Those TV New Doctors: Good Advisors or Fear Mongerers?

 

Dear Readers,

If Dr. Nancy Snyderman of NBC and Dr. Sanjay Gupta of CNN look straight into your eyes (through a TV camera lens) and tell you to get a simple, lifesaving medical screening test, should you run right out and do it?

And if not, why not? And what might you do instead to protect your health?

This month’s topic is health advice from M.D.’s on television. There’s been a recent spate of dramatic stories on TV about screening tests for heart attack risk.  How do you make sense out of them and what should you do?  Read on for more.

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TV Doctors Pump Calcium Heart Screening Test, but Leave Out the Other Side  

 It’s one of those classic television moments.  We see a patient being rolled into the giant donut hole of a CT machine for his calcium heart artery screening test, and — what’s this? — the patient is none other than CNN’s Dr. Sanjay Gupta, near the top of his one-hour special, “The Last Heart Attack.”

So if Dr. Gupta, a trim and healthy man in his early 40s, exposes his body to the high dose of radiation of the calcium scan to find out if his heart attack risk is really as low as the overwhelming odds are, should you get the calcium test too?

Well, another TV doctor journalist gave the same advice recently: ABC’s Dr. Richard Besser.  So that settles it.

 

Or not.

Larry Husten, a medical journalist who has followed cardiology for 25 years, wrote in his CardioBrief blog in Forbes that the CNN and ABC stories (along with an NBC story discussed in our next piece below), were striking for “how these news organizations actually take great effort to dumb down their stories.”

It’s not just dumbing down.  It’s telling only one side of the story. Fact is that calcium artery screening is very controversial among cardiologists.  It adds little understanding of a patient’s true risk but pumps a lot of money into the scanning centers that run the tests.

Dr. Steven Nissen of the Cleveland Clinic says, “Calcium scanning is one of the worst examples of medicine gone wild. It’s taken on a ‘cultlike’ following.”

I pulled that quote from the on-line version of the ABC story by Dr. Besser. Too bad it didn’t make the cut for his on-air piece.

And it’s not merely the hidden commercial bias that makes me want to scream. It’s the fear-mongering by people who should know better.

Read this excellent takedown of the CNN story by Marilyn Mann, a health blogger and lawyer, in a guest column on the Health News Review Blog. (Gary Schwitzer does a fantastic job with this blog, which I recommend to everyone.)  Ms. Mann explains why it’s dangerously bad advice to push large numbers of people into the calcium artery scans.  Her bottom line: the calcium artery test and other fancy tests like carotid ultrasound have never been shown to improve health better than a knowledge of the traditional Framingham type risk factors.

Following the Money Trail When TV Doctors Push the C-Reactive Protein Test  

NBC’s chief medical editor Dr. Nancy Snyderman wants all American women over 40 to “get a simple blood test that can save your life.”  It’s called C-Reactive Protein or CRP, and it shows inflammation and possible heart attack risk.  It’s potentially a good test for the right people — I’ve had it myself.  But forgive cynical me for pointing out a little something about the one Harvard doctor, from the jillions of heart specialists out there, whom Dr. Nancy picked to quote about what a great test CRP is.

His name is Dr. Paul Ridker, and he owns the patent on the CRP test as a heart risk marker. He licenses the test to companies that market it.  None of this was mentioned in the clip Dr. Nancy played, in which Dr. Ridker said: “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.” (My emphasis.)

Kind of sheds new light on what Dr. Ridker might have had in mind about who is the win-win beneficiary.

Back when I was a medical journalist (way, way back), I would have gotten in hot water for two sins at once with this use of Dr. Ridker: Failing to disclose his financial conflict of interest, and using him in the first place rather than some doctor with less skin in the game.

It’s not just the testing industry that profits from the spread of C-Reactive Protein screening to low-risk groups.  Big Pharma has a stake here potentially worth billions.  What happens when patients with normal cholesterol get diagnosed with a high CRP level?  Now an earnest campaign is underway to put them on Crestor or another “statin” drug to lower the already normal cholesterol level.  I wrote about this a year ago on my patient safety blog, pointing out that a statistical sleight of hand has been done to make the potential benefits sound a lot more impressive than they really are.

Call me an old-fashioned crank, but I will continue to point out the commercial bias that pervades much of the testing and screening recommendations that we get from the U.S. medical industry.  When unbiased sources are used, the story invariably gets a little more complicated but a lot more honest.

What Neutral Experts Say about the New Heart Screening Tests, and Some Simple Advice for You

One obvious authoritative group of doctors that could have been quoted by Dr. Snyderman or Dr. Gupta, but wasn’t, is the U.S. Preventive Services Task Force.  Here’s what it says on tests like CRP and calcium in the arteries: 

 

“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 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.”

 

Bottom line: If you have no history of heart disease and none of the traditional risk factors like high blood pressure or high cholesterol, the CRP test and the calcium artery test are of no proven value. You can get them if you want, but the risk is that you will then get a test result that throws you into a tizzy, and you will then get shoved onto a medical treadmill of more testing and more treatment that hasn’t been shown to help anyone — except the medical industry and patent holders like Dr. Ridker.

 

What you should do instead: 
Your age, weight, exercise level, amounts of cholesterol (LDL: bad — get it down, and HDL: good- keep it up), and blood pressure tell you what you need to know about your heart attack risk.
Think about a Mediterranean diet or a vegan diet.  Or at least trending in that direction.
And stop worrying that there’s some magic medical screening test out there that you should rush out and submit your body to.
That kind of boring advice may not make the TV doctor news stories, but it’s still the best.
To your continued health!

Sincerely,
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Patrick Malone
Patrick Malone & Associates