Some people will fudge the truth to become ophthalmologists

How honest are aspiring ophthalmologists?

It’s not a question many people would think to ask. But that didn’t stop Dr. Michael Wiggins, of the Jones Eye Institute at the University of Arkansas for Medical Sciences. He was curious about the veracity of applications sent to his institute by medical students who were interested in completing their ophthalmology residencies in Little Rock.

Amazingly, Wiggins isn’t the first person to wonder about this type of thing. The first published report on the credibility of physician applications was published in 1995. That landmark paper – in the Annals of Internal Medicine – focused on doctors applying to the University of Pittsburgh’s gastroenterology fellowship program, a highly competitive medical specialty. It revealed that 30.2% of doctors who said they had authored or co-authored studies in medical journals were involved in “misrepresentation” of some kind. Some of the applicants had listed “nonexistent articles in actual journals” while others cited “articles in nonexistent journals,” among other offenses.

In the 15 years since, the study has been repeated at least 17 times for fields including radiation oncology, orthopedics, emergency medicine, pediatrics, radiology, psychiatry, neurosurgery and other specialties. In one study, the misrepresentation rate was only 1.8%; in another it was 100%.

Ophthalmology is a competitive field. In 2008, more than 230 people applied for just 3 residency spots at the University of Arkansas for Medical Sciences. Would those long odds give some applicants an incentive to lie?

Wiggins reviewed 821 applications sent to UAMS between 2000 and 2004. Of those, 201 included publications in peer-reviewed medical or scientific journals. Altogether, 15 applicants engaged in 16 instances of misrepresentation, which worked out to a misrepresentation rate of 8.1%.

Eight of the cases involved students listing themselves too high on an article’s list of co-authors, and four involved omitting the names of other authors altogether. Among the remaining cases, two involved applicants who listed real articles that were written by others, and two involved articles that were simply made up.

Some of these misrepresentations could have been innocent mistakes, but Wiggins doesn’t think that’s likely. If applicants were simply being lazy in typing up their CVs, then students would be just as likely to bump themselves down on the author list as to bump themselves up. But whenever he found an applicant’s name was listed out of order, he wrote, “every case was a promotion.”

Alternatively, some applicants may have been listed as coauthors at some point in the research process, only to have their names removed later. However, Wiggins wrote, “It is difficult to imagine that a first author could have unknowingly been eliminated and then looked up the citation to record it on the residency application without noticing the absence of his or her name.”

Among the 15 transgressors, five were graduates of U.S. medical schools and 10 had studied abroad. Foreign medical grads are typically at a competitive disadvantage, and this may explain why they were more than twice as likely to be caught with an error on their applications, Wiggins said.

At 8.1%, Wiggins concluded that the misrepresentation rate he found was fairly low. “Although no level of publication misrepresentation is desirable,” he wrote, the rate for aspiring ophthalmologists is “the lowest reported among all previous studies except for internal medicine and dermatology.”

The results are published in Tuesday’s edition of Archives of Ophthalmology.

-- Karen Kaplan

Photo: Aspiring ophthalmologists are comparatively honest, according to a new study. Credit: David McNew/Getty Images

Rodent of the Week: Athletes! You must win at home

There was good reason to be worried when the Lakers lost that second game of the NBA championship playoff series against Boston. The loss was at home. According to new animal research, winning at home appears to be important to the male species' ability to prepare for, and win, future conflicts.

In a study with mice, researchers showed that experiencing a win caused changes in the brains that enhanced the ability to win in the future. Researchers also found that winning at home had a particular effect, causing more activity in male hormone receptors in brain regions thought to influence social aggression.

The researchers paired territorial male mice who had winning experience -- sort of macho male mice that, by the way, are a species of California mice called Peromyscus californicus -- with smaller and sexually inexperienced male mice in various settings, such as home cages and neutral settings. Naturally, the mice fought. The researchers then examined the brains of the mice and compared them to similar mice that were not paired for fights. The mice that won both home and away victories had increased expression of hormone receptors in their brains. But only the brains of mice that won in their home cages showed increased hormone sensitivity in two areas of the brain thought to control motivation and reward. Mice that won at home also won more fights with larger and tougher mice when fighting in neutral locations.

The experience of winning, especially at home, appears to actually change the brains of mice. Perhaps this phenomenon extends to other species. In this somewhat dense conclusion, the authors wrote their results "are therefore provocative because they suggest a mechanism through which environmental context modulates socially induced changes to the functional properties of neural circuits that control behavioral motivation and reinforcement."

The study, released online Tuesday in the Proceedings of the National Academy of Sciences, was conducted by researchers at the University of Wisconsin.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.

How are sadness and happiness like diseases? They're infectious, study finds

Is sadness a sickness? It appears to spread like one, a new study has found.

Researchers at Harvard University and MIT wanted to see if a mathematical model developed to track and predict the spread of infectious diseases such as SARS and foot-and-mouth disease could also apply to the spread of happiness -- and found that it worked. 

They used data collected from 1,880 subjects in the Framingham Heart Study, a long-term research effort that has followed subjects since 1948 (and added some new ones along the way), giving them physical and emotional exams every two years. At each visit, subjects were classified as content, discontent or neutral. The researchers monitored how these emotional states changed over time and how these changes depended on the emotions of the people with whom the participants came into contact.

When the information was put into a traditional infectious-disease simulation, slightly modified to reflect the unique qualities of emotional spread rather than actual disease, the researchers found a correlation between an individual's emotional state and those of the person's contacts.

In other words, it appears that you can catch happiness. Or sadness. Moreover, the "recovery time" doesn't depend on your contacts at all, which is a hallmark of diseases but surprising in an emotional context, since continuing contact with happy or sad people could be expected to affect one's emotional state even after the initial "infection."

People were found to "recover" (return to neutral) more quickly from discontent than from content; on average, a contentedness "infection" sticks around for 10 years, but it takes only five years to recover from discontent. While this may still seem like a long time, the work focused on long-term emotional states because they are more accurate measures of general life satisfaction than fleeting moods, which are already known to be contagious (think laughter).

On the other hand, sadness is more contagious than happiness: A single discontent contact doubles one's chances of becoming unhappy, while a happy contact increases the probability of becoming content by only 11%.

Researchers also found one way that emotions act differently than diseases -- they can arise due to events in your own life, such as a promotion or a disease diagnosis, rather than solely being "contagious." In another win for the good guys, it appears that happiness is more likely to come about spontaneously than is sadness.

A report of the emotions-as-diseases research has been published in the Proceedings of the Royal Society B.

-- Rachel Bernstein

Photo: We may recover from sadness more quickly than we do from happiness, but it appears to be more infectious. Credit: Reuters

School day starts too early for sleepy students (and teachers), researchers say

Here’s a question for all you high school students out there in cyberspace: If it were up to you, would you rather start your school day at 8 a.m. or 8:30 a.m.? (Sorry, noon is not an option.)

If you chose 8:30, you get an A+. According to a new study, students were far more likely to get eight hours of shut-eye at night and were less likely to report being unhappy, depressed, annoyed or irritated when they began their first class at 8:30.

Researchers from Rhode Island studied the student body of a New England boarding school that once began its day at 8 a.m. but later delayed its start time until 8:30. You might not be surprised to learn that the students slept in later after the change was made. But – get this – they started going to bed earlier too. Here’s how one student explained it to the research team:

“Well for me, ever since the 8:30 start, I have seen how much good 30 minutes of extra sleep does for me, so I have been inspired to … get an additional half hour on top of the 30 minutes.”

Of course, the switch to a later start time made students feel less sleepy. More specifically, the percentage of students who got less than seven hours of sleep per night fell from 34% before to 7% after, while the percentage of students who got at least eight hours of sleep jumped from 16% to 55%.

When school began at 8 a.m., 66% of students reported feeling “somewhat unhappy or depressed.” After delaying the first bell until 8:30, that figure fell to 45%. Likewise, the percentage of students who said they felt “irritated or annoyed” fell from 84% to 63%. (They were still teenagers, after all.)

But the time change wasn’t a panacea. Grades improved slightly, though the difference wasn’t statistically significant. And 89% of the kids still got less than the recommended minimum of nine hours of sleep each night, even after the start time was pushed back half an hour. As a result, 66% of students said they got sleepy while doing their homework, 18% continued to fall asleep during morning classes and 36% relied on naps to get through the day.

The lesson here isn’t that pushing back the clock doesn’t matter; it’s that a 30-minute delay probably isn’t enough, the researchers concluded in their study, which will be published in Tuesday’s edition of Archives of Pediatrics and Adolescent Medicine.

The study echoes lots of other research documenting the perils of forcing teens to get to school too early. Adolescence brings with it biological changes that make it difficult for teens to fall asleep before 11 p.m. or to wake up before 8 a.m. Yet my alma mater begins its first period at 7:30 a.m., which is hardly unusual.

Sometimes the reluctance to change the school day schedule is blamed on teachers, but the Rhode Island study found that the faculty overwhelming embraced the 8:30 start time. As one teacher told the researchers:

“On a more personal note, I have found the 8:30 start to be the single most positive impact to my general quality of life at [the school] since I started 12 years ago.”

Still not convinced? Just sleep on it.

— Karen Kaplan

Photo: This student is surely dreaming of a school day that starts later in the morning. Credit: Anne Cusack / Los Angeles Times.

Rodent of the Week: closing in on a universal flu vaccine

Flu viruses mutate rapidly, meaning that vaccines against the flu have to be continually updated to target the latest strains. Moreover, antiviral medications to combat flu sometimes become ineffective because of viral mutations. Thus, finding a so-called universal flu vaccine that could be used against a wide range of viruses over a longer period of time has been a long-held dream of medical experts and the subject of a lot of research.

Scientists reported this week that they have taken another step toward a possible universal flu vaccine. They discovered a target on the influenza A virus that has not changed much -- unlike other regions of the virus -- called influenza matrix 2 protein (M2e). The researchers then found rare, naturally occurring antibodies in humans that target the protein. When these antibodies were given to mice infected with influenza, 60% to 80% recovered compared to a 10% survival rate in the untreated mice. The antibodies protected against two influenza strains: seasonal human H1N1 and an avian flu, H5N1.

The study was completed by researchers at the University of Wisconsin-Madison, University of Tokyo, Johns Hopkins University and Theraclone Sciences of Seattle. It was published Monday in the Proceedings of the National Academy of Sciences.

While humans can produce these antibodies against the M2 protein as part of the immune system's natural response, levels appear to be too low to trigger enough protection. However therapeutic levels of antibodies might create the necessary protection.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.

Added sugar may be the mystery ingredient causing hypertension, researchers say

Blood pressure has been rising in the United States for more than 100 years. At the turn of the last century, about 5% to 10% of American adults were diagnosed with hypertension; today, the figure is about 30%. Why?

Perhaps it’s because there’s so much more added sugar in our diets now than there was a century ago. Studies have linked consumption of fructose – the ingredient that makes up 50% of table sugar and 55% of high-fructose corn syrup – to high blood pressure in rats. But in people, the link has been elusive.

Researchers from the University of Colorado Denver checked to see whether added sugar intake was linked to blood pressure among the thousands of representative Americans who participated in the National Health and Nutrition Examination Survey between 2003 and 2006.

By comparing the diets and systolic blood pressure (the top number in a blood pressure reading) of all the volunteers, they found that those who ate and drank more fructose from added sugars (as opposed to healthy sources like fresh fruit) had higher blood pressure than those who didn’t. They also discovered that volunteers with higher blood pressure tended to have larger waistlines.

Overall, those who consumed at least 74 grams of fructose per day from added sugars were more likely to be hypertensive. Compared with a healthy blood pressure of 120/80 mmHg, those with diets high in added sugar were 77% more likely to have blood pressure of 160/100 or greater. (The NIH considers anything over 140/90 to be high blood pressure.) The association between added sugars and blood pressure held up even when controlling for other factors, such as total calories consumed, physical activity, other health problems and consumption of salt, alcohol and carbohydrates. 

So, how much junk food do you have to eat to hit 74 grams of fructose? Drinking 2½ 20-ounce bottles of Coke would do it. Among the volunteers in the NHANES study, half consumed more than 74 grams of fructose from added sugars each day.

Why worry about high blood pressure? It’s a risk factor for a whole bunch of health problems you’d probably rather avoid, including coronary artery disease, congestive heart failure, stroke and chronic kidney disease. The World Health Organization estimates that hypertension causes 7.1 million deaths each year.

The good news, the researchers said, is that it’s easy to reduce your risk. Simply cut back on foods with lots of added sugar.

The findings were published online Thursday by the Journal of the American Society of Nephrology.

-- Karen Kaplan

Photo: Sugary foods aren’t just bad for your waistline, they may threaten your blood pressure too. Credit: Anne Cusack / Los Angeles Times

Obesity rate tops 25% in two-thirds of states; this should be shocking, but ...

Overall, Americans in 28 states are still gaining weight, but not residents of the nation's capital. They bucked the national trend, a new report has found, actually lowering their obesity rate. The former should be more surprising, more noteworthy than the latter; by this point, it might not be.

The latest numbers come from the annual obesity assessment offered by Trust for America's Health and the Robert Wood Johnson Foundation, and it's a goldmine of data, individual findings and broad overviews. Can't get enough of those "which state is fatter" comparisons? This analysis is for you.

Not only does the report rank states and the District of Columbia by their obesity rates, showing the trends over time, it compares ethnic groups within those states as well. It also includes a nice synopsis of what states are doing, in terms of legislation, to combat the seemingly unstoppable gain. Then there are various other comparisons -- breast-feeding rates, physical activity rates and the like. This doesn't imply causation, of course (so no need to e-mail us about it!) but the correlation is interesting: D.C. also has the highest rate of fruit and vegetable consumption.

In any case, Mississippi has the highest rate of adult obesity; 33.8% of its residents are obese. Colorado is the relative slimmest; only 19.1% of its residents are obese. California ranked fairly well as such things go, with 24.4% of its residents characterized as obese. (We have to point out, that's an increase over last year.)

As for obesity rates by ethnic groups, those numbers paint their own picture. Wisconsin has the highest rate of obesity among black residents; 44% are obese. Nevada, at 25.8%, has the lowest rate. Tennessee claims that distinction for Latinos; 39.5% of Latinos there are considered obese. D.C., at 20.6%, has the lowest rate.

By this point, the individual numbers are likely to garner quiet dismay more than the disbelief they warrant. Obesity rates now top 25% -- repeat, 25% -- in two-thirds of the states; that should be shocking, it should. But, somehow, it isn't.

If there's a bright side (other than D.C.), the trends, the ethnic differences -- all are useful in assessing where to go from here. The report offers its authors' thoughts, all policy-oriented, on that matter.

Here's the full report, "F as in Fat: How Obesity Threatens America's Future 2010." It can also be found at either organization's website, www.healthyamericans.org or www.rwjf.org, should you be interested in checking out the organizations.

-- Tami Dennis

Photo: If states were people, two-thirds would now be considering -- if not actually undertaking -- a diet.

Credit: Los Angeles Times

Obesity increases the risk of cancer death among Asians too

Historically, obesity has been a problem of western countries. For instance, nearly 1 in 3 Americans is obese (defined as having a body mass index that tops 30), as are about 1 in 4 members of the United Kingdom. According to this ranking compiled with data from the Organization for Economic Cooperation and Development, the most obese countries in Asia are Japan and South Korea, where a mere 3.2% of the population has a BMI over 30.

But with obesity rates rising in China, South Korea, Thailand, Singapore and other Asian countries, an international group of researchers wondered how those extra pounds might be raising the risk of death from cancer. After all, adding 5 points to one’s BMI is known to increase the risk of cancer among Caucasians by 10% to 60%. Was the same true for Asians?

To find out, they analyzed data from 424,519 people who were part of the Asia-Pacific Cohort Studies Collaboration. The researchers found that for every 5 points added to BMI, the risk of death rose 9%. (That calculation excluded two types of cancer – of the lung and the upper aerodigestive tract – whose risk is linked to a lower BMI.) Compared with people who have a healthy weight (BMI between 18.5 and 24.9), those who were obese were 21% more likely to die of cancer.

The increased risk was traced primarily across six types of cancer – ovarian, cervical, prostate, breast (among women older than 60), leukemia and cancer of the large intestine. The results were published online Tuesday by the journal Lancet Oncology.

Even though obesity is still a comparatively small problem in Asia, the large number of cancer patients there (6.2 million, compared with 1.6 million in North America and 3.4 million in Europe) means that a great many cases might be traced to excess body weight, according to an editorial accompanying the study.

— Karen Kaplan

Photo: These patients at a weight loss center in northeastern China have an increased risk of cancer. Credit: Sheng Li / Reuters.

Touch and go – what you touch may influence how you feel

Having a rough day? Got a soft spot for ice cream? It might be more than a feeling. In fact, tactile contact –  touching something light or heavy, smooth or rough, soft or hard – can have a profound effect on your perceptions and judgments, even when the object has nothing to do with the task at hand.

In a study published Thursday in the journal Science, a team of researchers from Harvard University, Yale University and MIT tested people’s subconscious responses to feeling objects of different weights and textures.

- In one case, participants had to evaluate a resume, some reading it on a light clipboard and others on a heavy one; the heavy clipboard readers thought the applicant was more serious about the job.

- In another study, people were asked to complete a puzzle, either with smooth or sandpaper-covered pieces, and then judge the harshness of a social interaction; those who did the “rough” puzzle thought the interaction was harsher. 

- The researchers also found that people sitting in wooden chairs, as compared to cushioned chairs, drove a harder bargain in a mock car sale. They believe that the participants associated the hard chair with strictness and stability, and thus were less likely to budge on their offer price.

In other words, even though the heavy, rough or hard objects weren’t directly related to the assigned task, they clearly affected people’s behavior.

Here's the abstract to the touch study.

Given the prevalence of tactile metaphors in our everyday language, the associations found in the study – heavy equals serious, rough equals difficult, hard equals strict – make sense. Still, it’s impressive that the subconscious cues just from touching something can have such a discernable effect on our impressions and behavior.

So, which came first, the emotions or the language?

It’s tempting to say that our idioms reflect innate qualities of objects – a hard, rough, heavy rock, for example – but trying to spell out the connection suggests that it's not quite so simple.

After all, what's so serious or difficult or strict about a rock?

— Rachel Bernstein

Photo: Sometimes, a touch can be worth a thousand words. Photo credit: Los Angeles Times.

Rodent of the Week: fixing jet lag and circadian rhythm disorders

When our circadian rhythms are thrown out of whack -- either by jet travel, shift work or sleeplessness -- our bodies object, according to a wealth of emerging research. The risk of breast cancer, stroke and heart disease rise in shift workers, for example. Finding a way to restore circadian rhythms would not only be helpful to travelers fatigued from jet lag, it could lead to a reduction in disease risk.

A new animal study highlights an interesting approach to the problem. Researchers at the Max Planck Institute for Biophysical Chemistry in Germany used mice that were subjected to jet lag and circadian rhythm disruption (by altering the light and dark cycles they were exposed to). The researchers found that the "clock" genes that are important to reestablishing normal circadian rhythms varies among different organs, such as the kidneys, liver, pancreas and adrenal gland. Further, the workings of the adrenal gland appear to coordinate circadian rhythms by gradually adjusting the release of adrenal hormones, called adrenal glucocorticoids.

"...the adrenal gland has a special role," in returning the circadian rhythms back into their proper alignment, the authors wrote.

The findings suggest a possible approach to treating jet lag and circadian rhythm disorders through the use of corticosteroids.

"Our study thus not only substantiated the importance of glucocorticoid rhythms in jet lag adaptation, but also established an informative experimental animal model to explore the treatment of jet lag and its associated symptoms," they wrote.

A medication called metyrapone, used to treat adrenal insufficiency, could be investigated in humans for treating jet lag.

The study "takes us to a new level of understanding of the molecular control of the resetting of the multitude of internal biological clocks disrupted in a mouse model of jet lag," said the author of a commentary accompanying the study.

The study was released this week in The Journal of Clinical Investigation.

 -- Shari Roan

 Photo credit: Advanced Cell Technology, Inc.