Alan Cassels is a drug policy researcher at the University of Victoria in Canada and a regular contributor to our blog.
Last week’s big health news was a study on two medication-assisted treatments for opioid use disorder. Published in The Lancet, the study compared the monthly injectable treatment Vivitrol (naltrexone) to a dissolvable oral strip called Suboxone (buprenorphine).
Depending on which news headline you came across, your main takeaway about the study would likely either be that 1) the two drugs were equally effective, or 2) the findings weren’t so clear-cut.
“Long-awaited study finds monthly Vivitrol as effective as daily pill for opioid addiction,” by STAT.
“Some opioid addiction drugs harder to start than others, study finds,” by CNN.
If we had to choose between the two, CNN’s headline better summarizes the study. The story, too, was nuanced and informative, which our reviewers noted, stating “this story will help readers understand important differences between the two drugs, at least in terms of starting treatment.”
Likewise, Vox and NPR had appropriately cautious headline framing. Vox’s headline (“A new study found a big problem with a popular opioid addiction medication”) also carried a useful subtitle: “A long-awaited study compared two opioid addiction treatments. There’s good and bad news.”
But, regarding the STAT headline–that the two drugs were equally effective–Oregon Health & Science University clinical epidemiologist Valerie King said via Twitter:
Except that it wasn't. That only accounts for people who actually started the therapy. But for every person who was allocated to the bupe group and relapsed, there were 12-13 who did so in the vivitrol group. If you can't start it, it isn't equal. https://t.co/BYq7XyYhL4
— Valerie King (@drvalking) November 16, 2017
This is in reference to an important point of the study: Only people who were already off opioids (those who had been through extensive detox) were able to join the Vivitrol group of the trial. Meaning, people randomized to Vivitrol did not do nearly as well as those randomized to Suboxone (referred to as “bupe” in the tweet)–because over a quarter did not tolerate or receive the first dose of Vivitrol. That’s because Vivitrol requires detoxing before starting, whereas Suboxone does not. But if a person made it through detox successfully and started Vivitrol, he or she did generally as well as a person taking Suboxone, in terms of average length of time before relapsing. A little more than half of all people in the trial–in both treatment groups–relapsed after six months.
It’s important to note that STAT wasn’t alone in mischaracterizing the findings. Similar headlines appeared in HealthDay (“Two meds to treat opioid addiction equally safe, effective in study”), The New York Times (“Study Finds Competing Opioid Treatments Have Similar Outcomes”), and the The Philadelphia Inquirer (“Medications to kick opioid addiction are equally effective, study finds”). The Wall Street Journal had similar framing, but was a bit more nuanced (“Opioid Addiction Study Finds the Drug Vivitrol, Once Begun, Is as Effective as Suboxone). Fortunately, once you got past the headlines, all of these stories did eventually explain the hurdle of getting the Vivitrol group into treatment.
This is not the first time we’ve taken issue with health news headlines–see our posts on breast cancer and alcohol, small studies that get big headlines, and headlines proclaiming that olive oil will prevent the onset of Alzheimer’s,
Why do we focus on the headlines alone? Many of us are notorious skimmers of headlines and if that’s all we get, we may be missing the big picture. The Washington Post reported a survey from a few years ago which found that 60% of people “acknowledged that they have done nothing more than read the headlines in the past week.”
The Post also reminded us that simple messages are most effective and that “the more complex an issue, the less likely it is to break through with a public that really consumes news via headlines and not much else.”
King points out that “one study is one study. You have to look at the context of all the research, especially those of high methodological quality like a systematic review.” Referring to this bigger body of research is vital, she says in order to prevent media “whiplash” (which we’ve reported on in the past).
She admits to harboring a “bit of grumpiness with headlines that are a bit disingenuous,” and adds that “all of these medicines probably have a place.”
But, she said, “People should not be misled like, ‘Oh gee, all we have to do is give people a monthly shot of Vivitrol’–which is not true.”