This story reports on the results of a large clinical trial published in the Journal of the American Medical Association evaluating surgery compared to non-operative care for herniated disc. This trial represents the first randomized clinical trial of surgery in the US since 1983 and greatly improves our understanding of the benefits of surgery. This story does a good job of explaining the strength of the existing evidence and rightly highlights some of the controversies. The story also does a good job of focusing on why patients need to be informed and take a lead role in decision making.
The story does a decent job of describing the new study and explaining the controversy over the large numbers of cross-overs, or people in the study who were initially designated to non-operative care who opted to have surgery (or vice versa). The also story mentions various kinds of non-operative care, including physical therapy, medications and steroid injections, as the alternative to surgery.
The story only quotes the study's lead author. The story should have quoted other clinicians/researchers who could have provided other perspectives. The story does not quantify the benefits of treatment and although harms of surgery are rare, the story should have mentioned the possible complications such as wound infection or need for reoperation. There was no discussion of costs of surgery or of any of the non-operative options.
Unfortunately, the story crosses the line into disease mongering in the beginning of the story by stating that back pain is "almost as common as the common cold." Although back pain is common, this story is really about herniated disc, a specific back condition that is relatively uncommon. The story does not clearly differentiate between the average patient with low back pain and the patients enrolled in this study who had sciatica due to a herniated disc. The study goes on to describe what a herniated disc is, but the first paragraph implies that 4 out of 5 of us will have the condition described in the story.
The story does not mention costs of surgery or any of the non-operative options.
The story does not quantify the benefits of treatment and presents qualitative results only.
Although harms of surgery are rare, the story should have mentioned the possible complications such as wound infection or need for reoperation. The story also does not address potential harms of non-operative treatment, such as permanent nerve damage from cauda equina syndrome.
The story at least attempts to describe the study and to explain the controversy over the large numbers of cross-overs, or people in the study who were initially designated to non-operative care who opted to have surgery (or vice versa). We'll give it the benefit of the doubt on this criterion.
The story crosses the line into disease mongering in the beginning of the story by stating that back pain is "almost as common as the common cold." Although back pain is common, this story is really about herniated disc, a specific back condition that is relatively uncommon. The story does not clearly differentiate between the average patient with low back pain and the patients enrolled in this study who had sciatica due to a herniated disc. The study goes on to describe what a herniated disc is, but the first paragraph implies that 4 out of 5 of us will have the condition described in the story.
The story only quotes the study's lead author. The story should have quoted other clinicians/researchers who could have provided other perspectives.
The story mentions various kinds of non-operative care, including physical therapy, medications and steroid injections, as the alternative to surgery.
It's clear from the storyt that surgery for herniated disc is widely available.
It's clear from the story that surgery is not a new idea.
There is no way to know if the story relied on a press release as the sole source of information, although it did only interview the study's lead author.
Systematic, Criteria-Driven
We’ve written about the hype of liquid biopsies for years (see link in comment below). And now this…. https://www.statnews.com/2022/01/12/medicare-shouldnt-cover-liquid-biopsies-early-cancer-detection/
Case counts still matter. “(There) are stories that may not be told adequately if only hospitalizations and deaths are emphasized.” @garyschwitzer interviewed by @dbauder of @AP. https://apnews.com/article/omicron-changing-news-outlets-covid-data-da9272f7c4c8a109c3bfb56bed9e9c76
My friend Gary @garyschwitzer wrote to his city council representative in a Minnesota town about a Viva Las Vegas event scheduled for January.
The response he got seems to perfectly capture where we are now.
https://www.healthnewsreview.org/2021/12/2021-ends-with-covid-craziness-in-sports-and-politics/
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