Beware whenever you hear a story about a simple blood test

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.

Brian Williams led into the story stating: “Two of three women who die suddenly of cardiac heart disease have no previous symptoms which is all the more reason women may want to ask their doctors about a blood test that can be a lifesaver.”

Then NBC News chief medical editor Dr. Nancy Snyderman said:

“It’s not a new test, it’s not an experimental test but nonetheless it’s a test not a lot of people know about and that’s a problem because this simple blood test could save your life.”

The test in question is the C-reactive protein or CRP test.

We’re only seconds deep into the story and “lifesaver” or “save your life” have come up twice. We’ll hold our breath for the evidence to back that up.

Then the story profiles a woman at high risk of heart attack, but quickly transitions to stating that unspecified numbers of women who are told they’re at low risk are clearly at high risk. A doctor interviewed says:

“All too often we see people who were told they were at low risk for heart disease but they’re in the emergency room having a heart attack and so they’re clearly not low risk.”

And, Dr. Nancy says …

“… that’s because most doctors do not check for C-reactive protein for fear of overtreating them.”

That’s quite a leap: women are having heart attacks in the ER because doctors didn’t check them for CRP.

NBC’s choice of expert interviewee is Dr. Paul Ridker, who says:

“We have learned that the cost of the screening and the cost of the medication is quite small compared to the number of events prevented so it’s a win-win for everyone involved.”

NBC didn’t point out what others – such as Merrill Goozner and ethicist Howard Brody have – that another way of looking at the win-win is by looking at who holds the patent on the CRP test and who benefits from its use.

Goozner wrote several years ago:

“What if I told you Dr. Paul Ridker of Harvard owns the patent to using C-reactive protein as a biomarker of heart disease and it’s licensed to companies making the test. And what if I told you his research has been funded by drug companies that make statins, which lower cholesterol and may be used to combat high levels of C-reactive protein.”

Harvard’s Dr. John Abramson wrote to journalists in Nieman Reports:

“The commercial bias does not stop with the research, but affects the way the results are reported to the public as well.”

But we didn’t hear anything about financial conflict of interest in NBC’s story. Only this ending from Dr. Nancy:

“If you’re over the age of 40, this is the time to have a conversation with your doctor about this very simple blood test that’s covered by most insurance.”

Any woman over the age of 40? That’s quite a leap from the high-risk woman profiled in the piece.

The discussion of the evidence never came, did it?

Well, here it is, from the US Preventive Services Task Force:

“The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors (including CRP) to screen asymptomatic men and women with no history of coronary heart disease to prevent coronary heart disease events.

Although using CRP to screen men and women with intermediate coronary heart disease risk would reclassify some into the low-risk group and others into the high-risk group, the evidence is insufficient to determine the ultimate effect on the occurrence of coronary heart disease events and coronary heart disease-related deaths.”

Lifesaver?

Simple blood test?

Sounds a lot more complicated than what NBC reported.

Visit msnbc.com for breaking news, world news, and news about the economy

Gary Schwitzer has specialized in health care journalism in his more than 30-year career in radio, television, interactive multimedia and the Internet.  He is publisher of HealthNewsReview.org.

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  • http://twitter.com/katellington Katherine Ellington

    There’s a need for balance in media stories about health care. Pharma commercials that lead ahead and lag behind these stories is more evidence of a push. A compelling story need not be sensational, it should be accurate and offer balance. I see your point, clearly.

  • Matthew Mintz

    One interesting thing about the NBC story is that the patient profiled would NOT be a candidate for a CRP test even if one believes in screening with CRP.  The patient is diabetic, which means that she is at high risk for cardiovascular disease and should be on a statin regardless of her CRP level.  In addition, the story points out that she is indeed already on a statin.  I am not aware of any data on adjusting statin therapy, i.e moving from 40mg to 80mg of atorvastatin, based on CRP data.  Thus, the use of CRP in this particular case (again, even if you support using CRP to screen for risk), was a complete waste of her, her insurer’s, or taxpayers’ money (depinding on who is paying for this test).

  • http://profiles.google.com/petermbenglish Peter English

    Fascinating reading for a UK public health doctor like me.

    In the UK most health care is provided by the public sector. Screening decisions are generally made nationally by a National Screening Committee http://www.screening.nhs.uk/ following screening criteria based on those established by Wilson and Jungner http://www.ganfyd.org/index.php?title=Screening http://www.ganfyd.org/index.php?title=Screening_Wilson%27s_criteria . Screening programmes are expensive and often harmful: false reassurance from false negative tests; and unnecessary and harmful investigation and treatment from false positives.

    Of course, patients who can persuade their GP to do a screening test for “clinical” reasons, or who chose to pay for it, can have whichever tests they want; but for the most part, people have what’s offered (or opt out). There is very little direct-to-patient advertising for tests such as the CRP test discussed in this article.

  • http://www.facebook.com/people/Maggie-Keavey-Kozel/1383572933 Maggie Keavey Kozel

    This is an excellent piece, and once again illustrates the reason we have to keep corporate interests at a healthy arm’s distance from clinical practice. 

  • http://pulse.yahoo.com/_4T2HZNNG7WPCN2VQFUGGF3IU5Q LCG CHICAGO

    the test is hs-CRP, that is “high-sensitivity” CRP. It has a number of flaws in that anyhone with an autoimmune condition has a circulating CRP that is higher than the cut-off for increased risk. I know this much from personal experience. A much better marker, although it is not yet FDA for risk marker status is urinary thromboxane metabolite. The simplest explanation: thromboxane activates platelets, lowering thromboxane levels by taking 1-3 baby aspirin/omega-3/or other combinations lower thromboxane levels. This too is a simple urine test that is not yet widely ordered. The FDA clearance on this right now is to look at aspirin dose response. Aspirin is an inexpensive drug and Bayer promotes the low-dose for the prevention of heart attack and stroke. But if it doesn’t lower the circulating thromboxane, you may as well take a sugar pill.

  • Becky Stafford

    I saw that piece when it aired and I was so appalled.  It was grossly  misleading to the public and I’m disappointed our news outlets continue to sensationalize stories like this.  Thank you so much for your eye-opening article.

  • http://CANDIDMDEXPSLAINSHIGHCOSTDECLININGQUALITYUSHEALTHCARE.COM Alan D. Cato MD

    Good work, Mr. Schwitzer.  One of the excerpted quotes on the back cover of—The Medical Profession Is Dead and the Doctor  Is “Critically ill!” is— ‘In their attempt at bringing much-needed cost control to the American health care system, Congress faces the unique conundrum that the perpetrators of much of this unnecessary cost are the American consumer and the American ideology, free enterprise.  The single medium of television—with its overload of direct medical product advertising, and its “latest medical news” segments—is likely adding billions of dollars to unnecessary medical care costs annually.  The logical point, for saving the medically naive consumers from themselves, still rests with physicians (in the majority of instances—for a while longer yet).  So, this begs the question, what are the societal, cultural and medical educational changes that have led increasing numbers of physicians to buy into the-customer-is-always-right philosophy?  We cannot deny that this is on the increase.  The numbers of prescriptions written for influenza patients–for the priciest, most highly advertised “antibiotics”—during flu outbreaks is a simple and—all to common—example.

    —Alan D. Cato MD, F.A.A.F.P. (past) and author of The Medical Profession Is Dead and the Doctor
    Is “Critically ill!” (Oct.,
    2010)

       

  • Joe Kosterich

    Whilst the act of taking blood is simple ,the interpretation is not. Medicine has advanced but we know far less than we think we do

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