Using CT scans to see plaque in coronary arteries

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

Not Satisfactory

Again, since one expert says there is substantial benefit – "if you put patients with high calcium scores on a statin, you get a 43% reduction in heart attack and death." But the other says there is not – "there are absolutely no data [showing] that screening people for calcium with CT scanning affects the outcome in terms of survival." So readers are left stuck in the middle.

The information gets more confusing and conflicting when the story allows one expert to discuss  the CRP test as an alternative without challenging that statement or giving background on that test.

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

Not Satisfactory

Although the story mentions the potential cancer risk associated with radiation exposure, readers are given no numbers or other guidance to help them understand the extent of the risk. As for the risk of unnecessary treatment, one expert says it happens a lot, while the other says it doesn’t. Neither side offers any hard facts. Readers are expected to somehow judge the issues, when even top specialists don’t seem to agree.

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

Not Satisfactory

Casting this story as a point-counterpoint debate creates confusion, rather than understanding, about what evidence is currently available and what it means. The two experts make statements that appear to be incompatible, yet readers are given no context or guidance to help them determine the quality of the evidence being used to support each side.

The results of clinical trials (JUPITER and the St. Francis Heart Study) are mentioned in almost the same breath with zingers about how many billboards promoting coronary artery calcium screening may have once appeared in the Los Angeles skyline. As a result, the critical distinction between mere anecdotes and the results of scientifically controlled trials are muddied.

Is one expert or the other misquoting the research results? If not, then what could account for such diametrically opposing views? Readers are left to figure it out for themselves.

For example, Dr. Budoff said that, “The St. Francis heart study shows that if you put patients with high calcium scores on a statin, you get a 43% reduction in heart attack and death.” His statement is accurate, but likely to be widely misunderstood, because while a subgroup of people found to have very high calcium scores were less likely to suffer a heart attack or death if they were given statin treatment, that does not mean that people who are apparently healthy will be less likely to get sick or die if they are screened, since most of them will be found to be at low risk and thus don’t personally derive any actual health benefit from the screening. Indeed, a review of the evidence authored by Dr. Budoff noted that the St. Francis Heart Study found that while clinical events were lower in the total treatment group (including those with less extreme calcium scores) the difference was not statistically significant.

(See Limitations section of http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2496978/)

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

Not Satisfactory

While the two experts certainly represent differing perspectives, readers are not given any information about possible conflicts of interest.