This release summarizes an observational study noting a relationship with two groups of men (middle aged and older), their consumption of testosterone replacement therapy and whether they are hospitalized for respiratory problems. It found that testosterone replacement therapy users had a decrease in respiratory hospitalizations compared with non-users. While observational studies such as these are useful and hypothesis generating, they do not have the strength of a randomized, blinded trial and hence one cannot conclude that such associations are causal. Better information about the harms, costs and conflicts of interests of the researchers would have made this a better news release.
If testosterone replacement therapy (TRT) slows the progression of COPD in men by producing a positive lung function, this could indeed be a public health advance. Observational studies, however, are problematic in that the two cohorts of men observed (those who take TRT and those who don’t) may be different in other fundamental ways. There could, for example, be a “healthy user bias” in that the TRT cohort of men may be naturally healthier at the start, and that any improvements in COPD function may just be a function of their basic overall health. Studies like these allow us to draw conclusions, but only that there is an association — not that TRT caused a reduction in COPD.
There was no discussion of costs.
The benefits were reported in quantitative terms: “middle-aged testosterone replacement therapy users had a 4.2 percent greater decrease in respiratory hospitalizations compared with non-users and older testosterone replacement therapy users had a 9.1 percent greater decrease in respiratory hospitalizations compared with non-users.” Even though this suggests that testosterone replacement therapy may slow the progression of disease in men with COPD, one is still left wondering how often that occurs. We aren’t given any baseline numbers so the 4.2% and the 9.1% relative risk numbers lack context.
There are known dangers to TRT including raising the risk of prostate cancer but none of the risks are mentioned in the news release.
We are told that the study is based on a database of “450 men aged 40 to 63 with COPD who began testosterone replacement therapy between 2005 and 2014,” as well as “253 men with COPD aged 66 and older who initiated testosterone replacement therapy between 2008 and 2013.” It is hard to say whether the size of these study groups are large enough to draw conclusions.
As the published study pointed out, the research had several limitations, none of which are pointed out in the news release:
The results of our study may have been influenced by several limitations. First, all diagnoses were based on ICD-9-CM codes, which may be inaccurate or incomplete. It is possible that some of the cases we identified may have been based on misclassified data. Second, the pharmacy plans used by both study cohorts did not cover over-the-counter medications. Our database, therefore, did not include information on coadministration of these drugs; some of them, such as n-acetylcysteine, may influence the risk of respiratory outcomes. Third, the claims data used in this study did not permit examination of certain potential confounding factors such as diet, alcohol use, and other health-related behaviors. Fourth, our study cohorts were relatively small and may have lacked adequate statistical power and precision. Finally, our data included the date the prescription was filled but not the date it was obtained by the patient. In view of this, some of the drug exposure periods may have been misclassified.
There is no disease mongering here. The release provides context on how many people could be affected globally by COPD.
The funders of the study are not named in the release. The lead author, we learn in the full paper, “has received payment, for consulting, from AbbVie, Endo Pharmaceuticals, GlaxoSmithKline Pharmaceuticals, and Auxilium Pharmaceuticals.” Some of these companies manufacture testosterone replacement therapy. This was not mentioned in the news release.
There are a range of treatments for COPD, none of which are mentioned in this release.
It is pretty obvious that TRT is available to men, so the fact it wasn’t mentioned as available is a moot point.
The release notes that there are some previous hypothetical links between TRT and lung function in men and that this is the first “large scale nationally representative study on this association.”
There are no examples of egregious and unjustified language here.
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
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like