Shared posts

17 Dec 22:35

Pre‐medical majors in the humanities and social sciences: impact on communication skills and specialty choice

by Laura E Hirshfield, Rachel Yudkowsky, Yoon Soo Park
John Epling

I've only been saying this for the last twenty-five years...(Russian Studies major checking in...)


Medical school admissions committees use a variety of criteria to determine which candidates to admit to their programmes. Effective communication is increasingly considered a key requisite to the practice of effective medicine. Medical students with pre‐medical backgrounds in the humanities and social sciences may be more likely to acquire skills relevant to patient‐centred communication, either prior to or during medical school.


The purpose of this study was to investigate the relationship between pre‐medical backgrounds in the humanities and social sciences and outcomes in medical school, including in communication and interpersonal skills (CIS), licensure examination results and postgraduate specialty choice (primary care versus non‐primary care specialties).


The American Medical College Application Service database was used to identify pre‐medical college majors, demographic characteristics, Medical College Admission Test scores and college grade point averages for medical students at a large, midwestern medical school. Data were obtained for 465 medical students across three cohorts (classes of 2014–2016). Correlation and regression analyses were used to examine relationships between pre‐medical background, performance on graduation competency examination standardised patient encounter CIS scores and on United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge scores, and postgraduate specialty choice.


Graduating medical students with pre‐medical humanities or social sciences majors performed significantly better in terms of CIS than those with natural science majors (Cohen's = 0.28, p = 0.011). There were no significant associations between pre‐medical majors and USMLE Step 1 and Step 2 Clinical Knowledge scores or postgraduate specialty choice.


These results suggest that considering humanistic factors as part of admissions criteria may promote the selection and training of physicians with good communication skills.

17 Dec 22:34

Screening and Referral for Childhood Obesity: Adherence to the U.S. Preventive Services Task Force Recommendation

by Omoye E. Imoisili, Alyson B. Goodman, Carrie A. Dooyema, Megan R. Harrison, Brook Belay, Sohyun Park
John Epling

Well, this is depressing...

The U.S. Preventive Services Task Force recommends clinicians screen children aged 6 years or older for obesity and offer or refer children with obesity to intensive weight management programs. This study explores clinician awareness of weight management programs meeting the recommendation, adherence to the recommendation of screening and referral, and associations between provider and practice characteristics and weight management program referrals.
17 Dec 22:26

Reflections on a 45-year career and 13 years leading

by Gary Schwitzer

Our home page 1st day 2006

In this, our final week of daily publishing as we wind down operations due to a loss of sufficient funding, I want to share some observations after a 45-year career in health care journalism, 13 of which were the pinnacle for me as Publisher of this website.

Earlier this year, after Alexandria Ocasio-Cortez’s “surprise” primary election victory that perhaps shouldn’t have been a surprise, the Washington Post’s media columnist wrote:

“(Journalists) need to get closer to what voters are thinking and feeling: their anger and resentment, their disenfranchisement from the centers of power, their pocketbook concerns.”

More recently, a Columbia Journalism Review article on media diversity issues focused on an urban crime story in The New York Times. An excerpt:

“The story, to me, spoke to the problem of what happens when the demographics of the Times—and American newspapers in general—look nothing like the demographics of the communities they cover. The people who are most likely to appear in these kinds of stories are the least likely to have a say in how those stories are told.”

The same critique could be made – but rarely is – about health care news.

Too few health care journalists know their readers’ needs

There is a Grand Canyon-sized gap between the kind of information that patients and consumers need and what they’re actually getting in most health care news stories and PR news releases. Most, but not all.

Today, too many people (but, again, not all) writing and reporting on health care are not connected to what their audience is thinking and feeling – their true concerns. In part, it’s because some writers/reporters are tied to their computer screens and the daily drumbeat of dreck that comes to them in PR news releases and industry handouts. Some aren’t given the opportunity to get out and meet patients and health care consumers, or the time to seek out these people online. If they include a patient perspective, it’s often one that is gift-wrapped and spoonfed by a PR person serving up the rosiest, most satisfied and possibly unrepresentative patient story imaginable.

I recently wrote about Medicare open enrollment issues that I don’t see journalism adequately addressing. There aren’t many Medicare-aged journalists any more and there weren’t many Medicare recipients interviewed in the stories I saw. But an estimated 44-million people, 15% of the population, are on Medicare.

Battling health care hype for decades

I started covering health care news in the ‘70s, when there were very few fulltime health care journalists in the US. I had no specialized training for this assignment, but taught myself.

Nixon’s “War on Cancer” drew the publicity the President hoped for, but I was more intrigued by University of Chicago statistician John Bailar’s analysis that “It is difficult to claim success in the war against cancer on the basis of (the evidence).” 

In the ’70s, I interviewed Houston’s Dr. Michael Debakey about his artificial heart research. Then in 1984, I reported on the Robert Jarvik/William DeVries artificial heart partnership as it moved from the academic setting at the University of Utah to the corporate Humana hospital environment in Louisville. I had a front row seat to watch the hype surpass the true hope, and to reflect on the insidious influence of corporate pressures.

I reported on U.S. Department of Health & Human Services Secretary Margaret Heckler’s 1984 prediction that “We hope to have (an AIDS) vaccine ready for testing in about two years.” How’d that work out?

Also in 1984, I saw my own network, CNN, join in the incredible runaway hype of extremely early Alzheimer’s disease research at Dartmouth. Jay Winsten, who is now director of Harvard School of Public Health’s Center for Health Communication, addressed the episode in a landmark piece in Health Affairs, “Science and the Media: The Boundaries of Truth.” He wrote: “This case illustrates serious issues. Many news organizations have not developed adequate criteria (even informal ones) for evaluating when a science story has achieved a minimal threshold of validity.” 

In 1990, I objected when CNN, my employer at the time, reported on a blood-heating experiment in AIDS patients. In Quill, the magazine of the Society of Professional Journalists, I wrote:

TIME magazine June 25, 1990

“A story was rushed into place in reaction to a local Atlanta television station’s disclosure of this experiment. Strikingly, and in violation of journalistic good judgment, no second opinion was sought before the story aired. Only the statements of the physicians who were carrying out the experiment appeared in the original story.

TIME magazine reviewed the CNN coverage in its ethics column of June 25, 1990: “What is a TV viewer, particularly one who has AIDS, to make of this story? Is the treatment a miracle cure? Or is it a mirage that cruelly raises the hopes of AIDS sufferers?”

Pack journalism set in and many members of the media picked up on the story. The coverage led to such a furor that several federal government researchers visited the hospital where the experiment took place. They reported that the hyperthermia “appeared to have offered no clinical, immunologic or virologic benefits.” … Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, accused the experimenters. He said, in a September 1990 Associated Press story, that they caused “a lot of confusion, frustration and false hope on the part of HIV-infected individuals….This is just another example of why we’ve got to be careful before we jump on claims…of a new treatment or cure.”

I resigned from CNN in disgust not long after.

I shuddered in 1998 when Gina Kolata’s front page story in the Sunday New York Times quoted a senior scientist (from a dinner party conversation) predicting that a researcher would “cure cancer in two years.” That story caused the biggest backlash I’ve ever seen about science journalism.  (The quoted researcher later denied saying that.)

The seeding of an idea for

Those were just a few of the stories that shaped my thinking about what I could do over the rest of my career to try to improve health care journalism and, if not, to improve the critical thinking of patients and consumers in the face of rampant sensationalism.

In 2000, I wrote about “The Seven Words You Shouldn’t Use in Medical News.” The words were: cure, miracle, breakthrough, promising, dramatic, hope, victim. The words were not mine.  All were suggested to me by patients I had interviewed through the years.

A researcher even older than me recently sent me recommendations for what I should add to my 2000 list:

Leading- or cutting-edge

The themes overlap and coincide. The words matter. The evidence matters. Conflicts of interest matter.  Helping patients and the general public cut through hype matters. This became the blueprint for the latter half of my career.

I always try to credit a pioneering effort named Media Doctor Australia, launched by researchers Amanda Wilson and David Henry and colleagues, as the model for They allowed me to adopt their review criteria, which became the systematic backbone of our efforts. Then Floyd J. “Jack” Fowler, PhD, president of the Foundation for Informed Medical Decision Making (now defunct), convinced his board of directors to fund my fledgling project in 2005. I never thought we’d last this long. We had created a monster. The last four years of funding, from the Laura and John Arnold Foundation, helped us develop the project into the leading voice of its kind in the world.

What people have said about

This graphic captures some of the most thoughtful things that our followers wrote about us.  It’s on a headstone because I would love it if that’s the way we would be remembered.


Rarely, we also got ugly Twitter messages from a journalist, such as:

“I thought HealthNewsReview died from lack of interest.  Oh, well, soon enough thankfully.”

Another journalist Tweeted in response to that ugliness:

“Perhaps those who rolled their eyes at the site’s reviews weren’t really engaged with feedback – from or anyone else.”

Far more often, journalists expressed their appreciation for our efforts.

From a veteran health care journalist:

“Thanks very much. Your reviews help make the case when editors sometimes think certain details or numbers are expendable.”

One of my clearest reflections after 13 years of work on this project is how much I admire the journalists who are open-minded and accepting of constructive criticism. Conversely, I have always felt pity for the journalists who are thin-skinned and defensive about any and all such constructive criticism. Whose interests are they serving?

But whatever the response was from journalists, and regardless of the accolades and awards that this project has garnered, it is the feedback from patients and consumers that has been most heart-warming. They told us that they were getting help from us that they couldn’t get anywhere else. Examples:

“Thank you for this helpful counterweight to the breathless and lazy coverage of (this drug) by most mainstream outlets,” patient response to our article on a new ALS drug.

“So often HealthNewsReview pinpoints problems with news stories that patients could never glean themselves. I’m thankful to have the HNR watchdogs on the trail of truth!” – from patient advocate Trisha Torrey.

“Thank you for your most important ‘call out’ to hype related to trials and outcomes in Alzheimer’s & related dementia treatments. I concur this is inauthentic and cruel to families. Shame on the media for such distortion.” – patient response to our critique of ” ‘Historic breakthrough Alzheimer patients around the globe have been awaiting’ “

“Too often the health stories we read have been poorly analyzed and reported on by today”s time-pressured reporters. The reviews and methodology presented on this site can help patients bring better quality information to the care relationship with their clinicians, and help all parties make better informed decisions.” – from leading patient advocate “e-patient Dave” DeBronkart.

There’s no way I can capture all of the kind words from patients, health care consumers and others who relied on our public service project to help them navigate the confusion of American health care.  There’s no way that I can thank them adequately for their interest and support.  I’ve written personal thank you notes to nearly 400 individuals who have made donations to our project to keep us going.  I can’t tell you how moved I am by their thoughtfulness and generosity.

A long strange trip

As I have grown older, some people have told me that I look a little like the Grateful Dead’s Jerry Garcia. I don’t know. I do know that I love what Jerry said about protecting the rain forests:

“Somebody has to do something, and it’s just incredibly pathetic that it has to be us.”

Well, it won’t be us any longer working every day to help people improve their critical thinking about health care. At least not nearly as often nor, perhaps, as forcefully or with as much impact as I slip into at least semi-retirement.  But I am incredibly thankful for the opportunities I’ve had and for the wonderful people who have worked with me on this project over the last 13 years.

I have written elsewhere about some of the news and information sources that people could turn to in our absence. They – and others – are doing important, innovative work. Many of these journalists have changed and adapted to changing times.

Garcia famously said about his music, “To me, being alive means to continue to change, never to be where I was before.”

And so change has come for me, my team, and This band is breaking up. Even at this 11th hour, people continue to suggest that somebody someday will pick up the baton again.

What a long, strange and gratifying trip it’s been. Thanks for coming along for the ride.

16 Oct 21:04

These prostate cancer screening campaigns are giving men the finger

by Gary Schwitzer
John Epling

When will the DRE die?

Fifty years ago, in a golden moment of television comedy shows, Rowan & Martin’s Laugh-In program regularly featured “The Flying Fickle Finger of Fate” award.  Wikipedia says it “recognized actual dubious achievements by public individuals or institutions.” Do a Google search.  You’ll quickly see how popular this award became.

Yes, I’m dating myself by going back 50 years.  But mine is the generation that often becomes obsessed with being given “the finger” by doctors for digital rectal exams (DRE) looking for prostate cancer.

And it is in that context that we propose to revive The Flying Fickle Finger of Fate award.  It could be awarded to prostate cancer screening promotions that deliver a new Laugh-In about prostate exams. While they are funny, it is no joke that they fail to educate men about the evidence that raises important questions about the DRE.  The following is what you will not learn in these promotional campaigns.

An UpToDate analysis states:

We suggest not performing digital rectal examination (DRE) for prostate cancer screening either alone or in combination with prostate-specific antigen (PSA) screening. Although DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.

There are inherent limitations to the DRE. It can detect palpable abnormalities in the (areas) of the prostate gland where the majority of cancers arise; however, other areas of the prostate where cancer occurs are not reachable by a finger examination. Furthermore, the majority of cancers detected by DRE alone are clinically or pathologically advanced, and (early) stage T1 prostate cancers are nonpalpable by definition.

…there is no high-level evidence that DRE screening improves survival outcomes.

The author of that analysis is Richard Hoffman, MD, MPH, the director of the Division of General Internal Medicine at the University of Iowa Carver College of Medicine.  He wrote to me, “Even the American Urological Association, whose members are probably most adept at performing DREs, admits that evidence is insufficient to justify using DRE as a first-line screening test.”

A systematic review and meta-analysis of the evidence published in the Annals of Family Medicine this year concluded: “Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.”

After years of going through the perfunctory DRE from my own doctor, I finally challenged him about the evidence.  That was a couple of years ago.  He hasn’t put the glove on to give me the finger ever since.

A new low for an awareness campaign that doesn’t raise awareness

Mike Rowe, TV host of “Dirty Jobs” (no comment), probably had good intentions when he taped a prostate awareness public service announcement. But the end result is no public service because it is filled with misinformation. It features Rowe getting a DRE from his own doctor. In the video, Rowe states that with early detection, the five-year survival rate for prostate cancer is nearly 100 percent. We’ve written about how such five-year survival rate stats are often misleading. Nearly 100%? I recall one observer saying about such a statistic, “Hmmm. Almost as if it’s not a cancer.”  Indeed, early detection with a PSA blood test – also discussed in the video – may mean finding something that would never harm a man in his lifetime but would still end up being treated. So if you’re detecting many things that won’t cause harm, the five-year survival rate is bound to look pretty impressive. Rowe’s doctor delivers concise, catchy, but totally misleading comments about the only two reasons why you should not do a DRE.  “One, the doctor doesn’t have a finger,” he says.  “And the other is if the patient doesn’t have a rectum.”  Yuck it up, then look it up to see evidence-based reasons why you may not want to have a DRE. Rowe compounds the problem by telling men they have “no excuse” not to get a DRE.  That kind of heavy-handed blame game is often employed in screening promotions.  It’s a wrong-headed approach.  Dr. Hoffman wrote to me: “Missing from the amusing video is the part where the doctor tells the patient that getting screened for prostate cancer is not a slam dunk decision.  There are benefits—and harms—to screening and men should be helped to make informed decisions that best reflect their values and preferences.”  In other words, a fully-informed shared decision making discussion between patient and physician is needed, not a “no excuse” mandate.


In Canada, the Prostate Cancer Canada organization has gone all-out with a “Famous Fingers” comedy approach to DRE.  It features famous fingers through time that could be employed in DREs.  Take your pick:  Beethoven, Big Foot, Paul Bunyan, Sherlock Holmes, Winston Churchill, Al Capone, Genghis Khan, Napoleon, Babe Ruth, Frankenstein’s monster.  The campaign is woefully void of evidence.

Such campaigns are giving you the finger

In the end (no puns intended throughout), these campaigns do a disservice to uninformed men.  They generate laughs but present no evidence.  It’s an absurd way to conduct an awareness campaign.  It may raise awareness of the comical creativity of an advertising agency but does nothing to deliver the facts that men need to make an informed decision.

They’ve given you the finger, guys.  You can fight back by arming yourself with knowledge of the evidence. We’ve provided some highlights above. It doesn’t require a PhD to understand what the science shows and what it doesn’t.  If you still choose to pursue the DRE or the PSA blood test, more power to you.  At least you won’t be swayed by a rah-rah, single-minded promotional campaign on behalf of special interests who stand to gain by your business and by further fundraising.



07 Aug 19:48

New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound

by Randall S. Stafford
John Epling

"Back on track"??? Reading this abstract makes me dizzy - the author seems to agree with these guidelines while providing a laundry list of reasons why it will be very hard to implement them...nevermind the question of whether we should.

The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as <120/80 mmHg, but now define hypertension as ≥130/80 mmHg (previously ≥140/90 mmHg). This change categorizes 101 million Americans (46% of adults) as hypertensive (compared to 32% previously). The guidelines rely heavily on findings from the Systolic Blood Pressure Intervention Trial (SPRINT).
02 Aug 00:48

Development, administration, and validity evidence of a subspecialty preparatory test toward licensure: a pilot study

by John Johnson, Alan Schwartz, Matthew Lineberry, Faisal Rehman and Yoon Soo Park
Trainees in medical subspecialties lack validated assessment scores that can be used to prepare for their licensing examination. This paper presents the development, administration, and validity evidence of a ...
10 Jul 00:25

The Role of the Physician When a Patient Discloses Intimate Partner Violence Perpetration: A Literature Review

by Penti, B., Timmons, J., Adams, D.

Intimate partner violence (IPV) is prevalent and has lasting impacts on the health and well-being of the entire family involved. Primary care physicians often interact with male patients who perpetrate IPV and are in a role potentially to intervene, but there is very little research and guidance about how to address perpetration of IPV in the health care setting. We reviewed the existing literature research related to physicians' interactions with male perpetrators of IPV and summarize the recommendations. If a male patient discloses IPV perpetration, physicians should assess for lethality, readiness to change, and comorbid medical conditions that could impact treatment, such as substance abuse and mental illness. Experts agree that referrals to a Batterer Intervention Program should be the primary intervention. If there are no locally available Batterer Intervention Programs or the patient is unwilling to go, then a physician should refer the abuser to a therapist who has been trained specifically to work with perpetrators of IPV. In addition, physicians should be prepared to offer education about the negative impact of IPV on the victim, on any children, and on the abuser himself. Physicians should address any untreated substance abuse or mental health issues. Referral to couples therapy should generally be avoided. Physicians should continue to have regular follow-up with their male patients to support them in changing their behavior. Further research is needed to assess the role the health care system can have in preventing IPV perpetration.

01 Jun 19:13

Primary Care Outcomes Questionnaire: psychometric testing of a new instrument

by Mairead Murphy, Sandra Hollinghurst, Sean Cowlishaw, Chris Salisbury
John Epling


BackgroundPatients attend primary care for many reasons and to achieve a range of possible outcomes. There is currently no Patient Reported Outcome Measure (PROM) designed to capture these diverse outcomes, and trials of interventions in primary care may thus fail to detect beneficial effects.AimThis study describes the psychometric testing of the Primary Care Outcomes Questionnaire (PCOQ), which was designed to capture a broad range of outcomes relevant to primary care.Design and settingQuestionnaires were administered in primary care in South West England.MethodPatients completed the PCOQ in GP waiting rooms before a consultation, and a second questionnaire, including the PCOQ and seven comparator PROMs, after 1 week. Psychometric testing included exploratory factor analysis on the PCOQ, internal consistency, correlation coefficients between domain scores and comparator measures, and repeated measures effect sizes indicating change across 1 week.ResultsIn total, 602 patients completed the PCOQ at baseline, and 264 (44%) returned the follow-up questionnaire. Exploratory factor analysis suggested four dimensions underlying the PCOQ items: health and wellbeing, health knowledge and self-care, confidence in health provision, and confidence in health plan. Each dimension was internally consistent and correlated as expected with comparator PROMs, providing evidence of construct validity. Patients reporting an improvement in their main problem exhibited small to moderate improvements in relevant domain scores on the PCOQ.ConclusionThe PCOQ was acceptable, feasible, showed strong psychometric properties, and was responsive to change. It is a promising new tool for assessment of outcomes of primary care interventions from a patient perspective.
15 May 20:49

5-a-day fruit and vegetable food product labels: reduced fruit and vegetable consumption following an exaggerated compared to a modest label

by K. M. Appleton and H. J. Pidgeon
John Epling

Unintended consequences, huh?

Food product labels based on the WHO 5-a-day fruit and vegetable (FV) message are becoming increasingly common, but these labels may impact negatively on complementary or subsequent FV consumption. This study ...
14 May 01:20

Is Medical Education a Public or a Private Good?

by Lucey CR.
John Epling

This is a really important question that I don't think we wrestle with openly. In tracing the decline of medical student idealism over the course of their training, I think they are making a switch in this thinking.

The US educational system has 2, at times competing, goals. Education is commonly viewed as a public good, designed to prepare the workforce that the country needs and to educate citizens who contribute to the health of the US democracy. However, education is also seen as a private good, geared toward helping the individual maximize social mobility and personal success. From Virchow in the 19th century to Frenk in the 21st century, thought leaders have embraced the view of medical education as a predominantly public good rather than a private one, maintaining that the purpose of medical education is to improve the health of communities and to decrease the burden of illness and disease. The annual JAMA publication of data describing the demographic composition, geographic distribution, and specialty focus of learners and programs in US undergraduate medical education and graduate medical education provides an opportunity for the medical profession to once again consider whether the medical education community is designed to strike the appropriate balance between providing a public good and a private good.
14 May 01:17

Anscombe’s Quartet: 1980’s Edition

by Method Matters
John Epling

The importance of visualizing data prior to analyzing it.

(This article was first published on Method Matters, and kindly contributed to R-bloggers)

In this post, I’ll describe a fun visualization of Anscombe’s quartet I whipped up recently.

If you aren’t familiar with Anscombe’s quartet, here’s a brief description from its Wikipedia entry: “Anscombe’s quartet comprises four datasets that have nearly identical simple descriptive statistics, yet appear very different when graphed. Each dataset consists of eleven (x,y) points. They were constructed in 1973 by the statistician Francis Anscombe to demonstrate both the importance of graphing data before analyzing it and the effect of outliers on statistical properties. He described the article as being intended to counter the impression among statisticians that ‘numerical calculations are exact, but graphs are rough.’

In essence, there are 4 different datasets with quite different patterns in the data. Fitting a linear regression model through each dataset yields (nearly) identical regression coefficients, while graphing the data makes it clear that the underlying patterns are very different. What’s amazing to me is how these simple data sets (and accompanying graphs) make immediately intuitive the importance of data visualization, and drive home the point of how well-constructed graphs can help the analyst understand the data he or she is working with. 

The Anscombe data are included in base R, and these data (and R, of course!) are used to produce the plot that accompanies the Wikipedia entry on Anscombe’s quartet.

Because the 1980’s are back, I decided to make a visualization of Anscombe’s quartet using the like-most-totally-rad 1980’s graphing elements I could come up with. I was aided with the colors by a number of graphic design palettes with accompanying hex codes. I used the excellent showtext package for the 1980’s font, which comes from the Google font “Press Start 2P.” (Note, if you’re reproducing the graph at home, the fonts won’t show properly in RStudio. Run the code in the standalone R program and everything works like a charm). I had to tweak a number of graphical parameters in order to get the layout right, but in the end I’m quite pleased with the result.

The Code

# showtext library to get 1980's font
# "Press Start 2P"
# add the font from Google fonts"Press Start 2P", "start2p")

width=11,height=8, units='in', res=600)

op par(las=1, mfrow=c(2,2), mar=1.5+c(4,4,.5,1), oma=c(0,0,5,0),
lab=c(6,6,7), cex.lab=12.0, cex.axis=5, mgp=c(3,1,0), bg = 'black',
col.axis = '#F2CC00', col.lab = '#A10EEC', family = 'start2p')
ff y ~ x
for(i in 1:4) {
ff[[2]]"y", i, sep=""))
ff[[3]]"x", i, sep=""))
lmi lm(ff, data= anscombe)
xl substitute(expression(x[i]), list(i=i))
yl substitute(expression(y[i]), list(i=i))
plot(ff, data=anscombe, col="#490E61", pch=21, cex=2.4, bg = "#32FA05",
xlim=c(3,19), ylim=c(3,13)
, xlab=eval(xl), ylab=yl,
family = 'start2p'
abline(lmi, col="#FA056F", lwd = 5)
axis(1, col = '#FA1505')
axis(2, col = '#FA1505')
mtext("Anscombe's Quartet", outer = TRUE,
cex = 20, family = 'start2p', col="#FA1505")

The Plot


In this post, I used data available in R to make a 1980’s-themed version of the Anscombe quartet graphs. The main visual elements I manipulated were the colors and the fonts. R’s wonderful and flexible plotting capabilities (here using base R!) made it very straightforward to edit every detail of the graph to achieve the desired retro-kitsch aesthetic.

OK, so maybe this isn’t the most serious use of R for data analysis and visualization. There are doubtless more important business cases and analytical problems to solve. Nevertheless, this was super fun to do. Data analysis (or data science, or whatever you’d like to call it) is a field in which there are countless ways to be creative with data. It’s not always easy to bring this type of creativity to every applied project, but this blog is a place where I can do any crazy thing I set my mind to and just have fun. Judging by that standard, I think this project was a success.

Coming Up Next

In the next post, I’ll do something a little bit different with data. Rather than doing data analysis, I’ll describe a project in which I used Python to manage and edit meta-data (ID3 tags) in mp3 files. Stay tuned!

To leave a comment for the author, please follow the link and comment on their blog: Method Matters. offers daily e-mail updates about R news and tutorials on topics such as: Data science, Big Data, R jobs, visualization (ggplot2, Boxplots, maps, animation), programming (RStudio, Sweave, LaTeX, SQL, Eclipse, git, hadoop, Web Scraping) statistics (regression, PCA, time series, trading) and more...
04 May 19:38

Despite screaming headlines, England’s breast cancer screening computer glitch didn’t kill anyone

by Kevin Lomangino
John Epling

The headlines for this story were disturbing - I don't agree with the hyperbole generated by the modeling of the attributable deaths. But most interesting to me was the fact that preventive screenings were clearly the domain of the health system, seemingly not the responsibility of the GPs. It's a different system.

A bureaucratic snafu in England has generated international headlines bemoaning the deaths of hundreds of women.

Some coverage, such as this CNN story picked up by KSAT in San Antonio, brought visions of a mass casualty event on the scale of a terrorist attack or airline crash:

Dozens of other news outlets chimed in with similarly explosive framing:

The coverage focuses on a computer error at the National Health Service that caused some 450,000 older women (ages 68 to 71) not to receive scheduled invitations for a mammogram.

As a result, the stories claim, between 135 and 270 women may have died from breast cancer that could have been detected and treated earlier with lifesaving results. UK Health Secretary Jeremy Hunt is referenced as the source of these figures.

Lack of mammograms has never killed anyone

What’s the problem with these stories?

For starters, neither breast cancer screening nor any other form of cancer screening has been shown to reduce overall mortality, which is the best measure of whether lives are actually being saved or not.

For this reason, no one can say with any certainty whether mammograms would have saved these women — or whether the lack of a mammogram killed them.

Breast cancer screening has been shown to modestly reduce deaths from breast cancer. (About 1,000 50-year-old women need to be screened for 10 years to prevent one death from breast cancer.) However, this small benefit evaporates when other causes of death, such as cardiovascular disease, are factored in.

Why is this important? It’s possible that for some women, radiation and other toxic therapies that are used to treat screen-detected cancers may ultimately increase the likelihood of dying earlier from some other cause–canceling out any reduction in deaths from breast cancer.

That’s why it’s treacherous to consider lives “saved” by a reduction in deaths from a specific disease. The treatment of that disease may ultimately increase deaths through some other unrelated mechanism.

Overdiagnosis not accounted for

Another problem with this coverage is that it doesn’t adequately acknowledge the risk of overdiagnosis — the detection of cancers that never would have caused health problems or death. Some cancers are slow-growing and might never pose a risk to the patient, while others are very aggressive and may spread despite the earliest possible detection and treatment.

A recent Danish study estimated that about one-third of all mammography-detected breast cancers represent overdiagnosis. This means that women treated for these cancers had no chance to benefit, but experience all the harms of cancer treatment that may include surgery, chemotherapy, and radiation.

‘Epitome of disease-mongering’

Christine Norton, president and co-founder of the Minnesota Breast Cancer Coalition and a breast cancer survivor, called the headline and first paragraph of KSAT’s CNN story “the epitome of disease mongering.”

“Combined they engender fear not only in older women in the UK who were among those not invited to be screened but also in any woman of any age who has thought about the possibility of breast cancer,” she said.

UK Health Minister Jeremy Hunt addresses Parliament.

Norton said it was inaccurate and irresponsible to blame up to 270 deaths on a failure to invite women for breast cancer screening. “The more accurate and responsible statement is the quote in paragraph 5 [of the CNN story] by the UK Health Secretary, Jeremy Hunt, who noted that ‘At this stage it is unclear whether any delay in diagnosis will have resulted in any avoidable harm or death.’ Based on multiple studies, it’s more accurate to state that breast cancer screening results in false positives, over-diagnosis, and over-treatment.”

The point is not that mammograms are useless and should be avoided — it’s that the benefits are probably smaller than most women have been led to believe, and that those benefits are accompanied by significant harms that many women have never been warned about. Women are making decisions about mammograms based on incomplete, imbalanced information. News coverage of mammograms doesn’t help when it reinforces misconceptions about the effectiveness of screening and doesn’t address the harms.

Who will be notified?

According to the CNN coverage, “Health officials will contact the next of kin of women who are thought to have missed a scan and subsequently died of breast cancer, Hunt said. They will apologize and offer a process to establish whether the error led to an earlier death, and if compensation might be payable.”

This statement raises some interesting questions:

  • Will officials also contact women who weren’t notified and let them know that they may have been spared unnecessary and harmful treatment that might have been prompted by a positive screen?
  • Will they also apologize to the women who were notified and whose screen-detected tumors were treated unnecessarily? Will they inform those women of the significant chance that their cancer was overdiagnosed?

None of the superficial stories that I read about this situation asked these legitimate questions.

They missed an opportunity to bring balance to what is typically a one-sided message about breast cancer screening.

Editor’s note: A previous version of this story referred to “the UK’s breast cancer screening computer glitch” in the headline. References to a “UK” glitch have been changed to “England,” since the glitch only affected women in England and not Scotland, Wales, or Northern Ireland.  

22 Apr 18:28

Pseudoscience: The Conspiracy Against Science

by Harriet Hall
An excellent new book examines pseudoscience in 22 essays by prominent scientists from various fields.
17 Oct 01:23

Low Prevalence of Criteria for Early Screening in Young-Onset Colorectal Cancer

by Frank W. Chen, Vandana Sundaram, Thomas A. Chew, Uri Ladabaum
Colorectal cancer (CRC) incidence in adults aged <50 years is increasing in the U.S. despite an overall decline in CRC incidence in the general population.1,2 This trend has received attention in the general and medical press.3 The underlying factors for this trend are unknown.4