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GPS-like system helps surgeons align joints

Rating

4 Star

GPS-like system helps surgeons align joints

Our Review Summary

Too often when a reporter learns about a developing medical technology used locally, the result is a gee-whiz rave. This well-reported, judiciously written story on navigation-assisted joint surgery is a welcome exception.

The story plainly says the surgical technique has not been proven effective. The reporter interviewed four physicians about its value, including one who has not used the machine. The story discusses the potential benefits and harms without falsely emphasizing either one. 

The reader takeaway is that there is an interesting but uNPRoven new technology available for local joint replacement surgery. Some may want to talk to their doctors about it, but none will go expecting a miracle treatment certain to improve outcomes.

The story could have been improved in two ways:

  • It’s not clear who is paying the cost of using the machines if insurers do not. It’s also not clear what the cost difference is between navigation-assisted and conventional joint replacement surgery. 
  • The story did not report on potential conflicts of interest. It’s not known whether any of the physicians quoted has worked as a researcher or consultant for the device maker. The reporter should have asked and reported the answer. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

It’s good that the report states the price of the device–above $200,000–and that at least one insurer does not pay for its use. But the story should have stated what it costs a patient to get treated with the device, and who bears any additional costs.

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

Not Satisfactory

The story says the device’s efficacy is uNPRoven, but it does not explore the body of inconclusive data.

There is a 2007 study that shows 5 years of outcome data. The fact that that study did not demonstrate improved outcomes suggests the device does not have big, measurable benefits. The story would have been stronger had it referred to this study. 

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

Satisfactory

The story reports that the extra time required to do a navigation-assisted surgery may lead to more complications.

 The story would have been stronger if it had mentioned the potential risks associated with the surgeon learning curve. 

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

Satisfactory

The story does an excellent job of stating, plainly and repeatedly, that there is no conclusive evidence the surgical device improves outcomes.

Does the story commit disease-mongering?

Satisfactory

The story doesn’t exaggerate the severity or prevalence of the underlying joint conditions. Neither does it make false claims for the relief the device can provide.

The story does use one positive anecdote, which could be read to mean the navigational device contributed to the positive outcome. The reality is that most patients do very well with the surgery without the need for a navigational prompt to the surgeon.But since the story states repeatedly that the technology’s benefits are uNPRoven, this is not a serious flaw. 

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

Not Satisfactory

The reporter interviewed four surgeons, three of whom use the device and one of whom does not. The reporter did not quote the device maker, an impressive show of restraint.

A key shortcoming: The reporter did not explore potential conflicts of interest of the sources. Doctors who are early adopters of expensive new technologies often have relationships with the device makers. So do the medical facilities where the doctors practice. Such relationships should have been disclosed, or the lack of relationship should have been plainly stated.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story indicates that most surgeries are done without the navigation device, and that other similar devices are in development.

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

Satisfactory

The story names four Iowa institutions that have the computer assisted surgery device. It also names four surgeons who use it.

Ideally the story would stated how many of the devices are in use in Iowa, Des Moines or the U.S.

But the story includes sufficient information to be rated satisfactory under this criterion. 

Does the story establish the true novelty of the approach?

Satisfactory

The report makes clear that the device has been in use for a few years but is still considered investigational.

By reporting how many surgeries certain centers and surgeons have done with the device, the story provides an adequate view of its clinical use. 

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

Not Applicable

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

Total Score: 6 of 9 Satisfactory

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