It is laudable for a news show to offer airtime for exploration of challenging diseases with major public health and personal repercussions. And it might be inspiring for viewers suffering with or from alcoholism to see an example of recovery. However, allowing one individual to detail the means of their own personal triumph is an inadequate means of addressing a serious medical problem like alcoholism.
This story was neither objective nor insightful but rather sounded like an infomercial because it:
• didn’t discuss costs
• didn’t quantify harms or benefits
• didn’t evaluate the quality of the evidence
• offered conflicting information on supposed results
• committed disease-mongering (see criterion comments below)
Instead the air time could have been much better spent educating viewers about alcoholism, informing them about the treatment options available, and then explaining the potential roles for a medication like baclofen.
Most noteworthy is that this is the second time in a month that the ABC Good Morning America program has devoted significant chunks of airtime to this one author and his experience and his new book. (Many authors would love to have that kind of free publicity even once!)
We reviewed that prior effort – which wasn’t much different than this one.
There was no discussion of the costs associated with this treatment other than to raise the point that the French physician interviewed intended to take it for the rest of his life.
The benefits of treatment for one patient, the doctor interviewed in this piece, were described. The doctor made a claim that he was able to even have a drink, without problem. This claim was not critically examined.
The story mentioned a study in which 80% of the people treated with the drug were said to have benefited. But there was no explanation about the type of study, the longevity of the benefit, or any information that would allow a viewer to learn more.
A statement was made that there were no harms associated with this drug. This statement is not supported by the clinical information about the use of this medication for its approved use. Further, there is the potential for problems developing when going off the medication, which was not explained in this piece.
The doctor interviewed as the central character in this piece asserted that there are no side effects whatsoever. No attempt was made to question the basis for this comment beyond his own personal experience.
The "evidence" presented was the experience of a single doctor. A self-study by one individual is insufficient evidence of benefits or harms that may be associated with the treatment.
The assertion by this doctor that the treatment has worked for everybody who tries it was accepted without question. He later went on to contradict this and mentioned that there was an 80% response rate (not the 100% previously stated). This was also not questioned.
The piece stated that alcoholism is a chronic condition that progresses without treatment. But the scientific literature describes a high "spontaneous remission" rate for alcohol dependence, that is people who improve without formal treatment. Further, the story notes that the drug has been tested or will be tested in other conditions (to wit: "binge eating") – leaving a possible viewer take home message that whatever the cause of craving — poor self esteem, anxiety, etc. — baclofen at a high enough dose just might do the trick.
This story included information from the doctor promoting his book and from another clinician who is currently engaged in overseeing a clinical trial to determine whether the medication enhances the impact of another drug currently approved for the treatment of alcoholism. There was also a graphic with a statement from the CEO of a private addiction treatment facility, though this does not represent the comments of a disinterested expert.
An independent expert should have been included to provide some estimate of the impact of baclofen for treating alcoholism.
12 step programs were briefly mentioned. And the doctor interviewed mentioned his experience in a rehabilitation program. But there was no discussion about psychotherapeutic approaches either alone or in combination with medications or mention of currently approved treatment for alcoholisms, or information about the success rates associated with any of the treatments as compared to the study results with baclofen.
This is a story about an off-label use for a currently available medication. While interviewing a French physician and talking about a clinical trial in Philadelphia, the story failed to indicate whether the drug was currently available and if so, whether it was approved for the use discussed.
Although the discussion was about a use for baclofen for which it is currently not approved by the FDA, it is also not a new use for this drug. There are studies dating back to the 1970s and 80s looking at this drug and others in its class for its effect on alcohol craving.
We can’t be sure if the story relied solely or largely on a news release. We do know that the central figure of the story is a doctor on a promotional tour for his new book.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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