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January 13, 2009 -- 4:45PM EST

Dreadlines About Stents Revisited
My last entry was about the January 1 article in the New England Journal of Medicine which took health care journalists to task for glossing over facts, for not presenting a truthful picture of complex issues, etc., etc., etc. This is a concept I have written about extensively, even critiquing the critique in NEJM. It's a phenomenon I have dubbed, "Dreadlines" -- where a news article wants to grab your attention, so it invokes serious illness or death as a journalistic strategy.

So only days after the NEJM article, the New York Times published a piece by esteemed health reporter Jane Brody, titled "More Isn’t Always Better in Coronary Care". And in case you were wondering where this article was headed, you might just take the lead sentence:

"Ira’s story is a classic example of invasive cardiology run amok."

Amok, as defined by the American Heritage Dictionary:

"In a frenzy to do violence or kill; in or into a jumbled or confused state; in or into an uncontrolled state or a state of extreme activity; crazed with murderous frenzy."

Yow! Got the image? Hordes of out-of-control invasive cardiologists running around, crazed and sticking stents into patients' arteries with neither rhyme nor reason: killer cardiologists!!

If Ms. Brody was not envisioning such a dramatic picture, perhaps she should have used a more accurate term -- however, her article certainly delivers the message that angioplasty, stenting and interventional cardiology in general are being grossly over-used: an assumption that is not only untrue, but dangerous!!

Dangerous? How can a mere article in the "newspaper of record" be dangerous? Is the pen mightier than the catheter? Is there such a thing as a "killer journalist"?

My answer is "yes". And here is why. Two years ago, the CHARISMA study was presented at the American College of Cardiology. The study's take-home message was that aspirin plus Plavix did not add benefit, and that in a subset of patients, it slightly increased heart attacks and mortality. But the study had nothing to do with stent patients. If you had a stent, it was critical that you continued to take both aspirin and Plavix. I wrote about this extensively and issued a warning to stent patients "Don't Stop Taking Your Meds". But patients read the popular press headlines (or rather the "dreadlines") which totally misreported the study and stated: "Plavix plus aspirin may be a risky combination", "Plavix with aspirin is deadly for some", and so on. And patients did stop taking their meds. And in the next couple of weeks, patients with stents wound up having heart attacks. I know this to be true, verified by cardiologists I have spoken to.

So reading (or seeing) the news can cause heart attacks!

That being said, I would also like to state that nowhere in Jane Brody's brief 800-word story is the issue of emergency angioplasty mentioned. Ms. Brody and the popular press have been delivering the message for quite a while now that angioplasty and stents are overused and that you should do everything you can to avoid them.

There's only one catch: if you are having a heart attack, you need to get to a cath lab ASAP so that a balloon can open up your blocked artery and prevent your heart muscle from dying. 90 minutes is what you should aim for. This is not hype; this is fact: backed up by multiple studies over the past two decades.

Angioplasty saves heart muscle.

But the retail press would have you believe otherwise. As Dr. Gregory Dehmer, former president of the SCAI, told me a few days ago:

"Right after the COURAGE Trial was published, and this is not the fault of the investigators of the COURAGE Trial -- it's the fault of the way the media rolled the story out -- because I remember watching the 5 O' Clock national news and the headline was "Angioplasty Doesn't Work".

So the next week I'm back in good old Texas and I get called in for an acute MI and there's a cardiology fellow trying to convince the patient in the Emergency Room that 'you're having a heart attack and this [angioplasty] is what we need to do' -- and the patient is like 'But I saw the news and they say it doesn't work.'"

"It doesn't work". Thank you Jane Brody. Her article goes into more detail about the types of plaque that cause heart attacks, etc. and it leaves you with the sense that doctors don't really know what they're talking about. But her article depends almost entirely on the observations of one single physician: Dr. Michael Ozner, author of the book, "The Great American Heart Hoax". His idea, that more resources should be put into prevention, is completely correct. But his statement that:

“Interventional cardiology is doing cosmetic surgery on the coronary arteries, making them look pretty, but it’s not treating the underlying biology of these arteries.”

is misleading. It is true that interventional cardiology is not treating the underlying biology of the arteries, but it is possibly preventing an acute event in those arteries -- one that just might save your life or, at least, save your heart muscle. There have been many recent studies that have proven this to be true. Yet Brody's article quotes decade-old studies to make her point -- a point which is, in fact, misleading at best.

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