The story does not discuss the costs or potential savings associated with the use of this drug. On the cost side, there are the direct costs of the drug itself as well as the diagnostic testing which must be conducted prior to administering the drug. In addition, hospitals incur significant costs to become certified as a primary stroke treatment centers, which is where candidates for tPA therapy are most likely to be taken by ambulance teams. On the savings side, successful treatment with tPA would potentially prevent significant expenditures on the care of disabled stroke patients.
The story doesn’t do a good enough job explaining what they observed in the study or the benfits of tPA in general. In discussing the differences between weekday and weekend treatment, the story reports that there was a 20% difference in the likelihood of receiving tPA. In absolute terms, however, the difference between weekdays and weekends is very small (1.1% vs 0.9%). In addition, there is some discussion about why the study did not detect a reduction in deaths among patients treated on the weekend and who were more likely to receive tPA. The study could have noted that tPA has never been shown to reduce mortality in randomized clinical trials. The primary benefit of tPA—which is never explained in the story—is that it may increase the likelihood of a patient’s recovery from stroke without disability.
The story was primarily about weekday vs. weekend use of tPA. While it could have mentioned other stroke treatments with proven benefits, such as aspirin, it would probably be unfair to dock points for not including this information.
The story explains that the tPA is only used within 3 hours of the onset of stroke symptoms. It also hints at the fact that tPA is effective only for ischemic strokes, and that treatment is more likely to be available at certified stroke treatment centers. While it could have done more to make the limitations on tPA’s use explicit, the reader will probably come away with the sense that tPA is available only for certain patients where it can be used early. This is a satisfactory outcome.
Although it recites much of the same information included in an AMA press release about the study, the story includes an interview with one of the study researchers as well as with an independent expert. While this is enough for a satisfactory rating, it should be noted that the press release for this study appears to have taken a more critical view of the results than the HealthDay report. The press release stated in the first paragraph that stroke death rates were the same in this study among weekend and weekday admissions, whereas the HealthDay report took nine paragraphs to relay this information.
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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