Washington Post’s story on platelet-rich plasma injections highlights drawbacks of first-person health reporting

Joy Victory is deputy managing editor of HealthNewsReview.org. She tweets as @thejoyvictory.

Earlier this week, an intriguing headline from The Washington Post popped across our news feeds here at HealthNewsReview.org: “I’ll never go through shoulder surgery again, so here’s what I did.”

The story recounts the author’s experience seeking treatment for her shoulder pain. She rejects rotator-cuff surgery in lieu of an experimental injection that contained platelet-rich plasma, or PRP, which, as the story explains, “uses the body’s natural healing properties to mend injuries.”

The first-person format immediately got our feelers up, because personal medical stories like these–written by established journalists–walk a fine line between opinion and journalism. In this case we were further worried by this emphatic, opinionated statement made early on in the story:

“Its practitioners believe [PRP] will transform orthopedics. Based on my experience with it, I think they are right,” she says.

USA online websitesThat kind of sensational statement is just the beginning of the problems with the piece, which is a case study in how not to write about a personal experience with an intervention, especially one as controversial as PRP.

“Readers and journalists need always be wary of first-person, personal-experience-driven articles,” explains Joann Rodgers, a HealthNewsReview.org contributor and medical research communications expert. “In this case, it’s caveat emptor for the reader, but the journalist has serious responsibilities which were filled only partially.”

We reviewed the story using our 10 systematic criteria, but we also wanted to take a deeper look at what the story should have included to make it accurate, balanced and complete, fulfilling the responsibilities Rodgers refers to:

The challenge of ‘choice-supportive bias’

One of the hazards of reporting on personal medical experience is the issue of choice-supportive bias, explains Andrew Holtz, a former CNN medical correspondent and president of the Association of Health Care Journalists and long-time contributor to HealthNewsReview.org.

“Anyone who makes a big decision like this is susceptible to having their judgment swayed by the normal human tendency to have memory and facts distorted by a need to believe that they didn’t make a mistake,” he said.

It’s always important for reporters to use skeptical inquiry, but especially if they’re including their own personal story and likely grappling–knowingly or unknowingly–with choice-supportive bias.

One way to counteract this? Interview several independent experts who have no vested interest in the intervention you’re writing about.

Seeking independent viewpoints is a must

“The piece needed more third-party experts without skin in the game (e.g. any physiologist not involved in sports medicine to talk about whether or how PRP might really work) and physicians who were less enthusiastic about the ‘potential’ of an unproven treatment,” Rodgers said.

Holtz agreed, calling a lack of independent sources akin to journalistic malpractice. “This story plays into the marketing strategy of the clinic she went to,” he said. And in fact, the story is already posted on the doctor’s web site.

What does the evidence say?

Readers deserve a robust, accurate discussion of the state of the evidence on PRP. But the story makes it sound like only one small study has been conducted–and the author implies the lack of interest is because there’s no financial interest in PRP since it’s not a new drug or device.

PRP involves placing blood in a centrifuge to separate the cells.

PRP involves placing blood in a centrifuge to separate the cells. “We were able to pool results from six studies and found no differences in long-term function between those who received PRT during rotator cuff surgery and those who did not,” a Cochrane review noted.

“Although Big Pharma has more than earned its status as a villain in our healthcare system, this story’s use of the industry as a whipping boy is ‘off,’” Rodgers said. Especially because the author offers no evidence for the claim she makes about pharma’s lack of interest, she said.

Also, far more research has been done on PRP than the story leads us to believe, notes Mark Schoene, a HealthNewsReview contributor and editor of The BackLetter, an international newsletter on spine research and evidence-based back care.

The story only mentions one “pilot study” of 7 patients, and the need for more research with larger patient groups. However, as a 2014 Cochrane systematic review points out, 19 studies have been done, and six were related specifically to rotator-cuff tears like the author experienced.

The Cochrane review found the evidence overall to be inconclusive and of low quality. Had the author noted that at all–especially near the beginning of the story–Schoene said he would have been more comfortable with the author’s personal tale being included.

“And [if the author stated] that her attempt to resolve her shoulder pain with PRP was just an experiment—an attempt to find a benefit in the absence of clear scientific evidence,” he added.

Dr. Steven J. Atlas, a physician, health services researcher and HealthNewsReview.org contributor, agrees.

“I find journalists using their personal experience as a guide for their readers to be very problematic,” he said. “When used as an example when discussing the evidence more dispassionately, it seems reasonable. I don’t think that was done here.”

How to do it differently

Last year, we reviewed a New York Times first-person account of insomnia therapy.

Using his own story as a jumping off point, the author looks at the evidence on insomnia treatments, and the data dive becomes part of the narrative:

“Before I reached for the pills, I looked at the data. Specifically, for evidence-based guidance, I turned to comparative effectiveness research. That’s the study of the effects of one therapy against another therapy. This kind of head-to-head evaluation offers ideal data to help patients and clinicians make informed treatment decisions.”

While the story would have been stronger with an outside perspective, our reviewers noted that the robust discussion of evidence paired with the author’s narrative made it “a very helpful and readable overview of the evidence on insomnia treatments.”

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