Here’s a guest editor column from one of our reviewers, Harry DeMonaco, a Senior Clinical Associate in the Decision Support and Quality Management Unit of the Massachusetts General Hospital.
News coverage of the recent American Heart Association Scientific Sessions (November 4 – 7) raises new questions about how journalists cover scientific meetings. On Monday November 5th, four news releases were issued under the banner of “Late-Breaking Clinical Trials and Special Sessions Coverage."
Three of the four studies addressed by the news releases received substantial news coverage, but one did not. We couldn’t find any major news organization that covered the new findings from the OAT – or occluded artery trial. The results suggest that percutaneous coronary interventions (PCI) – using coronary stents and balloons to open blocked blood vessels in addition to the use of clot-busting drugs – if done late after a heart attack offer no advantage but are considerably more expensive than medical therapy alone.
To put this into context, there are over one million percutaneous angioplasty procedures performed in the United States each year. Although the trial did receive news coverage a year ago, the new study offered new evidence that neither primary nor secondary benefits exist to offset the cost of these procedures. Many journalists must have received a Duke University news release, which included an investigator’s pithy summary: “What we have here is one of those cases where less is more. While it may seem that going an extra step in opening up clogged arteries late in the game makes sense, we know that clinically, it doesn’t seem to offer the advantages we expected. In addition, the minimal initial benefits that patients with PCI enjoyed diminished over time. Coupling that with the higher cost, we now know that adding PCI to standard medical care in opening blocked arteries more than a day after a heart attack is not good value. In an era when the high cost of health care is the subject of intense debate, this study offers us one way we can offer high quality care for less money.”
Seems pretty newsworthy, doesn’t it? But many stories focused, instead, on the potential of new drugs and new devices.
While criticism of news coverage of scientific meetings is in many cases justified, the blame does not lie solely with the media. Conference organizers, scientists and their affiliated institutions share in the responsibility.
What is the primary intent of the session?
Unfortunately the answer depends on whom you ask. The sponsors of the session undoubtedly seek to inform members of the organization of the most up to date information in their field. However, media interest translates into advertising dollars for the organizers. Greater media interest also fuels subsequent years’ sessions attracting marquee scientists and their affiliated institutions. For the individual scientists, the primary intent is to share information, seek peer review and advice and obtain some level of notoriety. The academic institutions associated with the scientist know full well that media attention can help attract patients and money from donors as well as corporate sponsors of research. Journalists should ask: Do conference organizers decide which press releases to write based at least in part on marketing rather than science or importance? Relying on press releases may not be in the best interest of the media – or of the public they serve.
Can the results of studies publicized at scientific sessions be viewed as important or conclusive?
It is important to recognize that in many instances the research presented at scientific sessions has not been peer reviewed and as such should be viewed with some degree of skepticism. A measure of the relative value of research presented at annual scientific sessions may be the rate of subsequent publication in high quality medical journals. A 2002 study published by Schwartz and colleagues tracked the publication history of research published in abstract form at five different scientific sessions held in 1998. A total of 252 media reports were generated by 147 abstracts. In the three years following the meetings only 50% of the research originally reported in abstract form was published in high quality medical journals. One would assume that newspaper front page reports of research results would fare better, but this is not so. A total of 39 abstracts received front page coverage fared no better in their eventual publication rates. Not surprisingly, abstracts that were promoted in official press releases were more likely to obtain front-page coverage but no more likely to be published in a top medical journal.
What research deserves coverage by the media?
As was noted by Schwartz and her colleagues, session buzz and press releases may not be a reasonable measure of importance. Few, if any, studies are definitive. Medicine is iterative and moves based on accumulated knowledge. Given the nature of medicine then, it is not surprising that today’s breakthrough is tomorrow’s disappointment.
Newspapers that find many column inches to give to baseball batting averages may want to find room for posting long-term research success rates.