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A good death

Rating

2 Star

A good death

Our Review Summary

This article described a single case of a young woman facing end-of-life pain control problems. It did not give details on other possible attempts at finding relief (pain clinics, hospice care, etc). This is pure anecdote and one that might have just as easily ended badly. The study planned for this drug is interesting and greater emphasis should have been given to the scientific basis of this drug for pain relief in certain populations, including more discussion of potential benefits and potential for harm.

While it did explore a difficult topic – end-of-life care – the story was more a description of a less than typical use the illegal drug ecstasy. The story of one individual’s use of ecstasy was really an interpretation of that experience by her parents. Although merely a description of a single individual’s experience, an article such as this runs the risk of implying that any benefit described could be attained by anyone making this therapuetic choice. What if the parents had watched their daughter die suddenly of cardiovascular collapse the first time she used the drug?

While this story also mentioned that the use of ecstasy might be seen by some potential users as negatively impacting their capacity to be engaged at the end of life, it was weak in its presentation of potential physical harms that could result. This article would have been improved by the use of less anecdotal third party material and more information quantifying the harms and benefits compared with other available options.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

None of the costs associated with obtaining this drug or associated potential legal liabilities were mentioned.

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

Not Satisfactory

One anecdote about potential benefits is incomplete. The benefits reported in this article are those observed by an interested second party and contained no first person report on whether the experience was perceived, overall, to be a positive one. The story mentioned that ecstasy can have adverse cardiovascular effects. While the story mentioned that this treatment “could take away from someone’s ability to be fully engaged at the end of life,” it did not explicitly describe the potential for shortening life.

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

Not Satisfactory

The benefits reported in this article are those observed by an interested second party. The story contained no first person report on whether the experience was perceived, overall, to be a positive one. The story did mention that ecstasy can have adverse cardiovascular effects. What if the parents had watched their daughter die suddenly of cardiovascular collapse the first time she used the drug? Even outside of shortening one’s life, the drug could have other side effects that impact quality of life (rebound symptoms, for example). While the article mentioned that this treatment “could take away from someone’s ability to be fully engaged at the end of life,” it did not explicitly describe the potential for shortening life.

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

Satisfactory

Much of the material in this article appears to come from a piece available from the Multidisciplinary Association for Psychedelic Studies web site. Additional material providing a context for understanding some of the pertinent issues regarding the use of ecstasy for the treatment of terminal cancer pain comes from others with interests in this field. The field is young and the story does not suggest there is a body of evidence to support this use.

Does the story commit disease-mongering?

Not Satisfactory

It would seem that fear of a painful end of life may be fueled by presenting the experience of a single individual who felt her only resort was using a hallucinogenic drug in an experimental context. The story would have had a better balance if it had contrasted this individual’s experience with one who had acceptable pain relief from conventional approaches. Although an expert was quoted as finding that 40% of dying patients report insufficient treatment for pain, this suggests that the majority of patients do obtain adequate pain relief. And most of the data about undertreatment of pain in cancer patients are old; physicians do a much better job of recognizing pain and addressing it now.

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

Not Satisfactory

Several individuals with different perspectives on the use of ecstasy with this patient population were quoted. However, there was lack of balance here. There was no one who articulated the point of view that ecstasy is an illegel substance with no clear record of benefit in any setting but with demonstrated potential for harm. The advocates for these studies and use of this drug may be few and connected to each other.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

A major shortcoming of this article was that it made no mention of other treatment options available for relief of terminal pain. It made no comparison of ecstasy use with any of these approaches. There are a wide array of opioid and non-opioid options and specialized pain clinics, available at most major medical centers that do help assess and develop treatment plans for individual patients. This story fuels the idea that there is much unncecessary suffering among patients facing end of life when, if fact, patients facing end of life have options with regard to pain management.

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

Satisfactory

The article noted that ecstasy is an illegal drug. (Although it fails to explicitly state that this drug is not FDA approved for any purpose, this is likely to be understood by the reader.) It would have been responsible to note that this drug is not available by physicians, including oncologists and pain specialists, outside of scientific studies.

Does the story establish the true novelty of the approach?

Satisfactory

The article explored the possible benefits of the use of the hallucinogen ecstasy in people that have terminal painful and/or debilitating conditions. It was not represented as being a new treatment but rather an under-investigated topic.

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

Satisfactory

Did not rely exclusively on a press release (see sources of information), however the article quoted extensively from the Multidisciplinary Association for Psychedelic Studies web site.

Total Score: 4 of 10 Satisfactory

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