This story is about a new treatment option for low back pain – artificial disk replacement. For viewers suffering from low back pain, trying to make a treatment decision, there is too much crucial information missing in this story. Most people with low back pain will not be eligible for the device. Viewers need to understand how little is known about the risks of the device and how it compares to other treatment options. Even if the short-term risks/benefits look good, there will be major unanswered questions abouts the durability and long-term safety of the device. The 25 year old woman in this story may require additional spine surgery in the future as this device wears out. This is not intended to be a one-time cure.
In the story, the viewer learns that “More than 75% of Americans suffer back pain at some time.” While this may be technically correct, it’s not clear that all find it “significant.” The kind of back pain that would make an individual eligible for disc replacement surgery represents a very small percentage of all cases of back pain. Most people suffer acute episodes of back pain that resolves on its own. More importantly, the story implies that “injured discs are often to blame.” In fact, only a small percentage of low back pain is attributable to an acute disc herniation. Finally, the statement that “doctors have treated problems by fusing spinal bones together” is unclear and also misleading. Most patients with low back pain are not going to need surgery of any type. For patients with an acute disc herniation, the accepted procedure is a discectomy, not fusion.
The story does quantify the benefits of treatment. Although the story quotes the surgeon saying he has had good results, this is not sufficient. The audience deserves more than just a single surgeon’s experience and a couple of days experience in one patient. Although the story mentions that the patient tried accupuncture and electrical stimulation, the story neglects other alternatives and does not discuss the pros and cons of the alternatives.
The story does not mention harms. The story does not mention either short-term risks of surgery, or the short to long-term risks of the device itself. Given that the ideal candidate is a young, otherwise healthy person, the device would need to work for many decades. Some early results demonstrate failure rates of 30% after a few years.
Furthermore, the story fails to indicate whether disc replacement is available or not, does not describe the quality of the available evidence, and does not mention costs (which could be substantial).
Even with the time constraints of TV news, much more could have been done with this story if the topic was to be covered at all.
The story does not mention the cost of the procedure, how it compares to other treatments, or whether it is covered by insurers. Medicare has just approved one device for its population. Most commercial insurers haven’t covered this procedure yet, but will probably start covering it as a result of Medicare’s policy.
The story does not attempt to quantify the benefits of treatment. Although the story quotes the surgeon saying he has had good results, this is not sufficient. The audience deserves more than just a single surgeon’s experience and a couple of days experience in one patient.
The story does not mention harms. The story does not mention either short-term risks of surgery, or the short to long-term risks of the device itself. Given that the ideal candidate is a young, otherwise healthy person, the device would need to work for many decades. Some early results demonstrate failure rates of 30% after a few years.
The story does not describe the strength of the available evidence. Although the story cites the surgeon as aying that he has had good results in his patients, this is not sufficient. No evidence other than the one surgeon who describes his case series is provided.
In the story, the viewer learns that “more than 75% of Americans suffer back pain at some time.” While this may be technically correct, it’s not clear that all find it “significant.” The kind of back pain that would make an individual eligible for disc replacement surgery represents a very small percentage of all cases of back pain. Most people suffer acute episodes of back pain that resolves on its own. More importantly, the story implies that “injured discs are often to blame.” This is not true at all. In fact, only a low percentage of low back pain is attributable to an acute disc herniation. Finally, the statement that “doctors have treated problems by fusing spinal bones together” is unclear and also misleading. Most patients with low back pain are not going to need surgery of any type. For patients with an acute disc herniation, the accepted procedure is a discectomy, not fusion.
The story only quotes one surgeon and provides no additional perspectives.
Although the story mentions that the patient tried acupuncture and electrical stimulation, the story neglects other alternatives and does not discuss the pros and cons of the alternatives. Many treatments are available and thus describing options is critical.
The story does not indicate whether disc replacement is available or not. As a new device, it is unclear how widely available it is throughout the U.S. If the pattern of past ideas is followed, it will likely be widely disseminated before we actually know the true benefits and risks of the device, as well as who it should and shouldn’t be used in.
The story clearly states that this is a new treatment. But even then, the story provides almost no information about just how novel this is conceptually and practically.
There is no way to know if the story relied on a press 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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