This article on a study about potential benefits of the antibiotic minocycline in reducing brain damage when given up to 24 hours after a stroke is very well balanced and reported. It makes clear that the findings are promising but preliminary, and that any clinical application at this point would be off-label and at a physician’s discretion.
The reporter explores the question of clinical application with four independent sources, which permits a reader to understand more fully how and under what circumstances the drug might be used.
The report would have been stronger if the differences in symptoms between the drug group and the placebo group had been detailed. Stroke symptoms can be mild or debilitating, and it’s not clear exactly how much practical benefit the treatment provides.
The report is particularly strong at the top: the author properly uses the word "intriguing" when the study is first mentioned, which keeps expectations in check. The following paragraph says "more research is needed to confirm" the findings. Too often these qualifiers are buried deeper in a story.
We’re pleased to give this story one of our highest five-star scores.
The article is sufficiently clear that the drug is generic and inexpensive. Because this use would be novel, and not used as an alternative to existing treatments, more information about its cost is not required.
While the report uses study data to describe the findings, it does not clarify what those findings mean to people who have had strokes.
The findings indicate the drug group (NIHSS scale rating 1.6) had "little nor no disability," and the placebo group (rating 6.5) "the high end of mild disability." Translating these into specific symptoms (slurred speech, difficulty walking, cognitive impairment, etc.) would be useful.
It’s also not clear how high the stroke scale goes–to 10? 15? 20? Knowing that would help readers understand the magnitude of the difference.
Finally, the study found that there was no difference in heart attacks, additional strokes or deaths between the two groups. Data on these critical outcomes should have been reported.
One credible source states that the antibiotic has a well established safety record. Other sources confirm this indirectly. Because the potential benefit is so large–preventing permanent brain damage resulting from a stroke–minor side effects are not essential to mention. It would have been useful to know, however, whether this drug could interact with clot-busting medications if they are given within the three-hour window.
The article indicates that the study is small and the first to produce these findings. It also explains that it was an "open label" study, meaning the patients knew whether they were getting the antibiotic or a placebo. Several sources reiterate that the findings are preliminary and require replication.
The reporter also mentions that a similar study of a neuroprotective agent had promising results but was later shown ineffective in a larger study. This context is very useful; it discourages readers from jumping to conclusions about this study’s value.
The article does nothing to exaggerate the effects of stroke or the drug’s capacity to minimize them.
The writer interviews four independent sources in addition to the study author, an unusual amount of reporting on a single study that adds to the story’s value.
The article makes clear that the study was not funded by an interested party, which also adds credibility to the findings.
The article makes clear that there are no treatment options outside the 3-hour treatment window when administration of the IV clot-buster tPA is effective at protecting against brain damage.
The article makes clear that the drug is cheap and widely available, but properly adds that any use as a treatment for stroke would be off-label at a doctor’s discretion.
The report makes clear that the use of the antibiotic as a neuroprotective agent is novel, though the product is widely used for other purposes.
There is no evidence the article was based on the press release.
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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