Health News Review

Call it a retraction.  Call it a correction.  Call it important to correct the record.

Back in January, I led the charge in criticizing ABC’s Bill Weir for his report on Dr. David Agus’ book, “The End of Illness,” and Weir’s claim that a CT scan Agus recommended may have saved Weir’s life.  You can read that original criticism here.

Well, last night, Weir and ABC corrected the record. On the air (not in the link I just provided), Weir acknowledged that there are legitimate questions about whether his original report did more harm than good. Important excerpts of the online correction:

“When I saw that interaction, I’d say it broke my heart,” said Dr. Richard Besser, former acting head of the Centers for Disease Control and chief medical editor at ABC News. ”He may truly believe that seeing that white spot in an artery around your heart means that you could drop dead from a heart attack. But, you know, the experts in cardiology I talk to say that there’s just not the data to support that.  You know, as we get older, we all get plaque forming in our hearts.”

Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, agreed.

“You have minimal calcium,” he wrote in an email after seeing my results. “In my view, performing a calcium scan on an otherwise healthy, 44-year-old man in not medically acceptable.”

After four other doctors supported these concerns, I realized I’d fallen into a raging debate over the value of full-body scans and what they are really able to find in the heart. Because of the radiation exposure and the chance a “false positive” could send a patient into a spiral of costly and potentially dangerous procedures, neither the American Heart Association nor the FDA recommends this test for people without obvious symptoms or genetic risk.

This was news I never received before taking the scan. And afterward, aside from describing mid-jog heart attacks, Dr. Agus never put my calcium score in context. A month later, I came across an article by Dr. Paul Grayburn in the New England Journal of Medicine that said a coronary-artery calcium score “below 100 indicates low risk, and a score above 300 indicates high risk.”

My score was 49.

When “The End of Illness” came out in paperback, I couldn’t help but notice that Dr. Agus had devoted much of his new foreword to my case, using me as an example of the power of preventative technology.

 

Over and over again, we have tried to help educate journalists about screening tests…and even specifically about heart CT scans…whether it be the little Sioux Falls Argus Leader or the much larger Minneapolis Star Tribune or the even larger CNN.

A physician friend once told me that the battle for health care reform is fought one foxhole at a time.  It is is clear that the battle for accurate, balanced, complete health care journalism is fought one foxhole at a time as well.  And we will continue to jump in as many of those foxholes as we can.

Speaking of CNN and retractions/corrections, the Poynter Institute website reports that “CNN removes story about hormones affecting a woman’s vote.

And the beat goes on.

Comments

Ken Leebow posted on October 25, 2012 at 10:28 am

As always, thanks for your great reporting. One of the best observations I’ve heard comes from Dr. Otis Brawley and can be applied to this story …

Doctors tend to confuse what they believe with what they know.

Of course, that can be applied to any discipline.

Ken Leebow
http://www.101Incredible.com

Jay Rosen posted on November 1, 2012 at 11:25 pm

A full body scan saved the life of a friend of mine-it detected a 1m malignant spot on a kidney at least 2 years before any other method would have found it. Also, my wife, who had done her due diligence and seen a gynocologist regularly for the last several years-found-via the scan 15 or more large fibroid tumors weighing several lbs.-thus in here severe abdominal pain-and un diagnosed by a supposedly competent, and highly regarded physician. The so called radiation from these short scans is about the same exposure anyone would get by flying to New York and back from Los Angeles-look it up. All patients are entitled to as much information about their own bodies as they can get-then they-not
physicans, health care providers, insurance companies can make an informed decision.

    Gary Schwitzer posted on November 2, 2012 at 9:35 am

    There is perhaps no website that promotes delivery of accurate, balanced and complete information to consumers more than this website does. We frequently, actively support the principle of shared decision-making between patients and their health care providers. So I couldn’t agree more with your last sentence.

    The point of what we published above should be clear: we tend to exaggerate/emphasize the potential benefits of many health care interventions – including full body CT scans – while minimizing or totally ignoring the potential harms. In reviewing more than 1,800 news stories by major US news organizations, we’ve seen this clear, consistent, and troubling trend. The ABC reporter slowly, but finally, came around to realize that his benefits-only reporting about the CT scan he had may have done more harm than good.

    In your note, you only mentioned radiation as a potential harm. Other harms include finding “incidentalomas” – harmless things you didn’t really need to or want to know about – and the additional testing and possible treatment that may ensue as a result – all of which carry their own potential harms. So the cascade of potential harms is real – and largely unrecognized in the public dialogue. The story of Dr. William Casarella of Emory – and what happened when he had a virtual colonoscopy (different than a full body scan but the impact can be the same) – is a chilling lesson for consumers – but the kind we rarely hear about.

    So, yes, some may benefit. But, yes, many will be harmed.

    If you’re not aware of it, here’s the renowned quote from Dr. Muir Gray:

    All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost. The first task of any public health service is to identify beneficial programmes by appraising the evidence. However, evidence of a favourable balance of benefit to harm in a research setting does not guarantee that a similar balance will be reproduced in practice, so screening programmes need to be introduced in a way that allows their quality to be measured and continuously improved.”

    Gary Schwitzer posted on January 10, 2013 at 8:04 am

    Dan Keller of Keller Broadcasting, Glenside, PA wrote in response to Jay Rosen’s comment:

    In the postings about the risks/benefits of CT screening (http://www.healthnewsreview.org/2012/10/abc-corrects-earlier-story-about-bill-weirs-lifesaving-ct-scan/), I don’t know where Jay Rosen got his figure that a CT scan, presumably of the abdomen to find fibroids or a spot on a kidney, exposes the individual to about as much radiation as a round trip flight between New York and LA. According to the EPA, that round trip would expose the person to about as much radiation as a chest X-ray (http://www.epa.gov/radtown/cosmic.html). However, according to the FDA (http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115329.htm), an abdominal CT exposes the person to about 400 times as much radiation as a chest X-ray. Therefore, that abdominal CT produces exposure equivalent to 400 round trip flights, not just one round trip. Also from the FDA on the same web page, that CT exposure is a dose equivalent to 2.7 years of natural background radiation. Various sites and studies (eg, the Radiological Society of North America, see: http://radiology.rsna.org/content/251/1/175.abstract) provide evidence of small but not zero increased risk of cancer from CT scans, not to mention the potential increased risk of harm from unwarranted follow up procedures. The medical profession is coming to recognize that even diagnostic CT scans are over-prescribed, and the consensus is that screening CT scans are just unwarranted. When my own doctor offered me a CT for determining a coronary calcium score, I asked him what I, an asymptomatic male nonsmoker, should do differently if the scan showed calcification, he said, “Nothing.” The answer was to continue to eat a healthy diet, keep exercising, and watch my cholesterol levels. When I asked him if the hospital he was affiliated with was pushing the staff to offer coronary calcium screening, he admitted that it was.