Faking the News (and Informational Chaos)

Logo for Frontline, a PBS program

I read in the paper this morning that some hackers successfully (?) broke into the PBS website on Saturday night and posted a story that is untrue. According to multiple sources, the fabricated article stated that Tupac Shakur, a rap performer who died in 1996, is alive and living in New Zealand.

Fox “News” (quotations added by ES) reports a group claiming responsibility was annoyed by a recent Frontline show on WikiLeaks. I googled Tupac and readily identified what is said to be his official website, 2pac.com. There’s a page dated sometime in February 2011, on the Legend:

…Born on June 16 1971 in New York City, Shakur’s parents were both members of the Black Panther Party whose militant style and provocative ideologies for civil rights would come to influence 2Pac’s music. At an early age, Tuapc’s love for performance and the arts began to show, as he began acting at age 13 and later enrolled in the Baltimore School of the Arts before dropping out at 17. Shakur broke into the music business with rap group Digital Underground as a back-up dancer and roadie. Eventually Shakur released his first solo album in ’91, 2pacalypse Now. 2Pac’s music career began to grow as his second album, Strictly 4 My N.I.G.G.A.Z included 2 top 20 pop chart tracks: I Get Around and Keep Ya Head Up.

Shakur’s legal battles began after he established his rap career. In the early nineties Shakur faced a wrongful death suit which settled out of court, accusations of assaulting police officers where charges were ultimately dropped, and even an incident where Shakur sustained 5 gunshot wounds from unknown assailants. In 1995 2Pac was sentenced one-and-a-half to four-and-a-half years in prison for sexual abuse. However, not even prison could slow the success of Shakur’s career.

While incarcerated 2Pac’s latest album, Me Against the World, was number one in the pop charts and would later go double platinum. Shakur became the first artist to reach number one in the pop charts while serving a prison sentence. Making the most of his time in jail, 2Pac became a passionate reader. Among his favourites were the works of Niccolò Machiavelli, an Italian Renaissance writer whose works were in part the foundation for western political science. Shakur’s appreciation of his work inspired the nickname: Makaveli.

After serving only eight months of his sentence, 2Pac was out on parole thanks to a 1.4 million dollar bond paid by Suge Knight, CEO of Death Row Records. Now signed with Death Row Records, Shakur went on to create All Eyez on Me, which featured hits How Do You Want It and California Love.

2Pac’s life was cut short in September of 1996 when Shakur became the victim of a drive-by shooting while his car waited on a red light. While Shakur survived the surgery that followed he was pronounced dead almost a week after the attack.

Even today, 2Pac’s influence is wide-spread…

album cover, "all eyes on me"

I have no idea how much of the legend is true, or if the 2pac website is really sponsored by the Tupac Amaru Shakur Foundation. Based on my limited education, I can confirm that Niccolò Machiavelli was an Italian philosopher of the Renaissance period whose writings influence some political scientists today. I might also confirm that guns really do kill people, here and elsewhere. This statement is based on my general knowledge and life experiences as a physician and citizen of the U.S.

In addition, I now know with certainty that at least one of my sons is familiar with Tupac’s music. He identified the artist in passing, while he walked by as it streamed from my laptop. He wondered why I was listening. In truth, I’m not sure about this. Curiosity, I suppose –

You can find some Tupac songs on YouTube. Based on a limited, first-time review this morning, I’d half-recommend Keep Ya Head Up. (You can send a ringtone to your cell phone, through this website with the lyrics.) In another video, he performs a song called Makaveli the Don. You can buy his CDs at Amazon.com, or elsewhere, or read one of several biographies.

My conclusion: It’s an information jungle out there.

The Medical Lesson: It’s hard to know your sources, especially when hackers can pretend to be a public broadcasting service. The only protection, as with health info that might come from a journal or doctor or a textbook in Texas, is having a good education and breadth of knowledge with which to assess the credibility of whatever you read or hear.

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News on Niaspan, Cholesterol Drugs and Biomarkers

The Times alerted me, this evening:

Lowering bad cholesterol levels reduces heart attack risks, and researchers have long hoped that raising good cholesterol would help, too. Surprising results from a large government study announced on Thursday suggest that this hope may be misplaced….

Common wisdom has been that such patients should take a statin drug like Lipitor or Zocor to lower bad cholesterol and, in many cases, the vitamin niacin to raise their good cholesterol. But in the trial, niacin provided no benefit over simple statin therapy.

It wasn’t clear to me which was the study, but Bloomberg News explains:

Niaspan failed to prevent heart attacks and may have boosted stroke risk in a U.S.-funded study that calls into question the benefit of raising good cholesterol to combat the leading cause of death.

The National Institutes of Health said today it stopped a 3,414-person study early after the addition of Niaspan to simvastatin, a standard therapy for high cholesterol, was linked to strokes in 1.6 percent of patients, compared with 0.7 percent in the control group. The combination failed to reduce heart attacks, heart-related hospitalizations and the need for procedures to reduce chest pain and restore strong blood flow.

So Niacin, what’s supposed to lower triglycerides and raise HDL – the “good” cholesterol – turns out to be a bust, at least when it’s given in the form of Abbot’s Niaspan.

As to how well cholesterol levels reflect a person’s real risk for heart and other vascular disease, I’ve been skeptical for years.

blueberries with oatmeal (at breakfast this morning, with a bit of grapefruit juice nearby, photo taken by sheer coincidence)

Still, I have faith in oatmeal, with skim milk and fruit, for breakfast.

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Good People, a New Play About Chance, Decisions and Fate

A short note on Good People, the title of a new play at the Manhattan Theatre Club starring Frances McDormand

It’s a simple story, at some level, about a middle-aged woman from south Boston who loses her job. She has a disabled, adult daughter who needs caregiving, and she needs money. She contacts some old friends, and scours the neighborhood for a job. She encounters a once-boyfriend, just for a summer at the end of her childhood, who’s become a doctor with a fancy office and a fancy house and a beautiful wife.

Frances McDorman, in a photo for the MTC

And she’s angry, angry because she’s never been able to leave her community despite, as she puts it, “being nice.” She put her daughter’s needs first and helped others when she could – or so she says, but she was too often late for work at one job and the next, because she was waiting for the daughter’s sitter, or because she couldn’t pay the bill on her car, or for some reason or other unfortunate event, as she sees it, that isn’t quite her fault.

The play’s well-executed, with firm acting and revealing details – like the wallpaper and mismatched furnishings  in the woman’s kitchen, and the spotty sportswear the women don when they go out to be sociable. Some scenes take place in a church, where the characters chat as they play “BINGO,” waiting and hoping for a lucky break.

It’s about fate, and responsibility, and assumptions people sometimes make. And it’s closing this Sunday.

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Psychology Colors and Emotions, from the Late Dr. Robert Plutchik

This morning’s med-blog Grand Rounds is up at MedGadget, where my colleague Dr. Nick Genes has put together a nice assortment of reads. One entry refers to the Plutchik Emotion Circumplex – “a wonderful graphic representation of a highly regarded emotion classification system.”

Plutchik's diagram, as featured in his book: "Emotions and Life: Perspectives From Psychology, Biology, and Evolution"

I never took psychology in college, and in med school they sent us straight onto (into?) the psychiatry wards. For whatever reason, I wasn’t familiar with the colorful schematic. Here’s what I learned today:

Dr. Robert Plutchik was an academic psychologist and author best known for his work on the nature and evolutionary aspects of emotions. He was a Brooklynite who attended City College, received a Ph.D. from Columbia University and became a professor at the Albert Einstein College of Medicine. According to an obituary in now-defunct New York Sun, after retiring he moved to Sarasota, Florida. He died in 2006, at the age of 78.

From the Sun:

He was best known for his theory, laid out in “Emotion: a Psychoevolutionary Synthesis” (1980), that there are eight primary emotions, which can to some extent be recognized in all animals. These are joy, acceptance, fear, surprise, sadness, disgust, anger, and anticipation. It was Plutchik’s insight that emotions could be laid out in a circular arrangement, much like a color wheel, and then combined into secondary emotional states. Love, for instance, was in this schema a combination of joy and acceptance. Delight was a combination of surprise and joy.

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Zombies are For Children, and Hits

A few more thoughts on the CDC’s zombie ploy

Today’s Disruptive Women in Healthcare features a post applauding the agency’s out-of-the-box “thinking” to get the public’s attention turned to emergency preparedness. (As if that should be necessary, just after the worst radiation disaster in decades, as tornadoes rip through hospitals here in the U.S.)

The approach seems like it might be confusing to people who are uneducated and perhaps can’t distinguish between the probability of a zombie invasion, UFOs and, say, re-emergence of the plague or the complete loss of electricity in North America. It seems careless, even unprofessional. I prefer the CDC be serious, 365/7/24.

The approach is patronizing, besides. I’m a woman who assumes responsibility for her health. Telling stories to gain people’s attention is how we treat children and early adolescents. It’s not for me.

As a blogger and journalist who looks at medical media, I can see that the topic garnered lots of hits. So for the WSJ health blog, the NPR Shots and podcast and (admittedly) for yours truly here at Medical Lessons, the topic has value. (Except that no one would turn to ML for emergency preparedness, and I wouldn’t want them to do so – see disclaimer.)

Maybe the CDC likes getting hits, too. Perhaps the subject of imaginary medical stories is good for the job security of people who run websites at any salary-paying organization. But I don’t think coverage of a health story by a responsible news outlet should be determined by how many people will click on it.

So this isn’t just about the zombies, really.

Just saying –

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On Media Snobs and Darwinism in the Blogosphere

Last week Aaron Sorkin wrote for The Atlantic a piece in which he details his daily news feed, in What I Read. He’s not into blogs:

When I read the Times or The Wall Street Journal, I know those reporters had to have cleared a very high bar to get the jobs they have. When I read a blog piece from “BobsThoughts.com,” Bob could be the most qualified guy in the world but I have no way of knowing that because all he had to do to get his job was set up a website–something my 10-year-old daughter has been doing for 3 years. When The Times or The Journal get it wrong they have a lot of people to answer to. When Bob gets it wrong there are no immediate consequences for Bob except his wrong information is in the water supply now so there are consequences for us.

PZ Meyers, whose tagline for Pharyngula at ScienceBlogs is a bit crass for my taste, but with whom I often agree, writes On What’s Wrong With the Media:

This is the problem, that people blithely assume that because it is in the NY Times or the WSJ that it must be right — I’d rather read BobsThoughts.com because there, at least, poor lonely Bob must rely on the quality of his arguments rather than the prestige of his name and affiliation to persuade.

I’ll also add that when Bob throws the wrong information into the “water supply”, he’s only contaminating his own well; when Brooks or Friedman do it, they’re soaking the whole nation. And if Sorkin thinks that having a position on a big name newspaper means you’re exempt from the problem of bad information, then he’s dumber than his writing makes him sound. It was the Times and the Journal that pounded the drums of war…

Meyers is right; the big platforms don’t always get the story straight. That much is clear.

There is value in blogging: Open coverage of news in all fields – including science and medical reports published in top-tier journals – by writers who may think “out of the box” promotes careful analysis from more varied perspectives, critical discussion of developments and, ultimately, progress.

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Cooking With Leeks

A note on cooking with leeks, inspired by a NYT Well post with a list of related Recipes for Health:

I use leeks all the time, as my neighbors are probably too aware. I use leeks sautéed in olive oil as filler, mixed with an egg and flour for a tart, or to season simple pasta, or to flavor and decorate roasted potatoes.

How I prepare leeks is this:

First I cut off the base and ragged tips of 3-4 stems, slice the mainly dark-green stems lengthwise, and then cut the stalks into 1 – 3 inch sections, depending on what they’ll be used for. Because there’s often dirt from the ground deep in the lower, paler sections of the leeks, I manually expose and separate each rounded layer, and then wash everything  under briskly-running water, thoroughly rinsing at least three times.

You don’t have to dry the cut, washed leeks. What I do is heat a heavy, wide pan on the stove, add a thin layer of olive oil, and then throw on the damp (or dry) leek pieces. With the flame set low, I toss on about a half teaspoon of salt for a volume of 3-4 large stalks. Sometimes I add fresh ginger, cut into tiny pieces, into the mix.

And then I work on other things in the kitchen – often while listening to NPR or talking to my mom on the phone – while the leeks wilt. If I’m running late, I’ll put a lid on the pan, which makes the leeks soften faster, but that’s not ideal. Every few minutes I stir them around a bit with a wooden spoon or spatula, until they’re soft and, typically, shiny with varied shades of green.

You can store cooked leeks in the refrigerator for a few days, if they’re in a sealed container. So you might, as I have, use a small amount with pasta on a Monday, and then use the remainder for a goat cheese and leek tart later in the week. There are many variations, and I’ve only started using this vegetable in the past four years or so.

This summer I intend to try making a potato-leek soup.

According to Martha Rose Shulman, writing for the Times, leeks are milder than onions but contain sulfur compounds present in onions and green garlic that some people find hard to digest. Leeks are a good source of nutrients like lutein and zeaxanthin, carotenoids – thought to be important in vision, calcium, iron, magnesium, phosphorus, potassium and vitamin K. Leeks are fiber-rich, I might add.

I should learn more about each of these elements; how they’re best cooked and absorbed. Unfortunately I’m still searching for the nutrition textbook they never assigned in med school.

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First Look at the Burns Collection of Early Medical Photographs

CBS News has posted a gripping set of images, mostly of cancer patients, dating to the 1880s. The photos from the Burns Archive are graphic, as much as they’re telling, instructive and rare.

 

This photograph, taken in New York City in 1886, is one of the earliest ever taken of breast surgery. Surgeons had begun to adopt infection-control measures in the operating room, but at this point they hadn’t yet adopted the use of surgical masks and hats and their surgical gowns were simply put on over their street clothes. The anesthesiologist whose hands are visible holding the patient’s arm on the left side of the frame is wearing street clothes. Anesthesiologists were the last doctors to don surgical clothing in the operating room.

Credit: Dr. Stanley B. Burns, via CBS News

According to its website, the Burns Archive houses the nation’s largest and most comprehensive collection of early medical photography (1840-1920). It turns out the collection is based on East 38th Street. It’s nearby, and I should explore it for real.

Meanwhile, I recommend that my non-squeamish readers take a look at the CBS-published images. If nothing else, these digitized relics display how far improved are surgical methods – and cancer treatments – since the late 19th Century.

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Shoutout: This Week’s Grand Rounds Hosted by the Prepared Patient Forum

Yesterday’s medical-blog Grand Rounds, on What it Takes, is hosted by the Prepared Patient Forum. There’s a nice array of diverse posts. Among my favorites this week are from patients’ perspectives: by Warm Socks, on complex and simple physical systems for remembering to take pills and by Heart Sisters, on ditching the bucket list.

I recommend the Prepared Patient® blog in general; it covers patient-doctor relationships, medical ethics, health care economics and related issues. The forum includes a “dial 411” section with links to on-line, telephone and community resources for patients. The website is sponsored by the Center for Advancing Health, a D.C.-based institute.

The center’s stated mission is to conduct research, communicate findings, and advocate for policies that support everyone’s ability to benefit from advances in health science.

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Defining a Cluster of Differentiation, or CD

One of the goals of this blog is to introduce readers to some of the language of medicine. As much as jargon is sometimes unnecessary, sometimes the specificity and detail in medical terms aids precision.

So what is a cluster of differentiation, or CD?

In medical practice, the two-letter acronym specifies a molecule, or antigen, usually on a cell’s surface. In 1982, an international group of immunologists got together for the First International Workshop on Human Leukocyte Differentiation Antigens. The initial focus was on leukocyte (white blood cell) molecules. The goal was to agree on definitions of receptors and other complex proteins to which monoclonal antibodies bind, so that scientists could communicate more effectively.

A few examples of CDs about which you might be curious:

CD1 – the first-named CD; this complex glycoprotein is expressed in immature T cells, some B cells and other, specialized immune cells in the skin; there are several variants (CD1a, -b, -c…) encoded by genes on human chromosome 1.

CD4 – a molecule on a mature “helper” T cell surface; T lymphocytes with CD4 diminish in people with untreated HIV disease.

CD20 – a molecule at the surface of immature B lymphocytes that binds Rituxan, an antibody used to treat some forms of lymphoma, leukemia and immune disorders.

 

In this schematic, an antibody recognizes a specific molecule, or cluster of differentiation, at a cell surface.

The CDs were named (i.e. numbered) not necessarily by the order of discovery, but by the order of their being deemed as bona fide CDs by HLA Workshop participants. There’s a pretty good, albeit technical, definition in FEBS Letters, from 2009:

Cluster of differentiation (CD) antigens are defined when a surface molecule found on some members of a standard panel of human cells reacts with at least one novel antibody, and there is good accompanying molecular data.

Perhaps the best way to think about CDs is that they’re unique structures, usually at a cell’s surface, to which specific antibodies bind. By knowing the CDs, and by examining which antibodies bind to cells in a patient’s tumor specimen, pathologists can distinguish among cancer types. Another use is in the clinic, when oncologists give an antibody, like Campath – which binds CD52, the responsiveness might depend on whether the malignant cells bear the CD target.

Still, I haven’t come across an official (such as NIH), open-source and complete database for all the CDs. Most can be found at the Human Cell Differentiation Molecules website, and information gleaned through PubMed using the MeSH browser or a straight literature search.

Wikipedia is disappointing on this topic; the list thins out as the CD numbers go higher, and the external references are few. To my astonishment, I found a related page on Facebook. Neither makes the grade.

Where should patients get information about these kinds of things? Or doctors, for that matter?

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