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Study is likely to bolster stent-graft use

Rating

4 Star

Study is likely to bolster stent-graft use

Our Review Summary

This is a technically well written story about a recently published study comparing two procedures that can be used to treat abdominal aortic aneurysms.  It accurately reported the information from the study that found benefits associated with the less invasive procedure. However it should be noted that in the study, while outcomes for patients receiving each surgical treatment are reported, in some of these patients, the alternative surgical intervention may not have been possible.   Although the study authors tried to adjust for these differences whenever possible, these patients could have potentially biased the study results in favor of one of the surgical options.  For balance, the story sought out the opinion of someone who could provide some comment about the benefits of the more invasive procedure.

But the story didn’t compare the risks and benefits of surgery versus watchful waiting or active monitoring.  It also did not mention anything about the types of patients for whom the two procedures discussed might be options.  Without these pieces of information, it is not possible to fully appreciate the implications for people who might consider such treatment.

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no discussion of costs associated with either procedure.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story did include clear numbers for potentially lethal ruptures following surgery, reinterventions, later abdominal operations, and most importantly, it did provide the surgical mortality rates for both procedures.  It did not , however provide sufficient information about the risk of death from aortic aneurysms if left untreated in order for the reader to evaluate the relative benefit to be gained from the treatments discussed.  We’ll give a satisfactory score here, but address this in the "Treatment Options" section below.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story compared the percentage of patients dying during the two procedures as well as the percentage who would need re-treatment at a later point in time.  But the story did not mention that there is evidence that the endovascular repair in those who are not physically well enough to undergo the open procedure does not provide benefit in terms of mortality. Thus for a subset of patients, undergoing the procedure and accompanying recovery involves the harm of discomfort and risk without benefit.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The article strictly compares stent-graft and surgery which is what the study cited did and does a fairly good job of summarizing lower short-term mortality advantages and fewer abdominal operations with stent-grafts but more repeat aneurysm interventions and higher long-term risk of rupture with stent-grafts.  An important omission, though, is that the story failed to compare the risks and benefits of treatment to those associated with taking a watchful waiting approach to the condition.  Although this was not part of the study the story was reporting on, it is essential for understanding how much ‘benefit’ the treatments actually provide. Nonetheless, we’ll give the story the benefit of the doubt on this criterion, and will address this concern in the "Treatment Options" section below.

Does the story commit disease-mongering?

Satisfactory

The story did not engage in disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Though most of the story was about the advantages of endovascular repair of aortic aneurysms, the story did include a quote from a surgeon who does open repair indicating that he felt that open repair was a better fix.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story did not provide adequate information about treatment options.  The story did not provide sufficient information about the risk of death from aortic aneurysms if left untreated in order for the reader to evaluate the relative benefit to be gained from the treatments discussed. Watchful waiting (or active monitoring) is an option, but it was not discussed.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story was about a study comparing two treatments for abdominal aortic aneurysms.  Because the story mentioned that it was about aneurysm repair in 2001 and 2004, a reader could infer that both are current procedure. 

Does the story establish the true novelty of the approach?

Satisfactory

This was a story about a new comparison of treatments for the management of aortic aneurysms.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is no evidence that the story relied solely or largely on a news release. 

Total Score: 7 of 10 Satisfactory

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