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The following is the first guest blog post from one of our new contributors, veteran health care journalist Trudy Lieberman. Another veteran, Andrew Holtz, also contributes.  I shudder to think that, among the 3 of us, we have well more than 100 years of journalism experience, but I’m thankful for what that means in bringing experience, background, and historical perspective to our work.


It’s no secret the Cleveland Clinic is a marketing operation extraordinaire and has carefully built its brand worldwide as a leading heart center. The Clinic has now become a prolific tweeter – another way, of course, to cultivate awareness of the Clinic’s name. But one tweet in early December got me thinking about the accuracy of its message. The tweet accompanied by a picture of a fast food meal—hamburger, fries, and soda—declared: “Consuming just 1 fast food meal per week is associated with a 20% increase in chance of dying from heart disease.”

Really?  I wondered if the two crunchy beef tacos I eat for lunch once in awhile would put me at serious risk for heart disease. (My doctors have said I’m in a low risk group.) Still, I wanted some proof of this claim. What was the evidence to back up this tweet?  I decided to look further and discovered the Clinic was recycling an old message. In May 2013, the clinic twice tweeted this: “Consuming just one fast-food meal a week could increase your risk of heart disease by 20%, says @American_Heart.”

Then I found that in September 2014 there were two more Clinic tweets accompanied by the same photo of the fast food meal. The message: “1 fast food meal a week associated w/20% increase in the chance of dying from heart disease bit.ly1mmcT6b.”

In October the Clinic decorated two tweets with a photo of a double burger with lettuce, tomato, cheese, and fries. The tweets advised: “Eating just 1 fast food meal per week is associated with a 20 % increase in the chance of dying from heart disease.” There was no link to a study or evidence of the claim.

Since the first tweet almost two years ago had a link to the American Heart Association, I started there and found the study in Circulation, a publication of the American Heart Association, on which the Clinic apparently based its claims.

The September 2014 tweet led me to the Clinic’s web page called Health Hub and to a piece headlined “4 Habits That Pack on Pounds” by Kristin Kirkpatrick, a registered dietician and wellness manager for the Clinic’s Wellness Institute.  Kirkpatrick wrote, “Even an occasional fast-food meal can do damage. A recent study found that consuming just one fast food meal a week was associated with a 20 percent increase in the chance of dying from heart disease,” and cited the study in Circulation.

The claim of heart disease reduction appears to be the gift that keeps on giving for the Clinic. But how accurate is it? The Clinic’s wellness manager made it seem like I should forget about my monthly lunch at Taco Bell. I consulted my colleague Andrew Holtz, one of the reviewers working with Holtz told me the study published in Circulation in 2012 was well-designed, but the data did not support the Clinic’s claim.

“The Cleveland Clinic is wrong in saying this study found a 20 percent increase in heart disease death from eating one fast food meal a week.” Holtz said. “The study did not say that.” Holtz told me that from reading the study it appears the Clinic may have misinterpreted the statistic in the journal article, which was picked up in its Health Hub article, and eventually made its way to the twitterverse. “One of the tables in the article reports a 19 percent increase in heart disease death among people who ate one fast food meal a week. That result was not statistically significant,” he said. In other words, the results were not robust enough to draw firm conclusions.

Furthermore, Holtz said, the study’s relevance to U.S. readers is questionable because the sample of people surveyed were Chinese living in Singapore who have different diets, lifestyles, and genetic profiles. But, Holtz said, it was fair to say that the study showed an association – but not a causal link because the study wasn’t designed to do that—between eating fast foods multiple times a week and an elevated risk of dying of coronary heart disease.

But even when using the term “association,” our team believes that some explanation and caveat should be included.  And when causal language like “could increase your risk” is used, that’s just going too far.

Maybe it’s time for the Clinic to stop recycling its shopworn claim. It’s more important to tell people that frequent fast food meals are probably not good dietary choices, but that’s boring advice. In this age of Twitter, outlandish or hyped-up claims that aren’t always true are the coin of the realm, and once an error is made, it has nine lives—-or more.

(Publisher’s Note:  Many people could learn from our primer, “Does The Language Fit The Evidence? – Association Versus Causation.”)


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