This report on encouraging results for a new type of headache surgery introduces viewers to a potential treatment for people with severe headaches that are unresponsive to other medical approaches. The vivid case histories demonstrate the need for new treatments.
But the segment fails to provide the necessary caveats and context that would help viewers understand the limited applications of the surgery and the preliminary, potentially self-interested status of the research supporting it.
The desperation of chronic pain sufferers who have been frustrated in their search for relief should make reporters doubly careful not to raise expectations unrealistically.
The 105 comments viewers have left on the ABC News Web site in response to this report (at the time of this review) suggest many people with many different kinds of headaches have been made hopeful that this surgery can help them or their loved ones. Many will be very disappointed when they learn they are not qualified for it.
Viewers would have been well-served by an explicit reminder at the end of the piece that this surgery would likely benefit only a small number of the most severely affected patients, and that others will need to continue working with conventional treatments. These approaches should have been described.
The segment would have been stronger if the report included views of an independent expert on severe headache treatment and a mention of the procedure’s costs.
The online version of the segment includes a link to the featured physicians’ Web site. For balance, the producers could have included a link to sources of information on conventional treatments for chronic headache.
The report fails to say how much the surgery costs and whether it is covered by insurance. Nor is the cost clear for the extensive testing required to identify eligible patients.
The numbers used to demonstrate benefits–64 percent of the first carefully selected 100 patients showed at least 50 percent improvement in symptoms–are encouraging. But they are not sufficient to justify the general enthusiasm for the procedure the segment conveys. The data essentially show meaningful but incomplete relief for a majority of carefully selected patients, and less or no relief for many other carefully selected patients. Emphasizing this would have helped patients understand the statistics more thoroughly. Further, the use of several anecdotes, whereby a few patients with severe symptoms experienced improvement, obscures the limitations of the surgeons’ claims.
During the host’s questioning, the reporter-physician discusses potential harms briefly. His comments about the surgery’s relative safety have credibility because he provides anatomical detail. The segment would have been improved had it indicated whether the doctors conducting these procedures have gathered data on potential harms beyond the risks of anesthesia, however.
While the report takes admirable care to mention that "the surgery is in very early stages and still needs to go through clinical trials," it fails to indicate that case series reported by researchers on their own work are a very weak form of evidence. This result is to emphasize the findings but not their limitations.
The report exaggerates the size of the population affected by the condition and the potential benefits of the treatment. The 40 million Americans figure cited represents all with chronic headaches, not the very small subpopulation whose headaches are disabling and unresponsive to other treatment. The statistics showing benefits are not delivered with the necessary caveats. Further, the segment creates unrealistic expectations with the question, "Could this be the cure everyone is waiting for?"
The report briefly summarizes skepticism from other physicians. But an interview with an independent clinical neurologist would have added useful context and perhaps information about risks and treatment alternatives. The viewers also do not get information that would help them evaluate the credibility and potential self-interest of the doctors at the center of the piece.
The report makes clear that this surgery is only for those who haven’t found relief through other more common treatments. It mentions acupuncture, medications and electrical nerve stimulation, but it does not provide adequate information about their relative effectiveness for the many people who do not qualify, or do not want, this surgical treatment.
While the segment reports the technique is currently offered by only a few doctors and is not yet proven effective in clinical trials, these facts appear late in the report. The segment would have been improved by a clear and early statement that the surgery is not widely available.
The report’s claims of novelty appear to be accurate. It would have been helpful to mention the other types of surgery used rarely on chronic headache patients.
We can’t be sure if the story relied solely or largely on a news release.