Failure to scrutinize claims about screening all US sixth-graders’ hearts

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Last week, several news stories across the country reported that a Houston sports cardiologist was calling for widespread heart screening of sixth-graders after he found seven with undiagnosed heart conditions — two of which required surgery.

The Houston Chronicle reported the story, but the only comment about concerns was one of cost:

“Such an endeavor, however, would be costly.

A $150 exam similar to the HEARTS screening is offered monthly at the Memorial Hermann Sports Medicine Institute.

The preventive EKGs and cardiac ultrasounds are usually not covered by insurance.”

CNN reported the story and managed to explain that there are “downsides to screening.” They mentioned how expensive it would be to screen all those kids for “relatively unusual heart problems.” And they mentioned false positives, with some parents being told their child has a heart problem when indeed they don’t. In this case, it was good to see CNN learn and disseminate the message: “With all screening, it’s important to ask what benefits are you getting but what are the downsides?”

The CBS Early Show did not deliver the caveats that CNN did. First, the main story was delivered by a general assignment reporter from the Dallas bureau. His report included the disease-mongering anecdote of a girl who died from sudden cardiac arrest. But, of course, they didn’t mention that there’s no evidence that any screening would have prevented that death. And the reporter did not challenge the doctor’s statement that this could lead to routine heart exams for all sixth graders in America. At the end of the segment, CBS had Dr. Jennifer Ashton come on the set but gave her all of 30 seconds. I don’t think I’ve ever heard anyone talk so fast. I believe I heard her briefly mention costs, but, no fault of hers, I don’t think anyone can do this justice talking that fast in 30 seconds.

ABC’s website was far more complete in its report. Excerpt:

“…the price of a nationwide pediatric heart screening program would be considerable. Some doctors say it may not be the best use of health care dollars.

“We are not good enough at screening to make this routine,” said Dr. Brian Olshansky, director of Cardiac Electrophysiology at the University of Iowa. He says that screening will cause some kids to be identified as needing treatment — even though any heart abnormalities they have may be harmless.

In these cases, “an intervention would actually create more harm than good,” he said.

Dr. Barry Love, assistant professor of pediatric surgery at Mount Sinai, agreed, saying, “finding the very small number of children who would have died suddenly…has the unintended consequence of excluding a large number of children from healthy sports participation.”

“We already have an epidemic of obesity and sedentary lifestyle in this country. Screening would make this worse,” Love said.

Dr. Steve Nissen, chair of cardiovascular medicine at the Cleveland Clinic, doesn’t feel that Higgins’ screening would be wise to apply widely.”

Nonethless, how you end a story often shows how a reporter feels about a story and the ABC story, like many, ended with the pro-screening personal anecdote of a parent:

“It’s a great thing that we have this technology and we are able to screen kids. It’s such a blessing that we were able to catch this.”

Finally, one of our medical editors, Dr. Michael Pignone of the University of North Carolina gave me his opinion of the stories. He wrote:

“These are pretty extreme claims based on limited data. What is not clear is the incremental benefit of doing their procedure-oriented exam (with EKG and echocardiogram) above and beyond a good history and physical exam by one’s primary care doctor (including an assessment of blood pressure, review of any symptoms like shortness of breath, and screening family history for red flags (early sudden death or coronary artery disease) It is likely that a basic assessment would be nearly as effective (with fewer opportunities for false positives) at a lower cost.”

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