This story about HairDX, a genetic test to assess "risk" of baldness, is fundamentally flawed.
It accepts the test marketer’s premises that:
This segment has the feeling of a story "too good to check," in the old newsroom phrase. You can tell if someone’s going to be bald with a cheek-swab? Great story!
Once produced, the story itself does apply a few good practices. It draws on a variety of sources, it includes useful caveats, it cites the price and it brings someone in to assess treatment options.
None of this competent work can make up for the flawed assumptions that allowed the story to go on the air.
It’s worth noting that on the same day this segment aired, it was announced that the company that makes HairDX, along with a dozen other California firms, had been sent cease-and-desist orders by the State of California earlier in the month. The state is investigating whether these genetic tests constitute a medical procedure, whether they can be sold directly to the public, what kind of quality control and licensing should apply, and other issues.
Viewers would have been well served if the reporters and producers had asked some of those questions. Or at least had shown some awareness of the state’s action.
On the day this segment appeared, HairDX announced that it would no longer sell its product directly to consumers via the Internet, and that in California or New York it would sell exclusively through physicians.
The segment states that the test costs $149.
However, the test is not as reliable as would appear and additional costs should be considered. A man with no evidence of hair loss and a positive test result will require a visit to a dermatologist and a set of confirmatory tests. The costs of the confirmatory tests, minoxidil or finasteride treatment and the degree of benefit should have been included in the discussion.
The spokesman cites figures connecting certain gene variants with either a 60 percent increased chance of baldness or an 85 percent reduced chance of baldness.
This is not correctly stated, and it causes a false impression of efficacy. The positive predictive value of 60 percent means that the test when positive is correct 60 percent of the time. Conversely, the negative predictive value of 85 percent means that when the test is negative, it is correct 85 percent of the time.
The test itself, a cheek swab, is risk-free.
But the segment should have mentioned the potential harm linked to false positives or false negatives–the chances of which are not specified.
A false positive or negative could result in unnecessary expenditures and psychological impacts. A 20-year-old could overtreat his hair and worry about a baldness "clock ticking" when in fact he retains his hair–and vice versa.
Since one justification given for the test is the psychological impact of baldness, this is a significant omission.
In addition, the reality is that minoxidil and finasteride are only marginally effective in some men. Both drugs have side effects that are not noted in the report.
The company spokesman cites figures linking chance of baldness to genetic features, but it does not provide a source. We have no idea what these data are drawn from–independent tests, company estimates, etc.
The segment implies baldness is a condition requiring treatment. This is not necessarily true.
The segment draws on two highly self-interested sources, a spokesman for the company that markets the test, and a doctor who sells it to patients.
The reporter also interviews an independent dermatologist, who provides some context to explain the shortcomings of a single-gene test.
The host interviews an independent dermatologist who discusses baldness treatments. Both the reporter and the host contribute some caveats the other sources do not.
But no one was interviewed about issues that were in the works this same day – and for some time prior.
On the same day this segment aired, it was announced that the company that makes HairDX, along with a dozen other California firms, had been sent cease-and-desist orders by the State of California earlier in the month. The state is investigating whether these genetic tests constitute a medical procedure, whether they can be sold directly to the public, what kind of quality control and licensing should apply, and other issues. On the day this segment appeared, HairDX announced that it would no longer sell its product directly to consumers via the Internet, and that in California or New York it would sell exclusively through physicians.
Spending more time with knowledgeable independent sources likely would have turned up some of these issues.
There are no other commercially available genetic tests for baldness.
The independent dermatologist discusses the efficacy of topical applications for baldness.
The host implies a "$12.99 baseball cap"could be a satisfactory response to baldness too.
The segment indicates the test is available directly from the maker and through some physicians. But, as noted, the availability of this product may be changing on the fly.
The story implies that this is a novel commercial application of genetic testing. The spokesman says this is "probably" the first direct consumer genetic test for baldness available. This appears to be true.
There does not appear to be a press release linked to this segment. However, the company did announce in April that it was marketing its test for the first time to women.
This resulted in press and television coverage in May, which may have triggered the Today segment in June.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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