Wednesday, 14 February 2007

BBC 'didn't spin' beard grows longer

The BBC replied to my complaint:

" Many thanks for your message, and interest in the site.

I am sorry that you were upset by this story.

The research was published in a respected peer-reviewed journal,
published by the British Medical Journal group, and as such I feel it is
valid to bring this to the public's attention.

I think the point about treating older patients differently for valid
reasons is covered by the following section:

"The doctors said their reasons for treating patients differently were
to do with the patients' wishes, potential complications and the frailty
of the individual concerned.

One doctor said: "I think generally you have to try and identify from an
individual what is in their best interests.

"I don't think bypass surgery in an 87-year-old is in their interests."

Also Vivienne Nathanson, from the BMA, is quoted in similar vein.

In addition, the researchers have suggested that even taking these
issues into account there is a problem.

For those reasons I do not accept that this story has been spun at all -
it is an accurate reflection of the paper.

Kind regards,"

I will keep this pretty factual. The research is:

Which doctors are influenced by a patient’s age? A multi-method study of angina treatment in general practice, cardiology and gerontology
C. Harries, D. Forrest, N. Harvey, A. McClelland, and A. Bowling
Qual Saf Health Care 16: 23-27

To quote this journal piece in its entire discussion and conclusion:

"Conclusions: Age, independent of comorbidity, presentation and patients’ wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences."


"These results replicate national and international case and survey research showing that elderly people receive different clinical management. They were less likely to be referred to a cardiologist, to be given angiograms, exercise tolerance tests, or revascularisation, than middle-aged patients. The study revealed that these differences reflect the independent influence of patient age on decision-making. Half the doctors in all three specialties treated the patients aged 65 and over with chest pain differently from those aged under 65, regardless of comorbidity or presentation. Each was influenced on one or two decisions. Those doctors who were influenced by patient age tended to be older than others. Those GPs and care of the elderly physicians who were less likely to refer elderly patients to a cardiologist were more likely to use alternative management strategies for them. Cardiologists who were less likely to provide a particular treatment for elderly patients were also less likely to provide other treatments for them. Examination of the reasoning behind decision-making suggests that age may be directly influential, indirectly influential, or may be used as a proxy for patients’ wishes and other age covariates.

International research, based on actual patients, shows that older people are less likely than younger people to receive indicated cardiological treatments. Our research shows that age is indeed a factor that drives these differences, but that reasoning about old age is rarely distinguished from reasoning about its clinically relevant covariates. Interventions are needed to address clinicians’ reasoning about patients of different ages at each step in patient management."

You can draw your own conclusions as to whether to agree with the BBC that they weren't sensationalist or using spin!

The BBC sums it up as "
Doctors 'deny elderly treatments'" and "Doctors deny older people treatments they would offer younger patients, according to a study." I quote from the horse's mouth here.

However there seems to be a large amount of grey and the actual scientific research openly states that it is hard to unravel the factors involved and that "
Examination of the reasoning
behind decision-making suggests that age may be directly influential, indirectly influential, or may be used as a proxy for patients’ wishes and other age covariates."; to me it seems that this is a very complicated topic indeed and the way the complicated issues were summed up by the BBC can only be described as 'sensationalist' and 'using spin'.

Indeed many of the doctors seemed to be taking the patient's wishes into account when making their decision- shock horror I know- couldn't the BBC sum it up us "Doctors care for patients- shock horrror!".

Overall a slightly dubious and very debatable piece of research with conclusions that were far from conclusive, has been summed up in a very sensationalist and deeply unfair manner.

Looking at the research out there, it is clear that elderly patients can benefit from intervention when appropriate. However the attitude of the BBC in denying that elderly patients have different wishes and attitudes, is somewhat unfair to the majority of doctors who try very hard to make the best of very tricky situations. Not that the BBC wanted to stop there, they wanted to introduce that politically correct term 'ageism' into the argument to stir up our emotions. Thanks to the Beeb, for their objective and balanced journalism.

post scriptum addition:

Given that the authors of the above journal article are so keen to claim that age should be ignored as an independent factor, and it should not be used to guide decisions. I would like to point out that this is a highly controversial area and that several studies have shown age is an independent risk factor:
( very relevant in cardiac surgery! )
( hip surgery )
(ageing as an independent risk factor in surgery)
(in cardiac surgery again)
(again in cardiac surgery)
(in coronary intervention)
(coronary intervention)
(coronary intervention again)
(PCI again!)
(coronary intervention)
(coronery intervention)
(coronary again)

I rest my case!

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