The story does include some commentary from some independent sources, and it does a good job placing the patches into the larger context of pain-relief traditions in other countries.
But it does not carefully analyze the evidence supporting the use of these patches, does not quantify the benefits of their use, does not quantify the harms and does not provide any cost information. We’re baffled as to why this story was published (twice – 6 months apart) and why so many outlets picked it up. (Yahoo, iVillage, MSN, ScienceMagNews, countless TV stations, etc. Just do a web search on the headline to see dozens and dozens of re-posts.) Old news that didn’t get better with time, and still spreads like wildfire!
Pain management is one of the most difficult areas of medicine. Patients who are in pain understandably will try any number of measures to seek relief. Good physicians, including the ones quoted in this story, tend to take a cautious approach, attempting to manage pain treatment holistically to avoid turning a pain sufferer into a pain medicine addict. Stories about various pain relief methods need to make it clear why one method might be an advance over another and why some methods might work better for short-term pain sufferers versus chronic pain patients. This story did neither.
There is no mention of costs. At CVS.com, a box of five patches costs $7.99. This isn’t high for short-term use, but if you are a chronic pain sufferer (a category not addressed in this story) you might run through a box or two per day. Regardless, costs should have been mentioned.
The story alludes to the benefits but never attempts to back them up with data. “The patches also deliver their medicine directly to the site of a person’s pain. This may eliminate some of the side effects that come with taking pills. For instance, some analgesics are likely to cause an upset stomach unless they’re taken with food. … And, because patches release their medication slowly into the body through the skin, people also should get more consistent pain relief than they do with pills.” Note that in the previous sentences, there are no declarative statements about benefits. “This may eliminate,” the story says. “People also should get more,” it says. Is the story hedging because of a lack of evidence or because the evidence was never reviewed?
No harms are quantified. Instead, the story relies on quotes that merely mention side effects. Interestingly, the story gives more space to the possibility of a skin reaction from the patches than it does the more serious potential harm. In one sentence it says, “On the other hand, people have to be sure to carefully follow instructions for using the patches, to avoid overdose.” The story should have given some estimate of how often that’s happened.
The story makes no attempt to evaluate the quality of the evidence supporting (or not supporting) the use of pain patches. Indeed, it does not even mention whether there have been any studies showing the benefits of these pain patches. We know that there had to be at least a few clinical trials or the pain patches would not have been approved. Some mention of how those trials were conducted would have been nice to see, at a minimum.
The story may lead the reader to think minor aches deserve treatment with a medication when, in fact, they might not benefit from any medication. The story does not exaggerate the numbers of people suffering from the condition under discussion, but, perhaps worse, it ignores the question completely. Not only do we have no idea how prevalent the problem is, there is no delineation of what type of “ache” this nostrum treats. It it good for a minor bruise? What about torn ligaments? Stress fractures? Metastases? When it is left to the reader’s imagination to select the disease, there is disease-mongering. This is exactly what vague advertisements for drugs hope to achieve. They plant the seed in the patient’s mind that there might be help for whatever problem they have.
The story quotes some independent sources. We just wish the story had made better use of these sources. Why not ask them to help quantify the benefits and harms? Why not have them discuss some of the alternatives to sticking a patch on the affected area?
Alternatives are barely mentioned, and no non-pharmaceutical alternatives are mentioned. “Both doctors said that they expect more over-the-counter pain patches to hit the market if the popularity of Salonpas continues to grow. Future over-the-counter options, they predicted, could include reduced-dosage versions of the NSAID-delivering patches now available through prescription. “Success begets success,” Dombrowski said. “If this does very well, other drug companies will say, ‘I want a piece of this action.'”” Readers are left with the message that people are running out to buy these pain patches because they work, and that more companies are going to be making these patches because they are so beneficial. But there is no proof provided in this story of their success or their benefits. There is no evidence conveyed that the patch is better than nothing, let alone existing, accepted treatments. From a business story standpoint, this story fails. From a medical story standpoint, the story is incredibly misleading.
The story makes it clear that pain-relief patches have been used in some form for decades while only recently becoming popular in the US. “The U.S. Food and Drug Administration approved the country’s first over-the-counter, pain-relieving transdermal patches in 2008. But the patches, marketed under the brand name Salonpas, are nothing new. They’ve been sold in various countries in Asia since the 1930s, according to their manufacturer, the Japanese firm Hisamitsu Pharmaceutical.”
The story started out in a promising way, by showing that pain patches are commonly used in other countries. One of the quoted experts says that the US is simply late in beginning to use them: “If you are an Asian kid, you’ve had these placed on you since time immemorial,” he said. “It’s just now starting to hit more mainstream in the United States. They’re gaining more acceptance.” They are not novel and have been available by prescription. The story, helpfully, explains that “active ingredients include such medications as lidocaine, capsaicin and non-steroidal anti-inflammatory drugs, or NSAIDs. The active ingredients in Salonpas are methyl salicylate and menthol, common components of pain-relieving gels and creams, such as Bengay.” This is all good context.
The story does not rely on a news release.
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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