Room for improvement:
Medication can be very effective for reducing the symptoms of Parkinson’s disease, especially in the first few years after onset. However, Parkinson’s is a progressive disorder that can eventually cause significant disability in a significant number of sufferers. Deep brain stimulation (DBS) has been used for almost two decades for people who no longer benefit from drug therapy. Although DBS provides relief of symptoms for many, it is not a panacea. The kind of experimental gene therapy discussed in this story could eventually provide another option to help patients manage their symptoms.
We would have liked to have seen some mention of costs. While the gene therapy is in the early stages of development and a price is not likely available at the moment, the cost of other non-drug treatments could have been included. For example, deep brain stimulation costs approximately $30,000 per side of the brain affected as is covered by many insurers. This information would provide readers with some perspective on costs.
The story relays the primary outcome in appropriate statistical terms when it says, “After six months, those who got the gene therapy scored 23 percent better on a standard test to measure motor skills while those who got the sham operation did about 13 percent better.” However, the story gets carried away in the last paragraph when it describes the anecdotal benefit of a single patient who goes from being nearly frozen to playing jazz music. Although the treatment was “like a miracle” for this patient, the magnitude of the benefit seen in the study was clinically quite small and not consistent with this description. There was also no reporting on the secondary outcomes, which included measures that assess quality of life and how well a patient is able to function. The treatment seemed to improve some of these measures, but not others.
Any discussion of an experimental procedure deserves comments on the potential and actual harms of the treatment. This is perhaps especially true for viral vector gene therapies that requires burring a hole in the skull and injecting precisely into the brain. To its credit, the story says that we don’t know if there might be any long-term damage from introducing viruses into the brain. However, it also should have mentioned that the treated patients in this study had more headaches and nausea than the sham surgery group (although these problems were described as mild to moderate and had resolved by the end of the study).
This was a carefully conducted study and the story’s coverage of it was fairly detailed considering the relatively short length. The description of the sham surgery was particularly good. Nevertheless, there were some critical gaps and the reporting was not entirely accurate. The story states, “Kaplitt and colleagues tested the gene therapy on 16 people while 21 others received a sham surgery.” That is actually not the case. A total of 22 patients were enrolled to receive the gene treatment and 16 were evaluable at the 6 month time period. This compares to 23 enrolled in the sham procedure with 21 evaluable. That’s a 27% drop out rate for the gene therapy group compared with only 9% for the sham surgery. And while the story notes that one of the limitations is a lack of longer-term data on how these patients fare, it doesn’t comment on the difficulty of generalizing results from such a small study to the larger population of Parkinson’s patients. Lastly, given the issues of observer and subject bias, we think that some comment on the blinding of the study would have been appropriate.
The story quotes an independent expert with a research and advocacy group. The story also discloses that the study was paid for by the drug’s developer, Neurologix, and that the researchers have financial ties to the company and other pharmaceutical companies.
The story noted that it is unclear whether the new treatment is as effective as another surgical technique, deep brain stimulation.
The lead sentence called the new treatment “experimental” and the study a “mid-stage test,” so we think readers will understand that this surgery is not currently available to the average patient. Given the early stage of the research, the story is probably a tad overoptimistic when it quotes one researcher saying, “We are getting much closer to a reality where this treatment can be offered to patients.” While this is true, the treatment still has many hurdles to clear before it can be widely used.
The story says that this is the first time a gene therapy for Parkinson’s disease has shown positive results in a placebo-controlled study. This is accurate, and the therapy does seem to be quite novel. It would have been informative to note that other gene therapies have been shown to be beneficial in open label trials and failed in randomized trials as compared to placebo. A previous attempt to demonstrate the value of another gene therapy for Parkinson’s failed in large measure due to problems with the study design.
This story was not based 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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