This is a story about an invasive procedure to treat stroke patients, known as stent retriever therapy. Unfortunately, the story presents a misleading picture to readers by relying on one successful patient anecdote, and by making unqualified statements, such as “experts call the [procedure] the most major advance in stroke treatment in two decades.”
Scant attention is paid to the actual benefits quantified in the study that is the meat of the story. No attention is paid to the possible harms of the procedure. Costs are never mentioned, and there is no real discussion of the quality of the evidence. Instead the audience is left with a very powerful image of an otherwise healthy 43-year-old man suffering a stroke while driving, nearly killing himself in a subsequent car crash, being treated by surgery, and being fully restored to a normal life. His experience is certainly remarkable, but the audience is given the false impression that it is representative of everyone who has undergone the procedure or might in the future.
Patient stories are powerful, which is why news outlets should choose them carefully when reporting on medical treatments. The impression left with readers is that miracle-like recoveries are commonplace with this procedure. But as we discuss in more detail below, this procedure is indicated for only a very small number of patients. Since the story chose to focus on one of these relatively rare patients, we think it was crucial to provide some broader context. How many patients are eligible for such treatment? How often are they treated within the 2.5-hour window associated with the best odds of a full recovery?
We found multiple studies that discuss the cost of these types of clot retrieval procedures, including this one. It would have been helpful for the reporter to have asked how much the procedures cost, on average, in the cases studied for the journal article.
The story mainly discusses the benefits as they pertain to one patient. We had to read the story multiple times to realize that the study in question went beyond this one patient.
A review of the study itself shows that 196 patients were part of the study, and less than half — 96 — underwent the treatment described in the story. The study says that, “In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay.” The story accurately reports this finding, saying, “restoration of blood flow within 2.5 hours of stroke onset was associated with minimal or no disability in 91 percent of patients.”
Despite this attempt at quantification, we think the story relies excessively on an individual patient’s story that is likely not representative of the broader experience. Since the optimal time window to perform this procedure is so small, many stroke patients may not be eligible for the therapy. In addition, the story does not explain that the study was done in 39 centers and only managed to randomize 196 patients over a 2-year period. This comes out to 5 patients per center or an average of one patient every 4 months, hardly a large number (or even percentage) of stroke patients who would benefit from (or be eligible for) this technology.
There are no mentions of potential harms from any aspect of the treatment studied. This is a major oversight in any story, but especially one dealing with a surgical procedure.
The study itself provides an easy-to-understand explanation of how the study was conducted and under what circumstances. Details like this are missing from the news story, even basic details like how many people were studied.
A closer look at the study itself would have revealed, for example, that the paper is looking mainly at the time intervals for each step in the process rather than the actual outcome of the patients, which is not directly reported, but only indirectly reported as an adjusted analysis.
There is no overt disease mongering in the story. However, we’d note that with a procedure such as this, there will be a temptation to use this device more often and this could lead to “indication creep” where more patients who don’t quite meet the very strict standards of the study are offered the therapy. This could lead to poorer results than are obtained here. The story could have commented on this.
Independent sources were included, but the story missed an important detail about conflicts of interest: The study was funded by Medtronic, the maker of the device used in the study. This detail was easy to find in the published paper about the study, which also provided a list of all the conflicts of interest declared by all the authors.
The story hints at the procedure being better than drug therapy alone, but it does not provide an actual comparison.
The story makes it clear that this procedure is not going to be widely available in the U.S. It says, “Centers accredited by the American Heart Association.currently, stent retriever therapy is offered in just a few hundred hospitals across the country, including all 96 Comprehensive Stroke Centers.” It also provides a map showing how few centers there are in the West.
Novelty is not established, and it’s not even made clear how frequently this procedure is performed or how long it has been around.
We’re always happy to see a story go beyond a news release — which this story clearly does with its inclusion of several independent expert sources. We have to note, however, that the release in this case actually provided more and better information than the story.
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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