This story describes the experience of an individual who had a deep brain stimulation (DBS) device surgically implanted for the treatment of pain following a stroke, and subsequently found that the device had a beneficial effect on his high blood pressure. It’s an interesting finding — no doubt about it — but results from a single person don’t amount to much from a scientific standpoint, and they don’t mean much to other patients. And so we question why this report would be considered newsworthy for anyone outside of this field of research.
To its credit, this story did spend some time drawing attention the limitations of this evidence. However, the story failed to provide information on costs and harms that would have provided a counterweight to enthusiastic talk of benefits. The story also didn’t identify financial relationships between the case report authors and manufacturers of DBS devices–information that readers deserve to have as they ponder the merits of these very preliminary findings.
If a friend tells you that he was able to sleep better at night because he ate six raw eggs before going to bed, you might:
You probably would not turn around telling someone that “eating six raw eggs might ease your insomnia.” Yet this is what stories about case studies do, especially ones that present the findings in as optimistic a tone as this one does.
The story speculates that DBS might become a treatment for hard-to-control high blood pressure. But it didn’t offer any estimates as to what it might cost to treat patients with this technology. At the very least, the story could have pressed the authors of the case report to discuss the cost of the device and the price tag for a typical implantation procedure. In this 2008 Chicago Tribune blog post, the cost of DBS was estimated at $150,000 or more per patient. There would also be additional costs for ongoing monitoring and follow-up once the device was implanted.
The story never actually describes how high this patient’s blood pressure was prior to DBS, or how much it was reduced after treatment. Providing this data — limited though it may be — would have given readers a better idea of DBS’s effects on blood pressure, at least for this particular patient.
The story makes passing reference to risks, but it doesn’t mention any specific problems and doesn’t discuss how commonly they occur with DBS. This is, after all, brain surgery, and there are a host of things that can go wrong, ranging from obvious problems such infections, bleeding, and strokes, to more subtle effects such as cognitive impairment. The story should have explored these. The competing WebMD story, while failing to quantify the harms, at least listed quite a few of the potential problems.
The fact that this story is based almost entirely on a single case is a major flaw that deserves to be flagged. With that being said, the expectation for this criterion is that the story will provide an evaluation of the evidence — no matter what kind of evidence it is — and this story did provide a forceful disclaimer about the extremely preliminary nature of the research. We’ve commented previously about how the closing paragraph can be an important tool for framing a story, and in this case the coverage wrapped up strongly with an expert who said, “This is a case report, and not a treatment for anything.” The story also deserves credit for including the fact that the study was on just one patient in the lead. This matters more than ever, we think, because of RSS feeds, Twitter and the like where people often see just the first sentence, or less, of a story.
The story did a nice job here. It doesn’t exaggerate the risks associated with hypertension, and it is careful to provide statistics about the smaller subset of individuals (about 10%) who might conceivably be candidates for treatment because they don’t respond to or can’t tolerate medication. The story also avoids including individuals with “pre-hypertension” (a recently coined term for people who are at risk of developing hypertension — i.e. a risk factor for developing a risk factor) in its statistics.
Although the story seeks out independent perspectives, it should have alerted readers to the fact that several authors have received speaking honoraria and other financial support from companies that make DBS devices. According to coverage of the study at MedPageToday, these disclosures were included in the published article.
While we can’t award a satisfactory, this story did a better job than WebMD of talking with people who provided a less optimistic take on the implants. For example, the first independent quote in the WebMD story says, “What their case report shows is that blood pressure can be reduced in a sustained fashion in a patient with unsuccessful deep brain stimulation for pain….“I think that’s important because it paves the way for potentially studying patients without chronic pain and offering the treatment sometime in the future to reduce blood pressure.” That is much more supportive of the technology than the first quote in the HealthDay story, which says, “It’s a really interesting paper. … I thought it was compelling, though single cases are always questionable” to generalize.
Although the story mentions that multiple drugs may be needed to control blood pressure in individuals with treatment-resistant hypertension, it never mentions the lifestyle factors that contribute to the problem and can help alleviate it if addressed. These include obesity, high sodium intake, and heavy alcohol use.
Readers will come away from this story understanding that DBS is not currently available for the treatment of high blood pressure — and probably won’t be any time soon. That satisfies the main expectation of this criterion, so we’ll award a satisfactory. The story could have provided more information about which conditions DBS currently is used to treat. (DBS is FDA-approved for the treatment of several movement disorders, including Parkinson’s disease, and is sometimes used to treat other conditions, including chronic pain and depression.) It also could have explained that DBS is available primarily at large urban medical centers, and that doctors’ experience with the procedure can vary widely.
The observations discussed in the story about DBS and hypertension are apparently quite novel. The story’s characterization of the results is appropriate. The story also mentions another novel surgical technique known as renal nerve ablation that might be effective for hypertension that doesn’t respond to medication.
The story includes interviews with two independent experts, so we can be sure it wasn’t based on a news release.