This story about an experimental new technique for controlling asthma spent a lot of time emphasizing benefits but glossed over the limitations, risks and unknowns. Our reviewers were particularly concerned by unsupported claims about effectiveness and a lack of balance and caution.
Asthma attacks account for millions of emergency room visits each year and thousands of deaths. Thermoplasty might be an option for reducing this burden in patients whose severe asthma is not responding to available medications.
The frequent emergency room visits described in this story represent a big cost burden that this treatment might help alleviate. But the treatment itself is also likely to be expensive and might counteract these benefits. Regardless, the story doesn’t mention costs.
There wasn’t much quantification of the benefits observed in this study. And when there are no long-term data showing how people fare after treatment, we find it puzzling that the story would claim that asthma symptoms are "generally gone for good" in patients who receive this procedure. Moreover, we were concerned about the story’s emphasis on the impressive-sounding 84% relative reduction in hospital ER visits in the thermoplasty patients. As we note here, using relative risks can make a treatment’s benefits sound more impressive that they really are. Finally, we wish the story had mentioned the fact that patients treated with a sham thermoplasty procedure (the placebo) in this trial also had a big improvement and fared nearly as well as the thermoplasty group according to the study’s primary quality of life outcomes. (See the abstract for more details.) This would have provided a more reasonable perspective on what patients can expect from this treatment.
There were a couple of openings for this story to better characterize the potential risks of this investigational procedure. At one point, the story says that the treatment "doesn’t come without risks," but the only downside subsequently mentioned is that "People will have to be trained to use the technique." Later, an anchor says more directly, "You are actually destroying some tissues in the lungs. Do they know anything about potential long-term complications?" But the reporter responds that the treatment "doesn’t seem to limit pulmonary, lung function at all." Faced with the lack of any long-term data on how patients do with this procedure, we feel it would have been appropriate to at least discus the potential for adverse consequences or emphasize the uncertainty of the current evidence. Instead, the "breakthrough" framing came across as cheerleading.
The story mentions a study that tested the new thermoplasty treatment in 300 patients, but what kind of study was it? Was it a case series or a placebo controlled trial? And if the latter, were the doctors conducting the study blinded to which treatment the participants were getting? These details make a big difference as to how much confidence we should have in the results, but the story focuses entirely on what the study found and not on how it was conducted.
There was no overt disease-mongering in this story, but it could have cited what percentage of asthma patients have severe symptoms that are not adequately controlled
The story failed to point out that the Dr. Castro, who led the study discussed in this story, is a paid consultant for Asthmatx, which manufactures the thermoplasty device tested in the study and which provided funding for the study.
The story notes that other asthma treatments aren’t "game-changers" for patients who aren’t responding to medical therapy, the implication being that thermoplasty is. But we don’t really know whether thermoplasty represents a big improvement over medical therapy just yet.
That being said, the story did emphasize that this treatment is only being considered for patients whose asthma isn’t being controlled by existing treatments. By providing this important context, the story does enough to satisfy the criteria.
In the lead-in to her interview with the reporter, the CNN anchor states in passing that "as always with things that are seeking approval, and there are benefits and there are of course risks." She is alluding to the fact that this asthma treatment involves an investigational device that has not yet been approved by the FDA. However, this is never directly stated. We think there’s a good chance the average viewer will think that this treatment is already available, but it isn’t.
While we were uncomfortable with this story’s characterization of thermoplasty as a "new medical breakthrough" (for reasons discussed here), the treatment is relatively new and different from existing techniques. We don’t think the story misled in this regard.
This story was not based unduly on any news release that we could identify.
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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