William Heisel is a former investigative reporter for The Los Angeles Times and is now the Director of Global Engagement at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
It’s a television journalism staple: the first-person experience.
These pieces are conceived with good intentions, but they can lead viewers to misguided, costly, and potentially dangerous thinking.
A journalist at WCCO, Minneapolis’s CBS affiliate, recently put himself through a battery of tests ostensibly to test his heart health. The set up focused on the reporter’s family history and his worries about dying young, as his father did. The video segment showed him getting an electrocardiogram (EKG), an ultrasound of the carotid artery, a test for arterial elasticity, an eye exam, and a respiratory test. The wrap up included the fact that this “one-stop, two-hour heart check-up” is available to all — and is all “standard stuff.”
I asked Christopher Labos, MD, a cardiologist and HealthNewsReview.org contributor, about the advice the story delivers. He was pretty blunt: “The truth is that many of the tests highlighted in this piece are unnecessary for otherwise healthy people and have little value in cardiovascular risk prediction. I can explain most of your risk by talking to you and asking you questions for 10 minutes.”
Recommending that anyone and everyone go in and get a battery of extensive and expensive tests is misguided because it is not supported by scientific evidence. Studies have shown that tests featured in the WCCO story, when conducted in people without risk factors, do not reduce the risk of dying from heart disease — or indeed from any cause. Which means it should not be presented to a general audience as something that everyone should go out and do.
The American Board of Internal Medicine Foundation runs an initiative called Choosing Wisely, in collaboration with more than 70 medical professional organizations and Consumer Reports. They review studies, synthesize the evidence, and put together plain language guides to help consumers sort through medical questions. Here’s what Choosing Wisely has to say about electrocardiograms:
An EKG, or electrocardiogram, measures your heart’s activity. In an exercise stress test, you have an EKG while you walk or jog on a treadmill. You may need these tests if you have symptoms of heart disease, like chest pain. Or you may need them if you already have heart disease or you have a high risk for heart disease. These tests can help your doctor evaluate how your heart is working and decide how to treat the problem. But in other cases, you should think twice about having these tests. Here’s why: Usually, you do not need these tests if you do not have any symptoms. The tests are not useful for people who do not have symptoms of heart disease, like chest pain. [emphasis added]
Even if you were hoping to learn whether you were at a higher risk for a heart attack or stroke, the tests being showcased in the segment weren’t necessarily the right tests, says Virginia Moyer, MD a senior officer of the American Board of Pediatrics and a HealthNewsReview.org contributor. “Estimating cardiac risk is useful,” she says. And yet, some of the tests highlighted in the TV news story “have been shown not to be useful for risk estimation.”
Moyer is a former chair of the the US Preventive Services Task Force, which examined the evidence around carotid artery ultrasound in 2014 and gave it a D grade (zero benefit with potential for harm). EKGs received a “D,” too, for adults who are at low risk. For adults who were at a higher risk, the evidence was declared unclear.
“There are well accepted algorithms based on large population studies for risk assessment,” Moyer says. Referring to the TV segment, she adds, “It sounds like this doctor has made up his own.”
Let’s return to Labos: What can 10 minutes in conversation with a doctor do? You might go in, as the WCCO reporter did, wondering whether your family history of heart disease has bearing on your risk for cardiovascular events. A good physician, however, would focus on the things that have the largest influence on your heart health: your blood pressure and cholesterol levels, whether you smoke or have diabetes, how much you exercise, what you eat, and whether you maintain a healthy body weight. What your parents died from pales in comparison.
This is not the first case of first-person health reporting that HealthNewsReview.org has covered. There are examples of stories that emphasize benefits of medical screens and tests and virtually ignore their potential for harm, as the WCCO story did. There are also examples of stories that succeed at illuminating a complex health care issue, rather than seeming promotional.
Getting it right is tricky. When the reporter becomes the focus of the story, objectivity can become compromised and the wider perspective can be neglected. The journalist’s own experience may unduly impact the coverage.
Journalists have a duty not to scare their audiences unnecessarily. Taking a first-person journey through a bunch of unnecessary tests with the specter of “family history” looming over the story seems, at best, wrong-headed and, at worst, harmful.
I’ll write about the harms – both in terms of health and in terms of costs – in a subsequent post.