Canadian researchers say you can improve memory with this one weird trick

Medical experts in Canada weigh in on 'do not resuscitate' tattoos and new regulations may give Canadians access to previously confidential industry information about drugs.

And Canadian medical experts weigh in on that 'do not resuscitate' tattoo

A study published in the journal Memory suggests that saying words out loud can help you to remember them. (Tom Wang/Shutterstock )

Here's a study tip just in time for exam season: if you want to remember something, read it out loud.

It's called the "production effect" — a term coined by the Canadian researcher who discovered it, Colin MacLeod, a psychology professor at the University of Waterloo.

Typing something out or writing it down also results in variations of the production effect on memory. Even mouthing something without producing sound seems to trigger the effect. But what appears to work best is speaking it aloud.

"I think that leads to better initial encoding of the information in memory," MacLeod says."But it's particularly useful at the time of test when you try to retrieve stuff from memory."

MacLeod first identified the production effect in 2010, and has tested it in a series of followup studies. The most recent variation was published in the journal Memory.

Silent was the worst.— Colin MacLeod, University of Waterloo psychology professor, on testing different ways of memorizing words

His team tested four ways of remembering by asking students to read a list of words silently, read them out loud, listen to someone else read them and listen to a recording of their own voice repeating the words. Then the students were asked to look at a long list of words and remember which ones they'd already seen. Their recall varied across the four techniques.

"Silent was the worst," MacLeod says. "It's a little better to hear someone else's voice. It's better still to hear your own voice, but it's best to produce [the word] yourself and both hear your own voice and move your own mouth."

MacLeod does not recommend reading an entire textbook out loud.

"But selecting the important stuff, that's good," he says. 

MacLeod's research was focused on storing information in long-term memory. Other research has shown that saying something out loud can also improve short-term recall, to reassure yourself that you did something that you fear you might have forgotten, such as saying, "I locked the door" or "I turned off the stove."

At this point the researchers aren't certain exactly why vocalization improves memory. MacLeod says his next research question is to understand the physiological mechanism behind the production effect.

Canadian experts weigh in on DNR tattoos

In last week's Second Opinion, CBC Health reporter Kas Roussy checked on an unusual case of a patient with a do-not-resuscitate (DNR) tattoo, which generated a bit of Monday morning quarterbacking from Canadian health experts.

In case you missed that story, here's a recap:

An unconscious 70-year-old man was brought to a Miami hospital's emergency unit with a history of chronic obstructive pulmonary disease, diabetes and heart problems.

Over the next few hours, the patient became very ill, suffering from septic shock. When doctors examined him they noticed he had tattooed on his chest the words, "DO NOT RESUSCITATE."

A medical article documented the case of a 70-year-old man with this 'do not resuscitate' tattoo on his chest. The medical team struggled with what to do. The Miami hospital's ethics consultants ultimately said it should be honoured. (New England Journal of Medicine)

The medical team was understandably flummoxed. Did the DNR tattoo represent the patient's true wishes? Was it even legal?

A decision was made to partially revive him until doctors could get some guidance from the hospital's ethics consultants who said the DNR tattoo should be honoured.

The patient died later that night.

"To be honest, I would not consider a tattoo anything legally binding," says Dr. Bojan Paunovic, medical director of the critical care program at the Winnipeg Regional Health Authority.

"That tattoo means nothing to me. That could have been done 20 years ago in a state of bravado. You have no context of what that is, and it's for sure in Canada not a legal document."

Some clarification is needed, he says.

"Even if a person just says, 'Hey Doc, I don't want to be resuscitated,' I don't just say, 'OK' and walk away. That engages a conversation." 

"I would say it's an abdication of professional duty to just look at a piece of paper, or tattoo and then say, 'OK. I'm done.'"

A 59-year-old patient with this tattoo told hospital staff he got it after losing a bet while drunk years before, but it did not reflect his actual wishes and he would want to be resuscitated. (Journal of General Internal Medicine)

"It's a hard call," says University of Toronto bioethicist Kerry Bowman. "You would think on the surface of it, DNR tattooed across your fricking chest is enough. But you know, it's actually not." 

Bowman says there's always the chance the patient changed his or her mind.

"You know, there's a lot of tattoo regret in this world," he says. "When you work in a hospital and you look at how these things play out, erring on the side of life is not the most unreasonable position in the world until things can be sorted out."

So what's the takeaway from the case of the DNR tattoo? Bowman and Paunovic both say that it's important for people to have advance end-of-life directives and to discuss those with family members. They also advise carrying those directives with you — a document, a piece of paper — anything beyond an inked message on your body.

Health Canada to release clinical trials data

Late Friday afternoon Health Canada quietly introduced new regulations governing the public release of confidential drug and medical device industry documents. The new regulations published in Canada Gazette would relax Health Canada's long-standing practice of denying public access to the clinical trial documents submitted by companies in their applications for federal approval.

"Overall it's an encouraging development," said Dr. Nav Persaud, a family physician and researcher at St. Michael's Hospital in Toronto.

Persaud had first-hand experience with Health Canada's restrictions after the federal ministry forced him to sign a non-disclosure agreement before he was allowed access to industry documents about the popular morning sickness drug, Diclectin.

Health Canada warned Persaud he could face legal action if he showed anyone the data, even though he intended to publish his review in a scientific journal. But under the new rules, Persaud said, similar clinical trial documents would be automatically made public.

Dr. Nav Persaud, who had to sign a non-disclosure agreement before getting access to industry information about a drug he wanted to review, hopes new federal rules introduced Friday will give the public access to clinical trial documents. (CBC)

"What's yet to be worked out would be all of the details about in what circumstances the information would still be kept secret," he said. "So what are going to be the exceptions?"

The new regulations would bring Health Canada's transparency rules in line with the European Medicines Agency, which releases all industry clinical trial documents. The U.S. Food and Drug Administration routinely releases detailed decision documents that disclose much of the same information.

"If this actually does end up happening it will be good news for anyone who takes medications or prescribes medications," Persaud said.

Innovative Medicines Canada, the group that represents Canada's brand name drug manufacturers, did not respond to a request for comment on the proposed regulations.

The regulations are an amendment under Canada's Food and Drug Regulations and are now subject to a 75-day public consultation period. Health Canada says it has been consulting with industry representatives, academic researchers and health-care professionals.

Nutrition scientists' dietary biases matter

If a nutrition scientist is also a vegan, does that matter? Yes, says John Ioannidis, professor of health research at Stanford University.

Ioannidis studies integrity in science and he says it's time for nutrition researchers to be more transparent about their biases — both financial and personal.

It's not enough to know if a nutrition study was funded by the food industry, he says. It's also important to know if the scientist has strongly held dietary beliefs, or has written a bestselling nutrition book.

"I think it's important to know who's talking and why, and unless we ask for that extra level of disclosure we're not going to see that," he told CBC News.

A professor of health research says nutrition studies should not only disclose any funding received by the food industry, but also any strongly held dietary beliefs held by the researchers. ( enterlinedesign/Shutterstock)

Ioannidis made his call for greater transparency in a commentary published this week in JAMA. He was inspired to write it based on his own knowledge about undisclosed conflicts among high-profile nutrition scientists.

Most high-profile nutrition researchers have some of these conflicts, he said. But he's not going to name names.

"We know there are some very strong belief systems and very strong dogmas and they're not visible. People think this is just objective science like studying exoplanets in the outer universe and it's not."

He's concerned that personal biases and beliefs are motivating researchers to draw strong conclusions about the effects of single nutrients on health which are not supported by the scientific data.

"It's always in the news with very bold claims being made," Ioannidis said. "Very few of those really have strong evidence to support them. The signal is far less than the noise."

Disclosure would depend on the researcher being honest about books, or advocacy or nonprofit activities, or personal health regimes and dogmatic beliefs.

"We're moving the responsibility to the author to come forth if they are strong believers in a vegan diet, or an Atkins diet, in low fat, low carb, eat lots of nuts, eat lots of broccoli or whatever. Come forward and make a statement."

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