Fact Check: NY Times Heart Disease Series Gets It Right– Mostly 1

In my opinion Gina Kolata, who writes for the New York Times, is the most extravagantly talented and gifted  health and science reporter working today. Her virtues are abundantly evident in Mending Hearts, a four-part series about several major developments and controversies involving the treatment of heart disease. You should read it right away. You’ll learn a lot. But be careful, because also abundantly evident are Kolata’s flaws.

For instance, here’s what she writes in the first story, about efforts to speed heart attack treatment:

Disparities that used to exist, with African-Americans, Hispanics and older people facing the slowest treatment times, have disappeared, Dr. Harlan Krumholz, a cardiologist at Yale, and his colleagues said in a paper in Archives of Internal Medicine.

But here’s what the Archives paper actually says:

Our analysis suggests that racial disparities in D2B times have significantly narrowed over time and that improving national quality of care appears to have not only improved overall performance but also diminished disparities.

Disparities that “have significantly narrowed” have not, obviously, “disappeared.” This is consistent with Kolata’s history, in which she takes a good fact-based story and transforms it into a great made-up story. (Most famously, Kolata did this in 1998 when she quoted James Watson— a quote which he later denied— predicting that researcher Judah Folkman was “going to cure cancer in two years.”) To be clear: this is only a minor point in an otherwise excellent story, but it would be unfortunate if readers of the story came away with the impression that treatment disparities are no longer a problem.

Even more disturbing problems crop up in her article on stents. Kolata claims that the 2007 COURAGE trial, which compared stents to optimal medical therapy, had little impact on medical practice:

Because of the doubts about that study and ingrained habits, medical practice was largely unchanged by its findings.

But this is simply wrong, and it is wrong about a key moment in recent medical history. Although COURAGE did not immediately change practice in a big way, it did provoke a great deal of heated discussion and soul-searching, and its overall effect has been long-lasting and profound. The principal investigator of COURAGE, William Boden, estimates that stent volume declined by about 20-25% from its pre-COURAGE peak in the mid 2000s. Quite simply, the trial ended an era of stent mania, and initiated in its place a medical culture much more likely to question unbridled enthusiasm for new drugs or devices.

In the same article on stents Kolata also makes a really basic error concerning patients with known heart disease. About one such patient she writes:

Like most heart patients, he had never taken the most important drug for those with his condition: a statin.

This is simply wrong. The vast majority of these patients– as many as 95%, according to one expert, Roger Blumenthal– are prescribed statins (if they are not already taking them) when they are diagnosed with heart disease. (Over time many discontinue the drugs but that is another issue entirely.)

I want to conclude with a discussion about a different sort of flaw in the first article on heart attack treatments. But first let’s be clear about its virtues. Kolata explains with illuminating details and quotes the behind-the-scenes efforts to shorten treatment times for heart attacks. In the past this story has been reported in only the most superficial manner. I’m sure many cardiologists and full-time observers of the scene like myself learned a great deal from this story. So Kolata deserves full credit for that.

But it’s also clear that Kolata fails to provide some important context for this story. For one, the article doesn’t touch on an even bigger and more intractable problem relating to the delivery of heart attack treatments: patient delays before seeking treatment. These delays are quite common. A short treatment time in the hospital won’t mean much if the patient waits several hours before calling 911 or showing up at the door. Knowing about this doesn’t diminish the significance of the achievement of reducing physician-related treatment delays as fully reported by Kolata, but it does add a wider perspective.

Similarly, Kolata writes that these reductions in treatment delay appear to have played a role in a 38% decline in deaths from heart disease over the past decade. But, again, she fails to place this decline in a larger context. The fact is that cardiovascular disease overall has been declining for more than 50 years. According to the CDC, heart disease deaths declined by 68% between 1960 and 2009, from 559 to 180 deaths per 100,000 people.  The precise reasons for the decline are unclear, though undoubtedly they involve broad lifestyle trends as well as major developments in the prevention and treatment of heart disease. Kolata’s readers would have benefited from knowing about this broader perspective.

So by all means go ahead and read the Kolata series. It’s good, really good. But it could be better.








One comment

  1. Regarding the first example, what we reported was “Over the study period, the difference in median D2B time between races narrowed from 18 minutes in 2004-2005 to 7 minutes in 2007-2008.” We demonstrated that improvement was progressing faster for black patients than for white patients. The trends were on the way to eliminating the disparity that we described in a JAMA article and were even longer in 1999-2002. The large disparities disappeared though by 2008 the disparities were smaller – it is worth checking but I expect that the disparities are even smaller now – or have disappeared completely. Larry is eager to blame Gina, but put this one on me. I would rather have seen Larry celebrate the achievement – talk about how remarkable it was – give kudos for Gina for shining a light on a remarkable improvement in medicine that occurred in the absence of any financial incentive and required the contributions of thousands of hospitals and tens of thousands of people. The temptation to criticize from the sidelines rather than applaud is common, but unfortunate. Would have been nice if Larry had written about D2B and gotten the same exposure to something good in medicine. But he didn’t. And I apologize to the readers if I suggested it I was not clear enough that the large disparity disappeared – even as, by 2008, there persisted a difference – and I could have been clearer that the disparity was on track then to be eliminated and we have made much progress overall since then.

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