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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.

Taking Plavix With Aspirin Proves Risky Associated Press**
Plavix, aspirin combo poses risks Chicago Tribune
Plavix with aspirin raises heart risks Buffalo NY News
Plavix plus aspirin may be a risky combination Mayo Clinic
Mixing Blood Thinner with Aspirin Could Prove Risky ABC7 News, Los Angeles
Researchers warn against Plavix and aspirin together KVUE-TV News, Austin Texas
Questions Are Raised About the Safety of a Major Heart Drug New York Times
Plavix-aspirin combo hurts many patients, study finds Lexington KY Herald-Leader**
Plavix with aspirin is deadly for some Cleveland Plain Dealer**
Doctors Rethinking Aspirin-Plavix Combination Dr. Koop

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 in LIFE MagazineCharles 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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