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Platelet-rich plasma for rotator cuff tears: Washington Post’s story gave us aches and pains

Rating

3 Star

Categories

I’ll never go through shoulder surgery again, so here’s what I did

Our Review Summary

Shoulder Pain InjuryThis story tells the tale of the writer’s experience using a new therapy for a rotator cuff injury, a procedure called platelet-rich plasma, or PRP.  The writer previously had undergone traditional rotator cuff injury surgery and cited a long and difficult recovery, making the allegedly easier procedure and recovery from PRP more appealing.

The story is problematic on several fronts, and was concerning enough that we used it to examine the hazards of first-person reporting on health interventions in a separate blog post, “Washington Post’s story on platelet-rich plasma injections highlights drawbacks of first-person health reporting.”

In sum, it is a first-person account of one individual’s experience, not an actual report on the efficacy of a new approach to such injuries. Research-wise, it only cites, anecdotally, one tiny pilot study of the procedure and fails to provide any real data on those and other results, including a Cochrane systematic review, which is one of the most authoritative sources of evidence on hand today. It also leans heavily on quotes from the physician treating the writer, and provides no information that would convince readers that his statements are free from conflict.

It’s also important to point out a factual error in the story: Injecting lidocaine into the shoulder or another area known as the subacromia bursa numbs up more than just the rotator cuff. The rotator cuff, itself, is not injected.

 

Why This Matters

Imagine sitting down over coffee with friends listening to one of them explain their latest medical experience. That’s what this story essentially is — one anecdote. It offers no data on success or failure of the procedure in question. A larger problem lies with the fact that the story ran in the Washington Post, one of the country’s leading newspapers and information source for hundreds of thousands of people, who might understandably assume the information in the story is more valuable than it is. Stories that report on advances in medicine, which interest us all, must have actual facts and data so that readers may evaluate their worth. This story lacks all that.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story attempted to discuss cost by citing the difference in price between shoulder surgery ($13,000) and the PRP treatment ($1,000, in this case for two injections). This is sufficient enough for a Satisfactory rating, but barely.

While this does give readers some idea of the possible cost difference in treatments, there is no assurance that the charges in the author’s case are typical for those for the general public. It is simply one single data point which is fairly useless to the public. And, since there is no evidence of benefit or how many shots one might require, cost could be all over the place.

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

Not Satisfactory

The story gives no information on quantified benefits measured in PRP research, and instead focuses only on the author’s experience.

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

Not Satisfactory

The only mention of potential harms in the story comes in this statement:  “The American Academy of Orthopedic Surgeons — which says PRP ‘holds great promise’ — describes the risk as minimal.”  That’s not acceptable given that there is no explanation of what those risks might be. Readers are left clueless when it comes to questions of potential harms.

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

Not Satisfactory

Simply put, the discussion on the quality of evidence here is at best minimal, just the experience of one patient who happens to be a writer for the Washington Post.  The story does cite a “recent pilot study” from a Canadian clinic of just seven rotator cuff injury patients who underwent PRP therapy.  It said the study “showed tissue healing in five of seven patients . . . as well as improvements in their pain and function.”  But the story offers no information on how much healing or what degree of pain reduction or function, information readers need to consider a new therapeutic approach.

There is no discussion of the growing body of evidence that has yet to show PRP actually improves clinical results. High-quality research, including a Cochrane systematic review, shows no benefit from injecting PRP. As Cochrane’s review noted:

“The quality of the evidence is very low, partly because most trials used flawed methods that mean their results may not be reliable….In terms of individual conditions, we were able to pool results from six studies and found no differences in long-term function between those who received PRT during rotator cuff surgery and those who did not.”

Does the story commit disease-mongering?

Satisfactory

When it comes to shoulder injuries like rotator cuff tears, the story does not disease monger.

However, the author’s claim that a vaccination injection resulted in the shoulder tear was an unusual claim, and one that we’re dubious of.

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

Satisfactory

Along with quotes from the author’s physician (who has already posted the story on his website) there are quotes from a researcher who was involved in one small clinical trial on PRP. The inclusion of the researcher just barely squeaks by as sufficient to earn a Satisfactory rating here.

However, the story would have been much stronger had the author interviewed an expert who disagrees with these two sources, which wouldn’t be hard to find given the Cochrane review and other systematic reviews that cast a less rosy glow on PRP.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story is basically touting a possible new therapy as an alternative to traditional rotator cuff surgery, but it does a poor job of comparing them in an evidence-based manner.

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

Satisfactory

The story explains that platelets are removed from a patient’s blood using a centrifuge, equipment readily available in most practices.  It makes the point of advising readers to seek out practitioners who do the procedure frequently.  The story suggests that the PRP procedure is becoming more available.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story does not make it clear that PRP is not a new treatment, and that has been studied for many years now, including in rotator cuff tears.

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

Satisfactory

This story does not rely on a news release.

 

Total Score: 5 of 10 Satisfactory

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