There was nothing irresponsible or misleading about this story, which describes a study of a nasally administered form of insulin for the treatment of Alzheimer’s disease. But in our opinion, it lacked many of the details we think are crucial for consumers to make informed decisions about their health care.
Alzheimer’s disease is a devastating condition for patients and their loved ones. Currently approved treatments do little more than slow down the progression for short periods of time. New treatments are desperately needed. Insulin delivered through the nose has been previously studied, but the use of the long-acting version of insulin reported on here is new. Though the study shows some benefit, it isn’t clear how the medicine works to improve memory. Nor is it clear how long those benefits will last or whether they can be delivered with adequate safety. Until larger studies with longer follow-up are performed, this novel treatment will remain in the research world.
Neither this story nor a competing column in the Washington Post discussed costs. Although the treatment being studied — detemir insulin delivered nasally through Kurve Technology’s ViaNase — is not approved for sale, an injectable form of this insulin is available and the device has been written about for a decade. Some estimate of cost could have been provided.
The story tells us that people who received the drug “showed significant improvement in their short-term ability to retain and process verbal and visual information” and that “performance on tests of mental manipulation and memory improved by as much as 25 percent.” That’s a reasonable accounting of the results, but without knowing the baseline scores, it’s hard to know how impressed we should be by this 25% improvement.
To provide as much clarity as possible for readers, we encourage stories always to report benefits in absolute terms. In this case, the story could have earned a satisfactory grade by reporting on the pre- and posttreatment test scores for each group in the study (which, we acknowledge, wouldn’t have been easy to find in a supplementary data table of the study). Alternately, it could have consulted an independent expert to comment on the magnitude of the improvement observed and what it might mean for patients.
The story does talk about risks, saying, “The insulin detemir doses did not cause any negative side effects.” But the study itself reported that were a number of minor adverse effects, including dizziness and nasal congestion. The story should also have explicitly pointed out that this treatment is usually given to diabetics via injections under the skin. The mode of delivery through the nose negated the effects of lowering of blood sugars, and there were no reported episodes of low blood sugar in the study. However, this was a short-term study, and it is unclear what metabolic side effects may occur with longer-term use.
The story nicely puts the explanation of how the researchers did the study in the second paragraph. That’s a rarity in health stories, and a great way to signal to readers up high how seriously they should take the study’s findings. The story explains how many people were in the study, what drug they took, that the study was placebo-controlled, and the types of tests they were given to test mental function improvement. The story also provides the ages of the people studied, the exact nature of their diagnoses, and the length of the study. It says that the study was published in the Journal of Alzheimer’s Disease.
With all that being said, we wish the story had put a bit more emphasis on the study’s limitations–specifically, the fact that this was only a three-week study. Yes, the story does tell us that the study lasted three weeks and that longer studies are needed. But it doesn’t really put this important detail into the appropriate context for readers. Alzheimer’s is a disease that progresses over years, and a three-week study tells us nothing about how this treatment may impact the long-term progression of the disease. Readers need to understand that crucial limitation.
There are no independent sources in this story or in a competing column in the Washington Post.
The story did not note that there are FDA-approved treatments for Alzheimer’s diseae that are of modest benefit for a limited period of time. New treatments are needed, and there is potential for insulin-based treatments.
While the story does describe this as a “pilot study” and notes that “future studies are warranted to examine the safety and efficacy of this promising treatment,” it doesn’t explain that this nasally administered form of insulin is currently only available as part of research studies. The story also offers no informed opinion regarding how long additional testing might take.
The story does not address the novelty of this research. The study uses a longer-acting form of insulin than was used in previous research.
The photo at the top and the longest quote from the lead researcher come directly from this news release. But it’s clear that the reporter also talked with the researcher and did additional reporting.
Systematic, Criteria-Driven
“Just one example of a wider phenomenon in which science is spun for the benefit of companies marketing clinical tests.” https://t.co/QqenHVKWLr
Journalist-patient @journotwit writes: “Like most men, I'll never forget my first time.” He’s done a great job chronicling his prostate patient experiences. https://t.co/JRNMxfKXa6
Why you should be a "medical conservative" - Lown Institute https://t.co/tipZeyuPp5
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