There is only one team on the field in this story about testing young athletes for heart problems. And in the Gannett family, USA Today simply picked up this Cincinnati Enquirer story and republished it on its website.
Based on interim results from an unfinished study, this story pole vaults to the conclusion that every teen should undergo expensive screening tests. Readers are given little background on the long debate about the effectiveness of such tests. At a time when sedentary lifestyles are a leading threat to health of young people, there is no consideration of the potential harm of labeling hundreds of thousands of teenagers as having “abnormal” hearts.
Identifying students participating in sports who may be “ticking time bombs” has intuitive appeal to any parent or school administrator. But what is not appreciated in this story is that this is the proverbial searching for a “needle in a haystack.” And when one adds the real life complexity that some of the needles are fake needles, meaning that the student appears to have something wrong but really doesn’t, you recognize that this goal of screening student athletes for heart conditions is really very challenging. This story presents the issues in a manner that is so oversimplified that it misleads the reader. It isn’t clear that more aggressive screening programs saves lives, and in theory could cause more harm than good. And even if we can show the benefit of such screening programs, there are real questions about whether we can afford them.
The story reports that this sort of screening would typically cost $2500 and that the cost is a challenge. The story might have made the challenge more obvious by noting that screening all high school athletes would cost $20 billion.
Although the story reports that false positive results in an existing screening program in Italy unnecessarily restricted sports participation and quotes a researcher as saying that “There’s got to be a better way,” the story presents the methods being used in this screening research study as clearly beneficial, even though the study has not even finished collecting data. Readers are not given any information about the numbers of deaths that proponents say screening might prevent; indeed the story does not even provide an estimate of the number of teens who collapse and die on sports field, so readers are unable to judge the size of the health threat.
Some of the statistics presented seem inconsistent. In one place, the article says “heart conditions that put one in 10,000 people at risk when doing top-level physical activities.” Then later, the story says one person in 100 is “born with potentially life-threatening heart defects.” The researchers say they recommended that 4 out of 500 students tested stop playing sports, close to the one in 100 figure, but then they also said another 22 teens (or more than 4 out of every 100) had some sort of abnormality requiring lifelong monitoring. The discrepancies are not clearly addressed.
The story does report that of the first 500 high school athletes enrolled in this heart screening study, four were advised to drop out of sports and 22 more were told they needed lifetime monitoring. However, the costs and consequences of these recommendations are not addressed. How much does reduce physical activity increase other health risks, including obesity? Does a detection of an “abnormality” on this sort of test mean that these children may have difficulty getting life or disability insurance… or even health care coverage, if pending insurance reforms are repealed? Will they be barred from certain careers because they have been labeled as having abnormal heart conditions?
Based on figures from the National Federation of State High School Associations (NFSHSA), if the rate of abnormal test results reported by these researchers were applied nationally, about 100,000 teens a year would be told they need lifelong monitoring and another 15,000 would be kicked out of high school sports activities. These are important consequences that the story should have addressed.
Note: the NFSHSA reports almost 8 million high school students participate in sports (which means about 2 million new students begin each year).
This story discusses the interim results of a study in progress as if they were the final conclusions of a peer-reviewed journal article. The limitations and caveats of this sort of study are not addressed. In addition, there is no mention of a control group. So this study will merely report the number of students identified as having an abnormality. It won’t even be able to say whether the change in sports (or not) make any difference.
Although the health risks of participating in sports (even after detection of some sort of unusual heart feature) are a matter of intense debate among medical experts, this story presents any abnormality as a clear and present danger. There is no evidence presented to rule out a repeat of the Italian experience reported in the story that “led to unnecessary physical restrictions of athletes,” and yet readers are told that the teens who didn’t pass this test had health conditions that put them at imminent risk of death. Based on the statistics reported in this story, if national screening were adopted about 100,000 high students each year would be labeled has having a heart abnormality requiring lifelong monitoring.
No experts other than the researchers doing this study are quoted.
There is no discussion of the relative value or effectiveness of standard physical examinations and health histories for identifying potential risks of sports participation.
From the way the tests are described in the story, they appear to be routinely available. However, there is no discussion of whether the capacity exists to test and properly interpret test results for the millions of teens who would need to undergo screening if it were demonstrated to be beneficial.
The story makes clear that this study uses existing technology in a way that is not currently standard. It also refers to a somewhat similar program in Italy. However, the story fails to tell readers about the many other studies of testing young athletes (including this one reported by Gannett just a year ago, “Study: Tests for heart defects in young athletes inaccurate“), nor does it inform readers that there is no consensus and strong debate among experts about the value of such testing.
It appears that the reporter spoke to researchers and parents and did not rely only on a news release. However, it is not clear whether the reporter gathered any information independently or merely relied on information provided by the researchers or their institution.