January
1,
2009 -- 20:40 EST
New
England Journal Criticizes CBS News on Transradial
Angioplasty Report
As
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 morning...in 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 Angioplasty.org/PTCA.org 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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