In some ways, this story about new options for getting rid of varicose veins is thorough and thoughtful. The explanations of the condition and the treatments are detailed and easy to understand. The story includes important cost information and makes good use of outside experts. We wish, though, that it had taken a little more care walking readers through the evidence, avoiding disease-mongering and putting some hard numbers to both the benefits and potential harms of the different treatment options.
Varicosities are very common, and for the vast majority of people, do not pose health risks. This story is off the mark for hyping the risk of varicose veins, when the majority of people are treated for cosmetic reasons. Anytime a procedure is being touted as quick, pain-free and relatively inexpensive, readers are likely to line up in droves. This is what makes it all the more important for reporters to carefully explain the trade-offs between risks and benefits. This story does this, in part, but could have been stronger with a few key data points.
Applause all around for this fast and efficient cost comparison. “Smaller veins can often be treated with sclerotherapy, which involves injecting a chemical solution into the vein to destroy it, and costs $250 to $500 per treatment. For larger veins, doctors may recommend endovascular procedures, which range in price from $2,500 to $3,000. These involve threading a catheter into the vein and directing a heat source such as a laser or radio-frequency device into the vein to incinerate it.” There was no price put on the “stripping” option of pulling out the veins entirely, but we still give the story a satisfactory score here.
We would have liked to have seen some hard numbers attached to the benefits of these therapies. One of the studies for the foam therapy approach, led by Suman Rathbun, who was quoted in the story, covered 166 patients over a three year period. The results are clearly enumerated in that study and could have been cited here.
Along with failing to evaluate the evidence, the story completely skips the numbers attached to any harms. One study on the foam therapy does spell out the different side effects, although most of them appear minor. Perhaps most troubling to people looking mainly to get rid of unsightly veins is that 51 out of 166 people treated reported that their skin had changed color. So, perhaps, patients are trading one problem for another. It’s information that, at a minimum, should be included. The story says, of the surgical approach, “The surgery can cause bleeding, bruising, nerve injuries, scarring and infection, and legs may have to be wrapped with bandages for several weeks.” It needed to at least note some of the harms associated with the other approaches.
This is where the piece falls down. There are a lot of allusions to studies but no true analysis of the evidence. “The drug has a strong safety record,” it says at one point. “Studies have shown that minimally invasive endovenous laser procedures that use local anesthesia are highly effective for removing the so-called saphenous veins,” it says at another. We wanted to see at least a few examples of the data or even a sense of how well understood this problem is. If “the exact cause of varicose veins isn’t known,” how can we know that these solutions are good?
In some ways, this story gives varicose veins the appropriate weight. “As many as 25% of women and 15% of men suffer from varicose veins; over the age of 50, one out of two people are affected. Heredity plays a part, but obesity, prolonged standing on the job and hormone therapy increase the risks. Sometimes, varicose veins have no signs or symptoms and require no treatment, though doctors may recommend wearing compression stockings and elevating the legs. Exercise can also help relieve pain.” Then it tips over into disease-mongering. “But often, varicose veins can be disabling and dangerous, as well as a warning sign of more serious problems in the circulatory system.” For the majority of people, this is merely a cosmetic issue, like wrinkles. The story also says, “Veins near the surface of the skin can also rupture and bleed heavily.” Our physician reviewer on this story wrote, “I have never seen this or heard of it in my nearly two decades in medicine.”
The story does a good job talking with experts who recommend a cautious approach to the new therapies. There is no cheerleading in this piece.
The story balances the different approaches well. Again, we would have liked to have seen some numbers used in the comparisons, though.
The story does a good job explaining what are basically three different approaches to varicose vein treatment: a surgical option, which is the most common; an injectable drug option, which is becoming more common; and the foaming injectable option, which some doctors use off label.
The story makes it clear that these are emerging approaches.
The story does not 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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