As the musical King of Siam might have said, this article is a “puzzlement.” Written more in the style of an opinion piece, and by a neurosurgeon at the Cleveland Clinic whose website states that it was the “first” to test the technology promoted in the text, the story describes a computer-assisted brain tumor ablation platform that was approved by the U.S. Food and Drug Administrative five years ago and was designed to offer life-extending options for those with difficult-to-treat or inoperable malignant brain cancers. The article does a pretty good job of setting out the limited and sometimes terrible therapeutic options such patients face, but the tone overall is promotional and there is no discussion of the costs or harms associated with the device. There is also no “news” context for the article, or answer to the question, “why is this information news now?” No recent clinical trial data are cited, and it appears that the last published clinical trial was in 2013, a phase I study of 10 patients, which saw modest life extension for some patients, along with serious side effects in most, including brain swelling. Without citing specific supportive data, the article states that “hundreds of patients” have undergone successful treatment with the NeuroBlate System. (Interestingly, there is an ongoing retrospective registry sponsored by the company to determine outcomes with no results as yet.) Overall, the information in the piece is accurate with respect to the challenges neurosurgeons and their patients face, but it’s a mystery why U.S. News & World Report (USN&WR) chose to “cover” the topic at this point in time; why a neurosurgeon was chosen to present it as a piece of journalism; and why no other sources were cited that might have updated the information and made it newsworthy.
As the article itself notes, primary malignant brain tumors — and brain tumors that occur because cancer in other organs have spread there — pose serious therapeutic challenges because healthy brain tissue can be damaged along with cancer during radiation, surgical or chemical treatments. In recent years, numerous computer-assisted, navigational, and tissue-sparing technologies have extended and refined the use of lasers and robotic probes. With them, neurosurgeons can prevent or minimize damage to healthy brain tissue by precisely guiding therapies that burn, cut, or kill off malignant tissue. The article explains the need for such technologies, but then mystifyingly focuses on just one such assistive platform called NeuroBlate, a self-described “minimally invasive robotic laser thermotherapy.” Collectively, such technologies do arguably offer a “ray of hope” as the title says, but readers would have been better served by a wider discussion of these technologies and their status and accessibility. And it might have been helpful to note what others, including a European technology assessment agency, had to say about the approach used by Neuroblate, which is called magnetic resonance thermometry (MRT)-guided laser interstitial thermal therapy (LITT): “At present, the effectiveness of MRT-guided LITT is unknown. Consequently, the small body of evidence cannot be used to make an informed decision regarding the use of MRT-guided LITT. Therefore, it is recommended that MRT-guided LITT be monitored for 24 months, at which time the results of three larger case series will be available.”
As with a variety of other medical technologies on or coming to the market these days, costs — along with clinical evidence of their value — are always part of the decision-making calculus used by medical centers to purchase and offer them. An additional factor in such decisions is marketing, and how much, if any, of a competitive edge the availability of each new technology will give a provider. So certainly some information about the costs of NeuroBlate to medical centers, insurers and patients is called for in this article.
The article notes in the next to the last paragraph that NeuroBlate “doesn’t yet qualify as a standard treatment for brain tumors,” but goes on to say that results are “promising” and the system “might be a ray of hope” in patients’ “gray sky.” But it offers no supporting data, either quantitatively or qualitatively.
While the article sets out the risks of any kind of operation or treatment on the brain, it does not reveal the particular harms of the NeuroBlate system, even those few reported in the Phase I clinical trial. This is not a slam dunk benign instrument. Seriously informing readers about these potentially life-saving or life-extending new technologies would include information about their harms and limitations.
The article reflects the scant evidence available, but it could have offered information from the published data (limited though it may be) or from interviews with neurosurgeons to add this dimension. There is virtually no original reporting here.
The article does not overstate the problem, but in fact from the first paragraph lays out relevant statistics.
Even in opinion pieces, independent sources are considered essential to credibility and news value, and here there are none cited. The conflict of interest issue in this article is more ambiguous. The byline clearly states that the writer of the article is a neurosurgeon at Cleveland Clinic. And although he is more than entitled to offer his expert views in print, it’s still a “puzzlement” as to why USN&WR would give him this quasi-journalistic platform and not disclose that his home institution had at least an academic stake in the use of the technology the article is “covering.”
This was a tough call. The article does describe in some detail alternative therapies and technologies, mostly to highlight their serious limitations. So we’ll award a Satisfactory on that basis. The story does not, however, compare NeuroBlate’s outcomes head to head with other treatments, in part because so little published clinical data are available for comparison. Still, the piece would have been better if it had tried at least to state the difficulty in gathering data.
The article mentions that NeuroBlate is FDA-approved, but that doesn’t necessarily mean it’s widely available. Surely the company has data on how many of its systems have been sold, but there is not a word here about where and how widely the system is available.
We’ll give the story a pass here. The story notes that NeuroBlate has been on the market for some five years, so there is no excessive claim to novelty. The story could have noted that a competing system (Visualase) is also marketed by Medtronic.
Although we could find no recent press release that could have been the basis for this article, we suspect that the author is relying heavily on company information about NeuroBlate and his own experience and/or familiarity with the technology. No other sources are cited. But in the end, since we can’t tell either way whether the story meets this criterion, we’ll rate it Not Applicable.