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Brain MRIs as a tool to prevent Alzheimer’s? Too much hype, and too little evidence, from a radiology society news release

Preventive neuroradiology: Brain imaging bolsters efforts to lower Alzheimer's risk

Our Review Summary

brain MRIVague descriptions, sweeping generalizations, overly laudatory quotes — these are some of the things that we think news releases should avoid. But this release includes all three and accordingly received low marks on most of our criteria. What are the major problems? The news release provides no evidence to back up its central claim — that MRI imaging will help convince people to adopt healthier behaviors that reduce Alzheimer’s disease risk. It also provides no meaningful description of the review article that’s the basis for the release, and does not describe the methodology utilized in identifying the studies included in the review. The release also never establishes what exactly is new here that merits attention. And it displays no awareness that overuse of medical technology (including so-called “MRI abuse”) is one of the main drivers of spiraling health care costs. In fact, there is no mention of costs at all in this release.

 

Why This Matters

Nearly 44 million people worldwide suffer from Alzheimer’s disease, which is the sixth leading cause of death in the US. Not only that, treatment is expensive: The cost of caring for Alzheimer’s patients in the US is estimated to be $226 billion in 2015, according to the Alzheimer’s Association. Since there is no cure for Alzheimer’s disease, any measures that could identify and prevent cognitive decline would be beneficial to patients and clinicians. What we don’t need are expensive new tests that will raise the cost of care without any evidence that they improve outcomes.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

There is no mention of costs in the release, but overuse of medical technology such as MRI scanning is one major reason for soaring health care costs. According to personal finance website Nerdwallet.com, median prices of a brain MRI range from $525 in Atlanta to a whopping $3,310 in Milwaukee.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The main contention of the news release is that “imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimer’s disease.” But there’s no evidence presented to show that these images have any effect — good or bad — on patients’ adoption of beneficial lifestyle changes. Does performing an MRI increase the likelihood that someone will lose weight, exercise, and stop smoking?

The release also states, “institutions… meld these approaches into novel ways to improve patient care,” but the report doesn’t detail what those “novel” therapies are. Experts in the report talk about pinpointing “volume loss in the brain” and characterizing imaging markers, but these are all surrogate endpoints. In other words, how do these translate to tangible health outcomes for patients?

Bottom line: The idea that a brain MRI is going to help motivate people to adopt meaningful lifestyle changes — and that those changes will, in turn, lead to an actual reduction in the number of Alzheimer’s disease cases — requires several leaps of logic that have very limited support from evidence. The release owed it to readers either to point out the preliminary nature of the hypothesis or provide some evidence to back it up. The release did neither.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

Procedures almost always carry risks, and MRI is no exception. Some physicians are concerned with “MRI abuse,” pointing out that MRIs often pick up abnormal – but harmless – findings that muddy up the clinical picture. These so-called “incidentalomas” can lead to more tests and treatments that cause harm and add to costs. Unnecessary imaging is a major contributor to spiraling health care costs in the US, since a single scan on average in the US costs $2,611, according to Medicare data.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

Beyond stating that it exists, this news release provides no information about the journal article that is the subject of the release. Nor does it detail any of the studies that supposedly support the value of imaging for Alzheimer’s disease prevention. We’d add that the journal article itself provides limited-quality evidence — it doesn’t detail the process for selecting articles that are included in the review (raising the possibility of “cherry-picked” studies) and includes little in the way of critical evaluation of the studies that are cited.

Strangely, three physicians, who weren’t listed as authors of the study, are quoted in the release and allowed to tout the benefits of quantitative MRI technology. They make sweeping statements, such as that this technology “will have a huge impact in the future” and that imaging “can have a powerful impact [on patients]” But the report fails to go into detail.

One of these experts adds, “Patients seem to enjoy reviewing results of their imaging studies, more so than reading the results of their blood tests or other clinical evaluations.” But one physician’s anecdotal observation is not evidence of enhanced quality or effectiveness of care. Again, supporting data is needed.

Does the news release commit disease-mongering?

Satisfactory

The news release does not engage in disease mongering and states that as many as three million cases of Alzheimer’s dementia could be prevented with lifestyle changes. However, it does imply that there would be more cases prevented with the addition of brain imaging, a claim that is not supported by the release or the underlying review article.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release does not specify funding sources for the work, which included the National Institute of Biomedical Imaging and Bioengineering and the National Institutes of Health. Many of the authors are consultants for medical device and pharmaceutical companies, including Toshiba (cited as “related” or relevant in the original research report). The release does not disclose this.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The main premise of the news release is that MRI imaging can help people lower their risks for cognitive decline by encouraging them to make lifestyle and behavioral changes. It states that risk factors include obesity, diet, sleep, hypertension, diabetes, depression and smoking. However, the release does not address any alternatives — besides brain imaging — that might help people make the desired changes. Behavioral change counseling, which is an established approach to reducing problematic behaviors, is not discussed.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Applicable

The release doesn’t address the availability of quantitative MRIs of the brain. MRI in general has been used since the 1970s, and its availability is not in question. But since the issue is not specifically addressed by the release, we’ll rate it Not Applicable.

Does the news release establish the true novelty of the approach?

Not Satisfactory

Using quantitative MRI technology to diagnose Alzheimer’s disease in its early stages is not a new concept. There have been blog posts and numerous studies in the past 10 years devoted to this topic. We’re not really sure what’s new here. The news release refers to “novel ways to improve patient care,” but does not specify what these new approaches are.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Not Satisfactory

The language of the release bordered on sensational, with neurologist Majid Fotuhi touting the benefits of quantitative MRI technology and claiming it will have a “huge impact in the future of diagnosis and treatment of Alzheimer’s disease.” The release never clarifies the how and why of this statement.

Total Score: 1 of 9 Satisfactory

Comments (1)

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Norma Cartwright

June 13, 2015 at 1:56 pm

I am not a scientist or doctor. Just a consumer.
I applaud your analysis. Your examination was comprehensive and helpful.
As an atheist and a skeptic, I find myself looking deeper into what has become “magical medicine”. Something has happened to medical science, in a very bad way. From anti-vaxxer Mercola to homeopathy to Dr Oz, some doctors have gone to the “dark side”, making outrageous health claims and peddling “nutriceuticals” – which have been cited for lack of evidence. Even “peer-reviewed medical journals have been infiltrated by “vanity publishing houses” that “publish” anyone’s research for as little as $150.00 (Australia). My favorite was just seven words repeated faithfully, from title to abstract to confusion to footnotes. (The seven English words are NSFW and unprintable-and say nothing of science.)
I hope we can restore ethics and good science right away. Could we start by removing Francis Collins from NIH?

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