Both stories relied on journalism tropes. In the Reuters story, researchers were “closing in on an accurate test for autism.” Here they are “finding more pieces of the autism puzzle of with the help of MRI scans”. The latter is more accurate. If you now have three pieces of a 500-piece puzzle, you still have more pieces than you did before. The story follows through with this more cautious lead by presenting a better — if not complete — analysis of the evidence and using independent sources to bring some much needed perspective on the findings. Unfortunately, like the Reuters story, this one gave readers no solid quantification of harms or benefits, and no cost information.
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. That is why a good diagnostic tool would be a welcome addition. It remains to be seen however if the promise of diffusion tensor MRI screening will be realized. To be useful, a diagnostic test for autism should have a high degree of sensitivity especially in young children. Identifying children at risk early is essential if any intervention is to work in reducing the impact of the disorder. 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. In the absence of real proof, journalists need to make sure any evidence they help to promote has been properly vetted.
Just as Reuters did, CNN ignored costs. 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.
This story and the Reuters story use the 94 percent accuracy figure with no context. “By scanning the brain for 10 minutes using magnetic resonance imaging, researchers were able to measure six physical differences of microscopic fibers in the brains of 30 males with confirmed high-functioning autism and 30 males without autism. The images of the brains helped researchers correctly identify those with autism with 94 percent accuracy, says Nicholas Lange, an associate professor of psychiatry at Harvard Medical School and one of the study authors.” What exactly does this mean? Was autism found in all of the 30 who had autism and none of the 30 who did not? Were there any false diagnoses?
The same as with the Reuters story, CNN mentioned no harms in this story. 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. The biggest harm, though, is the potential for false diagnoses, which should have been addressed.
This story analyzes the evidence better than the Reuters story by pointing out the limitations in the study. It also actually explains what this MRI does to find the differences. Because “the study included only males between the ages of 7 and 28” the study findings could prove problematic for the authors’ claims that the scans will lead to earlier diagnosis. “The earlier a child has been identified as having autism, the earlier behavioral therapies can be applied to lessen the impact of the disorder later in life,” the story says. But how will earlier children be tested? It’s simple, Lange says, “as long as they can go to sleep in the scanner – on their own, without sedation (because you can’t move during the test).” That’s a big “what if.” Any parent with a child under 7 can tell you how hard it is to get them to stay in one place, let alone fall asleep and remain immobile in a confined space.
Both stories rely on the CDC statistics for autism prevalence.
The story did a far better job than the Reuters story in making use of independent sources. Both Carissa Cascio, an assistant professor of psychiatry from Vanderbilt University School of Medicine, Zachary Warren, who is the director of the Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), offered cautious views of the study.
Unlike the Reuters story, this one actually pointed out that there are other ways to detect autism beyond brain scans. “Currently there’s no biologic test for autism, so pediatricians look to see if a child is meeting certain developmental milestones as well as signs and symptoms of autism. (The advocacy group Autism Speaks has posted videos to help parents see the signs of autism)” We would have liked to have seen a couple of additional comments about the current testing modes, their limitations and the degree of accuracy provided by them.
The story does a better job than the Reuters story of showing that these scans will not be rolling into your local mall anytime soon. “Lange is quick to caution that this type of test is not yet ready for prime time. “We do not want to give anyone false hopes that this is ready for the clinic yet. This method, this test, needs to be tried [and confirmed] with many more subjects outside our laboratory,” he says.”
The story allows the lead author to claim complete novelty. “”No one has measured what we measured,” says Lange of the MRI test he and Dr. Janet Lainhart from the University of Utah developed.” The story also says, “no one has looked at it the way we have and no on has gotten these type of results.” These two comments would lead one to believe that diffusion tensor MRI scanning in people with autism and autism spectrum disorder has not been done in the past. Although the scanners appear to be commercially available and diffusion tensor MRI scans have been done in people with autism and related disorder, the programming of the scanner appears to be unique. The story leaves this point murky.
The story does not 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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