This is a story about a study examining the costs, harms and the impact of doctor experience associated with the use of robotic prostatectomy. The story raised some important issues that are not ordinarily broached during patient – doctor conversations. While raising some potential red flags with respect to doctor experience, the story failed to critically examine what, if any, benefit there might be to this particular surgical approach. While it is valuable to know that after completing 80 procedures of this type, a surgeon is no longer apt to leave cancerous tissue behind, it is also important to know if there is any value added by having this more expensive procedure.
The story does serve as an important reminder to consumers that more modern sounding approaches do not necessarily offer the patient a less problem plagued experience.
This story is provides an example for consumers to consider about the value in knowing about both the benefits as well as the harms associated with whatever treatment option they are considering. Further – the story raises the point that newer or seemingly more sophisticated treatments are not always superior to lower-tech options.
The story indicated that the robotic procedure was more expensive than a standard surgical prostatectomy. In addition, it included information about the expenses associated with obtaining and running the equipment.
It is not clear from this story what, if any, the benefits are of having a robotic prostatectomy instead of a standard surgical prostatectomy. There was no discussion about the decreased hospital stay or reduced recovery time that has been reported with this approach. Although these are short term benefits, they may be of interest to certain patients. In this sense, the story was the flip side of what we often see – exaggerated benefts and no mention of harms. This story mentions harms (although data comes from biased literature review) and no benefits.
The story provides readers with some potentially interesting questions to raise with a doctor (e.g. how many of these surgeries have you done using this equipment; is this approach the best for the type of cancer I have, i.e. early or more advanced). The story mentions in passing potential harms such as impotence and incontinence, referencing a study published in October.
However – the story did not really follow-up on one of the key issues it raised. For example, the story mentioned that a surgeon will have to do 80 procedures with this equipment to ensure that they don’t leave any cancerous tissue behind. The story could have completed this thought and indicated the ramifications of leaving cancerous tissue behind in terms of health consequences.
The story indicated that the publication reported on examined data from a number of previously published reports. The story then extracted several salient facts to highlight some variables that affect outcomes of interest to patients. The story would have been improved by noting the weaknesses or biases associated with a simple literature review. This is not a systematic review of the literature or a meta-analysis. This is simply a literature review and the methods are flawed — for example, the authors chose 68 papers of 412 on basis of selection/inclusion criterion "…those with greatest relevance to the paper."
The story did not engage in overt disease mongering. It might have been useful to note that not all prostate cancers result in morbidity or mortality meaning that not all prostate need active treatment.
The story does not use any comments from experts in the field without a direct connection to the study reported on.
The story mentioned that the authors of the study reported on did not compare robotic surgery complication rates to traditional surgery rates. In a perfect world, we would have hoped that the story would have investigated these data points anyway.
The story mentioned that robotic prostatectomy was the ‘dominant approach’ to this procedure in the United States. But that is an erroneous statement by the physician who is from Australia. It is certainly booming in popularity, but that doesn’t make it the dominant approach.
The story indicated that robotic prostatectomy is not a new procedure.
Does not appear to rely exclusively on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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