNA once it’s in the body are not wiped out with the immune system. Thus, when the immune system “reboots,” the HIV signature remains and the whole infection process restarts.

The other thing to remember is that, today, millions of people infected with HIV are on a steady cocktail of anti-retroviral drugs that keep the virus at bay. In many of these people, levels of the virus are also undetectable. Provided they keep taking their medicine, many can remain alive in this state for decades. Does this mean that they are “cured”? Far from it. Take the drugs away, and HIV will emerge from its reservoirs in the body and begin its rampage on the immune system once more.

On our site, we ran the Associated Press story with the headline: “Cure for AIDS, or Lucky Fluke?” The answer, of course, was implicit. But perhaps it would have been better if we had left that infamous four-letter word out altogether.

Cases like this most recent one in Berlin give us real hope for new directions in treatment. But if hope for a cure, when teased apart, is found to be false, it can have an undermining effect on positive findings. For a disease for which good news is already in short supply, some hope can easily turn into no hope, and we find ourselves faced once again with the specter of a horrific and seemingly invincible disease.

Sure, call us skeptical. We’ll continue to man the battlements, looking for the next shred of hope against this killer.

Meanwhile, journalism professors the world over can rest assured that the sanctity of their hypothetical headline remains intact, for now.

November 13, 2008 | Permalink | User Comments (9)

A Bitter Pill to Swallow: Vitamin Supplements Don’t Make Us Healthy

November 12, 2008 2:22 PM

By Joanna Schaffhausen, ABC News Medical Unit

It’s more bad news for vitamins this week. New research shows that supplements of vitamins E and C don’t prevent heart disease in men. In fact, men taking vitamin E had a slightly higher risk for bleeding in their brains. In a different study, women taking vitamin D supplements did not have any lower risk for breast cancer.

This latest research joins a growing pile of studies documenting the failed promise of vitamins. Originally, vitamin B was supposed to keep our hearts healthy, vitamin E was going to lower our risk for Alzheimer’s disease and vitamin C would keep us free from diabetes. But none of these purported health benefits proved to be true in high-quality studies.

Currently, it is vitamin D’s turn to shine, as research suggests it may fight heart disease, cancer, diabetes and multiple sclerosis. I’m skeptical. I’ve watched an alphabet soup’s worth of vitamins come up short now, and each one has followed the same pattern -- early, preliminary research makes the vitamin look good for health, only to have later studies show no benefit. So far vitamin D is on the same path.

Indeed, the first study that actually tested vitamin D’s promise finds the supplement is a bust for preventing breast cancer and colon cancer in women. Doctors randomly assigned more than 36,000 postmenopausal women to take either daily vitamin D and calcium supplements or placebo pills for seven years. Thus far the women have not seen any decrease in their breast cancer or colon cancer risk.

How it possible for vitamins to look so promising in early research only to fall flat when doctors put them to the test?

The answer lies in the type of studies used to investigate vitamins and health. First, doctors do observational studies to compare two groups of people, such as cancer patients versus healthy people. Inevitably, the sick patients have lower levels of vitamins.

Next doctors do another type of observational study. They take blood samples from a large group of people and follow them for a period of several years. Again, those with the highest levels of vitamins – be they vitamin A, B, C, D or E -- are less likely to get sick.

All these findings mean it's looking good for the vitamins. People with low levels are sick and those with high levels are healthy. Doctors everywhere start recommending that people take a daily vitamin supplement to keep diseases away.

When researchers finally do the gold standard studies, called a randomized, controlled trials, the vitamins generally fail the test. People who are given vitamin supplements do not magically become healthier.

The reason is that vitamins are often a red herring when it comes to disease. Sure, they look guilty at first because sick people are vitamin deficient, but it turns out vitamins are not typically causing the heart disease, the cancer, or whatever other illness is under investigation. Sick people have low levels of vitamins because they are sick.

Similarly, healthy people have high levels of vitamins because they engage in many behaviors that are linked to good health, including eating more vegetables and getting more exercise. When healthy people take vitamin supplements, it makes it seem as if the vitamins are giving them some benefit, when the truth is that they were already unlikely to get sick.

This causes doctors to think they can give the vitamins to unhealthy people to make them better, when really the unhealthy folks need to embrace the healthy people’s whole lifestyle – lose weight, stop smoking, eat more vegetables, and so on.

Vitamin supplements can improve health in some ways. For example, folic acid supplements taken by women prior to pregnancy can reduce birth defects in babies. Vitamin D can help build strong bones throughout the lifespan. But can it also reduce heart disease, cancer, diabetes and autoimmune disease?

We're all waiting for the final verdict, but history suggests the answer will be no.

November 12, 2008 | Permalink | User Comments (21)

Why Heart Failure Fails to Make News

November 12, 2008 10:05 AM

By ROGER SERGEL, ABC News Medical Unit

BREAKING NEWS – New advances in heart failure.

Mute buttons are pushed. Channels are changed. There are no Web site clicks. You can hear the collective response.

“Not interested."

But heart failure affects 5 million to 6 million people and, with 500,000 new cases a year, is the leading cause of hospitalizations.

“But it’s boring. There are no sirens, no patients rolled into emergency rooms. I don’t remember seeing it on 'Grey’s Anatomy.' ”

Maybe not, but do you realize that the more people we keep alive after heart attacks, the more heart failure patients we will have.

“So what? Oh, yes, I do like those stories about patients with failing hearts who get artificial hearts or some cool device that keeps them alive. There are neat before-and- after-pictures showing how much the patient can do after getting a new heart.”

But , those devices cost $50,000 and may help only a few hundred patients.

“And I don’t get it. What is a heart failure?'

Other people wonder too. Dr. Milton Packer, a heart failure specialist from Southwestern Medical Center, says we really do not understand this disease.

So on a day like Tuesday when the American Heart Association offered the news that joyful music helps your arteries, and obese children have arteries that resemble those of 45-year-olds, the chance of any of the four major new heart failure studies getting much attention are pretty slim, even though one study had a significant finding that exercise for heart failure patients is safe.

Why is heart failure so often ignored by the press, despite the growing numbers of patients? Unlike a heart attack -- which you either fix, or you don’t -- heart failure is a slow process, said Dr. Clyde Yancy at Baylor University. Success is measured over months, not days or weeks. There is nothing immediate about heart failure.

Dr. Arthur Feldman at Thomas Jefferson was president of the Heart Failure Society from 1998 to 2000. He says the society studied the issue, and it learned the following:

1. Patients and families viewed heart failure as a death sentence;
2. Many members of the public viewed heart failure as a disease of the elderly -- not of the young;
3. Because heart failure is a collection of symptoms that can be caused by a variety of specific cardiovascular diseases, there is often confusion about the term -- and the public hates confusion.

Feldman also added that big pharma has not had any “blockbuster” heart failure drugs, and as a result any advertising would have to come from nonprofit societies.

So there are no "Viva" heart failure drug ads to raise awareness.

There are treatments for heart failure today, and heart failure primarily affects the elderly. But there are young people who develop heart failure too.

Dr. Jim Young at the Cleveland Clinic notes that we are paying attention to coronary artery disease when it is falling but ignoring heart failure, which is on the rise. “Though we have truly great treatments for heart failure, the total number of folks with the problem continues to increase (particularly those in advanced states). I think that he issue is allure -- heart failure just isn't very sexy.”

Not sexy. That’s what nearly all the heart failure specialists said.

What heart failure needs is some spokesperson, like Michael J. Fox for Parkinson’s or Joe Torre for prostate cancer or Nancy Reagan for Alzheimer’s. Breast Cancer has lots of attractive spokespeople who talk about the disease.

The heart failure people actually tried to get a spokesperson several years ago. Packer says. “The problem was anybody we found was too short of breath to talk.”

November 12, 2008 | Permalink | User Comments (24)

Blaming the Boob Tube for Your Baby's Baby Bump

November 03, 2008 5:22 PM

By Dan Childs, ABC News Medical Unit

Parents, lock up your daughters' TV remotes. And your sons' too, while you're at it.

Such was the message people may have gleaned from news reports this morning on a new study suggesting that television shows that feature depictions of sex or dialogue about the subject lead teens to engage in risky sexual behaviors themselves.

Reuters didn't qualify its lead on the study, making a direct link between the TV exposure and the sexual behavior.

"Exposure to some forms of entertainment is a corrupting influence on children, leading teens who watch sexy programs into early pregnancies and children who play violent video games to adopt aggressive behavior, researchers said on Monday," Reuters reported in its story.

Delve a little further into the research, however, and we see that the study suggests that there is an association between the amount of sexually charged television programming teens watch and their risk of becoming pregnant if they are girls, and impregnating someone if they are boys.

There's that word again in a medical story -- "association." When you see that word, a part of your brain that controls skepticism needs to flick on, triggering a big neon sign that reads, "caution -- association does not prove cause."

It could be equally valid to say that teens who are sexually adventurous are more likely to be attracted to sexually charged programming. That's exactly what the Washington Post reported in their story, at the very bottom.

The Post quoted Laura Lindberg of the Guttmacher Institute, which studies pregnancy-related issues: "It may be the kids who have an interest in sex watch shows with sexual content. I'm concerned this makes it seem like if we just shut off the TV we'd dramatically reduce the teen pregnancy rate."

If it seems like this alternative take dilutes the frightening nature of this report, it may be for good reason. The translation for parents is your TV set may not be the speaker box for teenage sin and sordid behavior that you believe it is.

Or it could be. The fact is, we just can't tell from the information at hand which way this river flows.

Let's take a look at the research. In the study, published in the journal Pediatrics, researchers at the nonprofit research organization RAND, led by behavioral scientist Anita Chandra, followed 718 adolescents age 12 to 17 who when surveyed indicated that they were already sexually active.

Researchers asked these adolescents about their TV viewing habits when it came to 23 different television shows. What they found was that those who watched the most shows that featured sexual content -- including depictions of sex, talk about sex and innuendo -- had about double the chance of being involved in a pregnancy than those who watched the least of these shows.

I talked with our resident study guru Joanna Schaffhausen this morning, and she said it is little surprise that the researchers would gravitate to one possible interpretation of this research over the other. It is, in large part, the job of the researcher to explore the most interesting possible interpretation of their findings in order to encourage further hypotheses and investigation.

Indeed, even the researchers themselves note in the study: "… the present analysis cannot establish definitively how much, if any, of the observed association between exposure to sexual content and pregnancy is causal …"

Here's what Joanna had to say: "The authors acknowledge the problem on the one hand, but in the very same sentence they also say that even if only part of it turns out to be causal, reducing teenagers' exposure to sexy TV could have a big impact. That's a lot of supposition, really, given that they allow as how they don't know if ANY of the relationship is causal.

"Basically, it's like losing your keys in the dark and looking for them near the light post because that's where you can see," she continues. "We can hide our kids' remotes but we don't have the faintest idea how to make them less interested in sex."

Thus, we as reporters should really have our eyes open for alternative explanations. In fact the alternative explanations are so important, that they belong in news stories within the lead -- or at least as a qualifier in the second paragraph.

Bear in mind that this study hits not only at a time when teenage pregnancies, on the whole, have been on a downward swing for the past decade and a half (the exception being a small, 3 percent bump last year according to the CDC, amid a general rise in pregnancies among all age groups), but also when the amount of sexually-charged content on television is ostensibly on the rise.

If it were true that: a) viewing more sexually explicit TV drives teens (teens who are already sexually active, in this case) to be engaged in more pregnancies; and b) we are in fact seeing more sex on TV in the age of Sex and the City than we were in the era of The Cosby Show (Huxtables, wherefore are thou?); then wouldn’t we be seeing a STEADY RISE in teen pregnancies?

To be fair, latching on to the sexiest -- no pun intended -- headline is probably something of which many of us in the field of medical reporting have been guilty at one time or another. In this case, several major media outlets took the bait.

But we should be aware that in these sex-laced times, a single stroke of our pens could lead to young Johnny and Jenny falling hopelessly behind in following the storyline of "The Hills." What ever will they do with that extra time slot in their evenings?

Just a thought. What do you think?

November 3, 2008 | Permalink | User Comments (10)