Same old, same old, with NY Times Well column – bisphosphonates for pneumonia this time

While the overarching theme may be the same – the puzzling editorial decision-making in the New York Times Well blog/column – the specific topics change – and so, provide more examples for instruction.

Bone Drugs May Have Added Benefit: Lower Pneumonia Risk is the headline of the latest troubled piece that caught my eye. The opening line:

Osteoporosis drugs such as Fosamax and Actonel may have an additional benefit: A new study suggests they are associated with a reduced risk for pneumonia.

The entire story used 220 words.  There is very little that can be covered effectively in a news story about a biomedical research study in so few words. The story did manage to confuse quite effectively.

Even that opening line mixes the fact that the study only showed a statistical association with the assertion that it showed cause-and-effect.  When it pointed to a possible “additional benefit” from the use of osteoporosis drugs – or bisphosphanates – it crossed a line.

At the end, it included a quote from one of the study co-authors and paraphrased him stressing “that the study is observational and does not prove cause and effect.”

But the story used cause-and-effect language throughout:

• additional benefit
• reduced risk for pneumonia
• The reason for the effect is unclear
• bisphosphonates lowered the risk

If the study did not prove cause-and-effect, which it did not, then you can’t prove benefit, risk reduction or lowering, or an effect.

This is a common failure in the Times’ Well blog/column. We regularly point to our primer to help journalists do a better job on observational studies, Observational studies: Does the language fit the evidence? Association vs. causation.

Worse, though, in this case, is that in the entire story there was only discussion of benefits from bisphosphanates and not one mention of side effects or potential harms. We have regularly warned readers that if you ever read a story about a drug study that only discussed potential benefits – but not harms – you should run for the hills because there’s no such thing.

And the potential side effects and harms of bisphosphanates are well known.

• Therapeutics Initiative: Given that bisphosphonates can cause severe adverse effects including fractures, which they are meant to prevent, it is urgent that the overall benefits and harms of long-term treatment be clarified. The available evidence suggests that the benefit-harm balance may be unfavourable for their use in osteoporosis.
• Ten years ago The Food and Drug Administration (FDA) warned that there is a possible risk of a rare type of thigh bone (femoral) fracture in people who take drugs known as bisphosphonates to treat osteoporosis.
• Nine years ago the Center for Medical Consumers published “Warning on bone drugs: stop after 5 years.”
• Five years ago The BMJ, under its Too Much Medicine heading, published, “Overdiagnosis of bone fragility in the quest to prevent hip fracture.” That paper concluded: “(Drug therapy) can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret.” The paper stated that “Bisphosphonates are the dominant drugs for fracture prevention.”

This is just a snapshot of the voluminous and evolving medical literature on the harms of bisphosphanates.

But the New York Times never acknowledged that any harms exist – only benefits – and now unproven “additional benefits.”

As I always do, I checked the reader comments in response to this piece. The Times should learn from the experience of its readers.  Comment excerpts:

• “Fosomax and those drugs are notorious for bad side effects, involving jaw death among other things. My dentist told me to stay as far away from them as possible. There’s no way I would take that stuff just to “maybe” reduce my risk of pneumonia. There’s a pneumonia vaccine that’s probably a world safer than a biphosphonate if you want to prevent pneumonia. And far better drugs if you want to fight bone loss.”
• “I had a femur fracture as a result of taking bisphosphonates—Fosomax, Actonel and Boniva. I know doctors do not like to hear this… those meds can be dangerous and should have black box warnings. Doctors will tell you there are “rare fractures” but the numbers of femur fractures are inaccurately counted. And now you make an observational claim that they help with pneumonia.”
• “Are people really still taking Fosomax? It’s a nasty drug that put my mother into the hospital for 10 days with a gastrointestinal track inflamed from beginning to end. People have suffered from other side effects including fractures. I thought they had cut way back on prescribing this medication.”

Finally, with all the resources of the Times, the story only quoted one source – a co-author of the paper.  No independent perspective was included.

Why was this newsworthy – when the world is focused on the COVID-19 pandemic?  Why was this worth even 220 words now?  Why did the story explain that the study didn’t prove cause and effect, but then used cause and effect language six times (including the headline)? Why no mention of harms?  Why was there no independent perspective with no conflict of interest?

These are the kinds of questions that should be answered for readers.  The Times, which is delivering some stellar journalism on COVID-19, should abandon 220-word stories like this one.  It only adds to the cacophony of noise from not-ready-for-prime-time health care news.