Immediately – in the second sentence – this story raised doubts about the North American study more forcefully than the LA Times story ever did. And it immediately offered the perspective that these "disparate findings…could help determine whether Medicare expands coverage to cover the stent procedure." The context was deeper, the balance better in this story.
While we don’t want our health coverage to devolve into "he said, she said" between research camps, good reporting has to present opposing views when reasonably justified by the evidence.
Although it hints at potential implications of expanded Medicare coverage for stents, this story doesn’t make any explicit reference to costs.
The story does a satisfactory job of presenting the major findings using the appropriate statistics. Like the LA Times, however, this story suggests that the disparate findings of the two studies might be explained by the better training and experience of the American CREST surgeons compared with their European counterparts in the ICSS trial. We wish it had spent some time exploring whether the typical patient in the U.S. can expect to receive the kind of expert care offered by the top CREST surgeons. In many cases, the "real-world" outcomes of patients will be less favorable than what the CREST team reported.
As with the LA Times coverage, this story gives us the key essentials regarding what happened to patients in both studies and their risk of major complications such as stroke or heart attack.
The story put appropriate emphasis on the fact that these were large, well-conducted studies that are likely to have a big impact on patient care, However, it should have included a caveat about the preliminary nature of the CREST study results, which were presented at a scientific meeting and have not yet been peer reviewed.
It would have been nice to see some perspective from someone who was in no way affiliated with either of these studies–something which the LA Times, in its defense, did provide in its coverage. Nevertheless, in the hierarchy of sourcing priorities, we felt it was most important that the coverage include some kind of European perspective to counterbalance the American voices advocating for stents. The New York Times managed to get a hold of the lead investigator for the European ICSS trial. He made a pretty good case for why one might think twice before opting for a stent instead of open surgery.
This story doesn’t give enough attention to the question of whether one should intervene at all in asymptomatic patients. It states that surgery "has been shown to be more effective than medical therapy alone" for preventing strokes, but it is not clear that this is true for asymptomatic patients.
The story states that surgery has long been considered the best treatment for obstructed carotid arteries, and that Medicare is considering expanding coverage to include stents. Readers can reasonably assume from these statements that both treatments are widely available.
It’s clear from the story that both of these approaches have been in use for quite some time.
This story is not based 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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