The story focuses on a recently published journal article that evaluates the available research on whether antidepressants or psychotherapy may reduce the symptoms of irritable bowel syndrome (IBS). The article does a good job of addressing the limitations of the research and incorporating input from independent experts. However, the story fumbled a bit when explaining the results of the meta-analysis, and didn’t discuss costs or harms of treatments.
According to the CDC, IBS affects more than 1 percent of the U.S. adult population. And those living with IBS can often suffer from a reduced quality of life. In other words, a great many people are very interested in news about therapeutic options for addressing their condition. While we think the story does a good job of stressing that antidepressants and psychotherapy don’t constitute a “silver bullet” for addressing IBS, we think it’s important to highlight that one of these options (antidepressants) carries risks of its own. And both options can carry significant costs.
Costs are not addressed. Antidepressants and psychotherapy can be expensive, and are not always covered even for those patients with health insurance.
The story attempts to quantify the benefits. We’re told that “rates of ‘no relief’ were highest with placebo treatments. People were 34 percent less likely to have no relief from antidepressants and 31 percent less likely to get no relief from psychotherapy, the study found.”
However, that phrasing is difficult to parse. The story would have been stronger if it had specified whether it was addressing absolute risk or relative risk, and expressed that information in clearer terms. What does “relief” mean? Complete resolution of symptoms or something less dramatic?
Potential harms are also not addressed. This is particularly problematic for the sections of the piece that deal with antidepressants. For example, the story specifically mentions both tricyclic antidepressants (which have potential side effects ranging from constipation to sexual problems) and selective serotonin reuptake inhibitors (which can also pose health risks). We don’t expect a story like this one to provide an exhaustive overview of risks associated with these classes of drugs, but we do think it should at least acknowledge that there are risks.
The story does a pretty good job of describing the study, which evaluated evidence from 53 trials — including language that highlights the limitations of those studies.
The story incorporates input from two third-party experts. The story does not speak to potential conflicts of interest, which is a shortcoming. We found no potential conflicts to report, but think it is worth making that clear in a story.
The story does refer to dietary interventions that are used to reduce IBS symptoms.
The story would have been stronger had it mentioned pharmaceutical interventions that may be used in IBS treatment. These pharmaceuticals often have limitations and potential drawbacks of their own, but given that the story specifically evaluates the use of antidepressants as a therapeutic intervention for IBS, this seems like a significant oversight. Why? Comparing some treatment to no treatment is very different from comparing some treatment to established treatment to see if benefits are comparable or better.
The story doesn’t specifically state that the antidepressants and treatment options studied in these various trials are available for clinical use. However, we think it can be broadly assumed that readers know these treatment options are available. As such, we’ll rate this as not applicable.
The paper being reported on in this story is an update of an earlier journal article that reviewed the available research on whether antidepressants or psychotherapy may reduce the symptoms of IBS. Of the 53 trials incorporated into this most recent review, 48 of them also appeared in the previous review. In other words, the current review incorporates data from only 5 new trials — four on psychotherapy and one on antidepressants. To what extent, if any, did the incorporation of data from these five trials change the findings of the review? Did the new data support what researchers already knew? Or did the data change our understanding of the relationship between IBS and antidepressants or psychotherapy?
The story incorporates original reporting and does not appear to be based on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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