The story had the right instincts, but we think its somewhat confusing treatment of the evidence may tempt some women to use their contraceptive devices longer than recommended — and it’s too early for women to go that route without discussing the issue with a health professional. Other items on our wish list include an independent perspective, costs figures to illustrate the potential savings, and an acknowledgment of other recent research that addresses this same issue.
Women need access to contraception. Long-term reversible contraceptives (LARCs) are especially important because they are among the most effective, convenient, and budget-friendly of the choices. Access to LARCs can be challenging, particularly in resource-limited settings, so an additional year of use might make a big difference.
The story mentions potential savings, but we would have liked some figures to give us context. We aren’t given the cost of an office visit and procedure to insert either of the devices being studied, and nobody tries to calculate what a year’s extra contraception is “worth” to a typical woman.
The benefit of effective contraception during the study is explained. The story notes that “By the end of the trial period, none of the women using the implant were pregnant and there was one pregnancy among the women using the IUD.” The story mentions that additional benefits of using the device for a longer period include cost reduction and convenience.
It’s strongly implied that an unintended pregnancy is a potential harm of keeping either one of these prescription devices longer than the FDA-approved length of time. But that’s fairly self-evident. We think the story should have addressed other potential harms that come with having an IUD in the first place such as infection, ectopic pregnancy, or expulsion. This could have been addressed succinctly in one extra sentence.
The story’s framing of the evidence is confusing. Although the story notes that the findings are “preliminary,” it says “the researchers say they believe that the hormonal IUD and the implant can both be used for an additional year longer than the FDA recommends.” It then goes on to say, “that doesn’t mean you should extend your own use of the contraceptives without talking to your doctor. The study is still continuing, and it could be quite a long time before any changes to clinical recommendations are considered.”
What’s worrisome here is that the story seems to pit the voice of the researchers — who suggest that it’s ok to use the IUD and implant for longer than the FDA recommends — against the voice of the journalist — who urges readers to talk to their doctors. We think the researchers will win this credibility battle, which is why the story should have gone further in describing the limitations of this study and discussing why additional research is needed. Presumably there are good reasons why it might it be “quite a long time” before clinical recommendations are changed, and the story should have elucidated them.
Unintended pregnancy is a real problem, both medically and socially, so the story might have made an even bigger deal out of this.
No one is quoted by name in the story, not even from among the researchers. We would have liked an independent comment from someone who was not part of this study about its implications.
The authors might have briefly mentioned the pros and cons of different methods other than implants and IUDs — such as birth control pills and condoms.
It’s clear from the story that these birth control choices are widely available in the United States. The story could have noted that access to LARCs in developing countries may be limited, and that using these devices longer might help with that problem.
Extended use of LARCs has been the subject of other studies and at least one review article that made clinical practice recommendations. A brief search and one sentence would have been sufficient to establish this context.
The story appears to draw exclusively from this university press release. No independent sources are quoted, and there are substantial similarities between text in the story and the news release.
Here is a side-by-side comparison:
News release: “Study participants were 18 to 45 years old, and their contraceptives had to be within six months of expiring when they enrolled. The women were informed of a possible risk of pregnancy if the devices were used beyond the time periods approved by the FDA.”
Story: “All the women were between the ages of 18 and 45 and their contraceptives were within six months of expiring before they enrolled in the study. The women were informed of the pregnancy risk associated with using their device longer than recommended…”
Conducting just one interview would have removed any doubt as to whether the story relied excessively on the news release.
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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