This story is one of two we reviewed describing new research in the use of diffusion tensor MRI. Unlike the competing story by CNN, this story starts off on the wrong foot and does not recover. The headline badly distorts the true value of the research study. The story itself does little to analyze the evidence, provides no solid quantification of harms or benefits, leaves costs to the imagination and relies on one source: the lead author of the study in question. The story brings together two favorites of health writers: the frightening specter of autism and the MRI, the medical hero with X-ray vision. Neither topic is given a complete picture here.
Autism and autism spectrum disorders are characterized by dysfunction in communication, socialization and behavior. Many children do not show signs of the disorder until 18-24 months of age. Identifying children at risk early is essential if any intervention is to work in reducing the impact of the disorder. The currently available specific testing methods for the diagnosis of autism and autism spectrum disorders are blunt instruments. While more accurate than routinely used tools, the current autism diagnostic tools are not as sensitive and specific as needed. To be useful, a diagnostic test for autism should have a high degree of sensitivity especially in young children. Given the estimated high prevalence of autism and the high costs — both financially and emotionally — to families, it is important for reporters to approach any study about autism with caution. Screening for autism early and making decisions based on that screening can have very real consequences. In the absence of proven clinical treatments for autism, parents spend whatever they can on natural remedies, specific diets and behavioral therapies. That is why we take strong issue with the overly effusive headline and the lack of context in the story. No one is served by exaggerating research findings in such an emotionally fraught arena.
The cost of the specialized MRI scan and its interpretation is not provided. MRI scans are a major driver of healthcare costs and the use of this technology as a routine screening instrument could have a significant direct financial impact. The cost of a routine MRI could have been provided
The second sentence of the story says, “The test, which uses conventional magnetic resonance imaging or MRI machines, detected 94 percent of individuals with a high-functioning form of autism, they reported on Thursday.” The 94 percent number is completely out of context and exactly the kind of overstated statistic that gives readers false hope based on flimsy evidence. This was, after all, a study in 30 people with autism and 30 without. Unlike the CNN story we reviewed, this story fails in keeping inappropriate enthusiasm at bay. The potential benefits of such a scan can only be speculated at this stage, and readers should have been provided absolute numbers to make it clear how many people were correctly identified, at what ages and to what end.
One would think from reading these stories that getting an MRI is as harmless as taking a shower. Neither this story nor the CNN story explained the real psychological and physical impacts of brain scans. For those who have had the pleasure, you know how tight and confining the scanner “chamber” can be. Younger children frequently require deep sedation for a scan due to the tightness and to the loud banging that occurs during the scan. Although there is no radiation emitted, MRI scans are uncomfortable, loud and intimidating especially for younger children. If this test is to become useful it would need to be conducted early in a child’s life. This should have been conveyed to the reader.
The story did not evaluate the quality of the evidence and missed several limitations of the study that were pointed out in the CNN story that we also reviewed. Unlike the CNN story we reviewed, this story provides comments from two of the investigators with no reservations. The only caveat noted suggests the study results are preliminary. That single statement is overshadowed by the headline and the remainder of the story content. To their credit, the study authors provided their view of the study limitations and a word of caution about over interpretation in the manuscript. Indeed, the press release comments of the senior author noted, “this is not yet ready for prime time use in the clinic yet, but the findings are most promising thus far.” The story should have shown similar restraint.
The story did not engage in disease-mongering. Like the CNN story, the story correctly notes that 1 in 110 children in the US potentially has an autism spectrum disorder according to the CDC.
This story has no independent sources, and, worse yet, it gives readers the mistaken impression that the lead author of the study is an independent voice. After the lead and setup, the story says. “These results are the best yet in the search for a biological basis in terms of being able to distinguish those with and without the disease,” said Nicholas Lange of Harvard Medical School, who directs the Neurostatistics Laboratory at McLean Hospital in Belmont, Massachusetts. Doesn’t that sound like someone outside the study explaining why the findings are important? Unless readers latched on to a passing reference to “researchers at McLean” they might read the entire story thinking Lange was unaffiliated. As CNN points out in its story, Lange actually helped create the MRI being used and would likely stand to benefit financially from its commercial rollout.
At the present time there are no biologically based tests for autism. The diagnosis is made on the basis of subjective signs and symptoms. Unlike the CNN story we reviewed, this story makes no attempts to provide information on existing diagnostic testing.
The story includes this odd claim: “You don’t need any fancy equipment. This is performed around the world,” Lange said in a telephone interview. Interestingly, neither the actual published study nor the McLean press release provides any explicit information about the MRI scanner used or the way in which its programming may have been altered. And neither does the story.
The novelty of the test is unclear from this story. Diffusion tensor imaging is not new and it has been used in previously published reports, a fact not provided to the reader. The way in which it was used was new and novel. We usually take people to task for suggesting a drug or medical device or procedure is novel when it is perhaps not. The story should have indicated that although the scanners used were conventional and others have employed the technique described, the programming is novel and not routinely available.
The story does not rely on a news release. The story provides quotes from the investigators that do not appear in the institutional press release. Having said that the press release provides a far more balanced story that this one does.