Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Medical News Stories: Beware Of Insufficient Evidence

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.

Brian Williams led into the story stating:

“Two of three women who die suddenly of cardiac heart disease have no previous symptoms which is all the more reason women may want to ask their doctors about a blood test that can be a lifesaver.”

Then NBC News chief medical editor Dr. Nancy Snyderman said:

“It’s not a new test, it’s not an experimental test but nonetheless it’s a test not a lot of people know about and that’s a problem because this simple blood test could save your life.”

The test in question is the C-reactive protein or CRP test.

We’re only seconds deep into the story and “lifesaver” or “save your life” have come up twice. We’ll hold our breath for the evidence to back that up.

Then the story profiles a woman at high risk of heart attack, but quickly transitions to stating that unspecified numbers of women who are told they’re at low risk are clearly at high risk. A doctor interviewed says:

“All too often we see people who were told they were at low risk for heart disease but they’re in the emergency room having a heart attack and so they’re clearly not low risk.”

And, Dr. Nancy says….

“… that’s because most doctors do not check for c-reactive protein for fear of overtreating them.”

That’s quite a leap: women are having heart attacks in the ER because doctors didn’t check them for CRP.

NBC’s choice of expert interviewee is Dr. Paul Ridker, who says:

“We have learned that the cost of the screening and the cost of the medication is quite small compared to the number of events prevented so it’s a win-win for everyone involved.”

NBC didn’t point out what others – such as Merrill Goozner and ethicist Howard Brody have – that another way of looking at the win-win is by looking at who holds the patent on the CRP test and who benefits from its use.

Goozner wrote several years ago:

“What if I told you Dr. Paul Ridker of Harvard owns the patent to using C-reactive protein as a biomarker of heart disease and it’s licensed to companies making the test. And what if I told you his research has been funded by drug companies that make statins, which lower cholesterol and may be used to combat high levels of C-reactive protein.”

Harvard’s Dr. John Abramson wrote to journalists in Nieman Reports:

“The commercial bias does not stop with the research, but affects the way the results are reported to the public as well.”

But we didn’t hear anything about financial conflict of interest in NBC’s story. Only this ending from Dr. Nancy:

“If you’re over the age of 40, this is the time to have a conversation with your doctor about this very simple blood test that’s covered by most insurance.”

Any woman over the age of 40? That’s quite a leap from the high-risk woman profiled in the piece.

The discussion of the evidence never came, did it?

Well, here it is, from the US Preventive Services Task Force:

“The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors (including CRP) to screen asymptomatic men and women with no history of coronary heart disease to prevent coronary heart disease events.

Although using CRP to screen men and women with intermediate coronary heart disease risk would reclassify some into the low-risk group and others into the high-risk group, the evidence is insufficient to determine the ultimate effect on the occurrence of coronary heart disease events and coronary heart disease-related deaths.”

Lifesaver?

Simple blood test?

Sounds a lot more complicated than what NBC reported.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »