If hospital PR people offer heart scans, should journalists bite?
I had never met Jim Walsh of the Star Tribune, but he called me recently about a story he was working on. I’m glad he did, because I think our conversation (and subsequent conversations with people to whom I referred him) may have altered the direction of the final product.
I hadn’t realized that Walsh had blogged about his decision to bite on a hospital PR woman’s offer to have a coronary calcium CT scan. Excerpt:
“The question was simple enough.
“Do you want to be scanned?” asked Gloria O’Connell, a public relations manager at Abbott Northwestern Hospital.
She had sent me news about HeartScan MN, the first electronic beam CT scan in the Twin Cities and, maybe, Minnesota to measure calcium in the coronary arteries. Abbott Northwestern started the program in about 1995, O’Connell said, adding that it was pretty controversial at the time.
Now, there is evidence that such a scan has a clinical benefit for people who have “middle-of-the-road” risk for cardiovascular disease. She asked me if I would be interested in having a scan to see how it works.
A little about me: I am a big guy, have been for years. But as my activity levels decreased, my weight increased. Still, over those years, my cholesterol levels and blood pressure have been pretty good. But, finally, alarm bells sounded when I stepped on the bathroom scale at the end of February and it showed my weight approaching 300 pounds.
My mom died five years ago, overweight and suffering from congestive heart failure and chronic obstructive pulmonary disease. Memories of my mom — and that bathroom scale – shocked me into finally doing something.
After a call to HealthPartners and a health coach, I started tracking my calories and exercise. The pounds, slowly, started to come off. I ate less, including almost no fast foods, few fried foods and a lot more salads and vegetables. And I started moving more. As of today, I am 38 pounds lighter than on March 1. I walk nearly every day, hit the treadmill on bad weather days and recently started bicycling, including riding to work a couple of days a week.”
So he had the scan, and then he blogged a followup about what it showed:
“A tiny spot of white. There was calcium in my left anterior descending artery. It was evidence of plaque, evidence of a chance for heart disease in the future. “Pre-clinical,” (the doctor) called it.
Despite everything I had been doing, this amounted to a 10 to 15-year warning that, without changing the path I had been on, I would face a higher risk for heart attack. The Doc wasn’t trying to scare me. He even told me that what I had been doing had “changed your risk.”
But the presence of calcium means I am not done. He suggested I get my cholesterol checked and think about making more changes to my diet. If my cholesterol proved high, I might want to consider statins to reduce my risk of heart attack further.
My coronary artery calcification score was 6.7, putting me in the 59th percentile for 48-year-old men who have had the scan. Not great. Not terrible. According to the scan, I have a low, but not zero, risk of coronary artery disease. …
Am I glad I did this? Truthfully, yes. Although my lifestyle at the time of the scan would not have put me in a risk group for whom it is recommended, I look at this as an affirmation of the changes that I already have made in my life – and the fact that I should not get complacent and stop working to improve.”
Right about here is when another journalist must have told Walsh to call me for information. After hearing his story, I visited the Abbott Northwestern website to see how they were promoting HeartScan. Their website includes this promotion:
At a cost of $100, a heart scan from HeartScan Minnesota is a simple, inexpensive way to get an inside view of your heart’s health.
Who should have a heart scan?
Anyone, age 35 to 79, with one or more of these risk factors for heart disease is encouraged to call for an appointment.
- Family history
- High cholesterol
- High blood pressure
- Physical inactivity
That may not sound unreasonable to the untrained, unskeptical eye and ear. But Walsh, in his final story, quoted me as follows:
Gary Schwitzer, publisher of the blog HealthNewsReview.org, said the hospitals are appealing to “the worried well,” as they push their scanning services.
“How do they promote this? ‘You are 35 years old and you’re physically inactive,’ or ‘You are 35 years old and have just been diagnosed with mild hypertension,’” Schwitzer said. “This gets you to come in the door and, ka-ching, you’re a new health care patient.”
Two physicians to whom I referred Walsh – two docs who focus on evidence – not marketing – also weighed in with critical comments in the final story.
Based on what I saw in the Star Tribune’s video of Walsh’s story – presumably taped back on September 25 – I think we were seeing a reporter who was about to go in one direction with his story – possibly a more one-sided, “Look what they found in me…this makes sense for all my readers” story. But that didn’t happen with the final piece on October 7.
If I were Walsh’s editor, I would have changed some things:
- First of all, out of a long conversation I had with him, he used only one little quote which probably wasn’t the most important point I made with him. But I don’t want to be like many interviewees who second-guess interviewers. So I’ll stop there. He asked smart questions and appeared open-minded. I enjoyed our conversation.
- Second – actually this probably should have been first – I don’t like the idea of any reporter biting on a PR person’s offer of being scanned. I think that sets up a dangerous scenario of possible perceptions – even if subconscious – of expectations and obligations. Walsh, in the end, avoided much of this potential danger. But it could be argued that he crossed the line on at least three of the tenets of the Association of Health Care Journalists’ Statement of Principles (which I drafted and shepherded through to approval). Relevant excerpts of that Statement:
I disagree with one of Walsh’s blog posts and the statement on the hospital website referring to such scans as “simple” or the decision about having such scans being “simple enough.” There is and should not be anything simple about the decision to have such scans. The balancing perspectives Walsh finally included in his final Sunday piece made this clear. There are, indeed, harms that can arise from a so-called simple screening test. How a story ends often seems to reveal the reporter’s (or editor’s) editorial leaning. This story gave the hospital’s scan-promoting director of preventive cardiology the final word – “Whatever it takes to get people to start taking the initiative.” Many voices in health care would question the “whatever it takes” approach. Over and over, every day we are learning that in health care more is not always better, newer is not always better, screening doesn’t always make sense for everybody.
- Preserve a dispassionate relationship with sources, avoiding conflicts of interest, real or perceived.
- Remember that journalists face other potential conflicts of interest. Think about questions such as: Were you a patient at a particular hospital? Do you have a relative with a specific disease that could unduly influence your handling of a story? … It is the journalist’s responsibility to recognize these conflicts and prevent them from influencing stories or story choices.
- Deny favored treatment to advertisers and special interests and resist their pressure to influence news coverage. The argument would be that he had at least a perceived conflict by accepting the PR person’s offer, and that this could not be defined as a “dispassionate relationship” as a result. He reported on himself being a patient at a particular hospital and his own “diagnosis” became part of the handling of his story. He and/or the Star Tribune did not resist the hospital’s pressure to influence news coverage.
But I am pleased that Walsh called me. I think it made a difference in his final story – the one most people probably saw of the 3 items he published. It had important balancing perspectives. He and I talked about many other things in our long conversation – much of which I won’t write about. But I also pointed out to him that what happened in his case, with his own health history and family history, may not be relevant or applicable to many of his readers.
This is not easy stuff to get right. Journalists who cover such issues tend to get it right when they scrutinize evidence, seek independent perspectives, question the marketing promotional statements, and frame screening decisions as complex, individual matters that should take into account the tradeoffs between potential benefits and potential harms – with actual data. In the end, Walsh got closer to that ideal, and readers were better served by the questions that eventually made it into his coverage.