In this story we learn of of a new “Magic Pillcam” that “scans your insides.” This non-invasive procedure is meant to replace endoscopy, which requires some sedation and time off work. However, the new approach would need to be shown to be equally effective, safe and at least comparable to the cost of endoscopy. In the story, we learn that the procedure is intended for people who have symptoms of acid reflux, who might have some measure of risk of having or developing Barrett’s esophagus, which could lead to esophageal cancer. But the person demonstrating the procedure is Katie Couric, who is asymptomatic. In addition, endoscopy lets one get a good view of the stomach. Since much heartburn is due to stomach and duodenal problems, the pillcam would miss these potential causes. So it could really only be effective if we know that person has esophagitis. How does one know that? One needs to do an endoscopy! Thus, this procedure could help if someone is known to have esophagitis and is followed for Barrett’s esophagus. But research is lacking in this area and this isn’t clear from the story. Furthermore, from this story, we have no sense of the strength of the evidence, harms, and costs of the procedure. Also, the failure to place acid reflux in the context of Barrett’s esophagus or esophageal cancer is a prime example of disease mongering. This story is an example of medical journalism that has let the intrigue of a cool new technology trump smart, responsible reporting.
Mentions that the pillcam costs $450 plus
the physician’s fee, but we don’t know what that means relative to endoscopy. Plus, those costs are going to be largely
out-of-pocket since insurance doesn’t cover it. Sidesteps around insurance coverage issue by saying that insurers are
beginning to cover it, but provides no basis for this claim.
No
quantitative estimates of benefits are presented.
No mention of any potential harms.
No mention of the nature or strength of the evidence.
This story
exaggerates the seriousness of heartburn and acid reflux. First we learn that 15 million Americans suffer from heartburn and
that they are at risk for acid reflux (GERD), Barrett’s esophagus and esophageal cancer. We learn that esophogeal cancer is
the fastest-rising cancer and that if you have Barrett’s, you are 40 times more likely to develop cancer. However, the
story does not provide us with any context for these numbers (esophageal cancer remains a rare cancer), and, as a result, we
are left with an over-inflated notion of how bad heartburn is.
Single source only. No attempt at independent corroboration. It
should also be noted that the physician interviewed was funded by a foundation established by Katie Couric.
Although the story mentions endoscopy
and how much the pillcam is an improvement, there is no mention of how this will fit into clinical practice. What are the
disadvantages? What if you do see something? Are you going to have to do an endoscopy anyway? The story makes the claim that
this should be routinely considered as part of standard care, but there is no evidence presented to support this.
The story does say that the device was cleared by the FDA.
The story is clear that this
is a new technology.
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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