CBS had a wonderful opportunity to put this important study into perspective. The segment failed to clearly and adequately communicate the results of the study and how to interpret those results. This study, while important, is certainly not definitive and should not have been portrayed as such. The approach taken is especially unfortunate given the fact that two superb editorials accompanied the study in question in the New England Journal of Medicine. The editorials describe a comparison between the Vytorin study and previous studies. Importantly, they note a number of potential contributing factors that were ignored in the news story. Even beginning journalists are taught to read the editorials as an easy way to get a different or broader perspective. Did anyone working on this segment read them?
One of the most important points that was not addressed in this piece was cost. There are statin medications that are available for a fraction of the cost of Vytorin. In an era where we are concerned about healthcare cost, is it not noteworthy that the more expensive treatment failed to provide added benefit?
The lack of cost information is a huge oversight in this broadcast piece. Generic simvastain costs about $1/day; Zocor costs $5/day and Vytorin costs $3/day. The economic implications of the study are significant and are likely an important aspect of the interest in the study results by the financial markets.
The segment missed a golden opportunity to talk about and educate the viewers on the distinction between intermediate outcomes and clinically significant outcomes. The story could have explained the difference between changing a laboratory value (a score or a measurement) and changing pathology (what’s actually happening inside the body to affect health).
The apparent benefit of the treatment is that LDL cholesterol (the ‘bad’ cholesterol) is lowered more when simvastin is taken in combination with ezetmibe. The problem is that this further reduction in cholesterol does not reduce the rate at which plaque is deposited in people with familial hypercholesterolemia. This finding may suggest that the mechanism by which LDL is lowered is important in general. Earlier studies using a statin (atorvastatin) demonstrated significant reductions in plaque thickness in patients with significant existing disease. The level of disease in this cohort under study was less than that in the atorvastatin study. The majority of subjects had been previously treated in this study and it may well be that there is a lower limit to further reduction regardless of cholesterol level.
There was no discussion of the possible harms associated with the use of cholesterol lowering medications.
In addition, the way the story was introduced with the lead that a popular drug ‘may not work’ may have had the effect of having viewers stop taking the drug altogether.
This story did an inadequate job explaining the finding that they were discussing. There was no mention of the type of studies nor the population that was studied.
Unfortunately, the segment made no reference to the editorial in the New England Journal of Medicine related to the study. If it had, perhaps it would have portrayed the result somewhat differently. Instead they chose to over dramatize the result and the implication.
The story engaged in disease-mongering when it said, "The simple matter is, the experts are all saying the same thing now. First of all, you want to aggressively lower your cholesterol with diet and exercise. You can never go wrong doing that." But it never defined the people for whom this might be good advice. It is NOT good advice for everyone and you can go wrong with doing that. And let’s leave the advice to advice columnists, and look to journalists to deliver data and evidence.
It does not appear any individuals with clinical expertise in this area contributed to this story. Even if the story had mentioned the two excellent editorials accompanying the article in the New England Journal of Medicine, there would have been more input, more balance.
The story did say, "The simple matter is, the experts are all saying the same thing now. First of all, you want to aggressively lower your cholesterol with diet and exercise. You can never go wrong doing that….Make sure you’re maximally lowering your cholesterol with proven drugs such as statins and other types of drugs that we know reduce the risks of heart attacks and strokes. If you’ve done all that and you still can’t get your cholesterol down, then Zetia really is a drug of last resort. And the medical community really is pretty clear about this now." Based on the history of medicine’s resonse to single studies, it is DOUBTFUL that the medical community is as clear on these questions as the story suggests. The reality is that the final answer is not yet available.
The on-air discussion assumed that viewers all have an intimate understanding about the various approved medications for lowering cholesterol and their different modes of action. The uninitiated viewer would have no understanding of the issues involved or why this study is important.
Although stating that they were discussing the new findings release by an independent panel, the newscasts failed to mention the source of the ‘news’ and what was new about this ‘news’. There is novelty to discuss here. Ezitimibe works differently from the statins and the combination presumably allowed for lower doses of statin in combination with ezitimibe. One advantage of this approach is the ability to lower LDL cholesterol with lower doses of a statin. This is important in patients who cannot tolerate adequate doses of statins.
We can’t be sure if the segment relied solely or largely on a news release. No source is cited. No expert is interviewed.