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NY Times’s look at non-drug heartburn treatments may leave readers confused

Rating

2 Star

Categories

Pop a Pill for Heartburn? Try Diet and Exercise Instead

Our Review Summary

This story focuses on “heartburn” and lifestyle changes that can reduce the likelihood of it and gastroesophageal reflux disease (GERD).

We were pleased with the way the story focused on non-drug options for a common condition. We often see news stories that do the opposite, prioritizing drugs and skipping over alternatives, such as dietary changes, that may be just as effective and carry fewer risks.

But, this story may leave readers confused. It conflates occasional acid reflux (or gastroesophageal reflux, which can cause heartburn) with the more serious problem of GERD, which can also cause heartburn. This is a common conflation, and may lead to overdiagnosis and overmedication in people without a disease. It also didn’t delve into any discussion of the evidence: What does clinical research show about treatments?

 

Why This Matters

Unlike occasional acid reflux, GERD is a severe, chronic acid reflux problem that not only causes discomfort on a more frequent basis, but can ultimately lead to additional complications, such as esophagitis or respiratory problems.

Patients seeking information about their condition, or what a given set of symptoms may mean, need to know that there is a distinction between occasional acid reflux and GERD. For the same reason, it’s important to let patients know about the full suite of treatment options — and to place those options in context.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The story does not mention cost, but given that the treatment option the story focuses on broad, non-specific recommendations for lifestyle changes, we’ll give it a pass.

Eating less fatty food and more produce is not a viable option for everyone, particularly those who live in so-called “food deserts” that have limited access to healthy foods they can afford, but that is a broader discussion — and not one that we would expect to be addressed in a story like this one. Taking all of that into account, we’ll rate the cost criterion as not applicable here.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story talks about a suite of lifestyle changes, from losing weight to quitting smoking to altering one’s diet. However, the story does not make clear to what extent any of those things reduce the symptoms of acid reflux or GERD, as measured by clinical studies.  And there’s a lot of research out there on this subject. For example, this 2006 paper in JAMA Internal Medicine looks at 100 earlier studies related to lifestyle changes and GERD. The story also pays particular attention to the approach laid out in a book titled The Acid Watcher Diet, but offers no information about how effective the book’s guidance may be in ameliorating symptoms or addressing underlying causes.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story does not address potential harms. However, it’s difficult to think of harms associated with quitting smoking, reducing alcohol intake or eating a healthier diet. There may be harms associated with not addressing GERD if lifestyle changes are not adequate, but the story does note that patients may need to take PPIs if lifestyle changes are insufficient. Ergo, the story earns a satisfactory rating here.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does not offer a discussion of the medical evidence, so it’s not clear how solid and high quality the evidence is. Are there randomized, controlled trials that evaluate these interventions? We think readers would be curious to know the results.

Does the story commit disease-mongering?

Not Satisfactory

As we mentioned in the summary, the story conflates occasional heartburn (known as acid reflux and other names) with gastroesophageal reflux disease (GERD), which is a persistent and long-lasting form of acid reflux. These are two different things.

For example, the story says “Acid reflux is a serious disorder that can and must be treated to prevent symptoms and stave off potentially life-threatening consequences.”

That is scary language — and doesn’t apply to someone who only gets heartburn once a year after having too many beers and chili dogs.

Second, the story states that proton pump inhibitors (PPIs) — a class of drugs used to treat acid reflux and GERD — “are now linked to a growing number of complications, ranging in seriousness from nutrient deficiencies, joint pain and infections to bone fractures, heart attacks and dementia.”

Fortunately, the story does note that “evidence from most of the risks identified thus far is lacking” — but that caveat may not resonate with readers scared to see a common drug linked to, for example, dementia. More detail on the risks–using absolute numbers–would have helped readers better understand the drawbacks.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The only person cited in the story is Jonathan Aviv, who wrote The Acid Watcher Diet. Input from an independent expert would have been a valuable addition.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does not address several other available treatments for acid reflux or GERD. For example, over-the-counter antacids can be useful tools for addressing heartburn in patients with infrequent acid reflux. Prescription strength and over-the-counter H2 receptor blockers are also often used to address acid reflux and GERD. The story also doesn’t discuss surgical options for GERD.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

The story doesn’t address availability–but it doesn’t need to: lifestyle changes are not products or services. We’ll rate this not applicable.

Does the story establish the true novelty of the approach?

Not Applicable

This is a column that looks at general health topics, and not a news story, so we’ll rate this one N/A.

That said, the timeliness appears to be due to The Acid Watcher Diet, which was published earlier this year. There are quite a few other books in the same vein, so it’s not clear what made this one worthy of a column feature.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to be based on a news release.

Total Score: 2 of 7 Satisfactory

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