We identified three shortcomings – all easily addressed.
Putting hard numbers to concerns about overdiagnosis and overtreatment is a vital health policy issue – and important for journalists to track, as Reuters did with this story.
No mention of cost – a signficant issue in the context of alleged overdiagnosis.
The story succinctly summarized:
The story explained: “the blood-thinning drugs used to treat blood clots increase the risk of bleeding in the brain or gastrointestinal tract, for example. According to the new results, such complications rose from three to five per 100,000 people hospitalized with PE per year after doctors began using chest CT scans.” It also reported: “CT scans expose patients to radiation, for example, which can increase the likelihood of developing cancer. And the dyes used to enhance the scan also cause kidney damage in a significant portion of people.”
Our medical editor who reviewed this felt strongly that an unsatisfactory grade was warranted for the following reasons. There are important limitations to consider. The diagnosis of pulmonary embolism prior to CT was always fairly uncertain because pulmonary angiography (the true gold standard) was rarely done due to complications of the test. Therefore, the baseline trends for incidence of pulmonary emboli are probably not very reliable. There are also lots of other tests and approaches used for PE diagnosis that could have influenced things in either direction, as well as trends/improvements in treatment of PE. Relying on discharge diagnoses from inpatient samples should always be used with caution. A validation procedure with a subsample of cases could have added more strength in the reliability and validity of the diagnoses. Perhaps if an independent expert’s perspective had been included, some of this may have been addressed.
No disease-mongering of pulmonary emboli.
No independent source was quoted. It would have been interesting to solicit opinions from radiologists, for example, that might have placed some of this in a different light.
The dilemma was framed appropriately at the end:
The story states that chest CT scans are “being used in millions of patients every year in the US.”
The relative novelty of the new analysis was clear from the story. It stated: “The new findings add to other evidence showing that medical testing is on the rise across the U.S., although in many cases the impact on overall health remains unclear.”
It’s clear that the story did not rely solely on a news release.