Last Thursday the Lancet published an extraordinarily interesting and complex study looking at the relative value of CRP tests and CAC (coronary artery calcium) scans (see my report here). Coincidentally, CNN, NBC and ABC this week ran reports on the same general topic. Exit complexity. Enter stupidity.
Health journalism watchdog Gary Schwitzer and his Health News Review has a definitive takedown on these reports (here, here, and here). I just want to call attention to some of the major flaws of these pieces, and then take a peek behind the curtain to show how these news organizations actually take great effort to dumb down their stories.
The CNN story, “Will you have a heart attack? These tests might tell,” pumps calcium imaging. It relies heavily on cardiologist Arthur Agatston, the South Beach Diet guru and an early advocate of calcium scans. Two of his quotes are perfect examples of what good health journalism should always avoid. Here’s the first:
“Unless you do the imaging, you are really playing Russian roulette with your life,” he said.
And here’s the quote that concludes the story:
“One of the best-kept secrets in the country in medicine is the doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It’s doable.
Here’s what the reviewer on Health News Review had to say about this assertion:
The claim that a few screening tests can make heart attacks and strokes disappear flies in the face of even the most optimistic interpretations of recent studies that indicate some incremental advantage to adding coronary calcium scoring to risk fact calculations for certain patients.
The same pattern holds over on ABC. Dr. Richard Besser narrated a short piece that actually focused on an important issue, which is that low cholesterol is no guarantee of safety. But then he offered this advice:
“Before you go on a cholesterol medication, I want you to ask your doctor about this: A coronary artery calcium test.”
Now this is a completely unwarranted recommendation. Responding to criticism from Schwitzer, Besser said on Twitter that his goal was to empower patients and then he made this claim:
I practice public health from my perch at ABC News. Would I stop at “Experts recommend flu vaccine?” No!
Make no mistake: although there is some dissent, there is a very broad consensus within the medical community about the flu vaccine. Although calcium scans have some very passionate advocates, there is absolutely no consensus within the medical community about their precise role, and Besser does a huge disservice to ABC viewers by pretending otherwise.
Over on NBC’s Nightly News, Dr. Nancy Snyderman uncritically pumped the value of CRP for women over 40:
“It’s not a new test, it’s not an experimental test but nonetheless it’s a test not a lot of people know about and that’s a problem because this simple blood test could save your life.”
Too often, according to Snyderman, women who think they’re at low risk end up having heart attacks. Says Snyderman:
“… that’s because most doctors do not check for c-reactive protein for fear of overtreating them.”
“If you’re over the age of 40, this is the time to have a conversation with your doctor about this very simple blood test that’s covered by most insurance.”
Once again, Snyderman’s report includes no caveats, and fails to inform viewers that the role of CRP in preventive cardiology is highly controversial and is the subject of intense debate. CRP is certainly not a “very simple blood test” and until a larger consensus is achieved TV docs like Snyderman shouldn’t blithely endorse its use.
Case History of a Quote
In the CNN report discussed above the Agatston quotes struck me as particularly egregious, but I was also bothered by another quote, which included the incredible assertion that half the population might benefit from a calcium scan. Here’s the entire relevant portion of the CNN article:
High-risk patients already receive such aggressive treatment as cholesterol-lowering statin medication, but many doctors don’t think low-risk patients need to incur the expense or small dose of radiation that comes with a coronary calcium scan.
“There is a large group in the middle called intermediate risk, which may be as much as 50% of the population,” said Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University
A good candidate for a coronary calcium scan, she says, would be a 50-year-old man with slightly elevated cholesterol and a father who had a heart attack.
“Do you put this 50-year-old who has this family history on a statin medication with potential expense (and) side effects for the next four decades of his life, or do you further refine how far at risk he is?” she asked.
A calcium score would answer that question, she says.
I asked Erin Michos about the quote. Here is her response:
My quotes in the CNN article were taken out of a much longer 30 minute interview about prevention (an interview where I tried to be balanced and evidence-based), and I actually did not see the article or get to approve the proofs before it published.
I actually never said that 50% of adults need a CAC scan. I did say depending on the definition of intermediate risk (see below regarding definitions) that “intermediate risk” can be 50% of a middle aged to older adult population (i.e. men 45-74, women 51-74).
Actually, Michos’s response was much longer than this, and she sent me a second email with additional clarifications and explanations. Clearly, this is not a person likely to make a broad and completely unqualified statement along the lines that fully half the population might benefit from calcium scans. But clearly the folks at CNN thought Michos’s message was too complex for their audience, and so they extracted the nugget they wanted and ignored everything else.
From conversations I’ve had in the past with many physicians and researchers who have been interviewed and quoted in the press, this is by no means an unusual or atypical occurrence. Unfortunately, it appears to be the norm for health journalism.