This story reports the results of a small study of fluoxetine (trade name Prozac) for the treatment of anorexia nervosa. Fluoxetine is approved by the FDA for the treatment of bulimia nervosa; evidence for fluoxetine as a treatment for anorexia is less clear, and results from this study suggest no apparent benefit. The story mentions that fluoxetine is “often used to treat anorexiaâ€, but this is an off-label use, which is not mentioned. It’s an important fact to include. The medication is more commonly prescribed for anorexic patients to treat depression and/or obsessive-compulsive disorder, common co-existing mental illnesses in these patients.
The story partially describes the study design, but does not mention it was a double-blind, randomized study. The story provides absolute numbers of patients who completed the year-long study and maintained their weight. The story also appropriately notes that the difference in weight maintenance and time to relapse between the fluoxetine group and placebo group was not statistically significant.
This was a small study, with less than half of the patients completing treatment, so the results may not be generalizable, especially for patients at earlier and less acute stages of anorexia. The patients in this study were recruited from eating disorders treatment centers and had been suffering with anorexia for several years (average was 4 years).
The story mentions that one teenage study participant attempted suicide. Adolescent suicide has been linked to certain anti-depressant medications, including fluoxetine. No other harms or side effects of the drug are mentioned. Even though the source journal article did not list negative side effects of fluoxetine, that doesn’t remove the obligation to discuss these as part of a complete and balanced story.
Lastly, the story provides several sources of information from researchers and clinicians not affiliated with the study to provide perspective on this study and the available treatment options for anorexia, a mental illness that some consider treatment-resistant. The story mentions behavioral treatments for anorexia, which have been somewhat effective, and notes that the study participants received psychotherapy (in the form of cognitive behavioral therapy) and medication.
The headline says “Prozac Failed Anorexic Women in Study,” so the story is not advocating fluoxetine as a treatment for anorexia. So, while the average cost of the drug is not mentioned, it is also not crucial in a story with this angle.
The story provides absolute numbers of patients who completed the study and maintained their weight. The story also notes that the difference between the treatment group and the placebo group was not statistically significant and that there was no apparent benefit from this treatment. The story does not mention that these patients were recruited from eating disorders treatment centers and had anorexia for several years (average 4 years). This was also a small study, with less than half of the patients completing treatment, so the results may not be generalizable, especially for patients at earlier and less acute stages of anorexia.
The story mentions that one teenage study participant attempted suicide. Adolescent suicide has been linked to certain anti-depressant medications, including fluoxetine. No other harms or side effects of the drug are mentioned. Even though the source journal article did not list negative side effects of fluoxetine, that doesn’t remove the obligation to discuss these as part of a complete and balanced story.
The story partially describes the study design, but it does not mention that it was a double-blind, randomized study. The story presents some quantitative information on how many women completed the year-long study and how many maintained their weight during that time. The story does not mention that of the 49 assigned to fluoxetine, only 7 achieved a full recovery from anorexia. The story mentions that the difference between the people who took fluoxetine and those who took the placebo was not statistically significant.
There is no evidence of disease mongering. The story provide prevalence statistics from The National Eating Disorders Association.
The story provides several sources of information from researchers and clinicians not affiliated with the study. The story also noted that the lead author receives funding from Eli Lily, maker of fluoxetine, and that this company provided medication for the study.
The story mentions behavioral treatment for anorexia and mentions that the study participants received psychotherapy (in the form of cognitive behavioral therapy) and medication.
The story says, “Prozac is one of the antidepressants often used to treat anorexia.” Fluoxetine is approved by the FDA for the treatment of bulimia, but not anorexia. Use in clinical settings is off-label and typically for co-existing depression or obsessive compulsive disorder, for which fluoxetine is approved.
Fluoxetine has been effective in treating symptoms of bulimia nervosa, but not anorexia. The story mentions that Prozac (fluoxetine) is used to treat anorexia, but this is an off-label use, which is not mentioned. This is an important fact. The medication is more commonly prescribed to treat depression and obsessive compulsive disorder, often co-existing mental illnesses in patients with anorexia. This story reported the effect of fluoxetine specifically on symptoms of anorexia.
There is no evidence that this story relied solely or largely 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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