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Read Original Story

Health Experts Call For Heart Checkups For Kids

Rating

2 Star

Health Experts Call For Heart Checkups For Kids

Our Review Summary

The death of a young athlete during exercise is a rare but nonetheless heartbreaking event. Some experts believe that these tragedies can be prevented by subjecting all student athletes to screening with an electrocardiogram (EKG). This story tilts strongly toward those who advocate this view and emphasizes a couple of positive anecdotes from children who benefited from an EKG. However, it provides no data demonstrating that this approach would identify more children at risk than current screening methods based on family history, personal medical history, and a thorough physical exam. Moreover, no attempt is made to balance the story with discussion of the costs and potential harms that frequent use of EKGs would entail. In the end, the story delivered a one-sided view of an issue that demanded a more nuanced treatment.

 

Why This Matters

A new screening program for heart abnormalities could potentially save lives but would entail significant costs and carry risks for some children. But one-sided expert arguments and supportive anecdotes do not give readers a balanced view of what is a very complicated story.   

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story cites unnamed experts who make the vague claim that EKG screening would be “too costly.” However, an estimate of the cost of the equipment and the cost per test would have been easy to include and would have provided valuable context to the discussion. Notably, the authors of the study discussed in this article have suggested that the cost of an EKG is as low as $3 under the research protocol they used.  However, the cost skyrockets to over $100 if the customary physician billing process is used. The story presents this tension in a one-sided and biased fashion without ever discussing the cost implications sufficiently. 

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

Not Satisfactory

 

The story amplifies the potential benefit of routine screening of high school athletes by focusing unduly on a couple of positive anecdotes. In particular, the reporter describes the experience of one child diagnosed with a serious heart problem for whom the EKG was said to be “life-saving.” This characterization is problematic because we don’t of course know whether this patient ultimately has been "saved" (the patient is said to be on a heart transplant list and the outcome of any intervention is as yet undetermined). Similarly, it is impossible to say whether this problem would have been detected by other means even if the child never received an EKG. The author leans heavily on this anecdote but provides no real data to support the contention that global screening of all athletes would identify more students at risk than the current approach.

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

Not Satisfactory

Apart from a passing reference to costs, there is no discussion of the potential downsides to screening, which are numerous and include overtreatment of benign abnormalities, unnecessary exclusion of children from sports and other health-promoting physical activities, and creation of undue anxiety in children who have no reason to worry about their hearts.  

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

Not Satisfactory

The story cites data from an uncontrolled short-term study of 2000 high school athletes which found that about 10 percent of the students had an abnormal EKG. There is no discussion of any of the many limitations that are inherent in this kind of study. The suggestion is that this testing uncovered real heart problems that required medical attention, but it is likely that many of these abnormal results were harmless false positives, and the story should have pointed this out. It also should have mentioned that because there was no control group, this study is very likely to have overestimated the benefits of screening with EKGs. Finally, the story did not disclose that this study was presented at a scientific meeting and had not yet been subjected to the scrutiny of other heart specialists via the peer review process.   

Does the story commit disease-mongering?

Not Satisfactory

The story correctly notes in the second paragraph that sudden death in student athletes is rare, but it later states that 10% of students screened in a recent study had abnormal EKGs. This is problematic, because the story does not then indicate how many of those individuals with an abnormality needed to be treated.  In reality not all EKG abnormalities require either treatment or alterations in exercise.  The 10% number in the story followed by a single anecdote makes it appear that the risks are larger than most data would suggest.

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

Not Satisfactory

The story quotes Thomas Debauche, a Houston cardiologist and author of the screening study, and Douglas Zipes, a former president of the American College of Cardiology (ACC), both of whom are supportive of screening. It also mentions that ACC officials say that “most members” support screening athletes. Although there is a suggestion that there is an opposing point of view, no such voice is quoted in the story. That introduces a clear imbalance. The story should have included the perspective of one of the many experts who would have disputed the wisdom of routine screening. It also could have mentioned that routine screening would result in more office visits and more revenue for cardiologists, thus creating a financial incentive for ACC members to promote the benefits of screening. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

 

The story makes no attempt to compare the standard approach of screening based on family history, medical exam and personal history to the proposed method of routine screening for all.  The story suggests that existing recommendations are inadequate. However, there is no evidence provided to validate the approach of routine screening. 

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

Satisfactory

The story states that electrocardiograms are not provided to all student athletes prior to participation in sports. Although it satisfies the minimum standard for a satisfactory rating on this criterion, the story could have done a better job in explaining that heart screening for student athletes (including EKG) is routinely available and relatively easy to obtain. A brief description of the way in which an EKG is obtained would have provided some context for the reader.

Does the story establish the true novelty of the approach?

Satisfactory

Screening athletes for heart problems is not a new idea, and the story does not suggest that it is. However, the story could have done a better job of explaining how athletes are currently screened and the role of EKGs in this process. Current American Heart Association guidelines recommend EKG and other diagnostic testing for children presumed to be at higher risk of heart problems based on personal history, family history and physical examination. The report does not provide this important information until the final sentence of the story. 

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

Satisfactory

The story includes two interviews and does not rely unduly on any news release that we could identify.

Total Score: 3 of 10 Satisfactory

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