This condition for the vast majority of people is a minor cosmetic annoyance that in no way affects their health, but the article suggests that everyone is potentially a candidate for expensive removal procedures based on trumped-up discussion of health risks. And while the story provides a fair amount of useful information about these treatments, it unjustifiably extols the benefits of newer treatments without comparing them to existing surgical techniques. It also relies too much on anecdote and didn’t seek out a perspective from someone with no financial interest in these procedures. Overall, a pretty poor showing from the Times. We expect and need better from the nation’s premier daily.
An industry has arisen to treat varicose veins, with dermatologists, vascular surgeons, radiologists, and other "specialists" all cashing in. It is shameful that our failing health care system cannot distinguish what is a cosmetic procedure the majority of the time from the very occasional patient who requires medical treatment for varicosities.
No discussion of costs — a big hole when we’re talking about treatments that are highly profitable for specialists and are often sought out for cosmetic reasons and not because of any health risk.
The benefits discussed in this story were ALL anecdotal. In addition, the story reports on a newly approved pharmaceutical intervention without citing any success rates, absolute or relative. Not satisfactory.
The story doesn’t get specific as to how often harms should be expected with the various treatments discussed, but it does mention some of the more common problems that can occur, including recurrence of the varicose vein or the creation of new varicose veins in the same area. Still, the story goes to significant lengths to make readers think this is a benign procedure (including a quote about one patient feeling a "a little tiny pinch"), when long-term consequences of superficial vein ablation on risks of deep vein issues such as clots are unknown.
Overall, because the story didn’t give any sense of the scope of the problems – how often someone considering the various approaches may experience harms if they do – we must rule this unsatisfactory.
The story doesn’t spend much time discussing the complexities of the medical evidence, but in its defense, it does make sure to provide specifics regarding which treatments are FDA-approved and which are being used off-label. This is in and of itself a key indicator of the strength of the data supporting different treatments. Still, the story goes a bit off course when it compares the effectiveness of different treatments without citing any data. It quotes an expert who says that newer, more expensive radio-frequency and laser treatments are "a heck of a lot better than surgery” for treatment of underlying varicose veins. But we would expect such an assessment from someone who developed a laser treatment for varicose veins, as this expert apparently did. What would be more compelling is some reference to studies showing that these new treatments improve outcomes compared with conventional surgery–but no such information was provided. In fact, recent reviews suggest that while these newer treatments may work as well as surgery in the short term, current studies haven’t followed patients long enough to determine which is more effective over the long term.
The story claims that doctors believe everyone with varicose veins should seek out medical care. Excerpt:
Really? How many doctors? Who are these doctors? Are they doctors who stand to gain from treating this condition? This is a terribly misleading generalization. While it is true that a minority of patients are at risk of more serious medical problems related to their varicose veins, the vast majority of people have nothing to fear and don’t need to see a doctor. The article should have emphasized the benign nature of most varicose veins and identified the uncommon circumstances under which people should seek out medical attention for potential health risks.
Although the story gets high marks for tapping a number of expert sources, it should have done more to identify potential conflicts of interest. One expert who supports laser surgery is appropriately identified as the developer of a laser technique, but Dr. Robert Weiss, another expert quoted in the story, is identified only as the director of the Maryland Laser, Skin and Vein Institute. If fails to mention that he is also a consultant to Medicis Pharmaceuticals, which manufactures Asclera, a drug recently approved by the FDA which is discussed in the story. To avoid the appearance of any bias, the story should have disclosed this relationship. It also should have tried to get a comment from someone who doesn’t benefit financially from these procedures.
The story discusses surgery for varicose veins in the past tense, suggesting that it is no longer used. ("It entailed ripping out the groin-to-ankle vein with a wire via an incision.") In fact, as discussed above, the supposed long-term superiority of newer techniques over surgery has not yet been proven, and surgery still has a place in the treatment of certain types of varicose veins, especially larger veins. The story also failed to mention lifestyle changes, such as weight loss or avoiding standing or sitting for long periods, which are typically the first line treatment for this condition. As the story was in the fashion section, they should have also mentioned makeup, hosiery, etc, in addition to therapeutic interventions that a doctor might recommend.
The story provides very specific information as to the availability of different treatments for varicose veins in the U.S.
The story doesn’t suggest that any of these treatments are more novel than is actually the case.
It’s clear that this story isn’t based on a news release.