HealthNewsReview.org | Independent Expert Reviews of News Stories | Holding Health and Medical Journalism Accountable |
|
|
The Cutting Edge: Robotic Surgery, Today!
May 05, 2009
A few minutes of techno-tainment with inexcusable, almost inconceivable lapses in journalistic hygiene. No discussion of cost, of evidence for benefits or harms, and no independent insight.
Our Review Summary
Let's start by saying there is nothing inherently wrong with a gee-whiz TV segment that does a live demo of cool new medical technologies. In a perfect world the segment would be coherent and would feel apropos of something, but even that is not essential.
Television is an ideal medium for this kind of demonstration.
The problem is that when they put the segment together, the producers disposed of fundamental journalistic practices as efficiently as the daVinci Si HD bags up old organs to throw them away.
Even if we accept that this piece is nothing more than a few minutes of techno-tainment, it still has inexcusable, almost inconceivable lapses in journalistic hygiene.
- It does not say how much these technologies and treatments cost
- It doesn't say whether any independent research has been done to verify the claims of benefits
- It does not mention risks
- It fails to explore what treatment options patients have, beyond assuming they are inferior
- It doesn't seek opinion from anyone who can provide insight about whether and how these things improve care, if at all
Yes, it is wonderful, even inspiring to see a doctor peel a grape and thread a needle with these tools. It's great entertainment and eye-opening. [See the video in order to appreciate how fun and fascinating the demo is. The transcript does not do justice to how engaging the segment is.]
But as journalists, the producers were simply asleep at the switch. One hopes this would not be the case for the medical professionals who use these technologies on patients.
Click on Criteria for definitions.
Several technologies are mentioned in this segment.
Navel surgery is presented as cutting-edge--the patient is said to have "ma[d]e medical history" as the ninth to have his prostate removed via his navel. Yet the piece says surgeons are also using the technique to perform a variety of surgeries, including hysterectomies and removal of lymph nodes. In either case, the piece doesn't say where navel surgeries are being done.
The story reports that 930 daVinci surgical robots are in use around the country, but that's a census of mostly the old da Vinci machines, not the featured daVinci Si HD Surgical Systems, with the newer, finer controls and optics. This machine was introduced in April. It is not clear where these newer models are in use.
It is reported that voice-activated robot assistants are being developed at Georgia Tech and Emory University, and it's clear on the video that the devices are not yet on the market.
The story makes no mention of how much all of this equipment costs, or how much it adds to the price of medical treatment.
This is a serious--and baffling--omission. The gee-whizness of the story almost immediately begs the question of how much all of this stuff costs. Not a word is mentioned.
The established daVinci models cost about $1.5 million. The price of the new Si HD has not been published yet. It is certainly higher than $1.5 million.
Analyses have been done that suggest that because surgeries done with daVincis generally produce fewer complications and shorter hospital stays, the devices actually result in lower total costs. This may be true. But again, the story should have mentioned costs.
The anecdote at the beginning highlights a prostate cancer patient, who emotionally discusses his desire to live for his family and friends. Yet his case says nothing about the type of surgery he had, trans-navel, and whether that might improve his prognosis. There is no evidence it will.
This is therefore a clear case of disease-mongering--using an irrelevant anecdote for nothing more than generating emotions to make the technology seem necessary.
The piece at various points says the robot-assisted procedures reduce pain and recovery time and allow previously inaccessible levels of control over minute movements. The segment vividly demonstrates how the device can be used to thread a needle and peel a grape. This all appears to oversell the benefits, another form of disease-mongering.
And the host at one point suggests the robotic surgery tools could "make human hands a quaint artifact of the past"--a statement that makes accuracy and plausibility look like quaint artifacts too.
The story presents no evidence that the techniques and technologies profiled are safe or effective.
The piece is silent on the potential harms of robot-assisted surgery, which include misapplication [as hospitals that have invested in it seek to use it as much as possible] and exposure to inexperienced users [because this surgery has a learning curve of a reported 18 procedures].
The piece discusses the advantages of belly-button laparopscopic surgery but does not discuss any risks.
Being the 9th person in the world to undergo a procedure is not necessarily a good thing.
The new generation of daVinci surgery robots was just introduced in April, so it's safe to call that novel.
Surgery through the navel is not widely practiced yet, and the piece is reasonably clear on this. It would have been useful to explain that laparoscopic surgery--through the navel or not, or with a robot or not--is standard practice for many types of surgery.
The life-assistant robots mentioned briefly at the end are clearly just in development.
The story does not attempt to quantify the benefits of any of the procedures discussed. Yet it allows interested sources to claim the benefits of better outcomes and fewer side effects.
We can't be sure what motivated ABC to devote so much airtime to this segment at this time.
Sources include:
- A patient whose story is used to generate emotion, not illustrate the value of doing surgery through the navel
- A physician who does and supports belly button surgery
- A physician and daVinci power user who has been conducting research on robot-assisted laparoscopic surgery for many years
- A patient and expert on robotic life-assistance devices, neither identified
There is nothing like balance or context in sourcing here.
The segment refers to laparoscopic surgery not done through the navel, and surgery not assisted by a robot, only to assert their inferiority.
Total Score: 1 of 9 Satisfactory
The U.S. Preventive Services Task Force is considered the gold standard of preventive health recommendations - including on screening tests. It's a good source for journalists and consumers.
About 70% of the stories reviewed from 2006-9 failed to adequately discuss costs, or to explain how big (or small) are the potential benefits and harms of treatments, tests, products and procedures.
We have documented a disturbing trend of news stories taking an advocacy stance, promoting certain screening tests outside the boundaries of scientific evidence.
Stories on new technologies like Cyberknife, DaVinci robotic surgery systems, and proton beam cancer therapy often fail to scrutinize the evidence and/or to discuss the costs involved.
Rather than suggesting that everyone should be screened for everything, news stories could explain: "All screening tests cause harm; some may do good."
The first 38 network TV network morning health news stories reviewed in 2009 earned an average score of 1.2 stars. 13 of the 38 stories got ZERO stars.
Both TIME magazine and BusinessWeek have published terrific stories explaining the importance of the Number Needed to Treat - or NNT.
Knowing relative risk reduction is like knowing you have a 50% off coupon but not knowing whether it's for a Lexus or a lollipop. Absolute risk reduction tells you what the "coupon" is worth. Read more.
The website NoFreeLunch.org posts "a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information."
To help journalists cover stories responsibly, we post a list of independent experts who state that they do not have financial ties to drug or medical device manufacturers.
We apply the same ten standardized criteria to the review of every story.
We have about 30 story reviewers. Each story is reviewed by 3 different people.
Gary Schwitzer's seven words you shouldn't use in medical news: cure, miracle, breakthrough, promising, dramatic, hope, victim. Read why.
Our reviewers include two former CNN medical reporters and a former editor of the Washington Post health section.