Laryngeal papillomatosis (also known as recurrent respiratory papillomatosis) is characterized by recurrent benign growths on the vocal chords. It can cause vocal paralysis and requires repeated treatment. Recently doctors have begun removing the growths with laser surgery to minimize damage to the chords. However, even with laser treatment, repeated treatments are often needed. After laser treatment, injection with the cancer drug Avastin may help prevent the growths from recurring, however little is known about the success of this treatment other than from a few cases. Clinical trials are underway.
This story very dramatically shows one opera singer’s struggle with and treatment for recurrent respiratory papillomatosis. However it provides little for the viewer in terms of useful information. Lacking from the story is any information on availability of the treatment (which is likely to be limited), the cost (which is high), the evidence to support the use of the treatment (which is lacking), the harms of the treatment (which could be substantial), and the alternative treatment options (of which there are several).
Furthermore, the story only quotes one expert who is invested in the results of the treatment since he is the lead researcher. The story should have quoted other experts who could provide some much needed perspective. That researcher may have said that there’s "absolutely no disease" and the patient may have said "You saved my voice" but we think journalism needs to put this into the context of a limited time frame of only a few months and a condition known for recurrence.
The story does not describe the cost of the surgery or the injections. The price of Avastin is notoriously high, calling many to question whether it is worth the cost.
The story does not quantify the benefits of laser surgery with or without Avastin injections.
The story describes no harms of the laser surgery or the drug injections. Laser surgery requires anesthesia, which carries some risks. The laser can also cause scarring and permanent injury to the vocal chords. Furthermore, because Avastin has mostly been studied in the context of cancer along with chemotherapy, it isn’t clear what the side effects of the drug would be in the context of a benign condition.
The story does not describe the strength of the available evidence to support the use of the laser surgery or the injections. The story mentions the presentation this week at the American Broncho-Esophagological Association of new results. These results are limited to the first 22 subjects who have undergone laser treatment (without the drug). Although the story mentions a clinical trial, the story does not make it clear that the use of Avastin in combination with laser treatment has not been studied. Indeed the story seems to suggest that one miraculous case study is in itself proof that the treatment works. Instead of letting Dr. Zeitels get away with saying "…there’s absolutely no disease"…the story should have framed his comment with a unit of time…it’s only 6 months since the last injection in December. Are to assume that if there’s no growth at 6 months then there will be clear sailing forever? The patient says "You saved my voice" but we don’t know that for sure; it’s only been a few months and this is a condition known for recurrence.
The story does not exaggerate the seriousness or prevalence of Laryngeal papillomatosis.
The story quotes only one expert – who is invested in the results of the treatment since he is the lead researcher. The story should have quoted other experts who could provide some much needed perspective.
The story does not describe any alternative treatment options.
It is not clear if the laser treatment or the Avastin injections are available, and if so, how many practitioners are trained in performing the surgery or injecting the drug.
Although laser surgery for Laryngeal papillomatosis is not a new idea, combining it with Avastin injections is.
We can’t be sure of the extent to which a press release influenced the story selection or content. We do know that only one expert at only one medical center appeared in the piece.
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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