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Obesity Surgery Helps Diabetic Patients Kick Medicines

Rating

4 Star

Obesity Surgery Helps Diabetic Patients Kick Medicines

Our Review Summary

As you’ll see, our critique of just the "Evidence" criterion was almost as long as the entire blog story, but we think the points we raise about evidence are essential – no matter the story format or its perceived limitations.

Good job analyzing costs.

No independent sources quoted; we would like to hear from an independent expert who could address the evidence questions we raise.

 

Why This Matters

Obesity and diabetes are major public health problems, and interventions that may reduce the impact of these conditions deserve the public’s attention.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

Health care spending before and after the surgery is a key point in this story. The story also includes an estimate of the cost of stomach-reduction surgery. However, neither the story nor the study offer a comparison of the spending of these patients to that of people who do not have this type of surgery.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Our primary reviewers (a journalist and a physician) were split on this one. 

The journalist said that the story reports specifics of how many participants in this study stopped taking diabetes medications following stomach-reduction surgery, but it does not provide any context. All of the study participants were extremely obese and had diabetes. How many obese people have diabetes? Readers are not told. How many people with diabetes are so obese that they may be candidates for stomach-reduction surgery? Readers are not told. How does the reduction in health care spending following surgery compare to the spending trends of other people who are obese and have diabetes? Readers are not told that the study did not explore that question. The lack of context makes it difficult to appreciate the true value of the reported benefits.

The physician agreed that context was not provided but felt the story did a satisfactory job of summarizing the main benefits as presented in the study.

The publisher tilts the scales toward a satisfactory score.  The call for context by the first reviewer is appropriate.  But the story met the baseline criterion for a passing grade – especially within the confines of a brief blog entry.  We also note that this blog – using best practice on the web – linked to the published study so readers could dig deeper if they wished.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story does report that some patients died and 21 percent had to be readmitted to a hospital within a year after surgery.  Since the story was about the study, we’ll give it a satisfactory score for reporting the harms reported in the study.  But such stories could (and we wish would) always include even a line about other side effects and complications of stomach-reduction surgery, which include nutritional deficiencies, gallstones, stomach ulcers, hernias, food intolerance, kidney stones, low blood sugar, blood clots, leaks in stomach staples, pneumonia, dumping syndrome (nausea, vomiting, diarrhea, dizziness and sweating caused by food moving too quickly through the small intestine) and other problems.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story and the journal article on which it is based both fail to note an important limitation of the study: that it included only individuals who were obese and had diabetes and who underwent stomach-reduction surgery. Readers are not told that this study is not a comparison of surgery to other treatments for obesity or diabetes. While a large majority of the individuals included in this study did report stopping their diabetes medications after surgery, this kind of study cannot reveal how this approach compares to alternatives.

The researchers wrote: "we believe that the patients studied are a reasonable sample of patients undergoing bariatric surgery in the United States at present." Even if you agree that belief is justified, the key qualifier is that the study included only people who underwent bariatric surgery – not a general population of obese people with diabetes. Is that an important difference? We don’t know and neither do the researchers, since their study didn’t look at that question. The story should have at least pointed out that this study does not provide direct evidence that surgery has benefits for obese people with diabetes – only that most obese people with diabetes who had surgery reported they stopped needing diabetes meds. As the researchers noted, they don’t know if BMI before the surgery or weight loss afterwards was important because they didn’t have that data. So is there a threshold BMI or post-surgery weight loss that is associated with benefits? This study can’t provide those answers. Therefore, the story should at least make clear that any conclusions about generalizability to the average obese person with diabetes is a leap of faith and not based on evidence produced by this study.

We realize that our critique on this one criterion was almost as long as the entire blog story, but we think the points we raise about evidence are essential – no matter the story format or its perceived limitations.

Does the story commit disease-mongering?

Satisfactory

The story does not exaggerate the prevalence or consequences of obesity or diabetes.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

This story does not include comments from independent sources. The researchers did not make any financial disclosures. The study was funded by a public agency, the U.S. Agency for Healthcare Research and Quality. It used data that was originally gathered for an obesity care project funded by a surgery device company and an insurance company.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There is no information about alternative approaches. Even in a brief blog post, just a line about alternatives would satisfy this criterion.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story says the researchers argue that the results support coverage of the surgery by insurers. That at least implied that not every plan covers the surgery now for this type of patient – which is at least indirectly a comment on availability.  It could have been more explicit.

Does the story establish the true novelty of the approach?

Not Applicable

Not applicable because the story really doesn’t make any claims about the novelty of stomach-reduction surgery. It could have provided readers with background about other studies about the effects of this surgery on diabetes. Even in a short blog story such as this, links could be used to achieve this goal.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Although it does not appear that anyone was interviewed for this story, it does include some information that was not included in the new releases from the Archives of Surgery and Johns Hopkins Medicine.

 

Resources:

Archives of Surgery article abstract:

http://archsurg.ama-assn.org/cgi/content/abstract/145/8/726

Archives of Surgery release:

http://pubs.ama-assn.org/homepage/media/2010a/0816.dtl#1

Johns Hopkins Medicine release:

http://www.hopkinsmedicine.org/news/media/releases/national_study_shows_weight_loss_surgery_frees_most_obese_type_2_diabetics_of_insulin_and_other_sugar_controlling_drugs

 

Total Score: 6 of 9 Satisfactory

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