This news release clearly describes the key findings of a comparison study of several nonsurgical treatments for knee osteoarthritis in a way that is likely to be useful to patients. However, the brevity of the release and the methods of the underlying meta-analysis mean that readers are not given specifics about the absolute clinical benefits of the treatments, only their relative rankings. There is only a brief, general mention of potential harms of some of the drugs included in the analysis. The release says that almost half of Americans are at risk of developing knee osteoarthritis. This eye-catching number comes straight from the journal article, but it is far higher than other estimates and is based on a study of only the older residents of single rural county in North Carolina.
Sophisticated statistical methods for combining the results of multiple clinical trials, such as the network meta-analysis used in this case, are powerful tools for discerning larger, more useful, conclusions from the results of many smaller research efforts. However, the very power of these methods imposes a substantial responsibility on the researchers to perform the work capably and carefully… and then a subsequent responsibility on journalists reporting the story to seek out independent sources who are qualified to comment on the work.
Although the news release does refer to the low-cost of naproxen (brand names including Aleve and Naprosyn), it does not discuss the costs of other treatments that were ranked highly by this meta-analysis. Injections of corticosteroids may cost about $100, not including associated clinic and provider charges. All of the treatments need to be repeated, so the cumulative cost should be considered.
The news release does not provide any specifics about the benefits of the treatments, referring only to their relative rankings. It should be noted that the researchers also did not address absolute clinical benefits in their journal article. The conclusions as stated may still be useful to patients who may have personal experience with at least some of the treatments. However, to satisfy this criterion the release should have provided some description of the absolute clinical benefit to patients.
We note that the news release highlights the conclusion of the researcher’s analysis that the results of hyaluronic acid injections were not significantly different than placebo injections. The attention to a lack of benefit is important news for patients.
The news release does refer to some potential harms of nonsteroidal anti-inflammatory drugs, including naproxen and ibuprofen. However, it does not quantify these risks and it does not address any of the potential harms of the other treatments in the analysis.
The news release includes key attributes of the methods the authors used to compare the results of clinical trials. These methods are what make this report potentially newsworthy.
The sort of network meta-analysis the researchers used is a powerful method for combining the results of many individual trials. However, the sophistication and complexity of the method also mean that the conclusions depend on the skill, discipline and effort of the researchers. Indeed, the authors criticize an earlier network meta-analysis for including lower-quality studies. Journalists reporting on this study should seek out qualified independent sources in order to get informed perspectives about how well this meta-analysis was performed.
The news release leads off with the statement that an “estimated 45 percent of people are at risk of developing knee osteoarthritis (OA) in their lifetime.” The journal article also leads with this statistic. However, the “45 percent” figure comes from a study of people living in one county in rural North Carolina. Another recent study estimates a far lower lifetime risk of about 14 percent. The authors of the latter report addressed the discrepancy, writing that the North Carolina study looked at an older population with different sex, race and weight distributions than the US population as a whole… and it noted that people without knee problems might have been less likely to stay in touch with researchers, which could lead to a higher estimate of lifetime risk.
The news release identifies only where the authors work. It does not include the disclosures listed in the journal article. These disclosures should have been included in the news release.
A comparison of existing alternatives is the point of the journal article. The news release highlights the comparisons in clear language.
It is clear that all the treatments noted in the release are generally available.
The release includes a quote from an author that, “This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes.” A search of PubMed.gov did not find any other similar meta-analyses, except for one that the authors discussed in their journal article. They criticized that earlier meta-analysis for including lower quality studies that they said muddled the results.
This news release clearly summarizes the main conclusions of the researchers’ journal article. Other than repeating the questionable estimate of lifetime risk of knee osteoarthritis noted above, the language of the release is moderate and useful.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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