It’s a difficult task given the sheer volume of research and the differences between the studies in question. The story mostly succeeds and deserves praise for taking a cautious tone. We would have liked to have seen more of the evidence presented in absolute terms, though, to help readers understand the significance of the findings.
As with many of the findings coming out of the landmark Women’s Health Initiative study, research related to calcium and heart health can leave consumers confused and even scared. Does calcium in a regular, balanced diet raise a person’s risk of having a heart attack or stroke or does this only apply to calcium supplements? And might the effect of those supplements be mitigated by other components of a person’s diet? All of these are questions that arise out of the series of studies that have begun to pile up in recent years. This story goes a long way toward answering some of them, but it also may leave readers confused on several points.
The story makes no mention of costs. Given that calcium supplementation can last for decades, we think costs would have been important information and easy to access. Although calcium supplements are inexpensive for the individual, the amount of money in aggregate that is spent on supplements would be an important piece of context.
Because this study was focused on avoiding the risk of heart attack and stroke, we think that the benefits category is not applicable here.
The story attempted to quantify the potential harms from calcium, but, because the numbers were presented only in relative terms, we feel readers will not be able to adequately assess for themselves whether they need to change their behavior. For example, the story says, “women who were randomized to take calcium and vitamin D as part of the study protocol had a modest 13 to 22 percent increased risk of cardiovascular problems, particularly heart attacks.” Then it says, “The case against calcium became stronger when researchers added in data from 13 other, unpublished trials involving almost 30,000 women. Now the increased risk for heart attack was 25 to 30 percent and, for a stroke, 15 to 20 percent.” We’re not sure why a 22 percent increased risk is considered “modest,” while a 25 percent increased risk is cause for alarm. Some absolute numbers and even an explanation showing the number of women who would have to take calcium regularly in order to see one heart attack would have been good context.
The story presents good information about the design of the latest study, although we would have liked to have seen more details. The story also addresses the study’s limitations, saying, “And in an accompanying journal editorial, medical professors Dr. Bo Abrahamsen and Dr. Opinder Sahota wrote that due to study limitations, ‘it is not possible to provide reassurance that calcium supplements given with vitamin D do not cause adverse cardiovascular events or to link them with certainty to increased cardiovascular risk. Clearly further studies are needed and the debate remains ongoing.’”
The story does not engage in disease-mongering and, in fact, takes a very cautious approach to the topic. This could have been a story that attempted to grab readers’ attentions by striking a fear-inducing note. Instead, it says repeatedly that the scientific consensus is still forming and that there may not be any dramatic clinical practice changes as a result of this latest study.
The story quotes some good independent sources, including Dr. Philip Houck, assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, and Dr. Susan V. Bukata, associate professor of orthopaedic surgery at the University of Rochester Medical Center.
The story does not provide readers with any information about possible alternatives, saying only that women should be making sure that they get a maximum of 1,500 milligrams of calcium from both their diets and supplements combined. This isn’t a very good guidepost for readers. We would have liked to have seen at least a sentence or two indicating what patients might be able to do for bone strength, if anything, were they to avoid calcium supplementation.
The story stated: “Many older women take calcium supplements with or without vitamin D to keep their bones strong, especially since that has long been standard medical advice.” So availability and widespread use is clear.
The story does a great job explaining why these study findings are an important step in sorting out the role of calcium in heart health while showing that this study alone will not answer all the questions patients might have.
This story goes well beyond any 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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