This is a story based on one true-believer-dentist’s use of oral DNA tests on 24 patients so far. Although we’re not even told what the experience is with those 24. Feels like an ad for the dentist and for the company marketing the tests.
The problem of oral cancer in younger adults was dramatically overstated. It is not clear that detecting HPV in the oropharynx results in any clinical benefit, even with heightened screening. This story is confusing because it mixes together oral HPV screening and bacterial testing.
Single source stories aren’t good practice in any form of journalism; in health care stories they are particularly dangerous. Where were the independent perspectives on this trend? Where were the data to back up the use of these tests?
the story says the tests cost $150 each. Of course, it also states that the manufacturer of the periodontal tests recommends re-testing in 6 weeks. So these costs are adding up. We wish the story addressed whether insurers cover these.
No discussion of the sensitivity or specificity of the tests.
The ultimate benefit from any screening test (HPV for example) should be decreasing the burden of disease (deaths and poor outcomes from oral cancer), or loss of dentition from periodontal disease. The story doesn’t address this: after you find it (HPV or troublesome bacteria) can you improve human health by screening for oral cancers in those who have it (for the case of HPV) or treating the bacteria in a targeted manner (for the pathogenic bacteria)?
What is the false positive rate of these tests? And how quickly do costs mount once that cascade of events begins?
There was no discussion of the evidence for these tests. How well do they perform?
As oral hygiene has improved, there’s been a longstanding observation that dentistry periodically re-invents itself, carving out new turf to remain profitable. Whether that observation is warranted or not, we wish there had been some independent expert perspective on the trend toward these tests being done in the dentists’ office. The problem of oral cancer in younger adults is overstated. Although periodontal disease is common and problematic, the story made it sound alarming. Additionally, the story did not clarify how good the test is at detecting pathogenic bacteria versus oral flora.
There are no independent experts quoted – something badly needed in the story.
The story doesn’t discuss the option of NOT being screened. Interestingly, the one patient interviewed said she “kind of questioned it a bit” before agreeing to the testing, but we’re not told what her concerns were.
Of course, the other alternative for the bacterial testing is just to treat the most common bacteria presumptively, which is usual practice. An independent expert could have been called on to compare the approaches.
The story explains that the manufacturer says the periodontal tests have been available for nearly two years and the HPV test since January 2010.
The story states that “researchers anticipate salivary testing mayh become the diagnostic tool of the future.” Those researchers aren’t named – just an interview with “one of the few dentists in the metro area offering the tests.” Are medical doctors using the tests? We really aren’t given any context beyond this one dentist’s practice and her experience with 24 patients.
We can’t be sure of the extent to which the story relied on a news release. We do know it apparently only relied on one doctor’s experience using the tests.
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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