History, context, costs, evidence – all were covered in this story. But the reporter also introduces the nagging question of whether “true believer” physicians will ignore the findings.
Embolic stroke can have devastating consequences for the patient and family. Many have assumed that aggressive management, including clot retrieval was important to improving outcomes. The three studies now put this assumption into serious question. While there are flaws in the studies, the totality of the results strongly suggest that endovascular retrieval does not provide additional benefits to the patient outcome. Long awaited comparative trials. A federal agency spent $27 million on one of the studies alone. Surprising findings. And now the hint that the findings may be ignored. This was an excellent piece of journalism.
Nice job on this. The story reported:
“Insurance companies and Medicare, the health insurer for the elderly, already cover the endovascular procedure. It costs about $23,000 compared with $11,000 for acute stroke treatment using intravenous clot-dissolving drugs, known as thrombolytics.”
“Will it change practice? That’s a good question,” said Koroshetz. “The payers may look at this and wonder if they should continue paying for these procedures. If it gets to that point, then clearly things will change.”
“mechanically removing a blood clot from a stroke patient’s brain is no more useful than the older treatment of giving an IV dose of a clot-dissolving drug to the whole body.”
Absolute numbers provided later. Another strong point in the story.
The only mention of harm was this:
“many practitioners think that newer clot-retrieving devices work better than the ones used in the three trials. Because endovascular procedures were shown to be no more dangerous than IV thrombolytics, physicians may continue to perform them and assume the outcomes can only get better.”
Since no benefit was seen with the invasive clot retrieving devices, we would have liked to have seen some additional information on the adverse events directly related to the placement of the device.
Another strong point of the story. We especially appreciate this context:
“The three trials demonstrated how hard it is to test things once they’re in widespread use. History is replete with treatments …used routinely before being shown to be harmful or of little value.
It took from 2004 to 2011 for the MR RESCUE team to recruit the 118 patients in the trial. It had permission to run the study in 30 hospitals but found only 22 that were willing to participate. More than 10 other hospitals were invited to join but declined because their neurologists were already convinced the catheter treatment was better — a view that turns out not to be true.”
There was no disease mongering noted in the story.
The deputy director of the National Institute of Neurological Disorders and Stroke provided some perspective, plus the reporter worked to include statements from investigators from each of the three trials and we credit that effort as satisfactory.
The entire story was based on the studies’ comparison of alternative approaches.
Beyond establishing general availability of the different approaches. the story provided this important big picture context: “The three trials demonstrated how hard it is to test things once they’re in widespread use.”
The novelty of the finding was made clear in the story.
It’s clear that the story did not rely on a news release.