The story describes study findings regarding an iPad game that appeared to help a small group of schizophrenia patients improve their so-called “episodic” memory — meaning their ability to remember things such as where they may have left their keys. The study discussed in the story evaluated a very small group of people (22), meaning that it may be useful for determining whether it’s worthwhile to pursue a larger study — but that it is impossible to tell whether the iPad game would have any real impact on schizophrenia patients in general. Similarly, the story doesn’t make clear how much improvement the game provided for the patients who participated in the study. The story made a bit of a leap in saying the training helped participants “in their daily lives at home and at work.” Statistical significance was reached on a scale that attempts to measure functioning at home and work, but it’s too much to say with this small group and short-term study whether it actually made a difference. More detail, and a clear statement that this is only the first step in assessing the efficacy of such games for schizophrenia patients, would have been valuable. The story did call it a “proof-of-concept” study, but we don’t think that a general readership will necessarily know what that means.
According to the CDC, schizophrenia is thought to affect between 0.5% and 1.1% of people around the world. The disease has a host of symptoms, from hallucinations to disorganized thinking, which are often treated with pharmaceuticals (with varying success). However, there are limited pharmaceutical interventions to help schizophrenia patients deal with memory problems — which are common among schizophrenia patients. Because so many people are affected by schizophrenia, it’s certainly worth tracking the development of a low-cost intervention that could help address a common symptom. However, it’s important to place these development stories in context, so that readers can have a good understanding of how effective such interventions might be and how far they are from use in clinical applications. Informed readers should discern that “could help” in the headline and “may improve” in the first line – after such a small, short-term study – means that just the opposite may be true.
The story doesn’t discuss cost at all. The relevant iPad game is, presumably, not free. And even if it were, a patient would need to own or have access to an iPad (definitely not free). While these things may be presumed, it’s still worth mentioning. For example, it would be good to know if the game were free, or if it could be accessed on a PC — in which case patients may have more low-cost options for accessing the game.
Even if – or especially if – it were a low-cost intervention, that would be worth a one-line mention.
The benefits aren’t quantified at all. The story simply tells us that patients who played the game “made significantly fewer errors and needed significantly fewer attempts to remember the location of different patterns specific tests.” This is somewhat understandable, since the paper itself offers no specific numbers, and includes a graph that makes it difficult to assign numbers to patient performance. However, one way to address this would have been to ask one of the researchers.
It’s questionable whether a 7.9 change on the Functioning scale (100 points total) translates into improved functioning in the real world. On the cognitive tasks, pretty much anyone who does cognitive tests (even some with dementia) get better over time, whether they are aware they are going testing or not. It’s a practice effect.
It’s not clear that there are any potential harms associated with playing the game. We’ll rate this not applicable.
The story doesn’t mention study design at all, which is problematic. Also, the journal article on which the story is based says that there were 22 patients involved in the overall study, who were randomly assigned to either play the game or to have “standard” treatment (the paper is not clear on how many patients played the game versus getting standard treatment). But the story says that 22 patients played the game. In short, the story makes it impossible for readers to get a handle on the quality of evidence to support the benefits being claimed.
There are no independent sources in the article. And, while there don’t appear to be any conflicts of interest, it would likely have been worth noting that the “brain game” research was funded by Janssen/Johnson & Johnson — a large pharmaceutical company.
The story says “There is increasing evidence that computer-assisted training can help people with schizophrenia overcome some of their symptoms,” but doesn’t tell us which symptoms or which types of training are relevant. The story also doesn’t tell readers whether there are other possible pharmaceutical, lifestyle, or cognitive training interventions that may help schizophrenia patients retain or improve episodic memory. Indeed, other computer systems are being explored as well as stimulation of brain regions using electro-magnetic fields. And options being used in clinical practice are skills training explained on the National Alliance on Mental Illness website.
The story doesn’t tell readers whether the game, called “Wizard,” is currently available for iPad users. This is particularly problematic, because searching for an iPad game called Wizard returns a number of options. Are any of those options the correct game? What is the current stage of availability?
The idea that brain games may be able to help schizophrenia patients deal with memory issues is not a new one. As the Washington Post noted in a 2013 story on using brain games to address schizophrenia symptoms, “Clinical trials aimed at FDA approval are being conducted at a dozen sites in collaboration with the Schizophrenia Trials Network, a group of university-based researchers.” Some discussion of this other work would have been good.
The story draws extensively from a Cambridge University news release about the study, including pulling quotes from the lead author directly from the release (without telling readers where the quote came from).
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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