Health News Review

An incomplete and overly optimistic story about a new and potentially useful treatment option. While it gets a 3-star score, it failed on our most important criteria.

Our Review Summary

This was a story originally published in The (Nashville) Tennessean newspaper and, for some reason, republished on the USA Today website. The story did not provide any semblance of balance in its reporting of the device.


Why This Matters

Depression is a chronic condition that waxes and wanes in its intensity.  Although clinicians have a myriad of drugs available and newer approaches to the treatment of resistant depression, new treatments are welcomed.  Transcranial magnetic stimulation is a novel and FDA-approved approach that is likely to benefit a segment of the population with depression.  We think that stories on new medical devices need to be balanced and need to provide the reader with the correct context in which the device might be useful.


Criteria

Satisfactory

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story provides the reader with information on the cost so it meets the criterion.  We would have liked a bit more information.  For example, how durable is the response and will patients need repeated treatments? Based on the literature to date, patients may need to undergo treatment every 2-3 months.  We are told that each treatment costs about $400 and the total cost is $8-12,000.  That means each patients receives 20-30 treatments.  There are ancillary costs associated with each trip that we would have liked to have included. Nonetheless, we’ll give the story the benefit of the doubt.

Not Satisfactory

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story describes a single patient anecdote and does provide us with some information about the NIMH sponsored clinical trial: “Both Cochran and West cite high patient response rates. A clinical trial funded by the National Institutes of Health revealed a “significant effect of treatment” when patients received TMS treatment. It compared outcomes of patients who actually received the magnetic pulses against patients in a “sham” group, who sat down in the treatment chair for fake sessions.”  

Here is what the lead author of the NIMH funded study said about the results (http://www.nimh.nih.gov/science-news/2010/magnetic-stimulation-scores-modest-success-as-antidepressant.shtml) performed in 190 patients with depression who failed standard drug therapy::

  • Thirteen (14 percent) of 92 patients who received the active treatment achieved remission, compared to 5 (about 5 percent) of 98 patients who received the simulation treatment.
  • “…the overall number of remitters and responders was less than one would like with a treatment that requires daily intervention for three weeks or more, even with a benign side effect profile.”

Hardly the results suggested by the story

Not Satisfactory

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story doesn’t provide any specifics about potential harms of the treatment,  We are told, “…treatments are more effective than medications with far fewer side effects,”  “…but for the most part, it is safer in general than taking a medicine. You’ve got less seizure risk than taking a medicine. You’ve got less side effects than taking a medicine.”  Exactly what are the risks and how often do they occur?  Here is a listing of side effects from  the NIMH website:(http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml )

“Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may contract or tingle during the procedure. Mild headache or brief lightheadedness may result. It is also possible that the procedure could cause a seizure, although documented incidences of this are uncommon. A recent large-scale study on the safety of rTMS found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred. Because the treatment is new, however, long-term side effects are unknown.”

Not Satisfactory

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

We are not provided with any details supporting the physician advocate’s comments.  As we noted previously, the NIMH study is briefly described but in rather glowing remarks that can give the reader an inflated view of the success of the device.

Satisfactory

Does the story commit disease-mongering?

Satisfactory

No disease mongering here

Not Satisfactory

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Besides the glowing comments by a psychiatrist who uses the device and the originator, we do have a comment from a spokesperson from an insurance company who does not as yet provide coverage. Given the controversy in this 15 year old technology, we would have liked to have seen comments from an expert in the field.

Not Satisfactory

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does provide some insight into the alternative approaches including drug therapy and electroconvulsive therapy. No useful information is provided about ECT, Vagal nerve stimulation or magnetic seizure therapy.   The comparisons however are provided by devotees of the technology and no references are provided.

Satisfactory

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story makes it clear that the device and thus the treatment is available.  The story does provide some insight into insurance coverage as well.

Satisfactory

Does the story establish the true novelty of the approach?

Satisfactory

The story makes it clear that the device approved in 2008 is novel as is the underlying approach to treating depression

Satisfactory

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not rely on a press release

Total Score: 5 of 10 Satisfactory


Comments

Jeff Nedelman posted on December 10, 2012 at 10:56 am

I have had Depression all my life and began seeking treatment as an adult. Every MD, I see tells me I am a tough case. Only recently have things began to change – a blood test revealed issues with thyroid and testosterone, a new psychiatrist (I moved) wants to get me off the benzos and then came the neurostar recommendation. Although approved by FDA most insurance companies don’t cover it and the out of pocket expenses for five sessions for five weeks is $12,000 with a 25% discount if you pay cash upfront. I am thinking about it.

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