We love all the cost information in this detailed and fairly well reported story. This makes good sense for a business story, and we’d like to see more financial information in other health-related pieces. We wish, though, that the same attention to detail had been given to the evidence behind some of the therapeutic claims being made in the story and that the story had relied less heavily on sources connected to the medical device industry.
Clinical depression can break a person’s will and leave them feeling isolated and desperate. Drugs have become the dominant treatment, but they also bring with them side effects. A non-surgical, non-pharmaceutical treatment option will surely attract a lot of people with depression looking for alternatives. This is why stories about devices like this need to carefully break down the evidence, the benefits, and the harms and use independent sources to help readers understand whether the device would be right for them.
This is one of the highlights of the story. It goes into good detail on costs. It says, for example, “The cost varies across the country, but is generally about $350 per session. Most patients undergo 20 to 30 sessions, putting the cost at between $7,000 and $10,500.” Most importantly, up high in the story, it explains that the high-cost procedure, “is not yet covered by insurance, and may not work for many patients.”
Like the harms, the benefits are mentioned in more of a passing way and no hard numbers are given. Because there are so many broad claims of superior efficacy that go unchallenged, we rate this unsatisfactory. One of the statements – “works better than sham treatments to reduce depression” – seems to beg for some kind of explanation of whether “better than sham treatment” is the standard we’re looking for with such an expensive technology.
This is a mixed bag.
Early in the story, in one place it mentions “few apparent side effects” but mentions two sentences later “a slight risk of seizures.” How slight is slight? Why not quantify.
A full 17 paragraphs later, the story says, “Side effects of the treatment include temporary headaches (which were reported by half the patients in one study) and slight discomfort during the actual treatment (reported by a third).” The lack of context about how many patients reported these side effects is an important missing piece.
We will give it a pass here, though, for mentioning harms up high and throughout, albeit clumsily.
There are a number of blanket statements made in this piece that go unchallenged. The first is the quote above from Neuronetics CEO who calls the device a “safer and more durable treatment.” Where is the evidence for that? Safer than what? And more durable than drugs, talk therapy, biofeedback? Then, a physician who was paid to run a clinical trial for the device said, “We’ve been pretty satisfied with the results….As a treatment, it has been very effective in major depression, which is where it has FDA approval.” We would have liked to have seen some deeper analysis of the device’s safety and its efficacy. At a minimum, one of the published trials should have been more critically analyzed. Also, it should have been noted whether anyone not connected to the device maker had independently studied the device.
The story does not engage in disease-mongering. It explains that the device is intended for a narrow audience. “The therapy, which carries a slight risk of seizures, is meant for patients with major treatment-resistant depression who do not respond to at least one medication.”
Save for Marie Duffy, the patient with depression in the lead anecdote, there is not a single independent source in the story. The story does point out some of the conflicts, but it does not note them all. Dr. Robert Howland, for example, according to this disclosure (http://www.sciencedirect.com/science/article/pii/S0376871609003913) has received funding from Northstar Neuroscience, which had attempted to create a similar technology to the NeuroStar. (http://seattletrademarklawyer.com/blog/2007/7/12/northstar-neuroscience-and-neuronetics-settle-dispute-over-n.html)
There’s a great paragraph in the story that packs a lot of information into a small space. It says, “The new treatment is not a panacea. One study found that, of patients who failed to benefit from one antidepressant medication, just one-third responded adequately to a second. TMS produced a similar response rate (as does talk therapy, according to other studies), although the effect was described as greater.” This tells readers that medication, the device in question and talk therapy all have produced similar results. We wish more stories pulled together the available evidence in an easy to understand way.
The story explains that “More than 4,000 patients have received NeuroStar treatment since its 2008 debut.” And it offers a website that lists where the technology is now offered.
The novelty of the device is not established, despite some of the cheerleading statements from the venture capitalists and the researchers.
The story goes well beyond any news release.