This is an engaging piece, detailing some of the behind the scenes work to uncover an additional use for a generic medication. While painting a generally optimistic view about the potential benefit of salsalate for people with type 2 diabetes, the story did not provide much information about the magnitude of benefit or the potential harms associates with use of this drug. The potential benefit from this medication addresses a pathway not commonly thought to be involved in type 2 diabetes. It is likely that it will be a long while before there is documented evidence about the utility of this medication in this context – a point that was not made in the story. Further, although framing this medication as an inexpensive option, the story failed to put that in the context of the other, generic and inexpensive type 2 diabetes treatments.
Although there was no specific price mentioned, the medication was described as ‘a cheap generic’. Further – there was discussion about a goal being to see it remain inexpensive. That said – it still would have been helpful to include the price since it is a currently available product.
The story did not provide information about the magnitude of benefit, either in terms of the drug’s ability to improve glucose load or about longer term benefits such as its impact on the predicted chance of heart attack.
The only potential harm mentioned with this medication is that it carries a safety warning about increased risk of heart attack and stroke associated with its use. The story went on to discuss that salsalate carries this warning because of its drug class but that there isn’t evidence demonstrating that these risks are associated with its use. The would seem to be confusing – does this medication increase the risk of heart attack and stroke or not?
Further – because this drug has been around for a long time, a lot is known about its side effect profile at least among people with arthritis. It would have been helpful to at least mention the known major side effects.
The story mentioned that there had been several observations made about the impact this drug may have to improve glucose levels and one study found that it ‘lowered the spike in glucose level’. However – as the claim was made that type 2 diabetes increased the risk of ‘everything from heart attacks to kidney failure’, the story should have made clear that there is currently no data on the impact of this drug to affect rates of heart attack or kidney failure. The story could have included the observed effect size in terms of glucose control from the 2 smaller studies that motivated the larger NIH trial that is currently underway. Because this drug has been around for a long time, we know a lot about its side effect profile among people with arthritis. It would have been helpful to at least mention the known major side effects.
The story mentioned in passing that type 2 diabetes was the most common form of diabetes and that diabetes increased the risk of ‘everything from heart attacks to kidney failure’. As there was no context provided for this claim about what the magnitude of this increase was or how long an individual would need to have type 2 diabetes before being at increased risk, this statement could be considered disease mongering.
The statement that this medication could ‘radically reduce these risks’ does not appear to grounded in data at this point in time.
The story includes comments from two individuals who are not directly involved in the specific study to examine whether salsalate improves outcomes for individuals with type 2 diabetes. In addition to comments from Dr. Shoelson who is a proponent of expanding the application of salsalate, the story had comments from a researcher with an opposing viewpoint as well a spokesperson from the governmental agency funding the project.
Other than a mention in passing about ‘costly medications’, the story did not contain information about means of treatment currently available for individuals with type 2 diabetes. While this drug was framed as an inexpensive, generic option, there are actually many low cost generic options that people with type 2 diabetes can use to keep their sugar level in check. There was no mention of this in the article.
The story described the drug being investigated as ‘a cheap, generic’ and as currently being sold as ‘an inexpensive generic’. It would have been useful to clarify whether it was available as a prescription or an over-the-counter medication.
The story was very clear that this is a compound with a long history which is now being investigated for a new purpose.
Clear enterprise reporting.