The following is a guest blog post from one of our contributors, veteran health care journalist Trudy Lieberman. Trudy keeps an eye out for the way in which health care topics are promoted to the public, often with a special focus on how health care policy might be influenced by news and health care communication.
Early this month I spotted a tweet from 2 Minute Medicine (@2minmed) – “Survey demonstrates broad support for medical imaging among PCPs.” (PCPs = primary care providers.)
It piqued my interest since it sounded like studies I had written about in my book, Slanting the Story: The Forces That Shape the News, published in 2000. The book documented efforts to “modernize” the FDA by loosening rules and regulations governing the approval of new drugs and devices. Back then I reported that the Competitive Enterprise Institute, a conservative think tank, had polled neurologists asking if the FDA was too slow in approving drugs and devices and if the time it took to approve drugs forced people to go without therapies. Another poll found that two-thirds of cardiologists said they opposed FDA restrictions on off-label drug uses. Those polls raced through the media and were used in lobbying efforts to pass the FDA Modernization Act of 1997.
Was this latest survey reporting that large majorities of primary care docs believe that advanced medical imaging provides considerable value to patient care an updated version of the same lobbying technique? It sure looks like it.
The study, published in the Journal of the American College of Radiology, concluded that the vast majority of 500 primary care providers (PCPs) who answered survey questions agreed that advanced medical imaging provides data that are not otherwise available, that it lets them make better clinical decisions, gives more confidence in treatment choices, and that the quality of patient care would be negatively impacted without advanced imaging. Most docs said it allows their patients to feel they are receiving the best care possible. Who financed this study with its glowing conclusions about the value of imaging? It seems to be a pertinent question, especially at a time when there are calls for better monitoring and guidelines and more regulatory oversight and concerns about Americans getting too many CT scans. “We know these tests are overused,” Dr. Rita Redberg, a cardiologist at the University of California, San Francisco Medical Center, wrote last year in a New York Times op-ed.
The Journal didn’t disclose who paid for the study. Still, I wanted to know since it might explain a lot about the study, its results, and possible uses. I contacted the Journal’s managing editor, Makeba Scott Hunter, who said the Medical Imaging & Technology Alliance (MITA), a division of the National Electrical Manufacturers Association, paid for the study. MITA calls itself the collective voice of makers of imaging equipment, radiation therapy manufacturers, innovators, and product developers—groups that would have a keen interest in showing how valuable their products are to patient care. The Journal editor also told me that the name of the funder had been disclosed in a form created by the International Committee of Medical Journal Editors (ICMJE) filed with the publication. Did that mean someone who wanted to know who paid for the study had to fish out this form somewhere? And how? From where?
A MITA press release in late January “lauded” the study findings including one that showed a “misconception of the costs associated with advanced medical imaging.” More than half of the docs overestimated Medicare’s reimbursement for an MRI of the brain. They believed it was two to three times higher than the actual amount. “Our theory is that these physicians may value advanced imaging even more if they knew the actual cost of the scan was half as much,” said Christine Hughes, the lead author. Does that open the door for even more use? There was not a word in the release noting MITA’s financial backing for the study.
I asked Hughes in an email how the trade group could use the study findings in its work. She wrote back, “No clear value metrics for imaging have previously been identified which could be used in policy decisions on reimbursement for imaging,” adding it could be used to educate payers and doctors about the value of imaging. “There is a great deal of downward pressure on PCPs to monitor their use of advanced imaging and consequently confusion over what tests are appropriate and when. The message to payers and policy makers is: advanced imaging (CT, MRI, PET) leads to better patient outcomes.”
Sure sounds like my hunch was correct! It’s the same lobbying MO used two decades ago. Self-serving studies still have currency in the regulatory arena especially when they’re published in respectable journals and their funders are not transparent. It’s important for journalists and the public to look skeptically when they come across any study on Twitter or elsewhere. There is one bright spot to report as a result of my little investigation. Shawn Farley, the director of public affairs for the American College of Radiology, emailed me on Wednesday, advising me that information about funders “will be published with articles moving forward.” A small victory for HealthNewsReview.org – and for transparency!
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