This Good Morning America segment on fatty liver disease in children fails nearly all measures of quality health journalism.
1. It is plainly derivative of an AP story on the same topic. The AP story, while it has the virtue of more reporting and detail, is itself not solidly grounded on high quality data or research. The GMA segment essentially enlists the network’s medical editor in interpreting a weak work of health journalism by others.
2. The segment presents no evidence or sources.
3. The segment four times mentions liver transplants, a fearsome procedure which carries serious questions about cost, fairness, personal responsibility and risk of death. Yet there is nothing other than an unnamed source’s speculation to justify raising this possibility. The effect is to inaccurately and unfairly generate a very high level of anxiety in the parents of overweight and obese kids.
A responsible report on this topic might have said that with so many kids being overweight and obese, parents should be aware of the risk of fatty liver disease. It would have suggested routine blood tests, as many pediatric experts now recommend. The segment could have described the condition a bit and provided information about symptoms, testing, diagnosis, and prevention. It would have mentioned that in rare cases that go undiagnosed, it could lead to liver failure, whose only treatment is transplant.
But then, that wouldn’t call for an "important medical alert" on the morning news.
The segment discusses diagnostic tests for fatty liver disease as well as treatment for end-stage liver disease, which is transplant.
As a matter of course, these costs should be reported.
Two specific approaches are discussed – and the benefits for neither are quantified: liver transplants, and liver testing including biopsies. A third approach was discussed but not quantified. The story stated, "There are some studies that suggest that if you lose weight in the early stages of fatty liver, the fat in the liver will start to disappear." But no evidence was provided.
Two specific approaches are discussed – and the harms for neither are discussed: liver transplants, and liver testing including biopsies. The statement and recommendation – "that our children are obese. Start worrying about that" – also carries the potential harm of anxiety and over-reaction, when the story didn’t always differentiate between overweight and obesity.
The segment presents no evidence that demonstrates fatty liver disease in children and teens is increasing or that it is leading to more transplants. In a story likely to produce fear, evidence to defend the assertion is particularly important.
By offering an "important medical alert" that four times mentions the possible increase in liver transplants, the segment exaggerates the gravity and urgency of childhood fatty liver disease. So does the comment that the problem is "much more urgent". . .than "childhood diabetes."
The segment does not identify differing risk levels between overweight and obese youth, likely exaggerating the risks to overweight children.
It’s true that many kids are overweight or obese, and that obesity is a risk factor for fatty liver disease. It’s also true that fatty liver disease can trigger more serious liver disease.
But the idea that the disease is rampant, rising and driving the need for pediatric liver transplants is all inference and speculation.
The segment names no sources.
The segment includes the following attributions and references: "doctors say" "we worry," "we are learning" and "many experts."
One unnamed expert is quoted as making a prediction–that "fatty livers in kids and teenagers today will become the leading cause of liver transplants by the year 2020"–whose specificity adds to the sense of alarm. Yet he or she is never named.
The segment correctly states that treating obesity and overweight in kids and teens can reduce risk for fatty liver disease, which in turn can reduce risk for more serious liver disease.
The segment does a responsible job of mentioning the improved likelihood of weight loss if the entire family participates in the healthy eating and exercise lifestyle required.
The segment should have mentioned that in addition to overweight and obesity, it appears that diabetes, high triglycerides, hypertensions and high cholesterol may be risk factors for more medically severe fatty liver disease in children and teens.
The treatments suggested–diagnosis with a series of blood tests and other tests, plus lifestyle modification to slow or reverse disease, are all easily available and this is implied in the story.
Liver biopsies and of course transplants are available only at specialized centers.
No claims were made about the novelty of treatment for fatty livers in children – only vague claims about this new trend.
There is no press release linked to this segment. But the broadcast clearly borrows heavily from an Associated Press report that was published three days before this segment aired.
The AP report itself is based on very little information beyond anecdotes–there does not appear to be a major study, consensus statement or dependable new data to hang it on. That story says it is based on "a surge of medical studies" it does not cite and AP interviews with medical experts.
The TV broadcast does not appear to add any reporting to the AP story other than the comments by the medical editor. This adds to the likelihood that the TV segment is based on the AP story rather than independent reporting.
Curiously, the AP says "many experts" predict fatty liver disease developed in childhood will become a leading cause of liver transplants by the year 2020. In the TV segment, this has been reduced to "one expert."
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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