Should you trust news reports about studies?

by MooshiMooshi

You know how everyone complains that studies get reported in the media which then get contradicted a year or two later? Well, it turns out there are reasons for this.

Study: half of the studies you read about in the news are wrong

It turns out that reporters tend to report on initial studies, which are more likely to be contradicted in one or more ways later on. In the world of science, inital studies are just that: initial.

Besides the attention grabbing headline, this article has a good critique of the reasons why initial studies tend to be reported instead of the later metareviews which are more likely to be correct.

This is a real problem. People learn about science mainly through the media, and if it feels like everything reported turns out to be wrong, people start distrusting science. If reporters were more careful to publicize the later, more complete studies, people might develop more faith in science. I think reporters, too, should spend more time explaining the process of science to their readers, rather than just pushing out headlines and brief explanations of what may be very small and very tentative studies.

Good science and financial reporters are in terribly short supply, And given the fragile state of the field of journalism these days, I don’t see it improving. But these are two areas that impact everyone. People have to make decisions about both science and financial information all the time, including when they vote. How can we improve public understanding?


130 thoughts on “Should you trust news reports about studies?

  1. Along with the issue of the media publicizing the initial studies and ignoring the follow-up/complete studies is the problem of replication studies not being done. People don’t want to spend the time and money to try to verify studies that have already been done.

    Here are some articles on it:

    This one isn’t about the replication issue but is still interesting:

  2. One issue is that most journalists have very little training in science or statistics, and poor understanding of that most basic principle that correlation is not causation. And many researchers are working in such specialized areas that they don’t always communicate well with civilians.

  3. DD, thanks for posting those links. That last Atlantic article had lots of good food for thought, including a discussion of the Number Needed to Treat concept that is critical for decision making but very poorly understood or explained by many physicians. Anyone diagnosed with osteoporosis or “osteopenia” (which isn’t even a real disease), for example, is likely to find the NNT data only by her own research.

  4. I think as humans we’re very uncomfortable thinking in terms of probabilities and risks, and the uncertainty in most studies means they aren’t worth reporting on without replication.

    There are also social implications to statistically accurate statements that can be hurtful. I’m glad it’s not my job to navigate statistical accuracy, statistical uncertainty, risk and the range of human emotion when writing about obesity research.

  5. From what I can tell from the original article and DD’s linked ones, many of the studies that could not be verified contain psychological, psychiatric, and/or lifestyle components. And this problem could not be extrapolated “to other domains such as physics and chemistry”.

    It seems there is a lot of fuzzy research based on fuzzy principles specific to psychology and psychiatry. This is consistent with what I’ve read elsewhere and observed first hand in schools.

  6. Mooshi Mooshi, are you suggesting that media report on what’s new and sensational, rather than digging for the rest of the story and trying to be useful in their reporting? In this country? I’m shocked. Not. The current triumph of form over function is very troubling.

  7. “One issue is that most journalists have very little training in science or statistics”

    Yup. This was Nate Silver a few years ago.

    … For journalism though, there are two ways to do it. You can go and take your traditional journalist—and many of them are fantastically good reporters, very good writers, certainly The New York Times—and try to train them more in some math and probability and statistics. Or you can hire people who come from that background, where maybe now some papers are going to hire economics majors and math majors, fields that you wouldn’t typically enter if you want to go into journalism. But I would think—I guess I would predict—you’ll see more data-driven analysts or reporters….

    But I doubt that is happening.

  8. Remember cold fusion?

    Yes, it was almost 30 years ago. Do you have a more recent example?

  9. I have to think that with the sheer volume of studies being done and reported on, most people tune them out anyway (or at least I do). Especially regarding diet recommendations – it seems like you can find a study to really back up anything.

    On Denver’s last article – I have had one run in with a pediatrician when my son was a baby where I truly felt they were wrong and was belittled for “being able to Google”. This was not our regular pediatrician but was the head of pediatrics for the local hospital. He wanted me to take DS to have all of these blood tests and go see a pulmonologist when I was pretty certain I knew what the problem was based on some You Tube videos. I decided to take DS back to my regular pediatrician the next day (it had been his day off the day before) and he confirmed what I thought it was (something benign that DS would just grow out of) and just shook his head as I recounted what his colleague had advised me to do.

    It is difficult to go against drs. advice even when what I’ve read contradicts their advice (like antibiotics for ear infections and strep throats and the need for a flu shot) so I usually follow along or just don’t take the kids in unless they’ve had an ear ache for more than a few days.

  10. On evidence based medicine – one of the big problems is not that patients are demanding treatments for which there is little evidence, but that doctors are insisting. This is especially true in obstetrics, at least in the era when I was having my babies. So many of the practices that obstetricians insisted on – episiotomities, aggressive use of pitocin, extensive bedrest, scheduled deliveries, flew in the face of recommendations based on evidence. Women found it impossible to argue. I can remember being on a due date mailing list and comparing notes on this stuff. It is really hard to argue with your obstetrician when you are pregnant, but darn, some of the things women were getting subjected to…

  11. It is hard for most patients to challenge their doctors. The heart patient profiles at the beginning of that Atlantic article had enormous presence of mind to Google the proposed treatment while he was in the emergency room and then decline it. Most people in that situation will automatically accept whatever the doctor tells them, especially when the proposed treatment is the standard one and the patient is in pain or otherwise distressed.
    That guy was amazing.

  12. this is the second time recently that someone on this list has discussed their disappointment with the physician who had an important administrative title. In medicine, we have our own form of the “triple threat”. It is the physician who is a good clinician, a good researcher, and a good teacher. Perhaps you should add administrator in there as well, though administrators tend to draw heavily off the group of people who are good researchers and teachers. Or, perhaps off of the group of candidates who are poor clinicians.

    My point is that it is rare to have a physician in a large medical system with an important administrative title who got there because they are the best of all the clinicians. They are likely a good politician, with some business savvy. They likely see very few patients and have strictly limited availability. I worked at a hospital where the chief medical officer worked one shift per month in the emergency department. I would not have wanted that person caring for a family member. Medicine or something that you are better at when you do it frequently. You were also probably better when people around you could speak frankly with you about your patients. Dr CEO did not have a collaborative relationship with other physicians or staff when he was working; we were all too intimidated by the title.

  13. I will also state that the hospitals and practices where I have given or received the most evidence-based care were government facilities. In private practice, including non-for profit hospitals, the need to make money shadows all decisions.

    I received prenatal care from three different providers and delivered at three different hospitals. The one that followed recommendations exactly was the public health facility. Trust me, I was checking.

  14. “My point is that it is rare to have a physician in a large medical system with an important administrative title who got there because they are the best of all the clinicians.”

    Thanks for this. It’s funny, in my own job, I can tell the folks who got there because they know the geek stuff from the folks who are good at the client interface from the folks who are awesome at playing the political game from the guy who’s just a total asshat who you wonder how he ever got into his current position. But it never would have occurred to me to evaluate/question a doctor I see in a hospital the same way. Maybe it’s the vulnerability (nothing like “interviewing” a professional with your backside exposed, not to mention in pain/feeling like crap/terrified); maybe it’s the aura of invincibility baked into the white coat; maybe it’s just that we still think of all doctors as Marcus Welby and not as individual cogs in the grand Machine O’ Medicine.

  15. On medical interventions when you’re pregnant–I carefully wrote out a birth plan, including what procedures I did not want and what I preferred. It was ignored. Placed in my chart during labor and simply not read. In the end, I told them to stop all the drugs (they did). A couple hours later when I was about ready to push, I asked for the birthing bar. They left the room briefly before telling me they didn’t know where it was. I demanded they find it. May have been straight-up bitchy. I’m not sure about that, just that I did not accept “I can’t find it” as an excuse. Turned out someone else had used it earlier that day and it hadn’t been put away yet. Worked just fine. Midwife said “I can’t believe you pushed that big baby out”. The midwife! Isn’t it her job to help birth children naturally?

  16. I can’t think of the last time someone challenged me based on evidence (or evidence that meets basic standards). My recommendations get challenged all the time, but never because “this professional society recommends…” or “studies have shown…”. Maybe because al me recommendations align perfectly with the evidence? ;)

    This is an interesting project. Specialty organizations were told to come up with five things (treatment, drug, procedure) that patients should question. It’s mostly accurate, though some of them hit you like, “does anyone do this??”

  17. The other time I’ve challenged a doctor was also “down there”. Fellow at a teaching hospital thought chopping off the end of my cervix was a great answer to my second bad Pap smear. (There is, of course, a better name for that, but I can’t think of it). As I thought I might want to have a child, I told him no. He brought it up at their weekly meeting and the supervising physicians agreed with me. But my understanding was that we were all set to schedule the surgery before I said no. Do other people honestly not question their doctors?

  18. I question my doctor & dentist all the time. It usually starts with ‘what if we did nothing?’ And then I work up from there.

    Recently one of my teeth (existing back most upper molar, wisdom teeth removed when I was in college) was a candidate for root canal, then, of course a crown. Something like $1600 all in, my share maybe 1/2 of that. I said what if I just have it removed? He agreed that was possible, maybe even preferable. Said no one ever asks that kind of stuff. Took care of it the next week with the oral surgeon who did my kids’ wisdom teeth. My share was $38.

  19. I may not challenge a dr. directly but I would get a second opinion if I didn’t agree (although not sure I would have the guts to do it in an emergency situation, even though we have certainly had our share of faulty ER diagnoses). Michael Lewis’ new book on Amos Tversky and Daniel Kahneman is a good read on just how bad people are at making decisions (even people well versed in statistics).

  20. Ada, that’s hilarious. Also may explain why they didn’t bother to look to see if mine made sense. It is probably hard to take that time during a shift. But I wish the person during the Q&A portion of the tour a few weeks earlier had just been honest, and I would have gone somewhere else, where standard procedures were closer to what I preferred.

  21. It is difficult to go against drs. advice even when what I’ve read contradicts their advice (like antibiotics for ear infections and strep throats and the need for a flu shot) so I usually follow along or just don’t take the kids in unless they’ve had an ear ache for more than a few days.

    Maybe a dumb question, but why would you go to a dr. for an ear infection or sore throat if you don’t want antibiotics?

    Along these lines, I spent a day in an urgent care during my clinicals. The MD I was with said all the administrative and research docs who are advocating to reduce the use of antibiotics need to spend a few days working in primary care or urgent care to see how long they can hold out. Parents bring their kids in because they want antibiotics. And with the push to tie reimbursement to patient satisfaction, it’s going to be even harder for providers to not give them. You can argue with the patient/parent and have them leave unhappy, giving you a lower reimbursement, or take the easy way and give the script and get a better survey and more money. It’s a no-brainer.

  22. I question my doctors frequently and part of the reason I don’t go to the doctor often is that I think I typically have better judgment than they do, mostly because I’m willing to spend hours researching when I think I have a problem. My doctor to whom I supplied a meta-analysis from the literature explaining why he was wrong about a particular pharmaceutical choice still said “Hi” to me at the grocery store. Maybe the fact that he remembers my first name is evidence that I’m a *special* patient.

  23. I totally agree with DD. Add narcotics in there too. My %ile for appropriate antibiotics is much higher than %ile for patient satisfaction. I’m paid based on both these numbers, but have yet to see the dr who is high in both categories.

  24. “Maybe a dumb question, but why would you go to a dr. for an ear infection or sore throat if you don’t want antibiotics?”

    Because you suspect strep or something else and would like a doctor to check it out before it (possibly) gets worse? Do you think it’s a bad idea to go to the doctor in those cases?

  25. We go to doctors who don’t routinely prescribe antibiotics in cases of bad cold symptoms. But we’ve also seen doctors who prescribe “just in case”.

  26. Denver – I’ve never taken the kids in for a suspected ear infection, it’s always been diagnosed when they either had goop coming out of their eyes as babies (and I was worried about pink eye) or at a routine check up. My oldest had strep right before Christmas and had thrown up in school from it, so I did take her in for that and she did take antibiotics for it (which subsequently made her sick). My kids are more prone to stomach bugs and that strep diagnosis was the first we’ve had in our family (and my oldest is 9). They may well have had it before but they’ve never complained about sore throats before this one instance.

  27. I do wait things out with kids but I once waited too long and my DD at seven months ended up very dehydrated and was admitted to the hospital. It was some sort of virus and she had severe diarrhea for almost a month after. At seven months, she looked like three months.
    Very scary.
    So, now I am a bit more cautious and will take them in.

  28. Because you suspect strep or something else and would like a doctor to check it out before it (possibly) gets worse? Do you think it’s a bad idea to go to the doctor in those cases?

    This is my point – you’re taking them in because you think they might need antibiotics. So if/when the doctor wants to give them antibiotics, why are you going to argue that you don’t want them?

    If you don’t believe in treating strep with antibiotics, then there’s no point in getting a strep test done because it wouldn’t change your treatment.

  29. Oh I’d love to see someone refuse strep testing! Not last decade, but maybe this one? Will report immediately here when it happens.

  30. Denver, I have an otiscope and am really bad at using it. Even if I think my kid has an ear infection, I’m not sure until someone who can use one well takes a look and sees it. (If I wanted to wait before starting antibiotics, I’d still take the script, but maybe some wouldn’t.)

  31. “Oh I’d love to see someone refuse strep testing! Not last decade, but maybe this one? Will report immediately here when it happens.”

    Last summer, I went with a kid with a sore throat to the doctor’s office. The medical assistant who took vitals said the make sure the PA did a strep test. The PA came in, looked at the kid’s throat. I asked about a strep test, she said no, I persisted to no avail. A few days later, I’m back with another kid with a sore throat, saw our regular doc, she did a strep test on that kid. It was positive. Had to bring back the other kid, who was still sick and also tested positive once she had a strep test.

    It is really hard to figure out where to push and what questions to ask. I am much more comfortable googling lab results and symptoms at home and then talking to the doc. I hate getting test results at the docs office because I can’t assimilate the info fast enough to have actual questions.

  32. The antibiotic thing is a hard sell to parents of miserable kids. Take them home without meds, lose more sleep and time away from work or school, and perhaps have to drag the miserable kid BACK to the doctor in the snow a few days later to get the meds anyhow, but at least you know that you’re, maybe, helping protect Other People from drug-resistant bacteria. Or take the meds home and, when the kid gets better, believe that it was because of the meds rather than time.

    There were a few times that I asked the doc to give us the scrip, which I promised not to administer unless the symptoms didn’t resolve in x days. That way, at least we avoided the second schlepp to the pediatrician and then to the drugstore.

  33. The first pediatrician we had was totally in love with ear infections. No matter what symptom the kid had, he would pronounce “ear infection!” and put the kid on antibiotics. So later on, I went the opposite way – avoided the pediatrician when there was an earache. Eventually it went too far – DD, who tended not to complain about pain anyway, suddenly had some blood coming from her ear. So we took her to the pediatrician and it turned out it was a ruptured eardrum due to an untreated infection!!

  34. Daycare and school policies have impact too. Many schools will let a kid back into care 24 hours after starting antibiotics, so there is a lot of pressure to get the kid on antibiotics.

  35. I also think there are a lot of unnecessary pediatrician visits because of school policies. I can remember the school nurse not letting my kid back in because of a minor rash on his face, so we had to go to the pediatrician and get a note. She just started laughing. Another time, it was a persistent cough after a cold that got us sent to the pediatrician for the note.

  36. Ada, I know you don’t like pediatricians with administrative roles, but in defense of our pediatrician, she is the best and most thorough one I have encountered. She takes a lot more time with her exams, asks more questions, and takes the time to find us resources. Most importantly, she follows the kids who were treated for cancer at her hospital (it is a COG facility) and even though my son sees a specialist at MSKCC (yes, one of those danged specialists!) for late effects followup, I really appreciate that the pediatrician is completely up to date with late effects guidelines and was always aware of the some of the oddities of childhood cancer survivors, such as the completely weird reimmunization schedule. She could write letters to our school district explaining why DS wasn’t following the school immunization guidelines – much faster and easier to ask her than to deal with the MSKCC people. Ad yes, I was happy that she was willing to refer to specialists and knew all the good ones. She is much better to work with than the pediatric practice (and major pediatric teaching hospital) that misdiagnosed my kid for 2 months when he was a textbook case of a latestage abdominal cancer.

  37. The one time that we decided to “wait it out” with DS and an ear infection/fever, I ended up with a super sick, miserable kid for days on end that just kept getting worse. He didn’t get better at all until we finally went to the pediatrician & got antibiotics. Never again. He got pretty frequent ear infections when he was 2-3 years old. Thank God for antibiotics. We did refuse the ear tubes though.

  38. I am not a fan of antibiotics for kids, but one of my friends has a kid that ended up in the hospital because he got so sick from untreated strep. The rapid test came back negative, but there was a miscommunication about the result of the culture. It was positive for strep, but his mom didn’t know this and they never got antibiotics to treat the strep. I didn’t even know someone could become this sick from strep if it is left untreated.

    I feel fortunate that DD rarely gets strep because some of her friends used to get it several times a year when she was in elementary school. It seems to be much less of an issue for many of these kids in middle school.

    I called the pediatrician today about a form that I need for sports, and the nurse told me that it was mobbed there today. I guess everyone is trying to fit in everything before the blizzard.

  39. Lauren, strep can cause serious kidney problems if untreated. That’s why they routinely give antibiotics for it. It’s not just to shorten the duration of the sore throat by a few days.

  40. Ironically, I’m taking DD to the ped in an hour because she has an ear infection. And yes, I’m going for the sole reason to get antibiotics for her. It sucks that I can’t just write the script myself but I like having a license.

  41. DD, what about that 24 hour rule for allowing kids with strep to come back to school? That seems to be the norm around here…you can return to school within 24 hours from the first dose of the antibiotics.

    I’ve had a couple of different experiences with my daughter when she had strep. She is usually so much better after the first day on antibiotics, but there have been times when she was weak until she had the antibiotics for at least two days.

  42. I thought that strep throat, left untreated, can lead to scarlet fever down the road, and eventual heart problems. I always thought that Beth in Little Women died because her heart was weakened from scarlet fever.

  43. What is it that makes some people more or less prone to strep? My sister stayed home with it several times when she was in high school, but I didn’t get it.

    DS got ear infections so many times, the last one resistant to several different antibiotics, that he got ear tubes shortly after his second birthday (the relief at the end of ear infections was soon tempered by the beginning of asthma). They fell out when he was around 4. I didn’t realize that was normal, but it apparently is. His ear infections started up again in second grade. I didn’t realize it at first, and he had them in both ears, a sinus infection, and bronchitis by the time I took him in. 5 scripts! I don’t even remember what they were all for.

  44. SSK, I never read Little Women, but my dad thinks that what led to his mother’s early death was an untreated case of scarlet fever. He says it could’ve been averted by antibiotics. I find it amazing to think that the use of antibiotics began when he was small, and they may no longer be effective when he dies.

  45. The other thing is that, DH (and I) were ignorant of the questions parents get asked when you bring a dehydrated infant into the hospital.
    We later realized that those questions related to child abuse but DH who was with her at the time was totally unprepared for that.

  46. ” those questions related to child abuse ”

    I used to get pummeled with those questions! DS had a large birthmark on his very low back, right at the top of the bone, and he has a small one on top of his wrist. Looks like he’s been beaten and someone held his little arm much too tightly. Several care givers were clearly very nervous about them. They might’ve been worried I’d try to accuse them of something.

  47. Lauren, they use 24 hours of being on antibiotics as a general guideline for not being contagious. But with a lot of stuff, they are contagious before they even show any symptoms anyway.

    What is it that makes some people more or less prone to strep?

    I wish I knew. DD used to get it all the time.

  48. Knock on wood, none of our kids have had strep yet. I do take them to the dr for ear infections now but wait until 24-48 hours after symptoms develop. Our last pediatrician was really great about the 2x trip – she would call in the Rx and give us instructions on when to take it if it was a Friday, for example, but the kid had only been sick for a day.

    I actually had an ear infection 2 years ago – it was very odd bc I hadn’t had one since I was about 4 or 5! I felt like all these childhood memories were resurfacing along with the symptoms! :)

  49. Regarding conservative school nurses- on Friday my son had 3 school tests and said he had a mild stomach ache. We told him to call us if he still didn’t feel better. Instead the nurse called and insisted we get him checked for appendicitis. Long story short after the pediatrician ordered an ultrasound out of an abundance of caution, he had it! His pain was getting worse every hour and a few hours later he was in the OR for an emergency appendectomy. He was back at school today! I love that nurse! She got big thank yous from us and our son!

  50. Wow, I wonder if there was something unusual about his mild stomach pain that tipped her off?

  51. “Maybe a dumb question, but why would you go to a dr. for an ear infection or sore throat if you don’t want antibiotics?”

    To be a counter to the parents who want antibiotics whether their kids need them or not?

    That’s one thing we asked of the pediatricians when we were picking one. So we’re pretty much on the same page as our pediatrician in not wanting our kids to take antibiotics unless there’s a clear reason. If there are tests involved to help make that determination, he’ll call us with the results, and if they show a need for antibiotics or any other prescription meds, his office will call in the prescription for us.

  52. “ most journalists have very little training in science or statistics”

    One peeve is that many in the media conflate energy and power, often in the same sentence.

  53. Mafalda, wow, wow, wow.
    Wow that he had appendicitis.
    Wow that the nurse caught it.
    Wow that he’s back in school already!

    Did she do a manual exam? My dad likes to tell about the day he reported for his military time. They had a guy waiting for him. He did a quick manual exam & diagnosed appendicitis. Went straight to the OR. After surgery, they did dad’s paperwork. That story always impressed upon me what an emergency that can be. So glad your son’s ok!

  54. It seems he felt pain when he moved in some ways, and it was on the appendix side and he had nausea too, but he had recently had a totally normal bowel movement, so she thought it didn’t seem like upset stomach. After her call we also had a series of “let’s just check one more thing.” From his doctor and the the hospital. Just one of the best experiences I’ve ever had with medical care. Also it was a children’s hospital and they were so sensitive to the fact that he is a child and we are his parents, even though he’s a big teenage man-boy. I just felt so grateful for the technology and the professionals involved!

  55. One peeve is that many in the media conflate energy and power, often in the same sentence.

    I’m guessing you have many peeves in regards to the written word. :)

    Mafalda, glad he’s okay. There are a couple of simple tests you can do that are very indicative of appendicitis.

  56. DD had appendicitis in 3rd or 4th grade. She had a bunch of high tech tests (sonogram, cat scan, maybe – I can’t remember). None of them showed she had appendicitis. Basically it was the doctors feeling her tummy that sent her into surgery, and sure enough, when they operated she had an inflamed appendix.

    While we were waiting around to decide what to do a group of med students came in and got a chance to push on her tummy to get a sense of what a bad appendix felt like!

  57. One of my kids had post streptococcal glomerulonephritis, diagnosed at 3. She was always a little sicky, we thought. What she had was a hell of an immune system that fought a long term chronic strep infection so well that it never got to fever/diagnosis stage. She ended up fine, and had tonsils, adenoids out and tubes at 4, and has not been sick since. Truly.

    I picked up the RAV4 today. I had forgotten how great it is to be up a bit higher (we had a VW bus for the family in the old days). Very well designed for the vertically challenged. I used the in dash nav system to get home (the dealer is quite a distance away) and it was significantly inferior in giving directions to the Google Maps lady. But it has a full display on the screen and a simple in dash turn by turn display. I will keep testing it. Bluetooth calling worked fine. Heated steering wheel, dy-no-mite. Foot operated lift gate, sweeeeet. Learning the rest of the gadgets will have to wait until I pick up Wednesday afternoon from the MBTA garage where it is avoiding the storm.

  58. “Foot operated lift gate”

    Sounds like they finally dealt with the issue of the rear door swinging the wrong way for cars driven on the right side of the road.

  59. And, following up on yesterday, I have marmoleum floors in the kitchen and entry. They are made of linseed oil and hemp and other natural stuff, the way real linoleum was made 100 years ago – not that vinyl stuff. They have a lot of give, so no breakage when you drop things on them. It is easy on the pets’ paws. You don’t need one of those cushy mats at the sink. And they are used in hospital operating rooms – they can be sterilized and cleaned easily. I spilled some stripping compound on them while refinishing a cabinet – wiped right up and no effect on the surface.

  60. Mafalda — I’m so glad your son is OK. When I fell ill this past December, I had no idea it was appendicitis. I woke up one morning with a terrible stomach ache right in the middle of my belly — the pain wasn’t located in the lower-right area at all. I was 100% sure it was some sort of stomach bug, since those seem to visit our home like clockwork every December. I waited it out more than 24 hours before I went to the ER. By that time, the appendix had burst, and I was in bad shape.

    My takeaway: If one of my kids ever complains of severe stomach or abdominal pain, I’m taking them to the doctor, stat! No waiting around.

  61. Meme, thanks for the updates. My Dad likes his Equinox for the height. In our family, all GPS ladies are named “Wanda,” a Boston-inspired mispronunciation. Your marmoleum suggestion is inspiring me to a Google search. We are in the process of flooring decisions.

  62. I love pediatricians in administrative roles! They are like the nicest administrators ever. However, I don’t think that they have the most clinical comfort of any pediatrician ever. It sounds like yours has tons of time and is really good at administratrivia. Actually, I bet she is NMSF at paperwork. However, you have noted in the past that you leave with a handful of referrals – it is possible she is not so comfortable managing typical pediatric problems. Hard to know – I am neither a pediatrician nor privy to all your medical information. I’m just saying that when I hear that someone is seeing Dr. Gigantatosaurus, Chief of Medicology, at Case Western Mayo Reserve Cleveland Clinic, I am confident that they are seeing a really great guy. Less confident that they are seeing a super competent clinician.

  63. Oooh! WCE – come visit our marmoleum. Lovely and forgiving. The cork tiles are orders of magnitude cheaper to install than the sheets.

  64. Here’s the Strep Article you’ve been waiting for!!!

    I won’t argue that kids can’t get really sick and need hospitalization from strep throat (they do!). Or that strep doesn’t cause life threatening infections (it does!). However, strep is everywhere (including in the back of 15% of teens throats. The reason some kids get recurrent strep is because it is always there!). The way we manage pharyngitis does not necessarily reduce hospitalizations from sore throats nor morbidity and mortality from complications

    tl,dr: Can’t prevent kidney complications with antibiotics (immune response related, antibiotics doesn’t change that. No evidence that you can prevent RF in an industrialized country (because we don’t understand who get RF – Not Americans in the 21st century, that’s for sure!!). “We are far more likely to harm patients with strep pharyngitis by giving antibiotics than to help them in developed countries. “

    Most ER docs I know give abx to patients for strep and never to family. Let’s revisit in the next 10 years and see where things stand.

  65. And now I must sleep, because I am on the night-shift-turnaround, and if not apparent, haven’t slept in 36 hours. It makes me giddy. About strep throat, administrators, and specialists (who I love, by the way!).

  66. “NMSF at paperwork”
    Ada,’you are funny when you’re sleep deprived. A regular Übermensch of humor.

  67. So, someone woke me at 1:30 this morning and I was awake the rest of the night, except of course for 15 min or so before my alarm sounded. In those 15 min, I had one of those ridiculous dreams where the people and places keep changing and none of it makes sense. At one point, Tamra from RH Orange County was painting my nails. Because that’s a thing.

    And then PTM and Mooshi showed up!! PTM was offering advice about something – and of course it was sage and he was right – and Mooshi was driving me around in a car while also searching online to find out if she could take a car on a plane.

    So. Not sure I’d count on my productivity level today.

  68. Mooshi wanted to take a CAT on a plane, not a car.

    Although at the end of our drive, she admitted she doesn’t actually have a cat, and was only curious.

  69. S&M, my ex-boyfriend posted that cartoon to my timeline on Facebook.

  70. I had no idea about the arguments against antibiotics for strep. If I ever get the chance, I’ll ask the doctor what he thinks. (I don’t recall ever getting strep, but I may have had it as a child and survived fine without antibiotics. However, we didn’t run to the doctor for every little thing as we do now.)

    Risley, do you ever use dreams as ideas for your writing? I had a great idea for a science fiction story of some type from one of my recent dreams. It had to do with an all white underground rail-highway thingy where vehicles traveled at breakneck speeds from town to town. Lots of great scary details. There was a Dunkin Donuts types of shop at one of rest stops, but with hostile people behind the counter that closed shop just when I walked up for coffee and donuts. Or maybe that book or movie has already been done. :)

  71. Risley, sounds like the plot for a short story.

    It’s nasty here, but it is ice/sleet that is hitting our windows right now instead of the snow that was predicted. I prefer snow because this ice mix is usually more dangerous.

  72. “What could possibly go wrong?”

    Eh, I truly wish them well, and I agree that a one-year-old baby is their golden window to do this. I think through-hiking the AT is a little like navigating the Great Loop: you’re never too far from civilization. There’s no real danger, there’s no time that you’re ever totally out on your own where a wrong decision could be fatal. You just mosey along a little at a time.

  73. CofC/Lauren – CofC’s idea would be a hit book/movie. My dreams, if written, would lead to my being committed.

  74. Agree with Milo – awesome if it works for them, doesn’t seem so risky if it doesn’t. Skeptical that a child should sit in a hiking backpack 6+ hours per day – seems like she probably will be waiting even longer to learn to walk.

    That is a lot of gear, food, water for one parent to carry – I’m assuming that Mom carries baby? We’ve done some very short trips and I am a sloppy backpack packer (I take canned goods and wine). However, with kids who are walking and can carry a few pieces of clothes, a water bottle and some snacks, I still find that I have to carry a ton of stuff. Also, “Mom’s breastfeeding so we won’t have to carry so much food”? Those calories have to come from somewhere my friend.

  75. On another sleeplessness tangent, DS hasn’t been sleeping well for weeks and not surprisingly ended up quite sick. His doting father got him a hotel room for the weekend because it’s not so restful in an apartment full of fraternity brothers. DS set off for the hotel with Tamaflu and Ambien, the latter which he was afraid to take because he already sleep walks.

    Anyway, he finally took it on Sunday night and said it worked perfectly EXCEPT THAT he had locked both the hotel room locks before going to bed, and when he woke, both were unlocked. He had no memory of leaving.

    Later, he texted to say: “more clues about last night – I found one of my socks in the hall and I have small paper cuts all over both hands.”

    Not sure he’s a god candidate for more Ambien.

  76. Ada – I wonder for how many days they typically need to provision. I’m thinking three or four, tops. And do they carry all the water for that, or are they just bringing iodine tablets and looking for streams? I can’t remember what Bryson did. The food part is easy; you could just do Kind bars, peanut butter, tuna packets and call it good. But water’s heavy.

  77. Oh, Milo – I love the math on this problem.

    You probably need to plan for 3-4,000 calories per person per day. (Normally, I would say less for mom, but the breastfeeding). Also, the baby probably should have some calories from food too, though harder to find calorically dense food appropriate for 1 year olds – peanut butter packets?

    8,000 calories per day, carrying 4-5 days at a time? Even if you can resupply every 3-4, you’ll want to carry a least a day of cushion. 40,000 calories.

    Kind bars: 40g = 200cal
    Tuna Packets = 74g = 190cal (even if we choose the stuff packed in oil)
    Dried Fruit: 100g = 300 calories

    Let’s eat one serving of each for every meal – 214g = 690 calories.

    Our 4-5 day food supply is 12,400 g = 27 pounds.
    (Which works out to expert recommendations of 1.5-2.5 pounds per day per person)

    Water, you can bring a pump. You really shouldn’t drink that much iodized water (4-5 liters a day) – especially not for a baby. Still, a conservative person should carry 1-2 liters at a time while backpacking, so another 5-10 pounds of water.

    Also, I could write a whole thing about carrying diapers in the wilderness. In in case, they will be wet and dirty and heavy.

  78. Hi all,

    I’ve mentioned a bit here about my son, who was diagnoses this year with a chronic illness. He has missed a lot of school because of doctor’s appointments and being sick. He has a 504 in place because of his illness.

    Yesterday, I got a notice from the school, saying that he has missed so many days of school that he has been declared truant. The letter basically says we need to make him go to school and threatened various sanctions and penalties for him and us if we don’t make him go.

    Does anyone have any experience with this sort of thing? Does anyone know of ADA protects him in this case?

  79. “Water, you can bring a pump.”

    And do what with it? Charcoal filter? Boil it? I really don’t know.

    All the details you provide are reason enough for me to not want to do it on my own. (Give me an RV or boat that I can outfit with plenty of food, water, Jim Beam, and air conditioning.)

    What’s harder for me to accept is that something that is relatively easy for moderately fit adults would become impossible if you have to carry an extra 20-lb sack, even if that sack needs food and water and diapers.

  80. Anon,

    Where was your child diagnosed? Your local children’s hospital should have a Child Life Services department that may be able to help you with the process. They deal with this sort of thing every day.

  81. Anon, I have received that letter, as has a friend. We each were required to write a letter explaining the absences. I referenced the 504. There were no truancy consequences, but the school did have him stay after a few days to “make up” what he had missed. He had not, in fact, missed anything, because he always emailed his teachers and we kept him caught up, but it allowed the school to document that effort was made to make up missed time. I would start by calling the person you work with on the 504. You are very likely not the first person at that school to have this issue, so they should be able to tell you how they handle it there. And if the school isn’t helpful, contact the 504 administrator for the district.

  82. What’s harder for me to accept is that something that is relatively easy for moderately fit adults would become impossible if you have to carry an extra 20-lb sack, even if that sack needs food and water and diapers.

    Ah, here’s where we differ. Hiking the Appalachian trail is something that is not considered easy for moderately fit adults. Roughly 26% of people who attempt to thru hike every year complete it. So, 74% of the people who quit their jobs, arranged for food caches to be delivered, bought all the gear, arranged the permits and showed up at the start line, quit. I would guess that as a group they are more than “moderately fit”

    So, with that kind of difficulty, it seems pretty challenging to add 30lbs of baby to be carried, a bunch of wet and dirty diapers, extra food and water, extra clothes. 50% of your party is mostly carrying baby and stuff, which means the other person is carrying gear and supplies for 2 people. It is remarkable to attempt.

  83. I agree with Ada that while it’s not life threatening it can be quite challenging for this family to succeed in their AT quest. They hope to average 12 miles a day, but so many things can waylay a hiker. (I wonder if they’re carrying antibiotics for strep throat?) If they are persistent they can do it, but maybe not in one year. Grandma Gatewood is on the other end of the age spectrum. She was amazingly resilient and persistent, pushing on alone in what seemed to me were sometimes frightening circumstances.

    Emma Rowena Gatewood, better known as Grandma Gatewood (October 25, 1887–June 4, 1973),[1] was an extreme hiker and ultra-light hiking pioneer who was the first woman to hike the 2,168-mile (3,489 km) Appalachian Trail from Mount Oglethorpe in Georgia to Mount Katahdin in Maine solo, and in one season.[2]

  84. CoC, an Underground Railroad that’s been expanded to include car lanes, for or run by white people. Just Finning you, but that is what I first thought. I’m a little fuzzy, having woken up halfway through the night, plotting with RMS’s ex instead of going back to sleep.

    Risley, I come close to that kind of stuff on Benedryl (though the appreciate are impressive). Never have pushed my luck & tried Ambien.

    Anon, you should be able to call and explain. I’ve gotten that letter, and others saying the school social worker had to come to our house. When DS switched to a private school, I didn’t pull him out of public until we’d had the 504 meeting. I pretty much ignored them, figuring that with forgiveness being easier to get than permission, and knowing that he was indeed enrolled in a school (IOW, relying on white privelege), I’d be able to explain my way out of any action. I officially cut the cord the day after the meeting. Several years later, when he was back in public schools in the same district, I got it again. I called and fessed up. Haven’t gotten any since.

  85. Anon, your school district should be providing alternative instruction as part of the 504 if he is missing that much school. You should get the 504 plan amended. This is pretty typical when a child has a serious illness.

  86. Also, I would use the hospital social workers or someone in the doctors staff to write the letter, not Child Life (they have a different function)

  87. Speaking of Doctor visits we had to do one this morning because DS had constipation issues and also developed a sore throat. He has been out of sorts but not flat in bed. He has been out of school some days last week and this week.
    The doctor tested him for strep throat ;. Nope, no strep and the stomach issues need plenty of water and a bland diet. The doctor told him that he has to go to school and not continue to linger at home (the teachers did email him work, so he has been working on things)

  88. Ada – Fair points. They probably won’t complete it. They’ll go as far as they’ll go, and then they’ll stop. They can do the rest later.

    It’s very different from saying “We’re going to sail with our one-year-old on a 24-foot sailboat to Australia.”

  89. Didn’t Roman soldiers walk 20 miles a day? Swahili porters did, and on far less food than that. Of course, that was during the colonial era and geared towards profit, not the porters’ health, but still, 12 should be doable. I agree that provisions & diapers are the main problem, assume there are many webpages with ideas about that. The whole route must be pretty well set up by now with provisions and waste facilities. If there are toilets for all those hikers, there must be trash cans.

  90. Anon, this is from a pediatric cancer site, but the advice pertains to all kids with a serious illness that limits school attendance. Part 2 has specifics on services
    “Homebound instruction is very common for pediatric cancer patients. A homebound teacher is a licensed teacher provided by the public school who comes to the child’s home, and in some cases the hospital, to help with assignments.”

  91. They have a blog and instagram, so I’ll have to check up on them to see how it goes. Part of the trail can be treacherous, from what I’ve read. Icy or wet conditions can add danger and slow you down. A slight misstep can cause an injury that will will either slow you down or stop you for a while. Adding a baby into the mix makes for even more possibilities.

  92. You’re getting old, CoC. ;)

    Just kidding. Sort of. Give us updates when you check on them. I guess they’re leaving pretty soon here.

  93. hospital social workers or someone in the doctors staff to write the letter, not Child Life (they have a different function)

    Good point, I may be conflating the two roles.

  94. Went down the rabbit hole far enough to satisfy my curiousity says
    Food required for one day weighs approximately two pounds, and with everything else a hiker carries, hikers typically resupply anywhere from every six to ten days. Resupplying can be done in two ways, hikers can either purchasesupplies from convenience stores and general stores in towns crossing the AT, or they can pick up care packages sent from home via mail drops. Either way, getting to these places will take additional time and effort. The Appalachian Trail Data Book and the Appalachian Trail Thru-Hikers’ Companion both include listings of directions and distances needed to go from roads crossing the AT to groceries, supplies, lodging, restaurants and post offices.

    If I were part of that couple, I’d split up for food runs, with one person hanging out with babe and gear. I do hope the kid gets many chances to walk and explore!

  95. We have 9 or 10 inches, but this ice/sleet/rain with wind is nasty. I would much rather have all snow. My friends that moved about 15 miles north have much more snow. They have the heavy, large flakes that feel here for just a few hours. It is bad for all of the kids because you can’t play in this when ice pellets are hitting your face.

  96. I think sailing to Australia with a one-year-old seems eminently more manageable But I think that just means I have really no concept of what that would require.

    I don’t know a lot about what it was like when the Romans were marching, but I suspect that there were usually supply wagons.

  97. Ada, I don’t know much about the Roman military either. The porters did not have official supply trains, but often had someone following along, with whom they had to share their provisions, such as they were.

  98. It’s fun until you hit a storm that de-masts your boat, if it doesn’t capsize you. It can go fine, or it can be really scary. But if things turn south, you’re all alone. On the Appalachian Trail, you’re barely out of cell range.

  99. The Romans also had slaves. Not sure it’s a relevant point-of-reference to modern day through-hiking, but I guess if that is what you know.

    12 miles of flat elevation is a lot different from 12 miles with lots of change in elevation too.

    I’m with Ada on this one. The AT isn’t as extreme as the PCT or the Continental Divide trail, but I think it would still take WAY more than “moderate” physical fitness to be successful. But yeah – if they drop out, no biggie.

  100. “Twelve-month-old Ellie isn’t walking yet”

    So they’ll be hiking right when she would normally be learning to walk. I wonder how that’s going to work.

  101. “So they’ll be hiking right when she would normally be learning to walk. I wonder how that’s going to work.”

    I bet she’ll still learn.

    Note that the woman who got tragically lost from the trail was calling for help via text message, which suggests I was right that you’re barely out of cell range.

  102. Milo – her profile suggested that she shouldn’t have been on the trail by herself even though physically she seemed to be in good enough shape.

  103. Bless her heart. The second article said she did not have a good sense of direction. Of course, the first time we looked at our house when we were shopping, I got turned around thinking that we were east of town when we were actually west of town. It took me about three years of living here to get it intuitively straightened out in my mind. Logically, I could tell you which cardinal direction to travel, but whenever I imagined it, it was backwards. For years.

  104. “Logically, I could tell you which cardinal direction to travel, but whenever I imagined it, it was backwards. ”

    I always get confused when large bodies of water are on the West side. (example – Western Michigan, Gulf Coast of Florida, California) It feels backwards, and I always get turned around in my cardinal directions. Too long living on the east coast of Lake Michigan and the East Coast.

  105. Hey Ivy – you are so right about yourself! You’re on the WEST coast of Lake Michigan! It’s the EAST coast of Illinois, of course.

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