Sunday, April 20, 2008

Medical Journalism Fails Readers

Alert readers will notice several key facts missing or misrepresented in this morning’s “medical news” story, New Technology for Aching Backs, featured in Feeling Fit.

Right off the bat, the technology is not new. If the reporter had researched the field instead of taking her source’s word for it, she would have discovered two things: First, the spine-stretching table promoted by the local chiropractor is a Canadian knock-off of a several prior models -- around since the 1980's -- that do essentially the same thing, and secondly, it’s simply traction, a long-used technique well known to temporarily relieve some types of back pain.

But the reporter's failures go deeper than that.

The reporter says patients sign up for daily, 30-minute treatments. A thorough, professional journalist would have informed readers how many 30-minute, daily treatments are usually prescribed. Two? Twenty? Two hundred? The chiropractic literature typically mentions between 10 and 20. So what happens if the patient misses one session or the weekend intervenes?

On the same note, the reporter fails to report how much each treatment costs and whether insurance or Medicare will pay. The literature mentions a typical $250 per treatment bill. Multiply that by 10 or 20 treatments, and most readers would seriously weigh the benefit against the $5,000 cost for what most studies report is temporary relief, at best.

The reporter fails to mention FDA’s limited approval for the device. It is approved as traction that may "relieve" certain types of back pain. However, it is illegal to claim it can correct herniated (bulging) discs. The chiropractor, Stephen Stokes, seems to makes this claim in the news story when the reporter writes: “In the past, treatment for bulging discs or back pain was surgery of manual manipulation of the back.” (And, just because a treatment was used “in the past” doesn’t mean it’s a poor choice. What’s wrong with either? The reporter doesn’t say. )

The reporter fails to report how the local chiropractor diagnoses a “weakened annulus” before beginning treatment. This condition is internal and non-visible so there must be some use of x-rays, MRI scans or other (expensive) diagnostic methods not reported.

The reporter fails to inform readers about what happens when the patient stands up. The decompression or stretching that occurs on the horizontal table is surely compromised when a several-hundred-pound person stands and gravity takes over. Muscles are not strengthened to hold the discs apart in this treatment. It seems reasonable to ask the chiropractor how his device counters gravity when the patient returns to a normal, standing position. How long does the perceived benefit last? The reporter never asks whether the "cure" is permanent or temporary.

The reporter cites an article published a decade ago in a publication called the Journal of Neurological Research. Old Word Wolf hope she actually read the article because she attributes none of the information she “reports” to anyone but herself. Is this a peer-reviewed journal? Why cite a 10-year-old study? Is there nothing newer? How large is the study? How long did the benefits last?

OWW’s reading finds the improvements reported were “self reported” by patients, using self-assessed pain scales that range from 1 to 3 in some groups and 1 to 5 in others. The article mentions neither an objective measurement of intra-disc pressure nor a range-of-movement measurement -- or any other way that the researchers evaluated the result apart from patient's self-reporting. Most significantly, the reporter also fails to inform readers, based on the study’s numbers, that about one in four patients reported being not helped by the treatment.

More recently, Dwayne M. Daniel, a researcher at Parker Chiropractic College's Parker Research Institute noted in a 2007 paper published in a chiropractic journal: “There is very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy. This intervention has never been compared to exercise, spinal manipulation, standard medical care or other less expensive conservative treatment options which have an ample body of research demonstrating efficacy. Considering the cost-benefit relationship, many better researched and less expensive treatment options are available to the clinician.” (D.M. Daniel, “Non-surgical spinal decompression therapy: Does the scientific literature support efficacy claims made in the advertising media?” Chiropractic and Osteopathy, Vol 15, No. 7, May 18, 2007) Full text available at:

The reporter fails to inform readers if certain conditions preclude using the device -- osteoporosis? scoliosis? Do real M.D. specialists, say orthopaedic surgeons, use or make referrals to the chiropractor's device? Does an orthopedic surgeon use the device in his practice? If not, why not?

OWW isn't the only critic to cast a skeptical eye on the device.

And finally, a real reporter would have noted Stokes cannot be a "medical director" if he has no medical schooling; his self-ascribed title is misleading. It would be helpful if the reporter would inform readers what school the chiropractor actually attended.

Yes, OWW is being mean again. But medical reporting is a specialized area that bears a special responsibility to the reader. With this article, the reporter abrogates that responsibility in the most obvious ways – lazy, naïve reporting based on a single, biased source who has something to sell to a particularly desperate segment of the medical market.

Oh, and did we note? Stokes is a regular, full-page, full-color advertiser with the reporter's employer.

No comments:

Post a Comment