Are there experts who urge people to have their heart arteries scanned for evidence of calcium deposits, even if they don’t have signs of disease? You bet. Are there other experts who warn against undergoing tests that may promise more than they deliver? Yup. Is pitting one expert against the other going to show readers who is right? Not likely, based on this point-counterpoint debate over coronary artery calcium screening.
This story demonstrates the pitfalls of presenting scientific issues as though they were political debates. This sort of “equal time” treatment gives the impression that there is equal evidence backing each side. Failing to give readers appropriate context makes the sparring claims almost impossible to judge.
Allowing two experts to advocate their points of view is better than presenting just one side of a contentious matter, but in this case, the lack of context and explanation is likely to leave readers feeling bewildered and helpless.
Screening has a natural appeal. After all, who wouldn’t want to have a health crisis prevented, rather than treated after the fact? However, determining the balance between potential benefits (Does a test actually help people prevent an illness or death?) and potential harms (Does the test expose people to costs and side effects of testing and treatment?) is complex and individual. News stories should attempt to clarify how people can interpret the available evidence so that it applies to their own situation.
The story says that the test costs a few hundred dollars.
It would have been helpful to point out the cumulative cost of the repeated screening schedule used by those who recommend using the test for screening.
Also, the discussin of insurance coverage is conflicting – saying, in one place, "insurers won’t pay for this test" and in another "That’s why Medicare has decided to pay for it in a majority of states."
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.
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.
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
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/)
While the statements by advocates of coronary calcium screening can make calcium deposits seem like a disease, instead of just a risk factor, the strong counter-statements included in the piece make it clear that the relationship between calcium scores and actual coronary artery disease is still being studied.
While the two experts certainly represent differing perspectives, readers are not given any information about possible conflicts of interest.
The story does mention alternative methods for assessing heart disease risk. However, here again readers are stuck between one expert who says the alternatives are superior and another expert who says they are inferior.
The story notes that coronary artery calcium scoring is widely available.
It’s really not clear from the story how new are these tests.
The story does not appear to rely on a news release.
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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