NOTE TO READERS: When this project lost substantial funding at the end of 2018, I lost the ability to continue publishing criteria-driven news story reviews and PR news release reviews - once the bread-and-butter of the site going back to 2006. The 3,200 archived reviews, while still educational, are getting old and difficult for me to technically maintain on the back end of the website. So I am announcing that I plan to remove these reviews from the site by April 1, 2021. The blog and the toolkit - two of the most popular features on the site - will remain. If you wish to peruse the reviews before they disappear, please do so by the end of March 2021. After that date you may still be able to access them via the Internet Archive Wayback Machine - https://archive.org/web/.
Read Original Story

Clip, coil or wait it out? Doctors debate aneurysms

Rating

2 Star

Clip, coil or wait it out? Doctors debate aneurysms

Our Review Summary

This article presented some treatment options available to people who find that they have a bulging blood vessel (aneurysm) in their brain. It highlighted the experience of a single patient who decided with her neurosurgeon that a surgical intervention to reduce the chance that this aneurysm would break open or rupture.

The article did not mention availability or approval for clip and coil. The story says “Only a half-dozen or so neurosurgeons in the U.S. clip more cerebral aneurysms than Nussbaum in any given year.” It also says “but many specialists now prefer coiling.” But that doesn’t tell us how widespread these practices are in real numbers. The story says, “At St. Joseph’s, Nussbaum is outnumbered by the three doctors who perform coiling. Still, Nussbaum said, his caseload grows every year.” Again, this doesn’t help the reader because it provides no absolute numbers, only relative ratios. And no long-term data on benefits or harms are given. Maybe they don’t exist. Readers should be told.

The article did make an attempt to highlight the correlations among the number of imaging procedures done, the number of aneurysms found and the number of invasive procedures done to treat them. Although the articles does state that “Not all aneurysms are treated (with surgery), and that is probably best.” and “lack of clinical trials proving which one [clip or coil] is superior”, the majority of the article emphasizes a self- acknowledged “pretty aggressive” surgeon who is one of the 6 most frequent performers of the procedure in the US. However, by featuring only one patient and her physician, the article did appear to be slanted toward the treatment choice of this pair, perhaps obscuring the point that not all brain aneurysms are in danger of rupturing and therefore not all brain aneurysms, though scary sounding, need to be treated. Why wasn’t a watchful waiting patient profiled? The choice of patient anecdotes lends a biasing weight to the story.

The article could have easily made the point more clearly that because most aneurysms never rupture (only 1% per year do), that the risk of harms associated with the surgery may be greater than those associated with not having a procedure done. The surgical complications from treating an unruptured aneurysm were reported in the article as being 5% (or 1% for one surgeon). The article mentioned a study from 2003 in which it was found that only 55% of coiling procedures completely cut off blood flow to the aneurysms without explaining whether it was essential that all blood flow be cut off and if it affected subsequent chance of aneurysm rupture.

There was no cost information for either invasive procedure; there was also no cost information for the imaging studies that can be used to detect and follow such aneurysms. The article, however, did mention that insurance covers both coils and clips. But how much is someone paying for all of this? That’s an important issue.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no cost information for either invasive procedure; there was also no cost information for the imaging studies that can be used to detect and follow such aneurysms. The article, however, did mention that insurance covers both coils and clips.

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

Not Satisfactory

The article mentioned a study currently underway at the Mayo Clinic that has found that the risk of small aneurysms is so small that they don’t warrant the risk of surgery. However, there were no quantitative estimates of benefit of treatment. While there were no specific benefits given for the coil, mentioned as “a less invasive procedure,” the article included the opinion that coiling may, at some point in the future, replace almost all clipping surgeries.

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

Not Satisfactory

The article was not clear that because most aneurysms never rupture (only 1% per year do), that the risk of harms associated with the surgery may be greater than those associated with not having a procedure done. The surgical complications from treating an unruptured aneurysm were reported in the article as being 5% (or 1% for one surgeon). The article mentioned a study from 2003 in which it was found that only 55% of coiling procedures completely cut off blood flow to the aneurysms without explaining whether it was essential that all blood flow be cut off and if it affected subsequent chance of aneurysm rupture.

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

Not Satisfactory

Although the headline promises a discussion of “debate”, the article tends to be lopsided with the majority of the article focusing on a particular patient and one surgeon. The reported complication rate of this procedure is 5% or higher, but later in the story the surgeon reports his complication rate as 5 in 450. No source or independent data is provided for the actual complication rate seen. Moreover, this particular surgeon says he has not yet published his results and patient selection could potentially confound his reported results. His statement also suggests that patients may be able to achieve better results if they see him because he does lots of these. These are not evidence-based comments.

Does the story commit disease-mongering?

Not Satisfactory

The article did make an attempt to highlight the correlations among the number of imaging procedures done, the number of aneurysm found and the number of invasive procedures done to treat them. Although the articles does state that “Not all aneurysms are treated (with surgery), and that is probably best.” and “lack of clinical trials proving which one [clip or coil] is superior”, the majority of the article emphasizes a self- acknowledged “pretty aggressive” surgeon who is one of the 6 most frequent performers of the procedure in the US. However, by featuring only one patient and her physician, the article did appear to be slanted toward the treatment choice of this pair, perhaps obscuring the point that not all brain aneurysms are in danger of rupturing and therefore not all brain aneurysms, though scary sounding, need to be treated. Why wasn’t a watchful waiting patient profiled? The choice of patient anecdotes lends a biasing weight to the story.

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

Satisfactory

Although most of the story focused on the experience of one surgical group in one institution, there was some input from another expert at another medical center, so we’ll give the story the benefit of the doubt and rate it satisfactory.

Does the story compare the new approach with existing alternatives?

Satisfactory

This article mentions brain surgery (old approach), watchful waiting and 2 new approaches (clips and coils).

The article should have been explained why it was not surprising that the physician described as clipping more cerebral aneurysms than almost any other neurosurgeons in the U.S., would advise the patient in the article to have this procedure done

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

Not Satisfactory

The article did not make clear whether both treatments as well as the watchful waiting approach were readily available . Options include surgery, watchful waiting and coil or clip. The article did not mention availability or approval for clip and coil. The story says “Only a half-dozen or so neurosurgeons in the U.S. clip more cerebral aneurysms than Nussbaum in any given year.” It also says “but many specialists now prefer coiling.” But that doesn’t tell us how widespread these practices are in real numbers.
The story says, “At St. Joseph’s, Nussbaum is outnumbered by the three doctors who perform coiling. Still, Nussbaum said, his caseload grows every year.” Again, this doesn’t help the reader because it provides no absolute numbers, only relative ratios.

Does the story establish the true novelty of the approach?

Not Satisfactory

There was no mention of FDA approval for these devices or of how long the new procedures (coils and clips) have been in use. If they’ve been used for a while, how much long-term data is there, and how long is the long-term data? These are important questions not answered in the story.

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

Satisfactory

Although most of the story focused on the experience of one surgical group in one institution, there was some input from another expert at another medical center, so we don’t think the story relied solely on a news release.

Total Score: 3 of 10 Satisfactory

Comments

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.