TV anchor Matt Lauer, an asymptomatic 47 year old man with no history of diabetes, with normal blood pressure, borderline high cholesterol, and with a family history of heart disease (his 72 year old father had coronary artery bypass graft surgery) undergoes a heart scan on national TV. We learn that two of his arteries are “pristine” while there is a small “bad” plaque in one artery that could “eventually develop into a problem.” The cardiologist suggests lifestyle modification, baby aspirin, and a statin. There is no independent, second opinion in the story. What have we gained from this experience? Nothing, unless we are GE (parent company of NBC), and manufacturer of the scanning device used in the story.
There are many problems with this story. At the end, we are told that this technology should be used only for people experiencing symptoms such as shortness of breath, chest pain, etc. Yet the story featured asymptomatic Matt Lauer modeling the procedure. That is an example of disease-mongering. In the end, the true message of what this technology can and can’t do is completely distorted by the beautiful pictures (3-D rendering of the heart) and empty, non-evidence-based promises. The costs of this technology are ignored. Insurance coverage (an important issue) is downplayed. And the potential harms of having such a scan are not mentioned at all.
Does not specify what the costs are, which are entirely out-of-pocket since most insurance companies do not cover
it. The cardiologist downplays cost saying that they have had “good luck” getting insurance companies to cover it.
No estimates of benefit
are provided.
No information on harms is provided, which is a glaring omission. Harms might include: reaction to beta-blockers
(to slow the heart rate) or to the contrast dye, exposure to radiation that is many times greater than an x-ray, not to
mention any risks from any interventions (catheterization) needed to follow-up on any abnormal findings (that may or may not
result in any benefit to the patient). Furthermore, the cardiologist recommends taking statins and aspirin as a result of the
findings, but what about the harms of these drugs? What if the lesion were a false positive and the drugs were entirely
unnecessary?
There is absolutely no evidence provided. In order to really
evaluate this, we would need to know how the images correlate with his actual plaque buildup and we would want evidence that
early intervention with these scans can actually do anything to prevent an event or bad outcome. Furthermore, we don’t know
if this lesion could be confirmed with a catheterization (gold standard).
Although the story doesn’t exaggerate the prevalence of heart disease, it does not
accurately portray the natural history of heart disease. It is still controversial to say that these scans “can show us
exactly what’s going on in the heart.” We still don’t know whether plaques (good or bad) found with these scans are
actually going to be the ones to cause problems down the road. Matt Lauer’s father’s heart disease is actually not a major
risk factor, which raises the controversy that we don’t know what to do with asymptomatic, active and healthy people who
could have ‘bad’ plaques. Matt Lauer also confuses his plaque value of 56 as being ‘mild’, when in reality this indicates
a ‘soft’ plaque that is more vulnerable to developing an MI.
No attempts are
made at independent corroboration. Only a single source is quoted. Does mention that GE makes the machine and owns NBC.
Mentions cardiac catheterization but
neglects exercise tests, MRI and older CT scan alternatives. Does not attempt to place this kind of CT in context or explain
the advantages or disadvantages.
Mentions the availability of the machine in the U.S. since May, 2005.
The story is clear that this
is very new technology.
We
don’t know if the info came from a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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