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Study Overstated Racism, Heart Disease Link, Journal Says

July 26, 1999|THOMAS H. MAUGH II

Doctors and medical journals often criticize the media for overinflating the importance or significance of new studies--in effect, unduly scaring patients. In a rare burst of candor, the editors of the New England Journal of Medicine conceded in Thursday's edition that they had misled the press in a February study that purported to demonstrate racism in the treatment of heart disease patients.

In the study, actors of different races and sexes visited cardiologists and presented a specific group of symptoms. Dr. Kevin Schulman and his colleagues at Georgetown University Medical Center in Washington, D.C., reported that women of all races and blacks of both sexes with chest pain were 40% less likely than white men to be referred for coronary catheterization, a process in which a thin probe is inserted in blood vessels to look for blockages. They concluded that this was a clear demonstration of racism.

But the 40% difference was arrived at only when the numbers were crunched a certain way--producing what's called an odds ratio. This, statisticians say, is not valid when dealing with events as common as catheterization. What really should be used is another kind of ratio, called a risk ratio. That shows that blacks and women were actually only 7% less likely to be referred for catheterization, while black women were 13% less likely.

The editors of the journal apologized and said that they should have made the authors use the risk ratios in the report's abstract and other material.

Early Smarts May Mean a Later Menopause

The smarter a young girl is, the later in life she will undergo menopause, according to British researchers. Such women may thus have a smaller risk of developing osteoporosis but a higher risk of developing breast cancer--both of which are associated with late menopause.

Dr. Marcus Richards and his colleagues at the Medical Research Council in London studied approximately 1,600 British women since their birth in 1946. Periodic assessments of their mental status were obtained, as well as complete medical records.

The team reported in the July 22 Neurology that menopause occurred by age 50 in 26% of those with the lowest mental ability as measured at age 8, in 21% of those with a medium level of mental ability and in 16% of those with the highest mental ability. Richards speculates that the higher estrogen levels associated with increased mental ability in youth may lead to a delayed loss of estrogen production.

Girls, Boys Show Similar Signs of Hyperactivity

The symptoms of attention deficit/hyperactivity disorder, commonly known as ADHD, are much the same in girls as in boys, even though the condition is diagnosed much less often in girls, according to researchers from Massachusetts General Hospital. The main difference is that girls are less likely than boys to display disruptive behavior disorders, which may be one reason for the lower rate of diagnosis, the team reports in the August Journal of the American Academy of Child and Adolescent Psychiatry. Disruptive behavior is often the trigger that drives parents to seek medical help, leading to a diagnosis of ADHD.

ADHD is thought to affect 3% to 5% of American schoolchildren, and is diagnosed five times more frequently in boys than in girls. Nonetheless, at least 1 million girls are thought to have the disorder by conservative estimates.

The researchers studied 140 girls with the disorder, with an average age of 11 years. Like boys, the girls scored relatively low on IQ and academic achievement tests, and all had severe problems at home, at school and in their social lives.

Positives of Putting Pharmacists in the Loop

Including a pharmacist among the group of medical professionals who make daily rounds in hospital intensive care units can sharply reduce the incidence of adverse drug events and produce significant cost savings, according to researchers from the Harvard School of Public Health. The study was carried out over two 10-month periods in a large Boston hospital--the first period without the pharmacist and the second with him.

They reported in Wednesday's Journal of the American Medical Assn. that the rate of adverse drug events declined from 10.4 per 1,000 patient-days in the control group to 3.5 per 1,000 patient-days in the group with the pharmacist. The pharmacist made 398 interventions during the study, recommending safer or cheaper drugs, pointing out incomplete or incorrect prescriptions or duplications, and noting the likelihood of severe drug interactions. The team estimated that the interventions would save $270,000 per year in this hospital alone.

Greater Intake of Vitamins E, C Urged

Everybody should consume up to 800 international units (IU) of vitamin E and up to 500 milligrams of vitamin C each day, the UC Berkeley Wellness Letter said Wednesday.

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