This story tries to explain a new analysis of many studies of cardiovascular and stomach bleeding problems caused by painkiller use. Although the background material for the article is complicated, this article is less helpful to a reader than it ought to be. Without presenting how often the events like heart attack, stroke, heart arrhythmias or kidney disorders occur, it is not possible for an individual to evaluate how much concern it causes them. Although these are serious risks and individuals thinking about or currently taking these medications should consider them, the article did a a poor job of clearly delineating treatment options. There is confusion about the various risks and how they differ among the available treatment options. Though the article mentioned sticking with a drug which hasn’t caused problems in the past, waiting seven years after FDA approval before trying a new medication, using naproxen plus an acid-reflux drug (without specifying the class that is most successful in this role) and recommending use of ‘pain ointments’, it did a poor job of clarifying how a given individual should assess these options and how they apply to themselves.
There was no information about the costs of the various treatment options, though this was not the focus of the article. However generic NSAIDS, such as naproxen, are much less expensive than name brand NSAIDs, such as Celebrex and Mobic, and this could have been mentioned.
The biggest problem with this article is that there was no framework for the estimate of the size of the risks, only that there were gastrointestinal, cardiovascular and renal risks associated with the use of these medications. Quantification of the risks in relative and absolute terms would have been valuable to the reader.
While clearly mentioning some disease risks which are elevated with long term or high dose use of NSAID medications, the article failed to provide fair balance about the benefits that these medications can confer.
In this story, the perspectives on benefits and harms were switched. The benefits discussed in the article were about the harms associated with some NSAID use, with the benefits being about using other meds instead. This was unsatisfactory because the article failed to provide a context about how often these harms are experienced. With respect to harms, the article failed to discuss the benefits of taking the meds in question and so would include the harms associated with not taking those medications. The article failed to mention anything about these and so was given an unsatisfactory.
The article explained that the newest reports on the risks associated with use of NSAID medications were published in the Journal of the American Medical Association. And the story briefly mentioned the nature of the analysis: “New reports on painkiller risks, based on reviews of dozens of studies including hundreds of thousands of patients…”
This article presented some information about risks associated with the medications without providing how often these adverse events occur. The reader is left with a sense that the adverse events are very common when in fact, they are not. For example, kidney dysfunction was observed in less than 1% of patients taking any of the specific NSAID medications studied.
The article included some confusing quotes from experts in the field. Recommending “If something has helped you in the past and you haven’t experienced an adverse reaction with it, stay with that drug” seems to contradict the recommendation from the FDA (web-link provided at the end of the article) about the chance of heart attack or stroke associated with NSAID use which increases “with longer use of NSAID medicines.” Another expert recommended that “patients should wait seven years before trying a new drug” when one of the drugs for which there are newly observed heart risks, diclofenac, has had FDA approval from at least 1996 and is well over that seven year waiting period. The article quoted experts; it is just that what the experts had to say was confusing and the story could have interpreted better.
The article did a poor job of clearly delineating treatment options. There is confusion about the various risks and how they differ among the available treatment options. Though the article mentioned sticking with a drug which hasn’t caused problems in the past, waiting seven years after FDA approval before trying a new medication, using naproxen plus an acid-reflux drug (without specifying the class that is most successful in this role) and recommending use of ‘pain ointments’, it did a poor job of clarifying how a given individual should assess these options and how they apply to themselves.
Many of the medications mentioned in the article are commonly prescribed medications which have been approved for use by the FDA.
This article basically summarizes the adverse reactions that have been documented to date with the use of NSAID medications and in particular, the subset set of NSAID medications which are exclusively COX-2 inhibitors. It is clear that these are not novel treatments.
Does not appear to rely exclusively on a press 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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