Health News Review

“Under the glare of an operating theatre lamp….”

Here it comes:  another drooling, fawning news story about robotic surgery – this time from The Guardian in the UK under the headline, “Newcastle hospital’s £2m robot transforms medical operations.”

It was surprising to see how unquestioning the story was.

The subheadline: “Dexterity of Da Vinci robot allows surgeons to operate with more precision and remove cancerous tissue that is hard to reach.”

Yes, but are the outcomes any better?

From the story: “The robot is already used for heart bypass operations and to remove cancers throughout the body, including those in the lungs, throat, prostate, bladder, spleen and colon. The next specialty to adopt the robot surgeon will be gynaecology later this year.”

Yes, and where are the data for those procedures?

“Cancer operations seem to be more successful, because surgeons can see tumours better and remove tissue more easily.”

Seem to be more successful? How are readers or patients supposed to judge what that means?

The UK has several dozen robotic surgery systems; the US has probably 1,500.  So we’re more accustomed to the hype.  And we have more experience from which to raise more questions.  Some of these are captured in the search results of things we’ve written about the robotic systems in the past.

Meantime, a paper published in the journal Surgical Innovation – “The impact of marketing language on patient preference for robot-assisted surgery” – describes a little experiment.  38 patients were asked to make two treatment decisions between robotic surgery and conventional laparoscopic surgery. One time, the robotic procedure was described as a “state-of-the-art, innovative new technology” – the marketing frame.  The other time it was termed a “promising new technology, which has not been used extensively and with research regarding its safety and effectiveness ongoing” – the evidence-based frame.  The methodology used is more thoroughly explained in the paper.

The results?  No surprise:

  • With the marketing frame, 20 of 38 chose the robotic approach.  Of those, 12 switched to conventional laparoscopy when the evidence-based frame was used.
  • 17 of 18 who chose conventional laparoscopy in the marketing frame made the same choice when the evidence-based frame was used.
  • Among the 13 patients who made discordant treatment decisions under opposing frames, the robotic approach was significantly more likely to be chosen under the marketing frame.

The researchers conclude:

“Our findings suggest that marketing strategies unrelated to the presentation of potential risks and benefits of a surgical technology may influence patient preference…This effect may be contributing to rising trends in the number of robot-assisted surgery procedures performed.”

They point out that “the evidence in favor of robot-assisted surgery is controversial” and “Robotic surgical systems typically cost between $1 million and $2.5 million, with $100, 000 to $200,000 in annual maintenance fees.”

Take home message:  “When patients are confronted with decisions regarding their care, they have a number of resources available to them.  Some of these resources misrepresent evidence relating to risk and benefits.”

As we’ve pointed out many times on this blog, it’s not only marketing messages that misrepresent the evidence.  Sometimes it’s also the supposedly independently-vetted news stories that misrepresent – or totally ignore – the evidence.  And that’s a tragic abdication of journalistic responsibility.

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