A couple of online commenters reacting to the story exhibited more insight than the story did overall, when they wrote:
When a drug is demonstrated to be safe and effective in one group of individuals (e.g. individuals with heart failure), this does not mean that the same is true for another group of individuals (e.g. healthy individuals). In addition, ‘sharing’ of prescription medication of any sort is potentially dangerous and unwise – in this case both for the person who would be taking the drug and also for the person who would be giving up the medication they are supposed to be taking to manage their condition. At one and the same time, the paper acted as though it had just discovered this long-standing practice of beta blocker use, yet it failed to give fundamental information that was important if this was its foray into this world of performance-enhancing drug use.
There was no discussion of costs.
The story provided anecdotes about performance anxiety relief from the use of beta-blockers such as indicating that ‘it decreases tremors and steadies nerves’. While descriptive, this type of information does not inform the reader about the amount of benefit that might be expected. Where are the numbers? Where are the data? Where’s the evidence?
Mixed bag, but a confusing one so we give it an unsatisfactory score. The story indicated that beta blockers ‘can cause problems for those who use them for non-medical purposes’ and that ‘no catastrophic events have been reported’. This is both contradictory and inadequate.
The story quoted one doctor who "recalled seeing a fellow doctor pass out while giving a speech because he had taken a beta-blocker for stage fright." We believe it is just as inadequate to cite anecdotes – and not evidence – for harms as it is for benefits. How OFTEN does this occur?
The story could have given much more helpful detail on the common side effects of low heart rate, low blood pressure (and its consequences), fatigue, sexual dysfunction, and several other side effects people might experience if they took beta blockers frequently.
Instead, the overall impression – steered by the weight of rosy anecdotes – was that this is a choice without negative consequences.
The story provided a number of anecdotes about the use of beta blockers to alleviate performance anxiety. Although it did mention that this class of medication has not been studied in healthy individuals, this was swamped by the sheer volume of personal testimony. The use of the personal narrative in this way is misleading as it suggests that it is an adequate substitute for an actual demonstration of safety and effectiveness, which it is not. The one study it cited was 19 years old and was done in 32 people. Is that the best evidence there is?
The story did not engage in overt disease mongering. It at least briefly acknowledged some dispute over whether stage fright is a condition requiring drug treatment, whether the desire to enhance performance warrants treatment with a prescribed beta blocker, etc.
While numerous musicians were quoted in this story about their perceptions about the use of beta-blockers, the actual clinical perspective about this use for the medication was inadequately represented in this piece.
By our count, generally positive promotional comments were represented in 6 interviewees – one of them even speculating on someone who couldn’t take the pills 46 years ago because they weren’t available with that person wondering if the pills could have saved the person’s career. Generally negative comments came from two interviewees.
Forget about balance.
While hailing the benefits of beta-blocker use for management of performance anxiety, there was no discussion of alternative methods, such as cognitive behavioral therapy, or even comments from other performers about how they deal with these problems.
The story mentioned that beta blockers are prescription drugs that are FDA approved for treating hypertension and heart failure.
It indicated that some people get a physician to write them a prescription for the drugs while some people get them from others who are willing to share.
Although the story adequately describes the availability of beta blockers, it should have explained that the use described in the story is an off-label use of medication.
The story was clear that beta blockers are not a new class of medication and that their use by individuals to address performance anxiety is also not new. (Although, we wonder why the paper chose to report on this now as if it WERE a new phenomenon. There’s no NEWS here.)
Does not appear to rely on a news 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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