Health umbrella reviews mask the real issues

You have to wonder why the breakfast tea doesn’t get the same level of attention. Or perhaps whether in France, the humble croissant is elevated to the same status. Or maybe the banana could soon be the star of another media show. But unfortunately it is coffee that headlines tomorrow’s fish and chips papers.

“Drinking three or four cups of coffee a day could have benefits for your health”. As we have seen previously, this kind of headline bears the hallmarks of a media health report:

1) repackaging of common information requiring little or no specialist examination;

2) use of a modal auxiliary verb (could) to conveniently justify or disclaim an

attention-grabbing headline – which, by the way, is point number three.

The health reports in the media also incorporate:

4) a statistically small group of trial participants, whose results are then blown up in proportion as if to be representative of the 7 billion people on the planet.

5) Assumptions. A media report about health could simply include assumptions.

Why dwell on coffee? For starters, it is a commonly consumed drink and so any meaningful research would potentially have bearings on millions of people. It is common media practice to focus on common food and activities because of the relevance to daily life.

But if you examine this carefully, why not tea? Why not write about tea? While conspiracy theories may be slightly far fetched, it is possible that – unless it is a speciality tea – coffees cost more, and any potential health benefits would lead people to spend more, hence generating more for the economy in the forms of tax. Perhaps this is why media writers don’t waste too much ink on researching the potential life-saving benefits of bananas, even though they are widely consumed. The research isn’t going to drive people to buy bananas in bulk, and even so, the extra revenue generated from a low priced item isn’t going to raise much extra tax.

Are there any notable similarities or differences in style across different countries? One wonders whether Parisian newspapers, on a regular basis, churn out headlines such as:

“Eating two or more croissants a day could reduce your chances of heart disease.”

“Pan aux raisins linked with dementia”.

The research done was an umbrella review to potentially examine whether further research should be undertaken into researching the effects of coffee and its role in preventing liver cancer. An umbrella review meant that no actual research was undertaken, but that existing research was examined and analysed to glean insights.

The problem with umbrella reviews is that they are very generalised, no actual research is done, and they are only brief analyses of existing research. This means that first of all, an umbrella review could arrive at a particular conclusion, but in no way should that be taken as the final conclusion.

In fact, the findings of an umbrella review are only the preliminary to more detailed investigation. If an umbrella review suggested that drinking coffee could prevent cancer, then what it is saying is more research needs to be undertaken, and the media needs to be ethically responsible by not reporting “Coffee prevents Cancer”, because there are people that look at newspapers and television as the source of their information and assume just because it has been released in the public domain, it is truth. Who could conceive that newspapers spend time and resources to publish trivial information and that television is pure rubbish?

The second problem with umbrella reviews is that the outcomes are only as good as the original sources. If someone gave you a set of grainy photos, then asked you to make a collage with them, then your collage is going to be as good as the grainy photos will allow. If the original sources were not thorough or exact in their investigation, are any subsequent findings based on these merely just a waste of time?

The third issue with umbrella reviews is that under closer scrutiny, the overall picture is distorted by over focussing on small statistical variances, or sometimes minute errors are magnified and lead one down the wrong path.

If you took a picture on your phone and then blew it up to the size of a mural covering the side of your house, the picture becomes very dotty. You might see big patchy squares. But if you started looking for that big patchy square from the image in your phone… one has to wonder what the purpose of that is.

The fourth is that because umbrella reviews are a prelude to a more thorough investigation, their end results are slightly skewed from the outset. If an umbrella review is bound to provide a few avenues for later time-consuming research then it is fundamentally biased into having to provide one in the first place. Why, in that case, have such reviews in the first place? Some may point out that the flaw in the system is that umbrella reviews are relied on by those in academia and research to warrant the continued longevity of their positions. In other words, if researchers had nothing to research, they might be out of a job, so they best find something to stick their noses in.

Have you ever read the London newspaper Metro and come across some research news such as:

“Going to bed angry can wreck your sleep” (25 Sept 2017)

It is the sort of headline that makes you think “Why bother doing the research in the first place?”

It is likely that you have read a media report of an umbrella review.

What were the findings of the original coffee review?

Drinking coffee was consistently linked with a lower risk of death from all causes and from heart disease. The largest reduction in relative risk of premature death was seen in people consuming three cups a day, compared with non-coffee drinkers.

Now, when an umbrella review mentions drinking coffee is linked with a lower risk of death, it is important to be clear about what it specifically means. And what it is stating is that those who had a lower risk of death all happened to drink coffee. It might have nothing to do with the coffee itself. It might have been that they took a break to slow down a fast-paced lifestyle, and the taking of a break gave them a lower risk of death. By that logic of association, tea could also be linked with a lower risk of death.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type-2 diabetes, gallstones and gout, the researchers said. The greatest benefit was seen for liver conditions such as cirrhosis of the liver.

Again, to be clear, the above link means that those who were at lower risk of those cancers happened to drink coffee. But it is not necessarily stating the coffee had anything to do with it.

And coffee is such a commonly consumed drink, that it is easy to use it to draw links to anything.

If people who died from car accidents happened to drink coffee, an umbrella review might state that drinking coffee is linked with higher incidences of car accidents.

The findings can be summarised by a health analyst:

“Does coffee prevent chronic disease and reduce mortality? We simply do not know. Should doctors recommend drinking coffee to prevent disease? Should people start drinking coffee for health reasons? The answer to both questions is ‘no’.”

We should perhaps add a further third question: Did the umbrella review produce any actionable findings, and should it have been undertaken in the first place?

Probably not.

Is there any truth about the benefits of Classical music?

Is there any truth to the commonly accepted notion that listening to classical music improves mental capacity? Somehow it has been accepted in modern society that classical musicians have larger frontal cortices, better mental reasoning powers and perhaps intelligence quotients. Over the last two decades or so this idea has fuelled a rise in the number of pregnant mothers listening to classical music – whether or not they like it – and parents enrolling their children into music classes. The music of Mozart, in particular, has enjoyed a resurgence as its classical form is deemed to be more logical and organised, compared to music of other periods, assisting in triggering patterns of organisation in the brain amongst its listeners.

How did this idea about Classical music come about? In the 1990s scientists conducted a series of experiments where one group of students were played one of Mozart’s piano sonatas before a spatial reasoning test, while another group sat in silence. The group that was played the music beforehand performed better on that task than the control group. The effect on the control group was temporary and only lasted fifteen minutes, meaning that after the fifteen minute mark the disparities between the results were minimal and statistically the same. The results of the group found also that while music primed the individual particularly for mathematical tasks, after an hour of listening to Classical music, the effect on the brain was lost.

That piece of research was pounced on by the media and other individuals and seemingly perpetuated to promote the listening of Classical music. One governor of the state of Georgia even decreed that newborn babies be given a copy of a CD of Mozart’s works upon leaving the hospital. The Mozart Effect, to give it its common name, was written about in newspapers and magazines, and this began the spur of Mozart-related sales of music as well as the trend of mothers playing such music to their children in and out of the womb.

The most important question we need to ask is whether there is any truth in such research, and whether it can be corroborated.

We know that some forms of music has a soothing, calming effect on individuals. Playing the music to the students may have calmed that so they were not nervous, allowing them to perform better on the task. However, relaxation need not take them the form of Classical music. Any activity that promotes calm before a task – reading a light magazine, playing computer games, talking with a friend – can also hence be said to have the same effect as the classical music that was played.

What if the students in the group had read a joke book or comic beforehand, been less worried about the test and scored better? It might have prompted a deluge of articles claiming “Reading Archie (or The Beano – insert your own title here) improves your IQ”.

Or if the students had been offered a protein drink beforehand, it would not be inconceivable that someone would latch to that piece of research and declare that “Protein Drinks not just good for your body, but for your brain too”.

Mozart’s music has been said to embody the elements of classical music as we know it. Organised formal structures, chords and harmonies through related keys, use of contrasting tunes, contrasts in volume all feature in his music. But the music of other composers have such features too. Imagine if the composer Josef Haydn had been the lucky beneficiary of the experiment and his music had been played instead. The sales of his music catalogue would have hit the roof!

Subsequent scientists all found that listening to music of any form caused improvements, and the genre of music – whether rock or Classical – was irrelevant. But studies today still quote Mozart.

Is it ethical that the media promotes unsubstantiated research by reporting without closer scrutiny? As we have seen in previous blogs posts, the media reports on things without necessarily scrutinising the evidence, and entrusts so-called experts to corroborate the evidence, while it fills column inches and air time with modal auxiliary verbs? Huh? In simple terms, it means that if there is a sniff of a link between A and B, the media reports that “A could cause B”. Never mind whether it does or not, there is always the disclaimer of the word “could”.

In this instance, students performed better on a spatial reasoning task after listening to Mozart; hence the headline “Mozart could improve mental powers”. Diluted over several recounts, you could get “According to XXX newspaper, Mozart improves brain power” before arriving at “Mozart improves brain power”. Unfortunately, this is when the headline is then pounced on by anyone who would stand to profit from espousing this theme.

Who would profit from this? The Classical music world – performers, writers, musicians – can use this “research” to entice people into taking up lessons and buying CDs and magazines. If you read any music teacher’s website you may find them espousing the benefits of learning music; it is rare if you find one that advises it is a lot of effort.

The media will profit from such “research” because it means there is an untapped well of news to report and bleed dry in the quest for filling column inches and air time. News exclusives will be brought out, and so-called experts will also profit for appearing on the news and programmes, either monetarily or in the form of public exposure.

One must question the ethics of incorrect reporting. Unfortunately unsubstantiated research leads to more diluted misreporting, which can then form the basis of new research – research that uses these claims as the groundwork for investigation.

It is scary to think that all the medical research that has been done into effect of music and health could be biased because of the so-called effect of classical music. Could musical activities such as learning the piano help reduce Parkinson’s disease? Could listening to the music of Beethoven reduce the incidence of higher cases of Alzheimer’s disease? Could it all be wrong – have we all been sent down the wrong tunnel by an avalance of hype reporting?

It may be fair to say the human impulse is to buy first and consider later, because we are prone to regret. If we have missed an opportunity to improve the lives and abilities of our children, then we will be kicking ourselves silly forever with guilt.

So if you are still not convinced either way about whether classical music – either in the listening or the practice – really does have any effect, you could at least mitigate your guilt by exposing your child to piano music, for example that has predictable patterns in the left hand. Sometimes, listening to structurally-organised music such as from the Baroque may be useful, but it is also good to listen to Romantic music because the greater range of expression arguably develops a child that has more emotionally subtlety and intelligence.

You may find that ultimately, any truth in the research about Classical music and its mental benefits is not due to the blind passive listening, sitting there while the music goes on around your children. It is in the child’s inner drive to mentally organise the sounds that are heard, the trying and attempts to organise background sounds that really triggers the mental activity in the brain. It is more the practised ability in the inner mind to organise musical sounds that causes better performance in related mental tasks.

A smart person thought up the mental improvement products

The trail of human evolution is littered with gadgetry that have outlived their usefulness. We can add devices such as the fax machine, walkman, mini-disc and tape recorder to the list of machines which seemed clever at the time but have now before obsolete. Those of us of a certain age will remember newer additions such as the PocketPC, a palm sized screen which was used with a stylus that tapped out letters on screen, and the HP Jornada, a slightly bigger tablet sized keyboard and phone. And who could forget the Nintendo Brain Training programmes for the DS and Fitness Programmes for the Wii?

Launched in 2005, Nintendo’s Brain Training programmes claimed to increase mental functioning. Nintendo’s premise was that the concentration required in solving a variety of puzzles, involving language, mathematical and reasoning, increased blood flow to the frontal cortex of the brain, which at least maintained brain functioning or helped improve it. After all, since the brain is a muscle, exercising it by bombarding it with mental exercises would keep it active and healthy, right?

It is the idea of keeping the brain active that leads many to attempt their daily crossword or Sudoku. The latter in particular has seen an surge in interest over the past decade and is now a feature in newspaper back pages and magazines. There are even publications exclusively filled with Sudoku puzzles, and even more complex versions where each traditional puzzle forms a square in a bigger and complex three by three grid. If you thought doing a Sudoku puzzle was hard, imagine having to work on it in relation to eight others. It would be absolutely mind-boggling!

Is there any truth about the positive enhancements to the human life that these objects or activities bring? Nintendo’s claims about the Brain Training programmes were doubted by leading neuroscientists, who doubted the tenuous links between the increased blood flow to the brain and the vaguely described positive effects to life. It is akin to making a blanket statement saying chess grand masters or academics are the happiest people around. Unfortunately it is yet another case of a company creating a product and then engineering the science around it.

Manufacturers of beauty products do it all the time. Whether it is skin care or facial products being flogged, you will find an aspirational theme within the first five seconds of the advertisement (“Look beautiful! Stay young!”) which is then followed by a pseudo-scientific claim, preferably involving percentages (sounds more authoritative) and a small sample size (easier to corroborate, or disclaim, depending on the need).

“Live young forever. XX skin lotion is carefully formulated to retain your natural moisture, so you look and feel twenty years younger. 86% of 173 women noticed a change in skin density after using it for three months.”

There you have it. The secret of beauty product advertising.

Unfortunately, if there was any display of mental acuity, it was by the marketing team of Nintendo. In pitching a product to adults, using the retention and improvement of mental agility as a plus point, they not only convinced adults to buy what was essentially a toy, but to buy one for their children as well. The DS alone has since sold over 90 million units worldwide, and when you take into account the cost of games and all that, you will have to concede that someone at Nintendo had the smarts to produce a tidy little earner.

(For those who were more concerned with retaining their physical functioning, the Nintendo Wii Fit programmes performed that function and filled in the gap in that market.)

The improvement of mental functioning is always a good basis for marketing any product. You can find a whole plethora of products huddling behind it. Multi vitamins, activity puzzles, recreational activities involving multi-tasking – all supposedly give the brain a workout, but more importantly, tap into the fears of missing out or the loss of mental function in the human psyche, that makes people buy not out of potential gain, but fear of lost opportunity and potential regret.

The loss of mental function can lead to Alzheimer’s disease, for which there is currently no cure. With 30 million people worldwide suffering from it, this presents an endless river of opportunity for people researching the disease, as well as people developing products to improve mental function in the hope that it can stave off the disease. Like the Nintendo Brain Training developers realised, it is not so much about whether these scientific products work that makes people buy them – the evidence that is produced is biased and not independent – but it is the fear of missing out and retrospective guilt that compels people to make the purchase. Buy first, examine the evidence later, is the apparent dogma.

Unfortunately we are at the stage of modern society where it is not just the product that needs scrutiny, but whether the scrutiny itself needs scrutiny for evidence of bias, either in the form of financial ties or expected research outcomes.

Mental improvement is an area that product developers – whether the products be vitamins, books or applications – will continually target because human beings will always seek to improve mental prowess, both in themselves and their children, in the hope that somewhere down the line it offers an advantage, or prevents the mental degeneration associated with the aging process. And the compelling reason to buy lies somewhere in the meeting points of being seduced by the aspirational ideals the product offers, the fear of missing out, and the assumption that the underlying evidence is empirical. The greatest mental sharpness has been displayed by the one who has understood the sales psychology of mental health improvement products and used it to his or her advantage.

Night time eating? Heart disease coming

That late night snack may be comforting and the perfect end to a day. However, if research is proven to be right, it could be the cumulative cause of heart disease.

Scientists have always known that night shift workers are at greater health risks than workers who work regular patterns. Which is why if you divided the pay shift workers receive by the hours worked, you would find that they have a higher hourly rate compared to those who do the same job during normal hours. That extra pay is to compensate for what is commonly perceived as the extra demand of working during the night, at a time your body is looking to shut down for a rest. The external pressures of going against your body, over a prolonged period, can exert a toll on the body.

Scientists in Mexico researching the links between diet and the human body tested their hypotheses on rats. The rats were fed food at a time when their bodies would normally be at rest, and the results showed that the fats from food remained longer as triglycerides in the body’s bloodstream for longer, because their bodies were at a resting state and not primed to break down food.

Bearing in mind that the research was done on rats, and while some results may have bearing on humans and some may not, what points could we take from these research results?

Having high levels of triglycerides in one’s body means that the risk of cardiovascular diseases such as heart attacks are significantly increased. Hence, if you are eating late at night, you may be at greater risk. Although the research is only at its infancy, they could suggest that the body is better when it comes to the processing of fats, when it is at its most active state, as it comes at more of a natural time.

What can you do if you work shifts? You may not have much control over the food you eat, but you can take steps towards eating a healthier diet and make time for regular exercise so the overall risk of heart disease is lowered. And if you do not work shifts, but work during the day, a big meal late at night is also best avoided for you.

Why mental health problems will never go away

Many people will experience mental health difficulties at some point in their lives. As people go through life the demands on them increase, and over a prolonged period these can cause difficulty and ill health. These problems can manifest themselves both in mental and physical ways.

What kind of demands do people experience? One of these can be work-related. People may experience  stresses of looking for work, having to work in jobs which do not test their skills, or be involved in occupations  which require skills that are seemingly difficult to develop. Another common theme with adults that causes stress is having to work in a job which increasingly demands more of them, but does not remunerate them accordingly. In other words, they have to work more for less, and have to accept the gradual lowering of work conditions, but are unable to change jobs because they have already invested so much in it in terms of working years, but cannot leave and start afresh because the demands of a mortgage to pay off and a young family to provide for means they cannot start on a lower rung in a new occupation. Over a prolonged period, this can cause severe unhappiness.

Is it surprising that suicide affects men in their thirties and forties? This is a period for a man where work demands more, the mortgage needs paying, and the family demands more of his time and energy. It is unsurprising that having spent long periods in this sort of daily struggle, that men develop mental health problems which lead some to attempt suicide. But mental health does not just affect men. Among some of the this some women have to deal with are the struggles of bringing up children, the work life balance, the unfulfilled feel of not utilising their skills, and feeling isolated.

One of the ways ill health develops mentally is when people spend too long being pushed too hard for too long. Put under these kind of demands, the body shuts down as a self preservation measure. But the demands on the person don’t just go away. You may want a break from work. But this may not be possible or practical. In fact, the lack of an escape when you are aware you need one may be a greater trigger of mental illness, because it increases the feeling of being trapped.

It is little wonder that when people go through periods of mental ill health, an enforced period of short-term rest will allow them to reset their bearings to be able to continue at work, or return to work with some level of appropriate support. But this is only temporary.

With mental ill health problems, lifestyle adjustments need to be made for sufficient recovery.

Under the Equality Act (2010), your employer has a legal duty to make “reasonable adjustments” to your work.

Mental ill health sufferers could ask about working flexibly, job sharing, or a quiet room, a government report suggests.

The practicality of this however means more cost to the employer in having to make adjustments to accommodate the employee, and unless the employee is a valued one, whom the employer would like to keep, often the case is that they will be gradually phased out of the organisation.

In fact, when an employee attains a certain level of experience within an organisation, employers often ask more of them because they know these employees are locked in to their jobs, and have to accept these grudgingly, or risk losing their jobs, which they cannot do if they have dependents and financial commitments.
And you know the irony of it? The mental ill health sufferer already knows that. Which is why they don’t speak out for help in the first place.

If these employees complain, employers simply replace them with younger employees, who cost less, and who are willing to take on more responsibilities just to have a job. Any responsibilities the redundant employee had simply get divided up between his leftover colleagues, who are in turn asked to take on more responsibilities. They are next in line in the mental health illness queue.

And what if you are self employed? And have to work to support yourself and your dependents? The demands of the day to day are huge and don’t seem to go away.

You can see why mental health is  perceived a ticking time bomb. Organisations are not going to change to accommodate their employees because of cost, but keep pressing them to increase productivity without pay, knowing that they cannot say no, and when all the life and juice has been squeezed out of them, they can be chucked away and replaced with the next dispensable employee.

A ticking time bomb.