From Family Practice News on October 6: "PPI Use Linked to Incidence of C. Difficile Illness". Seems logical enough. One of the risk factors in taking acid-reducing drugs is the increased risk of certain gastrointestinal and respiratory infections. This is thought to be due to decreased acidity in the stomach, making it possible for otherwise-sensitive pathogens to survive. Numerous studies have demonstrated links between the use of proton pump inhibitors (PPIs) and Clostridium Difficile-Associated Disease (CDAD), a really nasty bacterial infection of the gut that is usually seen in people who have been on prolonged courses of antibiotics.
Since most clinical trials on this topic have been conducted in Western countries, a Japanese group wanted to see if this trend held true in Japan. They evaluated the hospital records of 793 patients admitted in the spring of 2009 and compared the rate of CDAD in patients who had, and had not taken PPIs. They found a three-fold increase in CDAD in the PPI patients (P=0.04). Reasonable enough. But this is where it gets interesting.
Their concluding paragraph is:
"On multivariate analysis controlling for age; sex; use of antibiotics and H2 receptor agonists [sic]; and long hospital and ICU stay, the researchers noted no significant differences in the incidence of CDAD between PPI users and non-PPI users because of missing data."
I don't mean to be a stickler for details, but they made some teensy mistakes. First, they didn't control for antibiotic use, the main cause of the infection. Second, They didn't control for H2 antagonists, like Zantac, which do pretty much the same thing that PPIs do--reduce stomach acid. When these variables were taken into account all differences went away. Finally, the concluding paragraph not only misrepresented the entire study, but actually contradicted it. Thus, the real title should be: "PPI Use NOT Linked to Incidence of C. Difficile Illness". Oy. Someone really got this one wrong.
Although this study is absurd enough to be amusing and won't do any harm, it points out something that we all encounter that really does do us harm--bad headlines in the press. They are omnipresent, especially pertaining to health issues. My favorite is "Diet Soda Linked to Obesity," which came out recently, and probably had people hurling Coke Zero bottles out their windows. Of course, diet soda does not cause obesity. Obese people drink more diet soda--that is the link. Playing basketball does not make you tall. Tall people play basketball. But even some of my highly educated friends took away only the information from the headline.
In our fast-paced lives, headlines may be the only part of an article that is actually read. Poorly worded or incorrect headlines can do real damage by causing people to make wrong, possibly harmful choices. This is not especially funny.
