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Treadmill test has limited usefulness

Rating

3 Star

Treadmill test has limited usefulness

Our Review Summary

This story explains why, for many people, treadmill stress testing is a poor tool for detecting heart disease and predicting mortality. The article was whittled down by half from a longer version written by the New York Times’ Jane E Brody six days earlier. (Is it a coincidence that the Charlotte paper hacked the original story exactly in half – from the original 1,166 words to 583? Did an editor just say, "Cut it in half."?) Regardless of length, the story lacks important information on several fronts:

  • It does not describe the quality of the scientific evidence on stress tests
  • It fails to mention potential harms of a positive test
  • It does not adequately quantify the potential benefits of a stress test
  • It lacks information about other options for diagnosing heart disease

The edited version in the Charlotte Observer also introduced an error, sayings that the story’s single expert source was the physician of the late journalist Tim Russert. Brody’s original article states that the source “was not one of [Russert’s] physicians.” Why would the Charlotte paper go out of its way to change this fact, and get it wrong?

The diagnosis of heart disease is a huge, sprawling business. Diagnostic tests alone account for a significant fraction of this enterprise, but interventions make up the bear’s share. Stress tests leads to a diagnostic angiograms, which lead to interventions such as an angioplasties and stents–which are costly and potentially harmful and unnecessary. Brody’s story was designed to address just one piece of this puzzle: How could a smart, prominent journalist who passed his stress test die of a heart problem just weeks later? As Brody points out in a section of her story cut by the Observer, a stress test result is just one factor in predicting the date of our demise. Though every story has its limits, this one seemed to us to miss an opportunity: There may be harm in over-interpreting a negative result. But there is also potential harm in over-interpreting a positive one.

We are bothered by the Charlotte paper’s slashing of the NY Times original. These are difficult concepts to explain. And when the editing resulted in a weaker story, with a glaring error, we scratch our heads.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story explains that the charge to Medicare is about $150 per recipient, but three or four times higher to younger patients.

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

Satisfactory

The story fails to state exactly how much a person might benefit from a treadmill test. This is admittedly difficult to do, and an area of significant controversy in medicine. Who does it help—and how much? The story does provide the test’s prognostic accuracy: three in a thousand people with heart disease will die from heart disease within a year if they have a low-risk test, and about ten-fold more will die of heart disease if “they are deemed at high risk.”

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

This is a story about the pros and cons of testing for heart disease with a treadmill stress test—a method that is fast and cheap but often difficult to accurately interpret. Though the story does not explicitly say so, a reader could infer that such an unreliable test might easily lead to an unreliable diagnosis or prognosis. Still, the story fails to explain just how significant that can be: tests for heart disease quickly lead to additional tests as well as expensive and potentially unnecessary and harmful interventions.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory
This story relies on a single physician as its expert source and mentions two scientific studies—one that the expert source recently published and another report from the 1980s that appears to be a longitudinal cohort study of people with 3-vessel heart disease. However, the story provides virtually no description of the quality of the evidence to support most of its numerous contentions. The longer version of the story published in the New York Times describes two additional studies that help to explain the potential usefulness of treadmill stress tests, but not enough for a reader to determine their quality or limitations. For those who want to learn more, the Agency for Healthcare Research and Quality and the United States Preventive Services Task Force did a systematic review on this topic in 2005 (see http://www.ahrq.gov/clinic/3rduspstf/chd/chdsum.pdf).

Does the story commit disease-mongering?

Satisfactory

The story points out that there is a difference between heart disease and a test for detecting heart disease that does a poor job of predicting true problems in a lot of the people who receive it. This is essentially an anti-disease-mongering message.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story wrongly says that its single source was the physician of the late journalist Tim Russert. This error was introduced during editing at the Charlotte Observer. In the original article by the New York Times‘ Jane E. Brody, published six days earlier on 7/29, Brody states that the source “was not one of [Russert’s] physicians.” Had the Observer gotten this right, then the story would have received a “satisfactory” grade for this criterion.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story says nothing about the pros and cons of other methods used to diagnose heart disease.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story states that hundreds of thousands of Americans get a treadmill stress test annually.

Does the story establish the true novelty of the approach?

Satisfactory

It’s clear from the story that treadmill testing has been around a while.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to rely solely or largely on a news release.

Total Score: 6 of 10 Satisfactory

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