The story focuses on the potential for zinc supplements to reduce acid reflux, a related condition known as Barrett’s esophagus, and esophageal cancer.
The story addresses the uncertainty surrounding research into this subject, and even goes so far as to note that “studies don’t prove conclusively that zinc will have the desired therapeutic effects.” However, the story devotes most of its copy to two researchers who are marketing products that use zinc to address these health concerns — with no obvious input from independent, third-party experts. These experts endorse using it now, in spite of a lack of studies showing effectiveness.
Also, the headline violates a basic rule of headline writing: if X may cause Y, then you might as well say X may not cause Y. In other words, the headline could just as easily read “Simple mineral may not be cure for complex disease.” In fact, given that the story notes there is no conclusive evidence the new zinc supplement products discussed here will work, that may have been a better headline.
Editor’s Note: The original headline has since been changed. It now reads: “Could simple mineral help complex disease?” However, this rewritten headline reflects another technique we discourage, known as “question mark journalism.”
All in all, this is a trio of related medical conditions that can be fairly common (such as GERD) and pose major health risks (like esophageal cancer). For those reasons, the development of new options for treatment and prevention of these conditions is certainly newsworthy. That said, it’s incredibly important for news coverage of research like this to highlight the limitations of the research. This story pays lip service to the limitations — it clearly mentions them, but it quotes repeatedly from people who will profit from peddling zinc supplements without offering input from independent third parties, and tells readers about these new (unproven) products coming to market before it tells readers about the lack of medical evidence to support the use of the products.
The story does not tell readers how expensive the new zinc products will be, which is unfortunate. However, it does note that zinc supplements already on the market cost “pennies a day.” That’s an accurate description of the cost for existing zinc supplements, so this earns a satisfactory rating.
This area is problematic. The story refers to multiple studies, so we’ll deal with them separately. First, it refers to a study in which an unknown number of Barrett’s esophagus patients took zinc supplements in the form of lozenges twice a day for 14 days. For this study, the story tells us only that, for those patients who took the supplements, there were “molecular changes” in the relevant cells. Based on context, these were apparently beneficial changes — but readers aren’t explicitly told that. Nor is information given about how, why, or to what extent these changes are related to health. The story does note that an ongoing clinical trial is underway with 120 patients, and that “the results are promising” — but that language is so vague as to be meaningless for readers who want to understand exactly what is going on.
Second, the story refers to “published results from a series of experiments in animals as well as 12 healthy human volunteers.” The story then quotes from an unknown source that “Zinc offers a novel rapid and prolonged therapy to inhibit gastric acid secretion in human and rat models.” Not only is that not quantified, but it’s not even made clear to readers exactly how that is related to GERD, Barrett’s esophagus or esophageal cancer.
Third, the story refers to a large, longitudinal study in China. The story tells readers that this study found zinc supplements did not have an effect on deaths related to esophageal cancer (more on this particular study below).
The story includes this statement: “There is a caveat: Experts have set the safe upper limit for zinc in healthy adults at 40 milligrams per day. Too much can cause vomiting and more serious toxicity. So even though zinc is widely available over the counter, the researchers advise against taking more than directed.” That’s enough to earn it a satisfactory rating.
Even levels of zinc that are not much higher than the recommended daily dose have been known to cause health problems, so we’re glad to see this included here. However, it would have been better to acknowledge the potential risks associated with zinc toxicity much higher in the story.
As with quantifying benefits, the story’s approach to the quality of evidence is problematic — and for overlapping reasons. Again, the story refers to multiple studies, so we’ll deal with them separately. First, it refers to a study in which an unknown number of Barrett’s esophagus patients took zinc supplements in the form of lozenges twice a day for 14 days. How many patients were involved? How big was the distinction between the control group and those who received the zinc lozenges? Without this sort of basic information, or any information on how to find a related journal article, there is little to be gained from discussing the study. What’s more, the discussion of this study doesn’t give readers any clear information about how, why, or to what extent these study results are related to health.
Second, the story refers to “published results from a series of experiments in animals as well as 12 healthy human volunteers” related to gastric acid secretion. It’s not clear how many studies there were, how many journal articles were published, where they were published, or even what sort of studies were done. The story also fails to note that a study of only 12 human subjects can offer little or no useful information for clinical decision-making. In addition, the story doesn’t make clear to readers exactly how this research on gastric secretion is related to GERD, Barrett’s esophagus or esophageal cancer. Presumably, more gastric secretion is bad — but the story needs to spell this out.
Third, the story refers to a large, longitudinal study in China. The story tells readers that this study found zinc supplements did not have an effect on deaths related to esophageal cancer. It then said that “a high-tech chemical analysis of biopsy specimens from a small number of patients” found that high zinc levels were correlated with lower esophageal cancer risk. That’s an interesting statement, but it needs to be backed up with some facts. How strong was the correlation? If researchers only examined biopsies in a “small number” of patients, how much weight should readers give to these findings? And what do they mean by a “small number” of patients, anyway — 100 patients? 50? 5? For this study, the main point should have been “this study found zinc supplements did not have an effect on deaths related to esophageal cancer.” This was glossed over and an attempt was made to dismiss it.
There was no overt disease-mongering. However, the story could have done a better job by more explicitly stating the numerical rate of progression from something very common–acid reflux–to Barrett’s esophagitis, and eventually esophageal cancer.
The two sources quoted in the story, James Mullin and John Geibel, are clearly identified as being the driving forces behind new zinc supplement products. However, those are the only two sources quoted in the story — there is no input from independent, third-party sources.
The story does refer to proton pump inhibitors as a treatment for “severe reflux disease.” However, they’re not the only treatment option. Other options may include H-2 receptor blockers, medications to strengthen the lower esophageal sphincter, or surgical interventions. There are also surgical interventions that can help reduce the risk of esophageal cancer in patients with Barrett’s esophagus. Also, there are of course alternatives to zinc supplements as a source of zinc, such as dietary sources and multivitamins.
The story makes clear that zinc supplements are already on the market. However, there is one confusing point. The story refers to two forthcoming zinc supplements. The one mentioned by name, TummyZen, is described as being “slated for sale nationally in Target stores next month.” You can find TummyZen listed in online stores, including Amazon, but it is listed as being no longer for sale. It’s not clear if they were pulled from other outlets as part of an exclusive distribution agreement with Target, but based on online consumer reviews, TummyZen was previously sold via online retailers. If that’s the case, and the supplement has been available for years, it’s unusual for the story to treat it as if it’s a new product.
The story states in its opening paragraph that “For decades, scientists have had a hunch that zinc supplements could help prevent esophageal cancer.” But then the story doesn’t revisit this statement. A quick online search turns of dozens (and dozens) of studies relating to zinc and esophageal cancer, but the story doesn’t provide much information about this larger body of existing work. How does the research that’s discussed in the story fit into, or depart from, the existing literature on this issue? It’s not clear.
The story doesn’t appear to draw directly from any news release we could find.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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