This story about the failure of Celexa (citalopram) to control repetitive behaviors in autistic children does one very important thing wonderfully right: It explains why the conclusions of this study, which compared a group that got the drug to a group that got a placebo, are therefore valuable. Given the fact that the results sharply contradict current clinical practice, that’s a great service to readers. It essentially says: This study matters and its conclusions can be trusted.
The story also devotes some space to describing gold-standard clinical trials generally–something that’s particularly important for caretakers of kids with autism, who are faced with shams and scams constantly.
For all this the reporter deserves a public service award of some sort.
Having said that: The report falls short in three significant ways:
It does not report the cost of the drug. At a time of health care reform, when costs are central to the national discussion of care delivery, this piece of information is essential. In a case where a drug is expensive–and found ineffective–it’s even more important.
It underplays the harms. When a study has negative findings on a treatment, it’s essential to explore harms. The story skids past them too quickly. The story here is not only that the drug doesn’t reduce repetitive behaviors, but that it raises the risk of other negative behaviors and side effects that may be worse.
It doesn’t discuss treatment options. Once again, a study that finds a drug does not work immediately raises in a reader’s mind the question of what does work–or at least what other approaches are currently tried.
Overall, the story scores solidly under our rating system and earns points for explaining the value of well-controlled clinical trails. But its failure to address three of the most important issues–costs, harm and treatment options–prevent it from fully serving readers’ needs.
The story does not report how much treatment with Celexa costs, for the drug and medication management.
Celexa itself is an expensive, highly marketed drug; it costs between $3 and $4 per daily dose. That’s about $1,300 per year.
Generic, citalopram costs about a dollar per day but can be had at $10 for a 90-day supply.
Further, the study shows it doesn’t work, which only increases the relevance of costs. Even at pennies per day, the money is wasted.
The story does an adequate job quantifying most results. It describes the study’s size, population and duration. It reports that 33 percent of the treatment group and 34 percent of the placebo group had improvements.
The report should have said more about how "improvements" were measured and helped readers understand them as concrete behaviors.
On balance, however, the story deserves a "satisfactory" rating under this criterion.
The story mentions side effects of Celexa but underplays them.
The data show that nearly all children in the study who took Celexa had side effects, including increased energy levels, impulsiveness, decreased concentration, hyperactivity, diarrhea, insomnia and dry skin.
The side effects also included stereotypy–repetitive behaviors. Which is to say: In some children, the drug caused the very symptoms it was supposed to treat.
The story lists only "insomnia and impulsivity" as side effects. It says they were "twice as common" in the group taking Celexa, but it doesn’t say in absolute terms how many of them experienced side effects considered serious.
The story does an unusually good job explaining the value of the type of evidence this study produced. It explains why a clinical trial that uses a placebo is so powerful, and why blinded, randomized trials are the gold standard.
A reader comes away with a clear sense of why this study is authoritative, in a context where science is often sketchy, false claims are often made and the need for treatments so great.
The reporter might have mentioned that with 149 participants, only 73 of them in the treatment group, the study is considered small.
Further, the story fails to point out that the research question was very narrowly tailored: Did the drug reduce repetitive behaviors? The findings are silent on the value of Celexa and other SSRIs in treating other symptoms in the same patients. The reporter should have said so.
Having said all that: On balance, thanks to its exemplary work illuminating the world of study quality, the story earns a "satisfactory" rating.
The article does not exaggerate the prevalence or severity of autism spectrum disorders.
For greater precision and public value, the story should have said that the conditions studied and related to autism include Asperger’s syndrome and other developmental disorders.
The reporter quotes three sources:
This is adequate sourcing.
The reporter properly discloses the authors’ financial links to drug companies, including the maker of Celexa.
The story mentions that the drug Risperidone is approved for some symptoms of autism.
But it fails to say what the standard treatment is for controlling repetitive behaviors and similar behavioral symptoms of kids with autism and Asperger’s.
Studies have shown "early intensive behavioral interventions" to have some efficacy.
The story states that Celexa is taken by about a third of children diagnosed with autism.
The novelty of the treatment is not in question.
There is no evidence the reporter has drawn excessively on the press release.