If you follow me on Twitter, you may have noticed several 140-character conniptions I had last week over coverage of a Danish study that used antibiotics to treat low back pain.
I generally feel pretty protective of health reporters. I’m in the trenches with you. I have good days and bad days, too. Deadline reporting on medical studies is tough and sometimes undervalued for the work serious, balanced coverage requires. I’m with you.
Even so, I was dismayed by most of the stories I was reading.
Reporters were trumpeting the results of two studies published in the European Spine Journal, a less influential medical journal.
The first study tested tissue samples from patients who had suffered from bulging, or herniated discs in their spines. Nearly 40 percent of those patients tested positive for bacteria. And the presence of bacteria was associated with a certain kind of bone swelling, called Modic type 1 changes, near the ruptured disc.
For the second study, researchers recruited 162 patients with Modic type 1 changes and chronic low back pain. They randomly assigned half to take a 14-week course of antibiotics, while the other half took placebo pills. After one year, the placebo group saw little change in their back pain, while the group that got antibiotics saw significant improvements in measures of pain and disability.
Taken together, the studies suggest that antibiotics could dispatch as many as 40 percent of all cases of chronic low back pain.
Lower back pain is notoriously tough to treat. Pain relievers and muscle relaxants often don’t touch it. It usually gets better over time on its own, but it also commonly comes back time and time again. Surgery is almost always considered a last resort for most patients because it makes the problem worse nearly as often as it helps. So a 40 percent “cure” rate, if it were true, would be a big deal.
The British press widely quoted a neurologist and spinal surgeon, Dr. Peter Hamblyn: “Make no mistake this is a turning point, a point where we will have to re-write the textbooks,” he said in a quote for this cringe-worthy story in The Daily Telegraph. “It is the stuff of Nobel prizes.”
Wait now. What was that? Nobel Prizes? For a study of 162 patients?
Small studies like this one don’t even warrant a change in practice, says Richard Deyo, M.D., M.P.H., a back pain specialist and a professor of evidence-based medicine at Oregon Health and Sciences University, in Portland. Deyo called the study “innovative and provocative,” but said he’d also like to see some serious attempts to replicate the results before it was tried on patients.
But it gets worse; those weren’t the only ones that picked up on that Nobel quote.
The Guardian wrote a slightly more responsible story but still saw fit to paraphrase the over-the-top quote, as did The Times of London.
Who was this guy, Peter Hamblyn, and why was he suddenly passing out Nobel prizes? As it turns out, he was the guy who helped organize a press conference to publish the study. He’s also a doctor who stands to make money off the treatment, through a website he set up with the study’s author to promote the therapy, which has been dubbed MAST, for Modic Antibiotic Spinal Therapy.
Only one story, from the Independent, included that information. That story also reached out to independent reviewers to get a more balanced take on the study.
By far, the best story of the bunch came from Canada’s Globe and Mail. There was no mention of Nobel prizes, just balanced comments from two independent back pain experts. O Canada!
(Apparently I wasn’t the only one who thought the coverage of these studies needed a closer look. Dr. Margaret McCartney, a general practitioner from Glasgow, did a great roundup of the whole debacle for the BMJ’s Medicine in the Media column.)
Here’s what’s really troubling about this whole mess. The antibiotic therapy these two doctors are pushing is easy to get. Doctors could try it now just by writing off-label prescriptions for the treatment.
Stories that failed to note the serious conflicts of interest behind the push to promote the study did a great disservice to back pain patients, many of whom are desperate for help.
A long course of antibiotics isn’t likely to be harmless. And the study notes that 21 percent of patients experienced serious side effects, though the authors didn’t detail what they were.
“Cases of C. difficile colitis seem inevitable if this is widely implemented,” Deyo said. What’s more, “Prolonged [more than three months] broad spectrum antibiotic therapy in substantial numbers of people will undoubtedly contribute to antibiotic resistance,” he said. “There are big stakes in being right about this.”
