This is a review of a column originally published in the Miami Herald but picked up in the Hartford Courant when we found it. Hardly a word is wasted in this 300-word evaluation of Breathe Right nasal strips’ effect on snoring. It’s informative and easy to read. It has clear consumer value and an explicit takeaway message.
As the star rating shows, even in this brief space the item abides by most health journalism best practices.
Unfortunately, the story has two serious flaws which nearly negate its excellent form and content:
It fails to acknowledge that taken as a whole the evidence of benefit is equivocal, and some of the studies showing benefit are limited in significant ways (study size, methodology, lack of controls and consistent measures, etc.)
The failure to dig for negative findings results in an inaccurate positive impression of the product’s effectiveness. This does not serve the public well.
Interestingly, if the reporter had dug deeper and summarized the research findings more accurately, the consumer takeaway would be very similar: They might work, they probably don’t hurt, give them a try if you like.
The second flaw of even greater consequence.
The story implies, or at least permits a reading that suggests, Breathe Right strips can treat sleep apnea. The description of results from the Journal of Rhinology study are carefully worded: When used by people with snoring and sleep apnea, the strips "reduced nasal obstruction" for most study subjects. This could be misread to mean the strips successfully treated apnea.
This is not the case. Apnea is caused when muscles of the palate or other tissue collapse and block airflow to the trachea. It is not caused by nasal obstruction. The strips may have improved nasal airflow for people with apnea, but this isn’t relevant to the underlying disease mechanism.
Apnea is a serious condition with cognitive, cardiovascular and overall health consequences. It can be deadly. Breathe Right strips cannot treat it. The item allows readers to believe it can.
The approach taken in this item is excellent. More health journalism should embrace this "concentrated" approach, paring out unnecessary information, avoiding conventional forms and focusing on consumer value. In a time of shrinking newshole and growing web distribution, this form can be very effective.
But working in a tight, tailored format like this does not relieve health journalists of their most important obligations: Digging enough to find the truth, and protecting the public from harm. This item fails to do so.
The price appears on the first line.
Given the item’s brevity, it does a good job of quantifying benefits for one of studies:
"Some 18 out of 26 patients with sleep apnea and snoring reduced nasal obstruction when they used nasal strips in a 1999 study in Journal of Rhinology."
This lets readers know the study was small but showed benefits for most participants. It reports results as numbers of subjects benefiting, not by the often-misleading percentage. It implies it’s a clinical trial.
It’s worth pointing out that the author of this item provides the specific data about the clinical trial most relevant to consumers–how it performed in use with heavy snorers. The earlier studies appear to be more proof-of-concept and physiological observations.
As the item states, no serious side effects have been found. The Sleep Academy’s 2003 report cites only possible irritation and discomfort.
Given the brevity of the item, the amount of evidence provided is very good. The piece mentions FDA approval and Mayo recommendation. It cites five clinical studies, with one of the most relevant described in a bit of detail.
Unfortunately, the evidence cited is selective. There are several key studies showing the nasal strips to be ineffective. In 2003, the American Academy of Sleep Medicine found insufficient evidence found the evidence of benefit on snoring "equivocal" and insufficient to permit clincial guidance on their use.
This is a key failing of the item.
The item does nothing to exaggerate the health impacts of snoring. If anything, it conflates snoring and apnea, at the risk of suggesting the latter is a mere annoyance rather than a chronic disease with serious health consequences.
The author depends entirely on the conclusion of published studies. If you’re going to draw on a single type of source, this is the one to use.
The item reports that some of the research was funded by the strips’ maker.
The story would have benefited from a single quote or paraphrase from an independent ENT who could frame the use of these strips in clinical practice.
And as cited earlier, the reporter somehow missed the considerable evidence showing no benefits or only very slight benefits. It failed to draw on one of the most obvious credible sources, the Academy of Sleep Medicine.
The story does not mention other OTC or drug responses to snoring. It fails to mention the most common treatment for sleep apnea, a device called CPAP (continuous positive airway pressure), which keeps the airways open.
While the item does not say so explictly, the nasal strips are familiar enough and priced in a way that implies easy over-the-counter availability.
Novelty is not in question with a such a ubiquitous over-the-counter product.
There does not appear to be a press release associated with the product.
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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