No mention of the cost of hernia operations, which may play a role in someone opting for watching waiting. The story does not provide enough information on the effect of pain or the limits a hernia might place on daily activities. There is some information on this in the study in JAMA, but little is mentioned in story. 30% of the watchful waiting group decided to have surgery during the 4 years, though reports of pain at 2 years were similar in both groups. More information on why they decided to have surgery and the effect of hernia pain on quality of life would be useful in order to better inform patients who are trying to make a choice. However, overall, this criterion was met. The reporter used absolute numbers, not just relative — always a good idea. The story mentions harms and the frequency of surgical complications in this study, however, the discussion is limited when compared to the discussion of untreated hernias. Does not mention the harm that a hernia can recur even with the surgery (1.4% in this study.) The most significant harm reported may be the one case of nerve injury, which was not mentioned in the story. While the story states 20% had complications, three of them life-threatening, readers could have used more detail. Mentions some evidence from the Journal of the American Medical Association (JAMA) article. Mentions the randomization and an overview of the study design. Provides some appropriate quantitative evidence. This study raises an interesting question for medicine and for journalism: does the failure to demonstrate a significant difference mean that the treatments are equivalent? We think “no.” The story could have also further scrutinized the evidence by asking about the condition of the men in the trial. One of the trial’s inclusion criteria was having no pain or no interference with activities in the previous six weeks. So it’s not clear whether they really had no symptoms or just minimal symptoms. The story does a satisfactory job of explaining that hernia surgery is a common procedure and that this study challenges the conventional wisdom that all hernias should be fixed. Story includes perspective from editorial writer. In comparing treatment options, the possible harms of surgery could have been explored more fully. The story does not mention specific potential surgical or post-operative complications. 22.3% of those who underwent surgery (this included those randomized to the surgery group or those from watchful waiting who crossed over into the surgery group) had complications which included wound infections, urinary tract infections, and in a few cases, serious cardiovascular problems requiring hospitalization. This rating does not apply, as the story focuses on watchful waiting and active surveillance in lieu of preventative surgery for hernias. Hernia operations are a common procedure and available in most hospitals; the new treatment (no intervention, save for monitoring general health or symptoms typical of a hernia) is also now an evidence-based option for treatment. The story provides accurate information that watchful waiting vs. preventive surgery is a newer approach to treating men with mildly symptomatic hernias.
Study: Not Every Hernia Needs to Be Fixed