STAT does some great stuff. And some clunkers. They get enough praise for the great stuff, but not enough scrutiny of the clunkers. This is one such example.
A story based on very preliminary research touted the early work in very promotional tones.
Excerpts (with my comments added in bold italics):
- “a smartphone app — one that works on iPhone and Android — that can identify the presence of fluid in a child’s ear.” But the presence of fluid does not always mean the presence of infection.
- “physicians — and parents — can use it with relative ease” Emphasis on relative, perhaps.
- “The study did test a small set of patients although plans for larger studies are underway.” Hmm. And why shouldn’t the news coverage wait until those larger studies are done?
- STAT interviewed the researchers about their plans “for getting the app into millions of hands.” And I’ll bet that they’re very happy to get STAT’s help in furthering those plans.
- A researcher explained: “We approached parents just before their kids were about to have surgery to have ear tubes put in. …We had 25 parents do the test, and 24 of the cases, the parents had the same result as the physicians who used the app.” And what is the statistical power of this small a sample?
- The researcher also said: “It’s not currently available in app stores, but we’re hoping to have it in there in a year’s time. We’re also hoping to get FDA approval by the end of year. We created a company — Edus Health.” The cart is clearly in front of the horse. First comes the research, then maybe FDA approval – not a fait accompli, then we can talk about the company, and then we can talk about the app being in stores.
Alan Schroeder, MD, the associate chief for research in the division of pediatric hospital medicine at Lucile Packard Children’s Hospital Stanford, reacted to my comments via email.
“You’ve hit the nail on the head – the headline was “A smartphone app could help diagnose ear infections more accurately — and at home” but the patients studied did not have ear infections. They had fluid behind their ears. It does not seem that the app will be able to differentiate acute otitis media (an acute bacterial infection of the middle ear) from otitis media with effusion (fluid in the middle ear without signs or symptoms of inflammation – also called serous or secretory otitis media). Many patients with fluid behind their ears will not have otitis media with effusion. This brings up the potential for a lot of false alarms and unnecessary office visits/antibiotics.”
STAT wasn’t alone in reporting on the journal article in question. The Associated Press, Gizmodo, WebMD & HealthDay were among many others who reported on it. WebMD, picking up a HealthDay story, went beyond what the study actually showed and inaccurately reported:
Can a smartphone app spot an ear infection? It did so with high accuracy in new research.
It found fluid, not necessarily infection.
But NPR’s story, for example, took a markedly different tone. It placed caveats high in the story and had independent expert quotes that provided important context.
In the first sentence, NPR noted: “might help parents detect fluid buildup in a child’s ear — one symptom of an ear infection.” (emphasis added) The second sentence emphasized: “The app is still experimental and would require clearance by the Food and Drug Administration before it could hit the market.”
Independent experts were quoted:
“One big question is, just how useful will this be for parents and doctors?
Fluid behind the eardrum is a symptom of ear infection, but “not all fluid is an infection,” says Pamela Mudd, an ear, nose and throat specialist at Children’s National Health System in Washington, D.C.
Assuming the app is shown to be effective, Mudd says, she would want to talk to parents about how to interpret the results before recommending they purchase it.
“They may not have the knowledge that they need to understand what the device is telling them,” she says. The developers suggest that the app can help parents avoid a trip to the doctor’s office, but Mudd says the opposite may be the case.
“That may increase our use of the health care system” if parents take their kids to the doctor for what may be a temporary bit of fluid behind the eardrum. There may be instances where that’s appropriate, she says.
Kenny Chan, (an) otolaryngologist in Colorado, is also concerned about that. “To speculate that this may replace the need for a physician’s visit, I think that’s a little far-fetched,” he says.
I’ve had a child and a grandchild with awful recurrent ear infections. I know what it’s like. On this story, I’ll take the even-handed approach of NPR over the promotional tone of the STAT piece and some of the other stories any day.