Author + information
- Carl J. Pepine, MD, MACC, President, American College of Cardiology* ()
- ↵*Send correspondence to:
Carl J. Pepine, MD, MACC, Professor and Chief, Division of Cardiovascular Medicine, University of Florida College of Medicine, Box 100277, 1600 Archer Road, Gainesville, Florida 32610-0277, USA.
Last fall, a flurry of news stories highlighted an advisory from the U.S. Food and Drug Administration (FDA) concerning a new type of coronary stent and related reports of subsequent blood clots and deaths. Some newspapers ran sensational, doomsday headlines such as “Heart Stent Linked to 60 Deaths.”
Unfortunately, it is true that a small percentage of patients who receive a stent will die regardless of whether the device used is a standard stent or one of the new drug-eluting stents. Of course, we also know that many of those patients with coronary artery disease (CAD) who are candidates for stents will die from the disease whether or not they receive a stent. A somewhat larger group of patients, but still a relatively small percentage overall, will develop thrombus at the site of the stent regardless of the type of stent used. To its credit, in the case of the FDA advisory, the agency was ensuring that cardiologists using the new drug-eluting stent—which has been in broad use only since last April—are alert to such problems and that they do not fail to report them.
My concern, however, is how our patients and their families may react to media reports that sensationalize details about deaths linked to an important new treatment for CAD. As soon as I saw the first report on the advisory, I knew it would cause a great deal of anxiety among the hundreds of thousands of patients in the U.S. who have received anykind of stent. Indeed, many of my patients brought this up at subsequent office visits.
Patients and physicians alike regularly see news reports about the latest advances in a daunting array of treatments for many illnesses, as well as the potential downfalls or shortcomings of many treatments. It is a lot for our patients to digest and, more difficult still, to keep in the proper perspective, given chance occurrence, personal differentiations, and many other yet-to-be-defined variables.
An article published recently in a popular financial magazine, for example, included reports about a few patients who experienced severe neurological problems during a period when they took one of six statins. In most cases, the article relied on anecdotal evidence and some other significantly limited reports, but it devoted only a few sentences to the proven safety and efficacy of these drugs and the millions who benefit from their use. Nevertheless, without presenting any of the usual evidence-based data upon which we physicians rely, this article linked the statins to rare neurological problems. I am certain that some—perhaps many—patients read the article and immediately stopped taking their statins. How many others will refuse these drugs as a result of this article? I do not know, but I fear many are likely to deny themselves the opportunity to benefit from a statin.
In my experience, clearly, the best situation is for patients to be educated about their conditions and to take active roles in their treatment—a process in which the media play a role. Many news dailies and radio/television broadcasts, of course, provide consistently good coverage of medical issues, and they aid their readers and viewers in helping themselves via questions and answers, online chats about common health problems, and excellent columns on personal fitness. But, unfortunately, many others are not as objective, thorough, or useful.
That said, I urge all of you to carefully consider the medical news that you read and hear in the general media, and rather than simply dismissing the report because you know it is wrong, try to consider it from the perspective of your patients. Then pre-empt their possible concerns, which often are not voiced directly to us. Suggest that they analyze news reports the same way you do: with a healthy dose of skepticism, which is the same way some reporters write their stories about medical breakthroughs, new devices, and interventions. Advise your patients to check whether a medical news story refers to a large group of patients affected by a particular problem, or just a subset. Is the cited evidence from a large, randomized clinical trial designed to elucidate the findings being reported? Ask your patients to look for information on the risk-benefit relationship and the overall value of a new treatment. For example, they will understand that a treatment that saves 10 lives and prevents 10 heart attacks or strokes for every 100 patients treated, but is associated with one serious adverse effect in every 1,000,000 patients treated, has overall benefit. If such a treatment reduces the need for future hospitalization and additional testing, they also will understand that the treatment has value. If they do not, you may need to emphasize that it is a very strong benefit in exchange for an acceptable risk—a benefit that they should consider carefully and try to recognize.
Most importantly, urge your patients to discuss with you any reports they believe may have implications for their own treatment or care, particularly before changing their course of medication, diet, or exercise. Let your patients know that for the best effect, they need to work with you as a team. Be sure that your patients have access to all of the information they need about their current treatment and its goals, expected side effects, and other options available to them. Also, consider contacting your patients when news appears about therapies relevant to their condition to discuss the issue with them. You might send a letter, which could perhaps forestall a patient's lack of compliance with medications for fear of the unknown. Alternatively, plan to bring it up at the patient's next visit. Explain to patients why snap judgments on their part, based on a single news report, may create self-defeating situations for them.
Here is an excellent example. A few short weeks after its initial advisory on stents, the FDA issued another notice on the drug-eluting stent that had been linked to deaths as mentioned in the media. Based on its review of the available data, the agency stated: “it appears that the rate of thrombosis is within the expected rate for any stent.” Media coverage of this follow-up advisory, unfortunately, was mostly limited to only a brief paragraph, often as part of a roundup of health or business news. There were no banner headlines to catch anyone's attention.
Encourage your patients to be inquisitive and to get individualized answers to their questions—from you, not from the newspapers, on topics of importance to their health. You will build firmer trust into your relationships with patients, and they will experience greater confidence in you, their cardiologist.
And when reporters, editors, broadcasters, or other media types get it wrong, please help set the record straight. Write letters to the editor and/or call the news director of your local television station. You have a better-than-fair chance of being listened to and gaining space in the newssheet or time on the air to correct facts, clarify gray areas, or otherwise shift the perspective to one of greater insight, perhaps wisdom.
- American College of Cardiology Foundation