Again this week we turn to HealthNewsReview.org (HNR) to examine how well or poorly health science news has been communicated. This time, the study involved the association between the strength of someone’s grip and his or her risk for disease or death.
“This release about the ability of grip strength testing to predict death and disease rates leaves readers without enough context and ultimately overstates the importance of the findings,” the site concluded. “And although overall death rates are unquestionably an important outcome, …What use is that information and how would it affect how that person is cared for?”
Here are excerpts of the HNR analysis of the news release.
Why This Matters
“This release should have spent more time addressing how the study results might be applied,” according to HNR.
The Lancet publicists should know that news coverage feeds off “sexy” topics; they should know that if you don’t issue caveats about the limits of observational studies, which this was, you deliver an incomplete message to the public, because many news organizations simply rewrite releases, they don’t use them as an entrée to greater investigation.
The release did caution about interpreting the results, but it doesn’t make clear that this was an observational study, not a clinical study, although that distinction was clear in both the study write-up and an accompanying editorial. We’ve discussed the limits of observational studies versus those of more rigorous scientific inquiry.
Here are some headlines based on the release that illustrate the point that sexy news gets attention when context should have prevailed:
- “Palm ‘holds secrets of future health'”
- “Patients’ grip strengths reveal heart attack risk: study”
- “Why a weak handshake is bad news for your heart”
Does the story adequately discuss the costs of the intervention?
No. The release says that grip strength is low-cost, but a dynamometer (the instrument patients squeeze to determine strength) is not routinely used in clinical practice. There’s no cost estimate for the dynamometer, for administering the test in doctor’s office nor for how cost would vary depending on how many patients were given the test.
Does the story adequately quantify the benefits of the treatment/test/product/procedure?
No. The study identified a 7% to 17% increase in risk for the measured outcomes, but the release doesn’t say how important that really is. No absolute figures are given, only relative risks. Without context, readers have no way of knowing what the benefits of grip testing might be.
“It is also odd,” noted HNR, “that the headline and lead paragraph of the release highlighted heart attack and stroke, when the risk stratifications for those events were smaller than those for other outcomes.” (In medical decision-making, “risk stratification” means all the measures, such as lab and clinical tests, used to determine someone’s risk for suffering a condition and the need or lack of it for preventive intervention.)
Does the story adequately explain/quantify the harms of the intervention?
No. The release doesn’t explain how the test results might be used. If the intent is to point people identified as being at higher risk toward more testing or treatment, the release should have mentioned the risk of doing more harm through overtreatment.
Does the story seem to grasp the quality of the evidence?
No. The release should have included a clear statement that this observational study cannot say whether poor grip strength itself predisposes a person to health problems or is merely a result of factors otherwise known to contribute to health problems.
The journal itself fulfilled that need: “The observational nature of this study does not allow us to make strong conclusions on the causal role of muscular strength in death or cardiovascular disease,” it said. “Although we adjusted for many potential confounders, we cannot exclude the possibility that residual confounding underlies the associations between grip strength and these outcomes.” The accompanying editorial also described the limitations of observational studies.
“Journal news releases could do a great deal to help educate journalists and the public about the value of, and the limitations of, such research,” HNR said.
Yes, sort of. The outcomes noted in the release (overall death rates, cardiovascular disease), are important in terms of improving clinical practice. But introducing the concept of hand grip strength as a “new biomarker of aging” invites the perception of aging as a type of disease that requires better tools to diagnose and/or monitor.
Does the news release identify funding sources and disclose conflicts of interest?
Not really. It doesn’t appear that any conflicts were hidden, but, said HNR, “all news releases should routinely report a summary of funding sources and disclosures.”
The journal article, per scientific standard, reports funding sources for the study and lead authors. No competing interests are reported. The company that makes the dynamometer used doesn’t seem to have had a role in the study. Even so, news releases routinely should mention funding and disclosures by researchers.
Does the story compare the new approach with existing alternatives?
No. The release said that grip strength results are a stronger predictor of death than systolic blood pressure. But what about the most common ways clinicians assess patients’ health risks? “Call us picky,” HNR commented, “but we can easily recall widespread news coverage of whether wrinkles in your earlobes can predict heart attack risk. So we don’t think it’s unreasonable to expect some reference to an enduring, well-supported alternative to the risk predictor of the day.”
Does the story establish the availability of the treatment/test/product/procedure?
Yes. The release indicates that the type of dynamometer used to assess grip strength in this study is widely available, but a clearer statement about availability, especially in low-income countries, would have improved its message.
Does the story establish the true novelty of the approach?
Yes. The release said that the association between grip strength and health risks had been documented in high-income countries, and that a key feature of this study was the inclusion of people from low- and middle-income countries.
Does the news release include unjustifiable, sensational language, including in the quotes of researchers?
Yes, although it’s a close call. The tone of the release generally is measured, but its headline suggests that hand grip strength is “simple” and “low cost.” Neither has been proved in widespread clinical practice. It takes training to use the dynamometer and interpret the results correctly. And it’s unclear how accurate the test is or if it’ll lead to additional, unnecessary tests or treatments.
Although we agree with HealthNewsReview’s displeasure with the publicity by the Lancet to promote its study, we also believe that it is the media’s obligation to probe science news; if a publicist gets your attention with a less-than-objective approach, that doesn’t excuse you from doing the due diligence required to render a news story, not a rebranded news release.