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Study: Not Every Hernia Needs to Be Fixed

Rating

4 Star

Study: Not Every Hernia Needs to Be Fixed

Our Review Summary

Overall, this story does a good job summarizing the results of a recent study on watching waiting vs. preventive surgery for hernias. Hernia operations are a common procedure and the study challenges conventional wisdom that all hernias should be fixed. Watchful waiting, including active monitoring of symptoms, appears appropriate and safe for middle-aged men with asymptomatic hernias; however, neither strategy proved superior over the two-year observation period. The story summarizes the study design, and notes those included were middle-aged men with asymtomactic or mildly symptomatic hernias; however, according to the source article, half of referred patients were ineligible to participate in the study. In order for the authors, and in turn the journalist, to report that the finding is generalizable to real patient populations, this issue of how and why patients were excluded from the trial needs to be explained. The journalist and the authors might need to clarify that this study does not apply to men who have had ANY hernia related pain in previous six weeks (and that’s a lot of people!). Surgical complications are casually mentioned, however, the discussion is limited when compared to that of untreated hernias. There is also no mention that a hernia can recur even with the surgery (1.4% in this study.) 31% of the watchful waiting group decided to have surgery over the four-year duration of the study, though reports of pain at two years were similar in both groups. The journalist could include more information on why so many in the trial crossed over and decided to have surgery. The story could have further developed the effect of hernia pain on quality of life. Secondary pain and function outcomes were better in the surgery group, but this was not mentioned by their authors in conclusion, nor by the journalist. Lastly, there is no mention of the cost of hernia operations, which may be an important factor for someone trying to make this choice.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No mention of the cost of

hernia operations, which may play a role in someone opting for watching waiting.

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

Satisfactory

The story does not provide enough information on

the effect of pain or the limits a hernia might place on daily activities. There is some information on this in the study in

JAMA, but little is mentioned in story. 30% of the watchful waiting group decided to have surgery during the 4 years,

though reports of pain at 2 years were similar in both groups. More information on why they decided to have surgery and the

effect of hernia pain on quality of life would be useful in order to better inform patients who are trying to make a choice.

However, overall, this criterion was met. The reporter used absolute numbers, not just relative — always a good idea.

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

Not Satisfactory

The story

mentions harms and the frequency of surgical complications in this study, however, the discussion is limited when compared to

the discussion of untreated hernias. Does not mention the harm that a hernia can recur even with the surgery (1.4% in this

study.) The most significant harm reported may be the one case of nerve injury, which was not mentioned in the story. While

the story states 20% had complications, three of them life-threatening, readers could have used more detail.

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

Satisfactory

Mentions some evidence from the

Journal of the American Medical Association (JAMA) article. Mentions the randomization and an overview of the study design.

Provides some appropriate quantitative evidence. This study raises an interesting question for medicine and for journalism:

does the failure to demonstrate a significant difference mean that the treatments are equivalent? We think “no.” The story

could have also further scrutinized the evidence by asking about the condition of the men in the trial. One of the trial’s

inclusion criteria was having no pain or no interference with activities in the previous six weeks. So it’s not clear

whether they really had no symptoms or just minimal symptoms.

Does the story commit disease-mongering?

Satisfactory

The story does a satisfactory job of explaining that hernia surgery is a common procedure and

that this study challenges the conventional wisdom that all hernias should be fixed.

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

Satisfactory

Story includes perspective from

editorial writer.

Does the story compare the new approach with existing alternatives?

Satisfactory

We rate this

satisfactory, although, in comparing treatment options, the possible harms of surgery could have been explored more fully.

The story does not mention specific potential surgical or post-operative complications. 22.3% of those who underwent surgery

(this included those randomized to the surgery group or those from watchful waiting who crossed over into the surgery group)

had complications which included wound infections, urinary tract infections, and in a few cases, serious cardiovascular

problems requiring hospitalization.

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

Not Applicable

This

rating does not apply, as the story focuses on watchful waiting and active surveillance in lieu of preventative surgery for

hernias. Hernia operations are a common procedure and available in most hospitals; the new treatment (no intervention, save

for monitoring general health or symptoms typical of a hernia) is also now an evidence-based option for treatment.

Does the story establish the true novelty of the approach?

Satisfactory

The story provides accurate

information that watchful waiting vs. preventive surgery is a newer approach to treating men with mildly symptomatic hernias.

Total Score: 6 of 8 Satisfactory

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