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Hysterectomy, a better way

Rating

2 Star

Hysterectomy, a better way

Our Review Summary

This story reports on the tendency for women to still get abdominal hysterectomy in spite of the fact that there are less invasive alternatives available. This story does a good job of highlighting this problem, however this story is limited in its focus only on the laparoscopic versus abdominal hysterectomy decision. In doing so, the story ignores the larger context for this issue which is why so many women are getting hysterectomies for benign uterine conditions when there are many effective treatments that don’t involve surgery. Fibroids and abnormal bleeding are the two most common reasons why women undergo elective hysterectomy. The story makes it seem as though the only option is between abdominal and laparoscopic hysterectomy, when in reality a woman has a choice among lots of options, such as vaginal hysterectomy, myomectomy, ablation, uterine artery embolization, and medical management.

The lack of discussion about the strength of the evidence to support laparoscopic hysterectomy, the harms of the procedure, or the available alternatives make this story appear like a sales pitch for the procedure. The "experts" quoted in the story also raise this concern. Although the story does quote more than one expert, it is not clear that these are actual independent experts. Dr Cahill is the Executive Director of the National Women’s Health Resource Center, whose campaign "What’s going on down there?" was supported by Ethicon, Inc, a manifacturer of surgical equipment. And it is not clear what Dr Warren’s credentials are.

Although the story theorizes that the cost of laparoscopic surgery would be less than abdominal hysterectomy because of the reduced hospital stay, no further information is provided. This is not adequate information on costs. Furthermore, there are even cheaper non-surgical alternatives such as medication, IUD, and ablation.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Although the story theorizes that the cost of laparoscopic surgery would be less than abdominal hysterectomy because of the reduced hospital stay, no further information is provided. This is not adequate information on costs. Furthermore, there are even cheaper non-surgical alternatives such as medication, IUD, and ablation.

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

Satisfactory

The story does quantify the main benefit of laparoscopic surgery – reduced recovery time – relative to abdominal hysterectomy.

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

Not Satisfactory

The story does not mention the harms of surgery.

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

Not Satisfactory

The story does not comment on the strength of the available evidence to support the use of laparoscopic surgery.

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering.

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

Not Satisfactory

Although the story does quote more than one expert, it is not clear that these are actual independent experts. Dr Cahill is the Executive Director of the National Women’s Health Resource Center, whose campaign "What’s going on down there?" was supported by Ethicon, Inc, a manufacturer of surgical equipment. And it is not clear what Dr Warren’s credentials are.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does not mention any of the highly effective treatment alternatives to hysterectomy. Fibroids and abnormal bleeding are the two most common reasons why women undergo elective hysterectomy. The story makes it seem as though the only option is between abdominal and laparoscopic hysterectomy, when in reality a woman has a choice among lots of options, such as vaginal hysterectomy, myomectomy, ablation, uterine artery embolization, and medical management.

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

Not Satisfactory

The story does comment on the fact that the availability of laparoscopic hysterectomy is somewhat limited. However, the story does not address the reasons why laparoscopic hysterectomy is limited, including the fact that it doesn’t provide many advantages compared to vaginal hysterectomy. In fact, according to a Cochrane review, laparoscopic hysterectomy is associated with increased operating time and blood loss relative to vaginal hysterectomy.

Does the story establish the true novelty of the approach?

Satisfactory

The story adequately represents the novelty of laparoscopic surgery. Although the story makes it seem like the procedure is "new" it does mention that laparoscopic surgery has been around for 15 years.

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

Not Applicable

There is no way to know if the story relied on a press release as the sole source of information. However, we have some suspicions. Does funding of the National Women’s Health Resource Center report by Ethicon, inc. (a manufacturer of surgical equipment), released at the Congress of Minimally Invasive GYnecologists, have anything to do with this focus? If the concern is too many abdominal hysterectomies, the focus should be on all the alternatives to it — medication, progestin IUD, and especially vaginal hysterectomy. 

Total Score: 3 of 9 Satisfactory

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