March
19,
2006
Blame the Messenger: Reporting on Plavix and
Aspirin
Gee! I guess the big problem with patients
is that they don't know how to read plain English. That must be why,
as the American College of Cardiology puts it in their Thursday Public
Health Alert (italics mine):
"Recent
media reports regarding the results of the CHARISMA
Trial may be misinterpreted by patients with coronary stents
and other conditions,
causing these patients to inappropriately stop taking
the anti-clotting drug clopidogrel (Plavix®)."
Those pesky patients, putting
their lives in danger by misinterpreting the following finely-nuanced
reports that appeared nationwide only
hours after
the CHARISMA results were made public last Sunday.
My point
here is that how could patients who have been prescribed Plavix and
aspirin by their
cardiologists NOT be terrified by these headlines? Especially when
the widely-reprinted AP story begins:
"People taking the blood thinner Plavix
on top of aspirin to try to prevent heart attacks, as many doctors
recommend, now have good reason to
stop."
As many doctors recommend? Good reason to stop? So
is the message here that your doctor has made a terrible mistake
by giving you a
deadly mix of drugs and you'd better take this matter into your own
hands?
When I saw the news, I immediately realized
the problem -- not only were the headlines inflammatory (medical
pun intended) implying some type of toxic interaction between Plavix
and aspirin, but the articles themselves left out a critical piece
of information. The CHARISMA study was
about expanding the applications for Plavix;
it had nothing
at all to
do with the many patients
who currently take these drugs as per FDA-approved indications
-- patients for whom the drug combo is of proven benefit. And life-saving
benefit. For
years it's
been known that Plavix (clopidogrel) and aspirin are essential
for stent patients to take to prevent blood clotting inside a
stent, called stent thrombosis, an incident which is fatal more than
1/3 of the time!!
So by Monday noon I had posted our own Public
Health Alert, also written a warning at our very popular Plavix
and Aspirin Discussion Forum and ran a Google Ad, directing people
to these pages. At least Internet searchers would get the right
information: stent patients, don't stop taking your meds without
talking to your doctor.
As the week went on, I found no other place where
this vitally important caveat for stent patients appeared. I
couldn't understand how so many reporters could be at a major
cardiology meeting and not be aware of these fundamental medical
facts. I also saw the traffic on Angioplasty.Org
increase explosively by
50%, with the number one
search term being,
you guessed
it, "Plavix
and aspirin".
Finally, four days later, both the
American Heart Association (AHA) and American College of Cardiology
(ACC) posted a "Patient
Guidance" and the above-mentioned "Health
Alert" and Friday, in an Emily
Litella moment, a whole
slew of news reports appeared stating, "remember that thing about
stopping taking Plavix and aspirin together...never mind!" For example,
on
March 17, the Wall
Street Journal wrote:
In the wake of news accounts of the study, doctors'
offices were inundated with phone calls. "Patients are really misunderstanding
this," said Steven E. Nissen, cardiologist at the Cleveland Clinic and
president of the American College of Cardiology. "I'm really worried
about losing people."
Happy St. Patrick's Day! Hope we didn't lose you.
* * * * *
So what's to be learned from this roller-coaster? (Other
than that you should always read Angioplasty.Org for the most accurate
reporting.) Well, to the cardiologists who met last weekend in Atlanta,
I would
remind them that, while
these annual meetings previously comprised mostly scholarly arcane
symposia with little interest for the general
public, in today's world there are probably as many
business reporters, financial analysts, media buyers, venture capitalists
and industry representatives at the ACC as there are
cardiologists. And the media's
thirst for a sexy (or death-y) headline will not go unquenched!
This is a fact learned in the early days of angioplasty
-- and since Angioplasty.Org's
history timeline was utilized
by this year's ACC i2 Interventional Summit (with our permission,
of course) I feel vindicated in boring everyone with a short two-paragraph
history lesson.
Charles
Dotter, a radiologist in Oregon, invented angioplasty.
Surgeons thought him crazy. When this
photo of him appeared in the August 14, 1964 issue of LIFE Magazine,
everyone else thought him crazy too and, for all intents and purposes,
the concept of opening blocked arteries non-surgically was ended
in this country for almost 15 years. Dotter was personally and professionally
burned
by the bright lights of the media.
When
Zurich-based angiologist Andreas
Gruentzig took
Dotter's concept and successfully applied it to the heart in 1977,
the first thing his patient did was to call the newspapers. But
Gruentzig kept the
press away from the hospital because he knew the danger of prematurely
reporting on a procedure that had not yet been duplicated. His
careful, cautious
and scientific nuturing of angioplasty is credited
with its position today as the most oft-performed cardiac procedure.
So, cardiologists -- when you publish reports or make
speeches, you have to be aware how the retail and business
press are going to spin it.
And please don't blame patients for misinterpreting
these reports. They only know what they read in the papers!
* * * * *
** A media note: the original Associated
Press article, issued on Sunday, March 12 at 7:15pm was titled, "Taking
Plavix With Aspirin Proves Risky" -- the article went
through 6 online versions and on Monday was finalized with
a slightly less yellow headline "Doubt Raised on Aspirin-Blood
Thinner Combo" and two added sentences: "Nothing
in the study changes recommendations that people who recently
have had heart attacks or a procedure to unclog an artery
take those medicines. This study dealt with expanding use
of the drug to other people." Unfortunately, hundreds
of newspapers had picked up the initial article on Sunday
night and went with it. |
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