We wish more stories focused their coverage on the lack of good evidence supporting commonly used medical treatments, as this NPR story about remedies for morning sickness did. We also appreciate this story’s decision to cover a Cochrane Library systematic review–among the most authoritative evaluations of medical evidence available in the literature today. Still, a skeptical outlook cannot substitute for a thorough analysis of the evidence — something which this story came close to but ultimately did not provide to readers. In addition, high quality source material cannot make up for a story’s failure to provide an independent perspective. Overall this was a solid effort that met most of our criteria and communicated the key points well. A bit more detail in a few areas would have increased the story’s value to readers.
Morning sickness is common and can range from a minor annoyance to a life-threatening condition. It takes a significant toll on women and our economy via lost work days, increased anxiety, physical symptoms and reduced overall quality of life. Women who experience morning sickness inevitably are going to receive conflicting recommendations from doctors, family, and friends about the best way to deal with the condition. This story delivers an important message about the lack of good evidence supporting any specific therapy.
There wasn’t any discussion of costs of these treatments. The point of the story was tell readers that these treatments couldn’t be recommended on the basis of medical evidence. Even in an overview of available treatments, some cost information is important for readers, especially given the fact that regular acupuncture treatments are going to cost a lot more than vitamin B-6. How much money are people wasting on these treatments?
A mixed bag here, but ultimately unsatisfactory in our view. The story does note that there "wasn’t much hard data" on psychological, social or economic outcomes — all of which are important to look at considering the lost work time, anxiety, and reduced quality of life that women may experience because of morning sickness. But then the story goes on to state that there was "some evidence" that ginger, vitamin B-6 and anti-vomiting drugs relieved nausea. Well, how much evidence was there and what exactly did it show? While the story states that the evidence for these treatments "isn’t strong enough to make a recommendation," we feel the story should have tried to quantify this benefit in a way that would be meaningful for readers, whether as episodes of nausea/vomiting or some other "real world" outcome.
The story noted that most of the studies included in the review didn’t include enough information about potential harms — "something everyone would certainly want to know." We’ll call this satisfactory, but we wish it had included at least some information about the harms that were mentioned, such as heartburn in patients taking ginger and drowsiness in patients taking anti-nausea medications.
The Cochrane systematic review discussed in this article is actually a "study of studies." In this case, the story told us how many clinical trials were included in the review (27) and how many women participated in those studies (about 4,000). The story told us why the included studies, which at first glance might seem like an impressive volume of research, couldn’t provide reliable answers about the effectiveness of morning sickness treatments. The story noted that many of studies used different methods and had different ways of measuring outcomes, so the results couldn’t be pooled together to increase the statistical power of the analysis.
The lead overstates the case a bit by saying that the review concluded that there was "no reliable treatment to relieve vomiting and feelings of nausea in early-term pregnant women." But, in the third paragraph, the story says, "Dublin City University’s Anne Matthews, the review’s lead researcher, says it was disappointing not to find more studies that were consistent in testing the same approaches. Without enough data that could be pooled together, it wasn’t possible for the Cochrane folks to figure out if anything really works reliably and safely."
It would have been nice to see Cochrane’s methods evaluated as closely as those of any other type of research experiment. But it didn’t provide key information about how the researchers selected which studies to include in the review. We don’t know, for example, whether the included studies were randomized controlled trials or if uncontrolled trials were allowed. We also don’t know if the studies had to be of a certain size or quality to be included. This information is vital to understanding the strength of the review’s conclusions.
This story didn’t exaggerate the effects of morning sickness.
The only source quoted in the article was an author of the study being covered. As we discussed in our review of the competing LA Times piece, one could argue that this criterion should be ruled not applicable in this case since the Cochrane group authors are, by definition, an independent group of evaluators. Since other experts do sometimes dispute the way in which Cochrane authors analyze the evidence, however, we feel it would have added value to include the voice of another expert who wasn’t affiliated with the study.
The story discusses many different treatments for morning sickness and reports that they all lack good-quality evidence to support their use.
The whole point of the story was to discuss the most commonly used treatments for morning sickness: acupuncture, acupressure, ginger, vitamin B-6 and conventional anti-vomiting drugs.
The novelty of the treatments analyzed in the review isn’t really in question, so we’ll call this not applicable.
The story includes an interview with one of the authors of the study and doesn’t include any direct duplication of text from this press release. So we feel pretty confident that it didn’t rely exclusively on a release for its content.
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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