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January 1, 2009 -- 20:40 EST

New England Journal Criticizes CBS News on Transradial Angioplasty Report
CBS Early ShowAs Editor-in-Chief of the most popular public website devoted to interventional cardiology, I approached Susan Dentzer's article, Communicating Medical News — Pitfalls of Health Care Journalism, published in today's issue of the New England Journal of Medicine, with great interest. I unfortunately was a bit disappointed, specifically with her criticism of a September 24, 2008 CBS News segment about transradial angioplasty.

A leading thesis of the article is that journalists need to be aware that their reports can influence the behavior of clinicians and patients -- and on that point we agree completely. After all, one of the significant tasks that Angioplasty.Org has taken on over the years has been to correct misleading news stories about the field of interventional cardiology. Recent important examples include the flawed coverage of both the CHARISMA and COURAGE trials.

We also are very aware that many patients and healthcare professionals respond to these "retail press" stories by going to search engines to delve further. For example, traffic on Angioplasty.Org spikes every time a major story about stents or angioplasty hits the newswires.

Moreover, we agree with Ms. Dentzer that the popular press often will characterize the results of a study incorrectly, in order to concoct what we have dubbed a "dreadline". And these scare headlines have consequences. Cardiologists we have interviewed confirm that in March of 2006 some stent patients stopped taking Plavix and aspirin together, based on faulty headlines about the CHARISMA trial, and subsequently suffered heart attacks. There is a definite danger in misreporting -- and for that we applaud Ms. Dentzer's article.

But in her article, she cites a recent 105-second TV segment about the transradial approach to angioplasty that aired on CBS's "Early Show" and she takes it to task for incorrect reporting. Since we host the major online source of information in the U.S. about the transradial approach, and since we feature an interview with Dr. Howard Cohen, the subject of the CBS News piece, and since we are also aware that CBS News logged onto our site in the week preceding their report to research the issue, we must take issue with the New England Journal critique of this piece.

We, in fact, were impressed with the accuracy of the reporting by interviewer Julie Chen. Moreover, since I featured the CBS report in this blog, I feel obligated to defend my choice.

Ms. Dentzer critiques:

First, the interviewer incorrectly described all angioplasty as "the opening of blocked arteries through the wrist."

But she is misreading the inflection that reporter Julie Chen used in introducing the piece. The transcripts reads:

This our special series "Heart Watch": Angioplasty...which is the opening of blocked arteries...through...the WRIST! Joining us is cardiologist Dr. Howard Cohen.

Ms. Chen was very specifically drawing attention to the fact that the wrist approach was not the norm for angioplasties -- which was the entire point of this very short piece. Her second question to Dr. Cohen clarifies this:

...only 1 out of 100 angioplasties performed in this country is done this way and it's better. Why so few?

Other criticisms that the NEJM article levels at CBS is that, although Dr. Cohen states the wrist approach is cheaper, he is not given time to "to cite the study on which his assertions were based." The answer is that there are far too many such articles to cite in a short TV clip. But anyone motivated enough to Google "transradial angioplasty" will surely come to our special section on the Radial Approach at and find our extensive bibliographic references on the transradial approach. Television news is, alas, not a medium conducive to footnotes.

Finally, Ms. Dentzer faults CBS by not placing the discussion in context. She states:

Completely absent was any discussion of when and why angioplasty should be done, let alone of the large, year-older study that raised important questions about whether too many angioplasties were being performed.

This is a reference to the results of the March 2007 COURAGE Trial -- an important question and one which we have dealt with in some detail. But it is certainly not possible to discuss this responsibly in a short TV feature. In fact, to CBS and Dr. Cohen's credit, the one major contraindication to the wrist approach is stated twice -- patients without flow from two arteries are not candidates.

But I am not writing this blog merely to criticize the NEJM article on its finer points. Yes, it is critical to report medical news accurately, but in the case of the wrist approach to angiography and angioplasty, it is also important to publicize new and different techniques, so that a safer yet radically underutilized method of performing catheter-based procedures can gain acceptance. Recent multiple reports have shown a 50% reduction in mortality associated with the transradial approach for diagnostic angiography and angioplasty, yet only 1-5 procedures out of 100 in the U.S. use this approach.

For publicizing an underutilized yet safer procedure like transradial angioplasty, a 105-second feature on national network TV ain't a bad thing.

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