{"id":11031,"date":"2011-08-22T12:47:32","date_gmt":"2011-08-22T16:47:32","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=11031"},"modified":"2011-08-22T12:47:32","modified_gmt":"2011-08-22T16:47:32","slug":"cnn-abc-and-nbc-dumb-down-the-news-about-cv-screening","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/22\/cnn-abc-and-nbc-dumb-down-the-news-about-cv-screening\/","title":{"rendered":"CNN, ABC, and NBC Dumb Down the News About CV Screening"},"content":{"rendered":"

Last Thursday the\u00a0Lancet<\/em>\u00a0published an extraordinarily interesting and complex study looking at the relative value of CRP tests and CAC (coronary artery calcium) scans (see my news report here<\/a>). Coincidentally, CNN, NBC, and ABC this week ran reports on the same general topic. Exit complexity. Enter stupidity.<\/p>\n

Health journalism watchdog Gary Schwitzer and his Health News Review<\/em> has a definitive takedown on these reports (here<\/a>,\u00a0here<\/a>, and\u00a0here<\/a>). 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.<\/p>\n

The CNN story, \u201cWill you have a heart attack? These tests might tell<\/a>,\u201d pumps calcium imaging. It relies heavily on cardiologist Arthur Agatston, the South Beach Diet guru and an\u00a0 early advocate of calcium scans. Two of his quotes are perfect examples of what good health journalism should always avoid. Here\u2019s the first:<\/p>\n

\u201cUnless you do the imaging, you are really playing Russian roulette with your life,\u201d he said.<\/p><\/blockquote>\n

And here\u2019s the quote that concludes the story:<\/p>\n

\u201cOne 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\u2019s doable.<\/p><\/blockquote>\n

Here\u2019s what\u00a0the reviewer on\u00a0Health News Review<\/em>\u00a0had to say<\/a>\u00a0about this assertion:<\/p>\n

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.<\/p><\/blockquote>\n

The same pattern holds over on ABC.\u00a0Dr. Richard Besser narrated a short piece<\/a>\u00a0that actually focused on an important issue, which is that low cholesterol is no guarantee of safety. But then he offered this advice:<\/p>\n

\u201cBefore you go on a cholesterol medication, I want you to ask your doctor about this: A coronary artery calcium test.\u201d<\/p><\/blockquote>\n

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:<\/p>\n

I practice public health from my perch at ABC News. Would I stop at \u201cExperts recommend flu vaccine?\u201d No!<\/p><\/blockquote>\n

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.<\/p>\n

Over on NBC\u2019s Nightly News,\u00a0Dr. Nancy Snyderman uncritically pumped the value of CRP for women over 40<\/a>:<\/p>\n

\u201cIt\u2019s not a new test, it\u2019s not an experimental test, but nonetheless it\u2019s a test not a lot of people know about. And that\u2019s a problem because this simple blood test could save your life.\u201d<\/p><\/blockquote>\n

Too often, according to Snyderman, women who think they\u2019re at low risk end up having heart attacks. Says Snyderman:<\/p>\n

\u201c\u2026 that\u2019s because most doctors do not check for C-reactive protein for fear of overtreating them.\u201d<\/p><\/blockquote>\n

Snyderman concludes:<\/p>\n

\u201cIf you\u2019re over the age of 40, this is the time to have a conversation with your doctor about this very simple blood test that\u2019s covered by most insurance.\u201d<\/p><\/blockquote>\n

Once again, Snyderman\u2019s report includes no caveats, and it fails to inform viewers that the role of CRP in preventive cardiology is highly controversial and the subject of intense debate. CRP is certainly not a \u201cvery simple blood test,\u201d and until a larger consensus is achieved, TV docs like Snyderman shouldn\u2019t blithely endorse its use.<\/p>\n

Case History of a Quotation<\/h4>\n

In the CNN report discussed above the Agatston quotations struck me as particularly egregious, but I was also bothered by another quotation, which included the incredible assertion that\u00a0half<\/em>\u00a0the population might benefit from a calcium scan. Here\u2019s the entire relevant portion of\u00a0the CNN article<\/a>:<\/p>\n

High-risk patients already receive such aggressive treatment as cholesterol-lowering statin medication, but many doctors don\u2019t think low-risk patients need to incur the expense or small dose of radiation that comes with a coronary calcium scan.<\/p>\n

\u201cThere is a large group in the middle called intermediate risk, which may be as much as 50% of the population,\u201d said Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University<\/p>\n

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.<\/p>\n

\u201cDo 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?\u201d she asked.<\/p>\n

A calcium score would answer that question, she says.<\/p><\/blockquote>\n

I asked Erin Michos about the quote. Here is her response:<\/p>\n

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.<\/p>\n

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 \u201cintermediate risk\u201d can be 50% of a middle-aged to older adult population (i.e., men 45-74, women 51-74).<\/p><\/blockquote>\n

Actually, Michos\u2019s 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\u2019s message was too complex for their audience, and so they extracted the nugget they wanted and ignored everything else.<\/p>\n

From conversations I\u2019ve 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.<\/p>\n","protected":false},"excerpt":{"rendered":"

An analysis of recent health news coverage in the mainstream media: “Exit complexity. Enter stupidity.”<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[727,212,956,664],"class_list":["post-11031","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-cac","tag-crp","tag-media","tag-screening"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11031","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=11031"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11031\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=11031"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=11031"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=11031"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}