Fact Check: NY Times Heart Disease Series Gets It Right– Mostly 1

In my opinion Gina Kolata, who writes for the New York Times, is the most extravagantly talented and gifted  health and science reporter working today. Her virtues are abundantly evident in Mending Hearts, a four-part series about several major developments and controversies involving the treatment of heart disease. You should read it right away. You’ll learn a lot. But be careful, because also abundantly evident are Kolata’s flaws.

For instance, here’s what she writes in the first story, about efforts to speed heart attack treatment:

Disparities that used to exist, with African-Americans, Hispanics and older people facing the slowest treatment times, have disappeared, Dr. Harlan Krumholz, a cardiologist at Yale, and his colleagues said in a paper in Archives of Internal Medicine.

But here’s what the Archives paper actually says:

Our analysis suggests that racial disparities in D2B times have significantly narrowed over time and that improving national quality of care appears to have not only improved overall performance but also diminished disparities.

Disparities that “have significantly narrowed” have not, obviously, “disappeared.” This is consistent with Kolata’s history, in which she takes a good fact-based story and transforms it into a great made-up story. (Most famously, Kolata did this in 1998 when she quoted James Watson— a quote which he later denied— predicting that researcher Judah Folkman was “going to cure cancer in two years.”) To be clear: this is only a minor point in an otherwise excellent story, but it would be unfortunate if readers of the story came away with the impression that treatment disparities are no longer a problem.

Even more disturbing problems crop up in her article on stents. Kolata claims that the 2007 COURAGE trial, which compared stents to optimal medical therapy, had little impact on medical practice:

Because of the doubts about that study and ingrained habits, medical practice was largely unchanged by its findings.

But this is simply wrong, and it is wrong about a key moment in recent medical history. Although COURAGE did not immediately change practice in a big way, it did provoke a great deal of heated discussion and soul-searching, and its overall effect has been long-lasting and profound. The principal investigator of COURAGE, William Boden, estimates that stent volume declined by about 20-25% from its pre-COURAGE peak in the mid 2000s. Quite simply, the trial ended an era of stent mania, and initiated in its place a medical culture much more likely to question unbridled enthusiasm for new drugs or devices.

In the same article on stents Kolata also makes a really basic error concerning patients with known heart disease. About one such patient she writes:

Like most heart patients, he had never taken the most important drug for those with his condition: a statin.

This is simply wrong. The vast majority of these patients– as many as 95%, according to one expert, Roger Blumenthal– are prescribed statins (if they are not already taking them) when they are diagnosed with heart disease. (Over time many discontinue the drugs but that is another issue entirely.)

I want to conclude with a discussion about a different sort of flaw in the first article on heart attack treatments. But first let’s be clear about its virtues. Kolata explains with illuminating details and quotes the behind-the-scenes efforts to shorten treatment times for heart attacks. In the past this story has been reported in only the most superficial manner. I’m sure many cardiologists and full-time observers of the scene like myself learned a great deal from this story. So Kolata deserves full credit for that.

But it’s also clear that Kolata fails to provide some important context for this story. For one, the article doesn’t touch on an even bigger and more intractable problem relating to the delivery of heart attack treatments: patient delays before seeking treatment. These delays are quite common. A short treatment time in the hospital won’t mean much if the patient waits several hours before calling 911 or showing up at the door. Knowing about this doesn’t diminish the significance of the achievement of reducing physician-related treatment delays as fully reported by Kolata, but it does add a wider perspective.

Similarly, Kolata writes that these reductions in treatment delay appear to have played a role in a 38% decline in deaths from heart disease over the past decade. But, again, she fails to place this decline in a larger context. The fact is that cardiovascular disease overall has been declining for more than 50 years. According to the CDC, heart disease deaths declined by 68% between 1960 and 2009, from 559 to 180 deaths per 100,000 people.  The precise reasons for the decline are unclear, though undoubtedly they involve broad lifestyle trends as well as major developments in the prevention and treatment of heart disease. Kolata’s readers would have benefited from knowing about this broader perspective.

So by all means go ahead and read the Kolata series. It’s good, really good. But it could be better.

 

 

 

 

 

 

Is cancer “by far, the harder problem”? Reply

Really? Does everyone seem to have cancer? Compared to heart disease is cancer “by far, the harder problem”?

Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.

Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life.

–George Johnson: Why Everyone Seems to Have Cancer, The New York Times

Controversy Erupts Over Accuracy Of Cardiovascular Risk Calculator For Guidelines Reply

In the face of a highly critical story in the New York Times by Gina Kolata about the new cardiovascular guidelines, authors of the guidelines and leaders of the American Heart Association and the American College of Cardiology defended the value and integrity of the guidelines.

The Times story claims that the cardiovascular risk calculator used to assess individual risk in the new guidelines is deeply flawed. “In a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.” The story quotes former ACC president Steve Nissen: “It’s stunning. We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

But the guideline authors and AHA/ACC officials strenuously defended the guideline at a news conference Monday morning at the American Heart Association meeting in Dallas. They said  the new risk calculator is far superior to previous efforts, incorporating far more data that now includes stroke assessment and for the first time provides specific predictions for African Americans.

The assembled officials rejected any call to delay implantation of the guidelines, but one author, Donald Lloyd-Jones said that “over time we will modify the risk scores so that they get better and better.”

“We think we’ve done our due diligence,” said AHA president Mariell Jessup. “We have faith and trust in the people who developed the guidelines.”

Click here to read the full story on Forbes.

 

Press Conference

Salt Report From IOM Sparks Much Heat, Only A Little Light Reply

An Institute of Medicine report on salt earlier this week sparked a lot of controversy. The report concludes that there’s no evidence to support current efforts to lower salt consumption to less than 2,300 mg/day. Unfortunately, the press coverage offered little insight into the science behind the issue. On the Knight Science Journalism Tracker blog, Faye Flam deftly uncovers the almost universal shallow coverage in the media.

The one exception, the one story worth reading that “dug into the science,” according to Flam, is Gina Kolata’s story in the New York Times:

Click here to read the full post on Forbes.

 

English: A close up of salt crystals.

Is Red Meat A Fish Story? Why You Should Never Believe Health Headlines 2

Don’t believe the the hype! That’s the cardinal rule to obey when reading health news. “Breakthroughs” and “cures” are rare, and should always be viewed with caution and skepticism.

This week was a great example. Last Sunday, the New York Times, the major networks, and a host of other media outlets (including this one) reported on a paper in  Nature Medicine about the discovery of a novel and potentially significant pathway linking red meat to heart disease. Briefly, the research suggested that carnitine, which is found naturally in high concentrations in red meat, can lead to atherosclerosis when it is converted by gut bacteria to a chemical called TMAO. Almost immediately I received a lot of comment from experts who raised serious questions about the research. Then today, a separate study was published with an entirely different perspective on carnitine. Although the two studies don’t directly contradict each other, they suggest that the real truth about carnitine is likely to be quite complex and will never be adequately summarized in a headline.

Click here to read the full story on Forbes.

Hype shot glass

 

400 Patients Sue Kentucky Hospital and 11 Cardiologists Over Unnecessary Procedures Reply

After undergoing more than two dozen cardiac procedures over a period of twenty years at St. Joseph Hospital in London, Kentucky, a patient was told by an outside cardiologist in Lexington that a recent procedure had been performed unnecessarily on an artery that was barely blocked.

“I would have not carried out this procedure,” the cardiologist, Michael R. Jones, wrote in a letter to the patient. The story is recounted  in an article published on Sunday in USA Today and the Louisville Courier-Journal, about the latest and perhaps the biggest case yet to surface over unnecessary cardiac procedures.

Comment: By sheer coincidence, on the same day, the New York Times published a news analysis by Barry Meier about the scandal over Johnson & Johnson’s hip implant. “Doctors Who Don’t Speak Out” focuses on the failure of physicians to report problems with devices and drugs, but clearly the issue has even larger implications. A quote from Harlan Krumholz in the story– “Questioning the status quo in medicine is not easy”– could easily apply to the many recent cases of egregious overuse of cardiac procedures and devices. Imagine how recent history might have been different if colleagues of  Sandesh Patil and Mark Midei had raised earlier questions about borderline procedures. Cardiologists and other physicians complain about the intrusive and burdensome role played by the legal system, regulators, and insurance companies, but they have only themselves to blame if they refuse to police their own ranks, and indeed tacitly participate in a system that provides lucrative compensation to high-volume proceduralists.

Click here to read the entire post on Forbes.

Kentucky