This AP story gave us many of the same reasons that USA Today cited for not trusting the results of this study. But there were a few more enlightening touches, including the fact that a number of the study investigators were convicted felons, and that dropouts were disproportionately concentrated in placebo group–a result that raises questions about the blinding of the study and whether patients knew what kinds of treatment they were getting.
This is good reporting on marginal research on a complementary/alternative medicine approach that is funded by the NIH. Journalists need to ensure that they are as critical of mainstream research findings, particularly when presented at research conferences and not yet peer-reviewed.
According to the story: “Treatments cost $90 to $150 apiece, usually are done weekly for 30 weeks and then less often, and are not covered by insurance.”
Results are given in absolute terms: “Four years after treatment, 26.5 percent of the chelation group had [a cardiovascular complication] versus 30 percent of those given dummy infusions.” In addition, the benefits are called “small” and experts caution that chelation can’t be accepted as a mainstream heart disease treatment based on these results.
In this report (as opposed to the USA Today story) the total number of people in the study was given, but still not the number in each group who were enrolled and had the composite endpoint. This barely makes the grade.
The story makes it clear that chelation has potential to cause harm, but says that the regimen used in this study “seemed safe.” We recognize that it might be difficult to get more detail than that at a conference presentation, but it’s still not quite enough information to satsify the criterion.
The story provides many reasons to look skeptically on the findings:
The story includes sufficient detail about the conduct of the study and preliminary nature of the findings, as shown above.(KF)
No disease mongering about cardiovascular disease.
The story raises concerns about potential pro-chelation bias among the researchers, and we’ll make the same observation we did in our review of the competing USA Today coverage: Lots of trials are led by physicians and surgeons who provide the treatment that they’re supposed to be studying for profit–whether it’s a surgical procedure or some other form of treatment. So if this constitutes bias, it’s a bias that’s endemic to medical research. There is a suggestion here that this is something we’d only see in the alternative medical community.
Other than that, no concerns: there are plenty of independent voices quoted in the story.
The story mentions established treatments such as cholesterol-lowering medicines and stents to open clogged arteries.
The story explains how practitioners and patients can obtain chelating drugs for treatment of heart disease despite lack of FDA approval for a commercial product: they order it custom-mixed from special compounding pharmacies.
The story doesn’t make any inappropriate claims about the novelty of the study. It is also clear that this is the first report from a 10-year NIH-funded trial.
The story has enough original reporting that we can be sure it wasn’t based on a press 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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