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Read Original Story

AIDS treatment should be started sooner, study says

Rating

4 Star

AIDS treatment should be started sooner, study says

Our Review Summary

This is a Columbus Dispatch version of a story reported by the Associated Press.  Since the Columbus paper changed the original article substantially, we send our comments to the Columbus paper.

Taking the big view, this story about the benefits of starting the standard multi-drug AIDS treatment sooner than current guidelines suggest accomplishes its mission. It fairly describes important new research that verifies earlier work suggesting the same thing. It says, correctly, that the continuing research could drive changes in treatment. 

The story is well-sourced and provides a lucid description of the disease process and detailed definition of "early" treatment.

Having said that, the report falls short of two key best practices:

  • It fails to quantify the benefits of early treatment in a meaningful way. It uses "relative risk" [a percent reduction in mortality] instead of "absolute risk" [which would allow readers to understand the gravity of the risk and the size of the benefit. 
  • It fails to describe the limitations of the study with caveats and context.

If the story had mentioned those limitations, its predictions of imminent clinical use and eventual changes to the guidelines would have been properly tempered. As presented, the story fails to check the sources’ consistent enthusiasm with journalistic disinterest. 

Given the credibility of the study, the opinions of multiple high-quality sources and the previous research record, the predictions seem justifiable.

But the history of AIDS science, treatment and politics recommends a bit more reporting distance and care.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

As a matter of course, stories about the increased use of drugs should report the drugs’ prices.

A change in guidelines based on the study would increase the number of patients eligible for treatment by several hundred thousand in the US.  The annualized cost of drug treatment is $12,000-$24,000 depending on the regimen, leading to potential new expenditures of $24 to $48 billion. While there are significant offsets, the potential for this level of additional costs should have been included in the story

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

Not Satisfactory

The story states that delaying treatment "nearly doubles the risk of dying over the next several years" and yields a "70 percent improvement in survival." 

This reporting is vague. The story should have compared absolute risks, not relative risks. See our primer on this issue. The story should have included the time span studied.

These numbers should have stated the two death rates directly so readers can understand the magnitude of the benefit–whether the risk of death went from [say] 2 percent to 1 percent or from 30 percent to 15 percent. 

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

Satisfactory

The story places the recommended treatment of earlier drug intervention in the context of the treatments’ known side effects, which can be very serious. The story should have described the severity of those side effects. We give this a satisfactory score, but barely.

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

Not Satisfactory

The report is based on a study presented at a major medical meeting. The story should have mentioned the fact that it has not been published or peer-reviewed.

It should also have pointed out that it was a retrospective cohort study, which is considered to be less conclusive than prospective, double-blind studies.

It should also have pointed out, as the NIH press release does, that a clinical trial is needed to validate the results in a way that would call for changing the current guidelines.

These failures to provide caveats and context earn the story an "unsatisfactory" rating under this criterion. 

Does the story commit disease-mongering?

Satisfactory

The story does not exaggerate the gravity or prevalance of AIDS.

 

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

Satisfactory

The story quotes Anthony Fauci, one of the best-known and -respected experts in the field of HIV/AIDS. 

The story also quotes the study’s lead investigator, and the author of AIDS treatment guidelines. That source’s link to companies that make AIDS drugs is properly noted. 

The story also quotes an independent clinician familiar with the guidelines and the current research. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story plainly compares the current guidelines with the regimen tested. 

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

Satisfactory

The story explains that the drug combinations used by AIDS patients have been widely used since the mid-1990s.

Does the story establish the true novelty of the approach?

Satisfactory

No claims are made for the novelty of the drug treatment.

The recommendation to treat earlier is presented not as novel, but as a plan under consideration and study for quite some time.

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

Satisfactory

The story does not draw excessively on the NIH press release.

Total Score: 7 of 10 Satisfactory

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