This was the only one of the three stories we reviewed to explain that the benefits would be seen mainly in developing world countries where trauma care is often limited. On the downside, the story nevertheless claimed, without providing any supporting evidence, that the drug would also save "thousands" in Western countries that have more advanced trauma care. It also passed along the improbable claim that TXA could save up to 100,000 lives if readily available around the world.
Even when a clinical trial is large and well conducted, the results need to be greeted cautiously when they are first and only data showing a benefit from an intervention. While the data from this study suggest that TXA is an important lifesaving treatment for trauma patients, more studies are needed to confirm the benefit and establish whether the results are broadly applicable to all patients.
TXA costs $4.50/gram, according to the story, and a typical dose is 2 grams. However, a brief comment on the relative costs of treatment in the developing world would have been welcomed. While a $10 expense is minor in many countries, it may represent a significant barrier to access in the developing world where annual per capita health care expenditures may be less than $10.
This story does an inadequate job in its handling of the statistics. It notes that patients who received TXA had a 15 percent lower chance of dying from a hemorrhage and a 10 percent lower chance of dying from any cause compared with patients receiving a placebo. However, the benefits appear quite a bit smaller when put into absolute terms. It would have been more informative to say that the death rate from hemorrhage was 4.9% in the TXA group vs 5.7% in the placebo group (a 0.8% difference), while the risk of death from any cause was 14.5% in the TXA group vs. 16% for placebo (a 1.5% difference).
In addition — and similar to the AP story — this article didn’t do enough to challenge the claim that up to 100,000 lives could be saved annually through the wider use of TXA. For a variety of reasons, the results of clinical trials can be difficult to replicate outside of the study environment. Thus, the benefits of TXA in practice will almost certainly be smaller than this very optimistic estimate.
The story notes that there was no evidence of increased risk of blood clots in patients receiving TXA. The story also correctly notes that the presence or absence of blood clots is sometimes very difficult to identify in patients with trauma, especially those who succumb to their injuries.
The story did a good job of describing how many people were involved in this 40-country study, how the investigators treated them, and what effects were observed. Although the story is clear that TXA would likely have the largest benefits in developing countries, it should have been more cautious about extrapolating the results to Western countries where emergency care is more advanced and the benefits of TXA may be limited. The story says the drug "could save thousands of people in the West," but the only support offered for this assertion is a comment from an emergency department physician in London. If there are compelling data from this study showing that TXA is effective in Western countries, the story should have discussed them in more detail.
The story quotes two sources who weren’t affiliated with the study and who don’t appear to have conflicts of interest.
The story makes no mention of the other clotting agents that are available and how they might compare with TXA.
The story notes that TXA is commonly used in wealthy countries during elective surgeries to stop bleeding.
The story notes that TXA is widely used in elective surgeries to control bleeding, and adds that this study is the first to use TXA in the treatment of accident victims. Although TXA has been used in a number of traumatic injuries, widespread use in generalized trauma has not been studied previously.
From the variety of different sources who are quoted, we can be sure that this story isn’t based on a news release.
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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