A couple of docs react strongly to NYT “Well” blog post on vitamin D screening

The US Preventive Services Task Force this week released new draft guidelines on screening for Vitamin D deficiency.

The draft “concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency.”  Other bullet points:

  • There is no consensus definition of vitamin D deficiency
  • the accuracy of vitamin D deficiency tests is difficult to determine
  • Adequate evidence was found that showed treatment of asymptomatic vitamin D deficiency has no benefit on cancer, type 2 diabetes, mortality in community-dwelling adults, and risk for fractures in persons not selected based on having a high risk for fracture. The USPSTF found inadequate evidence on the benefit of treating asymptomatic vitamin D deficiency on other outcomes, including psychosocial or physical functioning. The USPSTF concluded that the overall evidence on the early treatment of asymptomatic, screen-detected vitamin D deficiency to improve overall health outcomes in adults is inadequate.

The draft falls into the “I” category, meaning:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

When the New York Times “Well” blog posted this article about the screening recommendation, it ended with this:

Dr. Roxanne Sukol, a preventive medicine specialist at Cleveland Clinic’s Wellness Institute, said that she often tests her patients for vitamin D, but for varying reasons. In some cases she may have concerns about the quality of a patient’s diet. In others, the concern may be that a patient is at risk of low bone density, or that he or she is not getting enough sun exposure to produce sufficient vitamin D.

Dr. Sukol said the draft recommendation would not change her approach to screening, and that she suspects many people may misinterpret the panel’s conclusions.

“It doesn’t mean you shouldn’t test,” she said. “They’re saying that if doctors decide to do it, that we should tell the patient that we’re not positive whether it will make a difference and we’re not sure if more good will come from it or more harm.”

That drove Dr. Marya Zilberberg up the wall.  You can read her bio here. She recently wrote a book, “Between the Lines: Finding the Truth in Medical Literature.”

When she read the final line of the story – the final Sukol quote, Zilberberg wrote on her Facebook page:

“WTF? What manner of bullshit is this? Why the f*$& do it then?!!!”

And she wasn’t alone.

In the comments left on the NYT Well blog site, an unidentified Tampa physician wrote:

 There are some problems with this article that reflect room for improvement in the author’s understanding of and regard for the USPSTF. I’m addressing them in the order in which they appear, not by priority. The USPSTF is not a “government health panel” or a “federal task force.” Use of “despite” in the first sentence suggests that the author disagrees with the task force’s conclusion, or (wrongly) that the decision was questionable, inappropriate, or controversial. The document that has been released is a draft recommendation statement. It’s the draft of an I statement, not a D. Including a second perspective suggests that there are two legitimate sides to this story. There aren’t. Dr. Sukol is described as a preventive medicine specialist. She’s not. Including a random internist’s nonexpert view suggests that disregard for a USPSTF recommendation is an appropriate way for other internists to respond/apply the statement in practice (it’s not) and that it’s appropriate to address concerns about a poor diet, to assess risk for low bone density, &/or to assess whether one’s sun exposure is adequate, by ordering a vitamin D test. (No to all 3.) I appreciate the title; it’s important to refer to the USPSTF as a panel of experts. If you want to include the perspective of a preventive medicine specialist in future articles, feel free to contact me. Unlike Dr. Sukol, I’m a preventive medicine specialist; I’m board-certified in Public Health and General Preventive Medicine.

Another reader countered:

Dr Sukol did not advocate routine screening just testing those who she thought needed it and so did fit with their recommendations.

And the Tampa physician wrote back:

The three situations which Dr. Sukol reportedly “thought needed it” were not substantially different from routine screening situations. There’s freedom to use clinical judgment, but holding up her opinion as a public example invites scrutiny that her clinical decision would have deserved even if it had been kept private, multiplied by the number of patients whose care will be influenced by the decision to publish it. (Peer pressure is powerful.) I’m suggesting that she and the blog author advocated liberal use of an unnecessary test.

I don’t know whether Dr. Sukol is a preventive medicine specialist or not.  She’s listed in the Cleveland Clinic’s department of preventive medicine.

And I don’t know why The New York Times chose to interview her, nor to end the story with her somewhat provocative quotes.  I agree with the Tampa physician that those quotes threw the story into an imbalance, ending with a physician who often screens and who says the new recommendation won’t change her mind about screening.

Whom you interview, and how you end a story can have a powerful framing effect on the takeaway message for readers.  It is one clear way that stories become biased.

Many times, on many different screening topics, I’ve pointed to an apparent media bias in favor of screening.  Sometimes it’s overt.  Sometimes it’s subtle.  But it happens a lot.  You could argue that we’ve just seen another new example.


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