This story covers a new study in which very high doses of the statin drug Crestor regressed atherosclerosis, or coronary artery plaque buildup, as shown on intravascular ultrasound, in high risk patients.The story states that the patients showed a 7 to 9% reduction in plaque. It is not clear if this is clinically meaningful. The story says “Crestor reduced so called bad cholesterol by more than 50 percent and increased good cholesterol by nearly 15 percent.” But 50 percent of what? 15 percent of what? What is the absolute increase or decrease? Although there is some mention of side effects, these are downplayed. Given that this trial used such high doses of Crestor, side effects are an important issue. The story also fails to mention that 12% of the patients discontinued using the drug before the end of the study. No costs are mentioned and only a single source, the lead author of the study, is quoted. The story doesn’t mention any alternatives, such as diet, exercise, or regular doses of statins (which is current practice). Although there is some description of the design of the study, there is no mention of the study’s limitations. The story hints at this point but doesn’t drive the point home: there can be a difference between surrogate markers (lowering LDL, raising HDL, shrinking plaque) and outcomes such as fewer heart attacks, strokes or deaths. These are important pieces of information that the viewer would need in order to critically evaluate the strength of the evidence. It was good that the story included the line, “Doctors say this does not suggest that everyone should start taking Crestor.â€
There is no mention of costs in the story.
Quantitative estimates are given in relative frame only. The story states that the patients showed a 7 to 9% reduction in plaque. It is not clear if this is clinically meaningful. The story says “Crestor reduced so called bad cholesterol by more than 50 percent and increased good cholesterol by nearly 15 percent.” But 50 percent of what? 15 percent of what? What is the absolute increase or decrease?
Although there is some mention of potential side effects, these are downplayed. Given the high dose of Crestor used in this study, side effects are important. The story also fails to mention that 12% of the patients discontinued using the drug before the end of the study.
Although the story describes some aspects of the trial, there is no mention of the limitations of this trial. Specifically, there was no direct comparison of high-dose Crestor to current medical practice for this population, such as a lower dose statin. Furthermore, the study was not designed to look at the effects of the drug on hard cardiovascular end points, such as heart attack or death. The story hints at this point but doesn’t drive the point home: there can be a difference between surrogate markers (lowering LDL, raising HDL, shrinking plaque) and outcomes such as fewer heart attacks, strokes or deaths.
No disease mongering. Story did a good job of including the line, “Doctors say this does not suggest that everyone should start taking Crestor.
Only a single source, the lead author of the story, is quoted. Even in a short TV piece, time and space should be found to include the input of independent sources.
The story doesn’t mention any alternative treatment options.
It is clear from the story that Crestor is currently available.
We can’t be sure if the story relied solely or largely on a news release, although, as noted, the story only included the input of the lead researcher.
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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