The Wall Street Journal took a medical review of surgical techniques that trumpeted it was “inconclusive” and wrote a story making it sound as if sugery is the best answer for rotator-cuff tears. The headline was especially biased toward surgery, even though the story included some good context and balance that consumers deserve.
Shoulder pain is a common problem that increases with age. If one buys what this story is selling, one could think that half the population over 60 needs shoulder surgery. While that may make the surgeons quoted in this story happy, the reader should do just the opposite of what this story recommends.
There are no dollar figures at all in this story. The story touts “lower costs” of repairing a torn shoulder “earlier rather than later” but
never delivers the data. The story should have compared costs of surgery to non-surgical alternatives and factored in the possible six-months of rehabilitation following surgery. From the available evidence, it appears the only reference to costs in the story is at best an overstatement. It says “that repairing a tear earlier rather than later may result in better patient outcomes, earlier return to work and lower costs.”
There are no data provided for the potential benefit of “increased strength” that the article says is possible if surgery is chosen “earlier” in the progress of the damage to the rotator cuff. The story does not give attribution for this claim: “one’s strength tends not to improve without surgery.” While the entire story makes a case for the benefits of the newest surgical techniques, no data is provided comparing new to old or new to non-surgical alternatives directly.
The story does a credible job of explaining that there are complications with any surgery. They did not explore the potential of surgery – even without complications – to leave a patient with reduced range-of-motion or other results that are less than desired outcomes.
This is a mixed picture. The story accurately states “there isn’t enough high-quality evidence” to recommend any surgical technique. Yet the story touts “new” surgery as better. The story fails to attribute one very important statistic: “surgery results in reduced pain and improved function in 80-95 percent of patients.” Who said that? What kind of surgery?
When a story peg is all about “new techniques” your data should be specific to technique – not mixing all surgery types together for a “success” rate without any attribution.
Another troubling issue is that the story refers to a review in the Annals of Internal Medicine. That Annals article states that the review was “inconclusive.” So, why is the story relying on that review if its own authors call it “inconclusive”?
Yes, the story avoids this. Cuff tears are so common, as the story says, that more than half of all adults over 60 are walking around with them.
The story quotes two surgeons who were not authors on the review in the Annals.
The story does mention that tears can be managed “without surgery,” but then it discredits this statistic by saying “one’s strength tends not to improve” without surgery. It does not attribute that assessment, and readers may be left in confusion.
Existing traditional surgery methods and non-surgical alternatives are not given the same weight in the story as new techniques. The Annals journal article referenced in the story stated: “Future studies of high quality are needed to explore the relative effectiveness of early vs. delayed surgery, nonoperative versus operative treatments.”
The story does not tell us whether what it calls the “mini-open” and other less invasive surgical techniques are widely available. It implies that they are, but by calling them “new” it likewise makes one wonder whether it may take time for them to penetrate to all surgical practices.
The story explains that a variety of surgical repair techniques – all lumped in the non-open incision category – are available. None of
these are truly novel.
The story does not rely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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