The news release focuses on an article published in the journal Menopause, which evaluated the extent to which acupuncture may reduce the number of hot flashes women experience during or after menopause. The release does a good job of describing the study’s key findings, but offered readers no information about its limitations, treatment cost and risks, and the availability of acupuncture treatment. Most importantly, the release did not reveal that the study wasn’t blinded and that there was no sham acupuncture given to the control group, making this a weak study. It’s well established that acupuncture can produce beneficial effects on a wide array of health problems; the issue is whether these effects differ from what would be expected with a placebo or sham treatment.
As the NIH puts it, “many women have hot flashes” during menopause — and they can persist for several years after menopause. In fact, according to a 1985 study, approximately 88 percent of women have hot flashes during menopause. Hot flashes, in themselves, do not pose a health risk. However, they can have a significant, adverse affect on a woman’s quality of life, with symptoms ranging from sweating to rapid heartbeat. In some cases, this can lead to sleep problems — and that can pose significant health risks. Given the number of women who experience hot flashes, it’s certainly worth discussing research that can inform patients and healthcare providers about treatment options. However, it’s important for news releases to place new findings in context. i.e., how do the new findings fit into the broader body of work that exists on the subject? This release doesn’t address that need.
Costs aren’t addressed at all. How much does it cost? And could acupuncture be covered by insurance? According to an acupuncture referral site, a single session of acupuncture typically costs between $60 and $120. Given that participants in this study received up to 20 acupuncture sessions over six months, that could present a significant financial hurdle for patients — particularly if they are paying for those sessions out of pocket.
The release does a nice job here, breaking down the results in a detailed, quantified way: “Of the 170 women who received acupuncture, a small group of women (11.9 percent) had an 85 percent reduction in hot flashes by the eighth week of the study, Avis said. Forty-seven percent of the study group reported a 47 percent reduction over this same time frame. However, 37 percent showed only a minimal reduction of 9.6 percent in frequency of hot flashes, while 4 percent reported a 100 percent increase in hot flashes.”
What would have made the release stronger would have been to note that 79.5 percent of the control group — who received no acupuncture — saw a 10 percent decline in hot flash frequency. That casts the 37 percent of the acupuncture group who had a reduction of 9.6 percent in a different light. i.e., it indicates that any reduction they saw may not have been tied to the acupuncture at all.
The release notes that 4 percent of study participants who received acupuncture actually had twice as many hot flashes (“a 100 percent increase”). That’s good. The release also refers to acupuncture as “low risk.” But that doesn’t mean no risk. According to the Mayo Clinic, acupuncture can cause soreness, minor bleeding or bruising — and that may be exacerbated for patients who are taking blood thinners. There are also more serious risks involved, particularly if an acupuncture therapist has not been properly trained. Those risks include infection and possible organ damage. Since the release explicitly says “women bothered by hot flashes…may want to give acupuncture a try,” it is especially important to be up front about potential risks and the importance of finding a certified acupuncture practitioner (as well as where that certification should come from).
The release doesn’t describe the weaknesses of the study — the lack of blinding, subjective outcome reporting and lack of a sham comparison group — all which have a high potential for bias.
Also, there is a hugely disproportionate size of the two groups (170 who received acupuncture and 39 who didn’t). The differences were actually fairly small with a 47 percent reduction in hot flashes representing two per day, on average. This number is so small that it could have been due to ‘wishful thinking’ on the part of the acupuncture group. One would expect that a study that was funded with a National Institutes of Health reserach project grant would have more sound methodology.
In addition, the study would have been stronger if they had compared the acupuncture to other ‘home remedies’ for hot flashes.
For the most part, disease mongering wasn’t an issue here. Some issues with language are addressed under the “Unjustifiable Language” section (see below).
The release does a nice job here, mentioning how the study was funded and clearly outlining the potential conflicts of interests. One of the co-authors is the primary shareholder of Chapel Hill Doctors which was subcontracted by Wake Forest School of Medicine to recruit volunteers for the trial.
There are a number of pharmaceutical options that are used to provide patients with some relief from hot flashes, and these are not mentioned at all. A release needs to note what a given treatment option (acupuncture in this case) brings to the table that other treatment options do not. How is it different? How might it be better? Or worse? That sort of context is invaluable for readers.
Acupuncture isn’t a new idea, and many — if not most — readers would be familiar with the concept and aware of its availability. If this were a news story, we would like to see some discussion of how accessible acupuncture is. For example, one can be fairly certain of acupuncture practitioners being located in New York City. Whether one would be able to find certified practitioners in rural areas is less clear. However, we don’t think that’s an issue that needs to be addressed in a news release from a research hospital.
On first reading this release, we wondered why no one had studied the use of acupuncture to reduce hot flashes in the past. A quick internet search found that it had. As in this study, or this one, or this one, or this one (and there are quite a few more). These studies are all over the map in terms of positive and negative findings. The release’s failure to address the existing literature on this subject makes it impossible to place the new study’s findings in context. How, if at all, does this research differ from all of the previous work done on the use of acupuncture to address hot flashes?
In its opening sentence, the release refers to hot flashes as “the bane of existence” for many women going through menopause. This is the sort of hyperbole that the “unjustifiable language” criterion was designed to address. Can it affect quality of life? Absolutely. Should it be presented as a life-destroying bête noire? No.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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