In describing why researchers think deep brain stimulation (DBS) might one day be a treatment option for patients with difficult-to-treat high blood pressure, the story didn’t adequately caution that the excitement is based on a case report from a single patient. The story also failed to provide readers with information on the significant costs of treatment or existing alternative approaches. And the story’s characterization of the procedure’s adverse effects might give readers an excessively rosy view of the potential risks.
These shortcomings notwithstanding, the story did do an exceptional job of explaining exactly how this treatment works and how it fits within the broader universe of nerve treatments for hypertension. The reporter deserves credit for making this complicated topic accessible to readers.
Case reports sit near the bottom of the hierarchy of medical evidence, just above animal and test tube studies. They typically involve small numbers of people who may not represent the average patient. And unlike more formal studies, they don’t feature any safeguards to prevent bias from influencing the observations. Case reports can be useful because they may prompt other researchers in the field to initiate larger, more careful studies to confirm the authors’ findings,. However, it’s hard to find the value in reporting on a single case for a broad consumer audience. With so many other health topics out there that have the potential to affect people’s lives right now, we think news organizations would have been better off letting this story percolate a bit longer before investing limited reporting resources in it.
The story does not mention costs – a major omission. According to one estimate our reviewer accessed within minutes, costs for the device and procedure may be upward of $150,000 per patient. Any discussion of costs should also include the costs required to monitor the device over time.
The story does a better job than HealthDay of describing the effects of DBS on this patient’s blood pressure, providing actual quantitative data about how his blood pressure fluctuated when the device was turned on and off. Although we’re tempted to flag the story for relying too heavily on unrepresentative patient anecdotes (something the standards for this criterion say stories should avoid), this is something addressed previously under the Evidence criterion. We’ll award a satisfactory here to acknowledge the story’s greater overall attention to the details of this particular case.
A tough call here. While the report is much more detailed than HealthDay about the potential risks of treatment, it features a clumsily worded quote from an expert who calls the risks of this surgery “tiny, but important.” The use of the word “tiny” here tends to minimize the risks associated with the procedure, which can be very serious. A 2% risk of stroke in patients undergoing the procedure (as reported on this UCSF Dept of Neurosurgery FAQ about DBS) strikes us as somewhat more than “tiny.”
This WebMD account provided more specifics than HealthDay regarding why researchers believe the findings may be important. It notes that blood pressure reductions have been observed previously in other DBS patients, but that doctors believed the benefits were related to the pain relief these patients were experiencing. This is the first time the blood pressure benefit was reported in a patient whose pain didn’t get better with DBS.
It’s a shame, though, considering the story’s length, that it couldn’t find more space to discuss the limitations of a single case report. By writing, “previous reports have observed the same kinds of reductions in blood pressure in people getting deep brain stimulation for pain,” the story leads readers to believe that there is a growing body of evidence supporting implants as a good course of treatment. We are not told anything about these studies, though. How many patients were studied and over what period of time? Have the same types of studies been done and produced the same results. We are given a hint when Dr. Erlick Pereira, a neurosurgeon at the University of Oxford, is quoted. The story says that “Pereira wrote about blood pressure reductions in a patient getting deep brain stimulation in the January 2010 issue of the Journal of Clinical Neuroscience.” Again, this was a one-patient study. Readers should have been given a clear picture of just how much evidence exists to support these implants as a hypertension treatment.
The story cites statistics about hypertension appropriately and did not resort to disease-mongering.
The story features two interviews, one with an author of this case report, and another with an expert who also reported observing a blood pressure lowering-effect of DBS in a patient (though this may have been related to the patient’s pain relief and not directly attributable to the DBS device). While these individuals are clearly knowledgeable, they both are sympathetic to the idea that DBS may lower blood pressure, and neither could be called truly independent. One of these experts — Erlick Pereira — has done work sponsored by Medtronic, one of the leading DBS implant makers (as discussed here). In addition, according to coverage of this most recent case report in MedPageToday, Patel and some of his coauthors disclosed financial relationships with manufacturers of DBS devices.
The story doesn’t mention lifestyle changes that are recommended for patients with high blood pressure, including those who don’t respond to medication. These include losing weight, lowering sodium intake, and reducing alcohol consumption.
The story implies that we are not close to seeing DBS used to treat hypertension outside of a research setting. Unlike the competing HealthDay coverage, the story notes that DBS is FDA approved for Parkinson’s disease and essential tremor, and that it is used for other conditions. We would have liked to have seen at least an expert view on the number of devices that are implanted every year or a statistic on this from one of the manufacturers.
The story appropriately characterizes the novelty of the research. It mentions other new surgical approaches to the treatment of hypertension that may also be effective.
This story includes two interviews and includes much more detail than this news release.