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Fungus Got Your Toes? Zap It


5 Star

Fungus Got Your Toes? Zap It

Our Review Summary

Balanced, generally complete, evidence-based, with clear language:

  • “published data is scant”
  • “Ask for the evidence, not just before-and-after pictures”
  • “study is small and short term”
  • “hasn’t yet published the data”
  • “recurrence is a certainty unless good prevention measures are taken.”


Why This Matters

We have a limited pot of money to spend on health care.  Do we want insurance plans to reimburse for toenail fungus treatments that don’t have a solid evidence base?  This story helps educate readers about what they might not get for a sizeable investment.


Does the story adequately discuss the costs of the intervention?


Costs of one treatment course is estimated at $750-1,500 and the story says that some may need one one to four treatments.  So up to $6,000 for ugly toenails.

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


Includes the caveat that “Solid evidence of the lasers’ effectiveness, is scant. In clinical practice, results have varied, according to doctors who have used the laser.”

It was quite specific about a small, short-term study and how often it s howed “new growth without fungus” or “at least three millimeters of clear new nail.”

All very helpful details to guide readers’ decisions about whether this is worth it.

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

Not Satisfactory

The story does a reasonable job in describing the side effects seen with Lamisil, a drug approved for this use. Unfortunately it does so with a bit of an apparent bias, “….If you are willing to risk side effects, …” in its discussion. Although the laser treatments are generally well tolerated, some people have mild pain and a sense of warmth. We would have been willing to give the benefit of the doubt but the suggestion that there are absolutely no side effects associated with the laser treatment leads us to rule this unsatisfactory.

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


At a broad, overview level, the column does an adequate job.  Language used is important;

  • Solid evidence of the lasers’ effectiveness, is scant. In clinical practice, results have varied, according to doctors who have used the laser.
  • “Ask for the evidence—and not just before-and-after pictures.”
  • So far only Nomir has published evidence of efficacy, but its study is small and short term.
  • “Patients and some doctors have this expectation that because it’s a laser treatment, once you zap it and its gone forever,” says Dr. Markinson. “That totally ignores the fact that this is an infectious disease and that recurrence is a certainty” unless good prevention measures are taken.

Does the story commit disease-mongering?


This is one story that does not commit disease-mongering of toenail fungus.  It includes a discussion of the mild end of the spectrum – in which nail fungus is “merely a cosmetic problem.”

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


Everyone quoted in the story had a conflict – a user, a consultant, a paid advser, someone who owns stock in a device maker, or a company spokesman.  But all of those conflicts are acknowledged.  And some of these people offer clear caveats about the approaches.

Does the story compare the new approach with existing alternatives?


The story offered good comparisons in its broad-ranging discussion of treatment options.  We only wish there had been a more direct discussion of not being treated, perhaps profiling someone who chose to forego treatment. And it did not mention the host of topical and oral drug treatments currently under study.

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


The “growing number of doctors” offering this procedure, the lack of insurance coverage, the FDA OK for one device and off-label use of others all address general availability issues.

Does the story establish the true novelty of the approach?


The story doesn’t treat any of the approaches discussed as new.  Good context on the range of stuff being done to treat toenails.

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


Given the number of sources cited, it’s clear the story didn’t rely solely or largely on a news release.

Total Score: 9 of 10 Satisfactory


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