In one version of an online headline, WSJ.com trumpeted this as “The Diet That Saves The Brain.” That is simply unacceptable.
And the body of the story didn’t do enough to establish how the principal finding – a change in brain imaging – may not be tied to the diet at all.
We need to do a better job of educating readers that what shows up on an imaging test sometimes has no connection to symptoms or health status.
Not applicable. The cost of a Mediterranean diet is not in question.
When you find this story online on WSJ.com, it carries the banner: “The Diet That Saves The Brain.”
There isn’t any discussion in the body of the story to back up that bold claim.
We don’t blame the reporter for this but someone at WSJ has to take responsibility for this hype.
We’ll also add this to our wish list: an explanation that higher “white-matter volume burden” is a surrogate measure of health — i.e. it does not necessarily translate to more brain damage. These white spots are often found in normal people and might not mean anything. The differences the researchers found were statistically significant, but there’s no attempt to sort out whether the changes observed are clinically meaningful.
Not applicable. No discussion of harms and we’re not sure what they would be.
The researchers actually published a long paragraph of potential limitations, which we include here to show that a simple line at the end of the story – cautioning “that the study doesn’t prove that a Mediterranean-style diet causes less brain damage and said more study is needed” – doesn’t really get at an independent evaluation of the evidence – something an independent expert could have provided as well.
The researchers wrote:
A MeDi (Mediterranean Diet) was associated with a lower WMHV (brain magnetic resonance imaging white matter hyperintensity volume) burden, a marker of small vessel damage in the brain. However, white matter hyperintensities are etiologically heterogenous and can include neurodegeneration.
…
However, our study has several limitations. We only measured food frequency at baseline, which was on average 7 years before the time of MRI WMH assessment (range, 2-14 years), and thus participants could have changed their diet before the MRI was performed. However, dietary patterns appear to be stable in other population-based studies. In addition, despite the use of a valid and reliable food frequency questionnaire to calculate MeDi scores, a potential for both random and systematic misclassification of dietary habits persists, although any misclassification is most likely to be random and thus tending to minimize an association between a MeDi and WMHV. Most studies depend on similar methods, and they are a practical approach, albeit subjective in nature. In addition, we used the traditional MeDi score method to quantify adherence, but this too has limitations because the score is based on the cohort- and sex-specific median values across 9 food categories, which does not readily allow for an examination of dose-dependent associations. However, most population-based studies have used this approach. Although the potential for confounding always exists, the persistence of associations after adjustment for many potential confounders suggests that this form of bias does not account for the associations observed. The MRI study population represents a subcohort of the overall NOMAS cohort and was younger and generally healthier than the full cohort. However, as mentioned previously, we did not observe diet differences between those who were included and excluded, again suggesting that selection into the study cohort did not bias our results. Last, MRIs to measure WMHV were only conducted once, so we are unable to infer the temporal association between the MeDi and development of WMHs.
One might argue that the story inflated the potential role of white matter hyperintensities, but we’ll give the story the benefit of the doubt on this one.
No independent perspective provided and – if the journalist isn’t going to do a critical analysis of the evidence – then an independent perspective is sorely needed in such stories.
The story didn’t even include a line about other stroke prevention research – dietary or otherwise.
Not applicable. The availability of components of the Mediterranean diet is not in question.
The story reported:
It’s the first study to specifically examine the effects of the diet centered around vegetables, fruits, fish, whole grains, nuts, olive oil and a moderate amount of alcohol, with limited consumption of red meat, sweets and refined grains like white bread or white rice—on the brain’s small blood vessels.
Previous studies have suggested adhering to a Mediterranean-style diet is associated with a lower risk of heart disease, stroke and cognitive disorders like Alzheimer’s disease.
We can’t be sure of the extent to which the story may have been influenced by a news release. We do know that it included no direct quotes, no independent perspectives.
David,
Thanks for your note. Sorry to hear this irritates you.
Our 10 criteria address things we think consumers need addressed in health care news stories. If you read our commentary behind many of our grades, you’ll see that a simple “Yes/No” answer is insufficient. So, for example, on the cost criterion, a story may address some aspect of cost but not adequately enough to satisfy our reviewers or the intent of the criterion. Some of these nuances are explained in more depth at: http://www.healthnewsreview.org/about-us/review-criteria/.
We’ve been doing this for nearly 6 years, applying the same questions/criteria to more than 1,600 stories and yours is the first and only comment to suggest that this approach sounds “ridiculous.” We’ll continue to monitor feedback to see if other users are bothered by this.
Gary Schwitzer
Publisher
Now that David K mentions it, the incongruence between the questions and answers bothers me a bit. But I can’t think of an alternate wording that is more correct but not terribly awkward.
To fix it, in some categories you could easily rewrite to noun forms, for example rather than “Does the story commit disease-mongering?” it could simply be: “Disease-mongering”. But other areas would be harder to reword in this way, for example you would have “Use of independent sources and identification of conflicts of interest”
Actually, maybe it works:
* Adequate discussion of costs
* Adequate quantification of the benefits of the treatment/test/product/procedure
* Adequate explanation/quantification of the harms of the intervention?
…
But really I don’t mind it the way it is. The question form pulls the reader in more, even if it is not strictly grammatical to answer a yes/no question with a “Satisfactory”.
Disclaimer: I welcome comments but will delete those with any kind of product pitch, profanity, personal attacks or those from anyone who doesn’t list what appears to be an actual e-mail address. I will also end any thread of comments that are repetitive. Because I moderate comments, I can’t keep reacting to repeatedly inaccurate or unsubstantiated claims. We don't give medical advice so we won't respond to questions asking for it.
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David K posted on February 20, 2012 at 10:23 am
Your questions are formed in such a way as to require “YES”/”NO” answers, yet you answer them “Satisfactory” and “Unsatisfactory.” Please change the answers or the questions. It irritates me, as a reader with a modicum of education, and you “sound” ridiculous. You might consider a Yes——–No continuum, if “yes” and “no” seem too abrupt to your editors.