Health Risks and the Media

I've been aware of a frightful trend that is particularly manifested in controversial health issues: that science is not enough anymore.

When people fear a particular health risk, it seems irrelevant whether the best available science shows the risk to be negligible. They want more than scientific assurance--they want politicians. journalists, family and friends, to tell them there is absolutely no risk.

Every now and then an issue arises where many people keep on fearing a scientifically refuted health risk. This is the case of the alleged links between MMR vaccine and autism and the preservative thimerosal and autism.

British researcher, Tammy Boyce, has written a great book analyzing the communication of health risks: Health, Risk and News: The MMR Vaccine and the Media.

P.S. You can also check my blog on Vaccine Risk Communication.

How Science Works (4): Epidemiology and Causality

In the previous post in this series, I discussed the difference between association and causation. Now I want to point out the role of epidemiology in establishing causality.

Epidemiology is the study of how disease is distributed in a population and of the factors that influence or determine that distribution. Epidemiological studies can help identify the causes and risk factors of a disease in a community. Causality is often inferred from epidemiological studies by using the following criteria:

• Strength of association: The greater the difference in rates between the treatment and the control groups, the more likely there could be a causal relationship.
• Consistency of association: The more studies that show similar results using different populations and differing study methods, the more likely there is a causal relationship.
• Dose response: When it can be shown that there is increasing risk for an adverse drug reaction with increasing dose, the more likely that there could be a causal relationship. If the drug—or a drug component—is the cause of an adverse event, removal of the drug or the component should decrease the occurrence of more adverse reactions.
• Cessation effects: Discontinuing a drug and having the adverse response go away suggests a causal effect.
  
• Statistical significance: The likelihood that the results of a study were due to chance is measured by the P value—the smaller the P value (0.05 or lower), the higher the statistical significance of the study, thus, the more likely the results were not found by a chance occurrence. See a more detailed explanation of statistical significance here.
  

Not all types of epidemiological studies carry the same weight in establishing causality. A rule of thumb to determine what type of studies are better for establishing causality would be something like this: Clinical trials, then case-control studies, then cohort studies, then ecological studies, and then case-series reports.

Grant Writing Workshop in March

The Grant Institute

Grants 101: Professional Grant Proposal Writing Workshop

will be held in

Flagstaff, Arizona

March 12 - 14, 2008

8:00 AM - 5:00 PM

Grants 101 consists of three (3) courses that will be completed during the three-day workshop.

(1) Fundamentals of Program Planning

This course is centered on the belief that "it's all about the program." This intensive course will teach professional program development essentials and program evaluation. While most grant writing "workshops" treat program development and evaluation as separate from the writing of a proposal, this class will teach students the relationship between overall program planning and grant writing.

(2) Professional Grant Writing

Designed for both the novice and experienced grant writer, this course will make each student an overall proposal writing specialist. In addition to teaching the basic components of a grant proposal, successful approaches, and the do's and don'ts of grant writing, this course is infused with expert principles that will lead to a mastery of the process. Strategy resides at the forefront of this course's intent to illustrate grant writing as an integrated, multidimensional, and dynamic endeavor. Each student will learn to stop writing the grant and to start writing the story. Ultimately, this class will illustrate how each component of the grant proposal represents an opportunity to use proven techniques for generating support.

(3) Grant Research

At its foundation, this course will address the basics of foundation, corporation, and government grant research. However, this course will teach a strategic funding research approach that encourages students to see research not as something they do before they write a proposal, but as an integrated part of the grant seeking process. Students will be exposed to online and database research tools, as well as publications and directories that contain information about foundation, corporation, and government grant opportunities. Focusing on funding sources and basic social science research, this course teaches students how to use research as part of a strategic grant acquisition effort.

Registration

$597.00 tuition includes all materials and certificates.

Each student will receive:

*The Grant Institute Certificate in Professional Grant Writing

*The Grant Institute's Guide to Successful Grant Writing

*The Grant Institute Grant Writer's Workbook with sample proposals, forms, and outlines

Registration Methods

1) On-Line - Complete the online registration form at www.thegrantinstitute.com under Register Now. We'll send your confirmation by e-mail.

2) By Phone - Call (888) 824 - 4424 to register by phone. Our friendly Program Coordinators will be happy to assist you and answer your questions.

3) By E-mail - Send an e-mail with your name, organization, and basic contact information to info@thegrantinstitute.com and we will reserve your slot and send your Confirmation Packet.

Upcoming Medical Writing Online Course

At the request of some of my readers, I have been working on some advanced training materials for medical writers.

Next month I will release an online course on epidemiology and biostatistics for medical writers. It will cover the basic concepts of these disciplines and will show how to understand and apply them to your writing.

Understanding epidemiology and biostatistics is vital for every medical and health writer--how else can they interpret biomedical research and communicate it to the public?

There are, of course, other topics like clinical research, technical writing and so forth, that I may work into future courses. So be on the lookout for the release of the course (late March). If you haven't done so yet, subscribe for this blog's updates (see form on the right column) and I will let you know.

Science Writing Internship at NIH

The National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health, is looking for a student interested in biology and science writing to join their team of writers for the summer.

The intern will cover cutting-edge science in cell biology, biophysics, genetics, developmental biology, pharmacology, physiology, biological chemistry, bioinformatics, and computational biology. Writing projects include:

• Producing Biomedical Beat, a monthly e-newsletter recapping recent science findings
  
• Writing articles and developing electronic features for our Web publication Computing Life
• Interviewing scientists for podcasts, video features, and online chats
• Profiling scientists, including for our magazine Findings
• Working with NIGMS staff to write news releases, fact sheets, and online material

Their office is located on the main NIH campus in Bethesda, Maryland, just a few miles outside of Washington, DC. Depending on education, experience, and work schedule, they will pay a monthly stipend of up to $2,500 for about 3 months. Start date is negotiable.

For questions, contact NIGMS writer Emily Carlson at 301-594-1515 or carlsone@nigms.nih.gov.

If you’d like to apply, send your resume, three writing samples, and a letter describing your interest in and goals for this internship to Emily:

Office of Communications and Public Liaison, NIGMS
45 Center Dr., Rm 3AN.32 MSC 6200 ∙ Bethesda, MD 20892-6200

www.nigms.nih.gov

How Science Works (3): Causation and Association

In the late 1990s researchers discovered that virtually all the women with cervical cancer in the world had something in common: they were all infected with certain types of human papillomavirus (HPV). They also knew that many women with cervical cancer were also infected with genital herpes simplex virus (HSV). Both genital HSV and HPV infections were associated with cervical cancer, but were they the actual cause of the disease?

Association and causation are not the same. While an association is an identifiable relationship between an exposure (HSV or HPV infection) and a disease (cervical cancer), causation implies that there is a true mechanism that leads from exposure to disease.

Later, scientists found that, in fact, cervical infection with certain types of HPV is necessary for a woman to develop cancer of the cervix: all of the cervical cancers and pre-cancers contain one of these viruses. Furthermore, an HPV vaccine protects against both infection and the cancer caused by the HPV types in the vaccine (but not against most other HPV types). This evidence suggested that there was more than an association; HPV was indeed the cause of cervical cancer.

In general, a disease is caused by an event or condition that precedes the disease and without which the disease would not have occurred. And most diseases have more than a single cause.

It is important that as medical writers we communicate clearly the distinction between an association and a cause-and-effect relationship. For instance, one study may find an association between eating chocolate and depression, but it doesn't mean that chocolate causes depression--it may simply be that depressed people in the study ate more chocolate than the control group.

What would happen if we don't communicate clearly that distinction? We may see a decline in chocolate consumption in the world (hard to imagine, I know, but bear with me for the example's sake).

I think the issue of causation is fascinating, so I'll keep writing about it in future posts. Happy medical writing!

Health Communication Training

The Centers for Disease Control and Prevention (CDC) offer public health training opportunities for medical writers and health journalists. These are very competitive but maybe you have what it takes to get in. They are definitively a great experience.

Check the Health Communication programs here.

How Science Works (2): Statistical Significance

There is a saying that if you look hard enough for something, you will eventually find it. In medical writing we often have to assess the validity of biomedical research, because--as in the saying above--some studies will "find" what they are looking for, even if it is not real. The results can be due to chance.

The likelihood that the results of a study were due to chance is measured by the P value—the smaller the P value, the higher the statistical significance of the study, thus, the more likely the results were not found by chance. 

If the P value is 0.6, there is a 60 percent chance that the difference is coincidental. By convention, a P value of 0.05 or less is considered a “significant difference” because the probability that the difference is due to chance is only five percent (or less). 

For example, if you toss a coin twice, the most likely outcome is one head and one tail. If you actually got heads twice you wouldn’t think there was a problem with the coin or how you tossed it, because that is the result you would expect to find twenty five percent of the time that you tossed the coin twice. On the other hand, if you tossed it 1,000 times and got heads every time, you would suspect that there was something wrong with the coin. 

That’s where P values come in; they are a mathematical estimate of the probability of a difference of finding 1,000 heads—instead of the expected 500—just by chance alone (luck) or because it may be a real difference (perhaps the coin was heavier on one side).

Check Tom Lang's article, Twenty Statistical Errors Even YOU Can Find in Biomedical Research Articles (see Error #6), for a discussion of how P values are often misinterpreted.

Also, the book I reviewed here, includes an interesting account of how the P value was born.

How Science Works (1): Reproducibility

You may think there is something wrong happening with scientists refuting and criticizing each other’s studies all the time. In fact, that is just the way it is supposed to be; that is how science works.

A researcher publishes his or her observations in a scientific journal, explaining why and how the study was done, and reaching a conclusion—which can be a theory—based on the results of this and other studies. Then, other researchers try to understand the methodology of the study and replicate or reproduce the results. This is known as reproducibility. If other researchers cannot obtain similar results using the methodology described in the original paper, the study is considered irreproducible—thus, it does not provide useful evidence of causality. On the other hand, study results that are reproducible have more credibility.

For instance, a few of years ago, Andrew Wakefield (the guy that started the MMR-autism scare) described a new syndrome called "autistic enterocolitis."

In a letter to the editors of Molecular Pathology, Eric Fombonne, a researcher from McGill University in Montreal, said about Wakefield's study:

The study [...] did not contain a proper Subjects section providing the necessary background clinical characteristics which are required both for a proper evaluation of the significance of the results and for allowing replication by independent research groups.” Fombonne also said, “Earlier reports by Wakefield and colleagues have consistently lacked basic descriptive clinical information on the research subjects. Thus, the methods used to arrive at the diagnosis of pervasive developmental disorders in these reports were unstandardized, were not uniform across subjects, and no reliability data were ever provided.

In 2006 Fombonne and his colleagues at McGill published a study describing how they repeated the experiments by Wakefield’s group. They found no evidence that measles virus persisted in autistic children. Wakefield’s results were not reproducible.

How Science Works Series

I've decided to start a series of posts on how science (especially biomedical research) works. I hope it will help new medical writers that sometimes feel daunted by the language and the methods of science.

If you think about any topic you would want me to deal with, just let me know. My first post will follow.

Can You Really Make Six Figures As A Freelance Writer?

By David Drake (Guest blogger)

Does $100,000 a year sound too ambitious? I hope not. Thousands of freelance writers have broken the 6-figure barrier and with some determination and a clear set of goals, it's very achievable.

Possibly you would laugh and burst out if I told you some freelancers even make $400000 - $500000 per annum , so I would save my face and stick to $100000.

There are different kinds of freelance writing. You could write for magazines, write general articles, write direct marketing advertisements (More on this later), and e-books . The world of freelance writing is huge and many times confuses newcomers.

The purpose of this article is to show you how achieve a six figure target, primarily using the Internet. (Get ready to work, eat and live in your pajamas!)

The September 2007 issue of The Writer published an excellent article: "Secrets of Six-Figure Freelancers", which covered magazine freelance writers who are making six figures, with one making $260,000 per year. This proves that you can make a great income as any kind of freelance writer. The money is there, all you have to do is take it.

• An average writer on websites such as Guru.com and Elance.com charges between $15 - $35 per article. These articles take about an hour to write. How many can you write each day? Even with 4 hours of work you have crossed the $36000 per annum barrier.
• Web Copywriters charge a minimum of $250 to about $2000 for 3 -4 pages. You need 50, $2000 assignments to break the 6 figure mark. If you can prove yourself, raise your fees to $25000, there still are buyers for that price! Yep it's true. That's what the best copywriters charge! It's hard to find a seasoned copywriter who charges less than $8000 per project.

Freelance writing is not a get rich scheme. $100000 per year is a very realistic figure to reach in freelance writing. No, it does not happen quickly, but it does happen. And it does not happen to especially talented or lucky people as sometimes the mind can trick us into believing.

It happens to normal people who make it happen!

As opposed to what many people think, it does not take a genius or greatness to make a six figure income as a freelance writer. All it takes is

• A New mindset: Change in beliefs which hold you back and your negative ideas on making money.It is indeed a fact that many of us have a negative attitude towards money and it actually hinders us. For example many of us have this belief that "life is hard" and "money does not grow on trees". They are perspectives but not the reality !
• Dedication: What are you willing to do to achieve your goal? Earl Nightingale in his famous book The Strangest Secret states it clearly..." The only way to achieve financial abundance is to provide value to people ". Are you willing to provide good service to people?
• Treating it as a business: All the freelance writers making six figure incomes treat their writing as a serious home based business and employ sound principles which are common in all successful businesses. That's the beginners secret to break the six figure mark. Treat it as a business.

David Drake is the author of the ebook 6 Figure Freelancer. It reveals powerful strategies and a step by step blueprint to lay out a 6 Figure action plan with online freelance writing.

Are Consumer Health Magazines Really Healthy?

Working on a media ethics project, I came across this interesting article in the Columbia Journalism Review: "How Healthy Is Men’s Health? A shovelful of sugar helps the medicine go down."

According to the author of the article, one of the most popular consumer health magazines in the US, Men's Health, misses the real issues:

In short, the magazine is preoccupied with health and “lifestyle” problems a person can readily resolve. It underplays bigger threats to health that have no quick fixes. Men’s Health thus gives its readers an unbalanced picture of the threats they actually face.

The article raises the issue of the media's responsibility in providing an accurate representation of reality--and in this case, health. This, of course, is not an appealing option to the editors and publishers of this and similar magazines. They have discovered the formula to sell more than 10 million magazines a month--tips for better sex, and great abs.

Still, medical writers should know better, right? At least I hope you do.

P.S. Last summer, I also wrote about the quality of consumer health writing today.

Creating Time to Write

By Shannon Evans (Guest blogger)

Making time to write is really difficult in our intrusive modern world. The siren song of email beckons us to respond to its 'in your face' immediacy. Blackberries chirp and ding in public places like a chorus of obnoxious magpies in discordant harmony. Telephone, email, and people clamor for my attention all day long. If only I could find some peaceful downtime I might be able to make time to write.

The easiest way to create more time for writing is merely a function of the earliest technological breakthrough of the Industrial Revolution: The ON-OFF switch.

So simple but so hard to use... but you owe it to yourself to develop the discipline to disconnect and start writing. Turn off the phone, turn off the email, turn off the instant messenger, and make the time to write.

• Your time is incredibly valuable
• Commit in writing to write
• Put your writing schedule in your calendar...in ink!
• Get organized before sitting down to write - time spent researching is not writing time

You have to schedule down-time for writing much like you schedule time at the gym and doctor appointments. Let people who matter know that you are not available at that time daily. Block out at least 90-120 minutes per day to dedicate to your writing craft.

Make a contract with yourself to write X hours per week or X number of pages per week. Create a viable plan that produces a measurable output. Start small and build more goals for time and output as you become more disciplined in your writing schedule.

Get a wall calendar and a day planner and schedule time for your writing. You and your writing are important. Make the time to write articles, blog entries, or your next chapter.

Writing with discipline and purpose can be hard at first but over time it becomes an ingrained personal routine. But beware! Writing regularly can become as addictive as email, IM, and texting.

Shannon Evans, senior editor and owner of www.mywritingmentor.com lives with her best friend Rick on Bainbridge Island in the Puget Sound just a "ferry ride from Seattle." She maintains two blogs: Authormarketingtools; Mywritingmentor. Article source here.

More on Writing Conferences

On my previous post, I encouraged you to get involved in a medical writing conference. But you know what? You can benefit from all sorts of writers conferences, no matter the topic (as long as you are interested in it). For instance, this year I'll try to make it to the American Christian Fiction Writers conference.

So how do you find about good conferences to attend? Here are some links that may help.

• AMWA Chapter Conferences
• National Association of Science Writers Annual Conference
  
• ShawGuides Writers Conferences and Workshops
• Writer's Conferences and Centers (2008 events)
  
• Writers Write: Writing and Publishing Conferences

I hope you find an event you like. Thanks for reading!

Getting Involved in a Medical Writing Conference

I always advice new medical writers to attend professional conferences, such as the AMWA annual meeting. They offer great networking, educational, and job-finding opportunities. But even better than attending, is participating as a presenter.

Can you be a presenter even if you've never attended the conference before? Sure you can. I did a poster presentation on my first AMWA conference. The following year I led a roundtable. And the following, two roundtables and two open sessions. You start small, and then get more involved. You'll learn as much (I would say more) from teaching others as from just listening to a lecture.

Why don't you plan on leading a roundtable discussion this year (you'll get a free breakfast)? Or maybe develop a poster presentation? Check out the opportunities available for this fall's AMWA conference in Louisville, KY.

What's a Medical Writer to Do?

Yet another Big Pharma company (Eli Lilly) is on the hot spot--this time for promoting off-label use of one of its drugs. A few months ago, it was Merck, lobbying for state mandates for the new HPV vaccine. See more about this topic here.

I work for a non-profit, so I kind of have the outsider perspective. But many of my AMWA colleagues work for pharmaceutical companies. In the midst of excesses by the marketing departments at their companies, what's a medical writer to do?

In my area of expertise (vaccine safety), the level of public mistrust of Big Pharma is very high. Not so much from the experts, who obviously need to work with manufacturers at some point in their careers, but from the general public. And sometimes, researchers--and even medical writers--are beaten up for their association with Big Pharma.

This is what is known as the guilt by association fallacy. Under this logical fallacy, someone would dismiss medical research as false by making an association such as this one: “Pharmaceutical companies are driven by profit. Medical researchers are supported by pharmaceutical companies. Therefore, researchers must be driven by profit.”

Guilt by association originates from an aversion of being associated with a person or an organization you dislike or distrust. If you distrust pharmaceutical companies, you wouldn’t like to be associated with them. This fallacy would imply that one should disregard a scientist whose analysis reaches the same conclusion as the vaccine manufacturer.

Yes, Big Pharma is usually driven by profit (aren't most companies?). I'm not trying to defend them here. It's just something that I'm faced with on a regular basis (anti-vaccine activists accusing our organization of being paid by vaccine manufacturers--NOT TRUE). I just want to point out that even if the management or the marketing staff at these companies have unethical behavior, that doesn't mean everybody else directly or indirectly associated with them is part of a conspiracy.

Okay, enough rambling for today. Thanks for reading!