This story was written for the San Mateo County Times, but we caught it as it appeared in the Buffalo News. This article informs readers about home hemodyalysis with portable machines, a treatment for advanced kidney disease that is not widely used but is growing in popularity. Unfortunately, it falls short of several best practices in health journalism, resulting in an unjustifiably positive impression about the treatment.
Journalists often use personal stories of patients in order to make their stories more compellling or to illustrate treatments. In this case, the article devotes over two-thirds of its space to personal stories. It leaves out important facts and context that would make it valuable to readers.
The story emphasizes that home dialysis is more "cost-effective," but it never cites the prices of the devices or treatments in home or in a dialysis center.
A recent article in Renal and Urology News states that home treatment, because it is done more frequently, is more expensive, not less expensive, than treatment in a center. This confusion may be due to whether the overhead costs of a treatment center are included in the calculation. In any event, the cost comparison should have been explored more.
The story also fails to compare the cost-effectiveness of home (or traditional) hemodialysis to transplantation.
Finally, the article also fails to make clear what costs Medicare will cover for home dialysis treatment or other options.
The article does not cite any research to quantify benefits in terms of complications, morbidity, mortality or quality of life.
The assertion that "numerous studies" show frequent, slow home dialysis sessions create the best outcomes is not defended.
The article does not explore what harms and risks are associated with home dialysis treatment. The home treatment is demanding and does have some risks: Patients and a care partner both must be trained for several weeks in order to prevent infection and to ensure the treatment is successful.
The only data cited to support the assertion that home dialysis has better outcomes than dialysis in a center are that hospitalizations for complications of kidney failure were halved for those on the home treatment. No details are provided about this research.
Other assertions about low cost and better outcomes are presented without evidence.
While the article uses two dramatic personal stories, these stories realistically portray the severity and risks of end-stage renal disease.
The report quotes a physician who analyzes home dialysis for Kaiser Permanente, and the medical director for a company that provides equipment and training for home dialysis. It also quotes two patients who are very pleased to be receiving dialysis at home.
The article would be better balanced if it had included comments from a clinicial nephrologist who has patients receiving dialysis at home and at a center–and who are candidates for a kidney tranplant.
It should also have included comments from someone familiar with the scientific literature.
The article does not clearly indicate which patients are best suited for home dialysis, what forms of home dialysis are available.
The failure to include transplantation among the treatment options is also an important shortcoming.
The story indicates that fewer than 10 percent of U.S. patients getting dialysis receive home treatment. It mentions one equipment supplier in California, and NxStage in Massachusetts, maker of the only device approved for home use.
But the article fails to answer the more fundamental question: Where is this technology available, and from whom?
The article correctly portrays home dialysis as small but growing. It indicates that a device was approved for use in the home by the FDA in 2005.
There is no evidence a press release triggered this story.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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