The article discusses surgical robotic technology and provides a little drama by telling stories through the eyes of patients. A key weakness of the story is that the evidence used to support claims of benefit is not the best evidence or perhaps not even the right evidence. A stronger study (meta-analysis) concluded that it’s uncertain whether outcomes are improved with the new technology compared to standard techniques. Given that much of the story is devoted to surgical removal of prostate cancer, there should have been some mention of the controversy over treatment of early stage prostate cancer. Touting another way to do surgery on the prostate when we don’t know if any surgery or any treatment does more harm than good is not good journalism. Because the article does not provide accurate or objective information, the article is not balanced and leaves readers misinformed. The real issue of whether the marginal benefits are worth the marginal costs of a very expensive technology is yet to be determined and is not developed in the story.
While costs of the machine are mentioned, costs per procedure and how that compares to standard
procedures (either open or laparoscopic) are not mentioned. Additionally, costs to the patient are not mentioned, since
patients may have out-of-pocket expenses associated with the new technology, even if they do have insurance coverage.
While some benefits, like blood loss and days in hospital, are provided, they
are in relative terms–like 5 times the blood loss, 4 times as fast. More importantly, the evidence chosen isn’t the best
evidence– the numbers suggested are supported by stronger research.
No mention of harms to the patient are reported. There are harms and
side effects with any procedure.
Again, purported benefits are mentioned based on some early research and what appear to be
surgeon anecdotes, but later meta-analysis (2004) of the evidence does not support improved outcomes. The evidence quoted is
not the “right” evidence. Importantly, the article lacks any comment on the lack of evidence that treating early prostate
cancer does more harm than good.
Descriptions of robotic techniques revolutionizing surgery are a bit premature given the lack of evidence that the
technology improves outcomes. Given that much of the story is devoted to surgical removal of the prostate for cancer, there
ought to be at least some mention of the controversy over treatment of early stage prostate cancer in general. Touting
another way to do surgery on the prostate when we don’t even know that surgery, or any active treatment, does more harm than
good is journalistic sensationalism.
Independent
input about the purported benefits of the technology was obtained (Finlayson, Dartmouth). This expert points out the real
issue: whether marginal benefit is worth the marginal cost. Unfortunately, that issue is not developed in the story and a
counterpoint is immediately presented after Finlayson’s comments.
The story mentions the alternatives of open and laparoscopic surgery for prostate removal.
Advantages (the story claims less blood loss, shorter hospital stays, etc.) and disadvantages (cost and surgeon training
time) of using robotic technology compared to open or laparoscopic technology are compared. But the purported advantages of
robotic technology aren’t supported by stronger, meta-analytic evidence, which concluded that it’s uncertain whether
outcomes are improved or not (Humphreys, Gettman, et al., 2004). Additionally, the article doesn’t even mention the very
important fact that experts don’t know whether any active treatment of early prostate cancer does more good than harm.
Story states Da Vinci robotic system has had FDA approval
since 2000. While it also provides number of machines that have been purchased and provides number of estimated procedures
performed, it is up to the reader to “connect the dots” and put together that these figures mean that finding the technology
and/or a skilled surgeon to use the technology may have many obstacles. Also limiting availability is whether a man’s
insurance would cover such a procedure. Because these very real issues of availability are not developed, the story gets an
unsatisfactory grade on this criterion.
The story talks about robotic
technology as a new (since FDA approval in 2000) technique.
Systematic, Criteria-Driven
A lot of interesting workshops are happening now at the #NBCCSummit! @garyschwitzer, the publisher of @HealthNewsRevu, is discussing new cancer research news. #BeBold
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