Perhaps, even free isn’t worth the price

Tuesday’s free Medscape CME course for doctors and nurses reviewed the latest INTERHEART data dredge. As covered here, it was a null study, finding no tenable link between diet and first heart attacks. Healthcare professionals, however, were given a different interpretation of the study:

“Western Diet Increases MI Risk Worldwide.”

The Medscape CME course* for healthcare professionals was a reprint of an article published at Heartwire, a WebMD news publication for cardiology professionals. The article was written by Lisa Nainggolan. For the free 0.25 continuing education credit, doctors and nurses then answered two multiple-choice questions.

According to the text of the course, the study found “that those who consumed the prudent diet had a 30% lower risk of heart attack compared with people who ate little or no fruits and vegetables, those who ate a ‘Western’ diet had a 35% greater risk of MI [myocardial infarction]…”

Rather than an objective, informed, and critical examination of the science — describing the study’s methodological weaknesses and the significance of this correlation — the bulk of the article was devoted to giving untenable odds ratios causal roles and then as turning them into preventive health interventions and forming the basis for recommending public policy changes.

INTERHEART co-author Dr. Sonia Anand, M.D., who teaches clinical epidemiology courses in methodology and cardiovascular disease at McMaster University in Canada, told Heartwire:

“We hope [the results of our study] will allow policy makers to try to think of creative ways of making the good foods more easily accessible and affordable and the bad foods less accessible and maybe not as affordable… Because the greatest gains in changing what people eat — by country, by region, and by community — will come from those policy-level changes. It's pretty easy: the more bad things you eat and the less of the good things, the higher your risk of MI. From a public-health perspective, having a simple message is very important.”

Medscape told medical professionals: “Simply put, an unhealthy diet, as assessed by a straightforward dietary risk score, increases the risk of AMI [acute myocardial infarction (heart attack)] significantly, whereas consumption of a prudent diet is associated with lower risk… and the population-attributable risk for AMI worldwide associated with poor dietary intake is substantial.” Dr. Anand concluded by saying:

When I think of my own training — which was fairly recent — there was very little information on nutrition or dietary advice. So you come out as a specialist who can treat a patient with a heart attack, but when it comes to prevention, there is not much training. I believe physicians will welcome this advice. If the family doctor and other specialists embrace a holistic but simple approach, this could lead to a reduction in heart attacks and is very consistent with cancer-prevention guidelines. And I think the results are broadly applicable to the population at large.

It’s difficult to know if cardiology specialists really are welcoming such vapid continuing medical education that’s indistinguishable from a press release read by any local television reporter. Their heart attack patients laying in cardiac intensive care units probably hope they aren’t, and that their doctors are, instead, staying abreast of the latest science.

* The disclosure statements of the INTERHEART study were not shared with Medscape readers, the CME author was listed as reporting no conflicts of interest.