I suppose it’d be nice to think we could trust the media when it came to presenting medical issues. Although, come to think of it, it’s kind of hard to trust them on all that much else [think: “The government is full of vampires, and they are trying to suck the lifeblood out of the economy.”–From the March 30, 2009, edition of Glenn Beck]. However, they do get the information from drug company press releases first, which, should qualify them for something, you would think.
Of course, you would think wrong.
I swear I am not making up the following statistics: When researchers asked newspaper reporters questions about their ability to report medical topics:
- 77% said they failed to “understand the complexities of scientific subjects.”
- 83% said they had never received any training in covering health news, and of those, 73% said that training might actually be helpful [I can’t account for the other 27%].
- And an underwhelming 31% felt “very confident” in reporting health news–with a winning 9.7% feeling confident in interpreting health statistics.
The media has a long history of not just mis-representing but over-hyping medications and treatments, declaring–and these are quotes– a “cure for cancer” (multiple times, for multiple cancers), repeatedly revealing new “wonder drug[s],” and informing us they have found a ‘functional cure‘ for AIDS.
Just these days they’re over the moon over Deep Brain Stimulation (it’s “a pioneering treatment for depression” which has “great success for treating major depression,” while one and the same time being a “life-changing treatment for tremors and maybe more).”
Yet researchers Gilbert and Ovadia (2011) make an interesting point about media coverage of certain psychiatric treatments.
This optimistic coverage of DBS is not the first time the media has enthusiastically hyped psychosurgery. In fact, the same happened in the first half of the twentieth century.
Greeted with great enthusiasm by contemporary media, despite the fact that there was a deeply concerning lack of scientific evidence of its efficacy, the ‘prefrontal leukotomy’ was performed on tens of thousands of patients. In the 1940s, the media presented it as a “miracle cure” for patients with disruptive behavior.
Known today as a lobotomy, researchers who studied the interaction between the media and the treatment concluded both that the press “used uncritical and sensational reporting styles,” and that the public’s acceptance of the treatment was influenced by such positive media coverage, especially in the 30s and 40s.
It does indeed seem that if you trust the media, a lot of treatments look so remarkably good, you might start to think the country could run out of sick people in a decade or two.
Skin cancer sufferers can be “be cured of the disease” as “[a]dvanced] melanoma could become a curable disease for perhaps more than 50% of patients within five to 10 years,” according to an article in this past September’s The Telegraph.
A pill that can “halt the . . .onset of Alzheimer’s disease. . .[and] greatly slow or even halt the progression of the cruel illness” will be on the market within 4 years, claims the October 30, 2012, edition of MailOnline.
Two cancer drugs combined were so effective in clinical trials that U.S. News & World Report quotes a researcher–in fact, the researcher who ran the trial, coincidentally–who says her results “mean [the sick people can be]. . .disease free. T[hey are] stunning results.”
On July 24, 2012, CNN told the story of a man cured of AIDS, noted that at the 2012 International AIDS Conference there was explicit talk of the possibility of a ‘cure,’ and quoted a Parisian researcher as saying, “I believe that if we work like in the early years of HIV, all together, we can move forward very fast as well for an HIV cure.”
That not one of these hoped-for cures has yet come to pass does not, in itself, undercut the accuracy and credibility of the media when it comes to presenting medical information, although it certainly raises questions. But some other facts just might.
This may come as no surprise to anyone anywhere, but “evidence suggests,” according to the New England Journal of Medicine, that “commercial funding may sometimes be associated with study outcomes that are more favorable to sponsors’ products. . .”
Who would have thought it?
In “How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories,” researchers found, after spending two years evaluating 500 news stories about medical treatments, that journalists generally fail to address costs of the presented treatment (of the 500, a paltry 23% gave reasonable coverage to such), the quality of the evidence, the possibility of the existence of alternative options (researchers gave a rather paltry rating of 38% when it came to assessing how many stories adequately addressed such options), and the “absolute magnitude of potential benefits and harms” (33% realistically covered potentially harmful side effects).
Moynihan et al, in 2000, looked at three medications that had made a big splash in the media: Pravachol, by Bristol-Myers Squibb, a cholesterol-lowering drug to prevent heart disease; Fosamax by Merck, for the treatment and prevention of osteoporosis; and, as they describe it, “an older, off-patent drug.” Which potential wonder drug did they mean?
Aspirin–in the use of preventing heart disease.
The researchers analyzed 207 newspaper stories released by 40 media outlets between the years 1994-1998.
A few points demonstrated how the media can slant presentation of medical information–and influence not just patients but doctors, too, in the process.
Of those stories that quantified the benefits of medications, a mere 15% included both relative and absolute risks.
I should take a minute here to clarify why that matters. Relative risk compares risks between two groups, while absolute risk can stand on its own two feet. If you’re trying to sell something, you want to go ‘relative risk’ all the way. BreastCancerDeadline2020 explains that in a trial of 200 healthy women for a drug to prevent cancer, 100 receiving placebo and 100 receiving the new wonder drug, if 2 people in the placebo group and 1 in the treatment group do, indeed, get cancer, and you compare the 2 groups, well, hey! You have a 50% reduction in cancer! (Welcome to relative risk.)
However, in the world of absolute risk reduction, if your original risk of developing the cancer at all was, say, 2%, taking this new drug might lower the risk to 1%. Hence you’ve got a 1% change in absolute risk. You see why this fails to float the media’s boat.
83% of the 500 presented their information in relative terms only, which, claim the authors, is a means of presentation that has been proven to “increase the enthusiasm of doctors and patients for long-term preventive treatments and that could be viewed as potentially misleading.”
When it came time to address some of the less appealing aspects of the medications, the media seemed a bit, well, under-active. Less than half of all stories (47%) mentioned any possible adverse effects at all, and only 30% mentioned the costs of the therapies (in some cases fairly staggering).
And, while we’re on the topic, of the 170 stories that cited an expert on a scientific study, one-half quoted at least one with an industrial tie to the studies. The media actually managed to mention that fact in only slightly over one-third of the cases.
Take Fosamax, for example. Researchers highlight news stories on May 22, 1996, on ABC, NBC, and CBS covering recently released results of a randomized, controlled trial.
All three shows presented only the relative reduction in risk, asserting that Fosamax could decrease the incidence of hip fractures by 50%, which, the CBS reporter felt moved to say, was “almost miraculous.” They simply failed to address absolute risk reduction–which was 1.2% fewer hip fractures over 4 years (2.2% fractures in the placebo group and 1% if the Fosamax group).
Only one story cited any adverse effect (with GI distress being a primary concern of those who must take it)–and none of the shows managed to reveal that the study investigator they had interviewed had himself received funding for the from the drug manufacturer.
Moving on.
HealthNewsReview is an organization dedicated to helping the average consumer really understand health care claims, and thus be able to make more informed decisions.
Let’s just take one example–the promise inherent in new drugs for Alzheimer’s disease (AD).
In October, 2012, NBC reported on the drug solanezumab for AD, proclaiming, “For the first time ever an experimental drug is showing great promise of slowing the progression of Alzheimer’s disease.”
Wow. Them’s exciting words.
But then. . .skeptical about a bunch of things, but also the phrase “for the first time ever,” a HealthNewsReview blogger ran a 5-minute web search, and found 6 different times that there was going to be a fabulous ‘slowing of the progress’ of AD:
- July 17, 2012: New Alzheimer’s Drug Slowing Progression of the Disease (CBS)
- March 8, 2012: Alzheimer’s treatment in late stages of disease does slow progression (The Independent)
- October 20, 2011: Antiviral Drugs May Slow Alzheimer’s Progression (Science Daily)
- May 11, 2009: Can New Drug Slow Progress of Alzheimer’s? (ThirdAge.com)
- August 3, 2008: Drugs May Slow Progress Of Alzheimer’s (NPR on two drugs)
And there were some problems with that original NBC story –aside from lack of originality. The drug has some major potential adverse side effects: we’re talking angina, brain swelling, brain bleeds.
Problems you might want to know about.
NBC was remarkably quiet on this subject.
And what were people ‘in the know’ saying?
Dr. Stephen Salloway, an AD expert not involved in the research, said the research indicated that any clinical benefit would be “modest” and also said made it clear the drug “may not make a difference in how well patients live.”
Dr. Ronald Petersen, director of Alzheimer’s research at the Mayo Clinic, also not involved in the project, said the effects of the drug were “subtle,” and–here’s a man who doesn’t exaggerate–clarified that the drug’s impact may mean that “somebody remembers one extra word out of a 15-word list”–without any actual improvement in their quality of life.
Drs. Peterson and Salloway were nowhere to be seen or heard on NBC during its presentation of the drug.
[FYI: solanezumab is still in clinical trials.]
And no story of hyped media drugs is complete without mentioning Herceptin, the drug that was going to cure a certain type of breast cancer found among 20-25% of breast cancer patients.
First approved by the FDA for use in women with metastatic breast cancer in 1988, it is the first of what come to be known as ‘targeted therapies,’ or drugs that specifically target the cancer molecules, without willy nilly wiping out other cells, as chemotherapy has historically done. Herceptin went on to be approved for several other uses, but in 2006 it had been granted priority review and was approved to treat this type of breast cancer justafter surgery.
The years between these two approvals saw Herceptin’s star rise–and then rise further.
The press couldn’t have been more excited: Forbes called it a “wonder drug,” the London Times claimed its performance was nothing short of “stunning,” and NBCNews declared it to be “perhaps the most powerful cancer medicine in a decade,” able to “can halve the risk of relapse” in many cases.
NBCNews quoted ‘several experts,’ mostly unnamed, who used words like “revolutionary,” “stunning” and “jaw-dropping” to describe the findings. Further, they wrote, “Some even talked of a “cure” for a considerable number of women.”
The BBC News swallowed hook-line-and-sinker–and regurgitated it for the public–the drug-maker’s claim that Herceptin cut the risk of tumors returning in women with early stage breast cancer by 50%, and–apparently protecting this cancer expert’s anonymity so s/he wouldn’t be attacked by adoring crowds–just stated that, “A leading cancer expert called the studies’ findings ‘stunning.'”
The Seattle Times quoted a researcher from the National Cancer Institute [whom they did feel free to name] as saying, “In 1991, I didn’t know that we would cure breast cancer, and in 2005, I’m convinced we have.”
And NBC News quoted one Dr. Gabriel Hortobagyi, of the University of Texas M.D. Anderson Cancer Center, who made himself available to a number of new outlets, and who saw fit to say: ”
“The strength of the evidence is so overwhelming at this point that it would be almost impossible to withhold this drug from the appropriate group of patients.”
We all were to find out later that Hortobagyi was a paid consultant of Genentech, to the tune of somewhere between (and I know this is a bit imprecise) $10,000 and $100,000. Of course he wouldn’t want any part of withholding the drug.
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You probably don’t need me to point out, particularly in Breast Cancer Awareness Month, that we still don’t have a cure for breast cancer. And if anyone ever believed we did–the media must share in the blame for those dashed hopes.
Our own Journal of the American Medical Association (JAMA) said in November of 2005 that “clinicians should view the results of [reported Herceptin clinical trials] with skepticism.”
And then it turned out the drug causes not just heart problems but actual heart failure in some patients.
Really, it just went from worse to worse (don’t you wish ‘worser’ was a word?). Just as another example: In 2012 the Daily Mail wrote: “Drug giant probed for not disclosing 15,000 patient death reports: Roche under investigation by UK watchdogs after 80,000 ‘adverse reactions.'” They clarify that the drugs include Herceptin (and came from trials run by Roche’s US subsidiary Genentech).
But the final blow, the reason I find it hard to forgive the media for its Herceptin frenzy, is that far from being a ‘wonder drug’ or a ‘cure for cancer,’ Herceptin’s stats when it comes to life expectancy, which you’d think might really matter most of all (and if you go back and look at the media’s coverage in the early years, you might notice a surprising lack of attention to this detail) are profoundly disappointing.
Compared to no treatment, death rates after one year “were not significantly different” between a group treated with Herceptin, and a control group that received no treatment at all.
One key difference? The control group had none of the cardiac problems that plagued the group taking Herceptin.
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So, look. If the media promises you nonstop coverage of the government shutdown—go on; believe ’em.
If they promise you they’ll get you the first shots of the Prince buckling his baby in a carseat–you can bet on it; they excel at royal families.
You want coverage of the funeral–may it be in many years–of the elder George Bush? The media has no problem inserting itself into such a situation.
But if you want to know if it is indeed true that “A simple pill may cure Alzheimer’s,” or if a new invention is “the closest medical science has gotten to a cure” for diabetes, or if nicotine is the ‘wonder drug’ for schizophrenia–do me a favor. Talk to your doctor, look up the clinical trials online (and remember the difference between relative and absolute risk), heck, write to me and I’ll check it out for you.
But the TV, the radio, the newspaper?
Let them take care of covering what’s going on in the political world, and helping us keep in mind important historical happenings. Surely they can do that–right?
I just sometimes get nervous when, say, someone like Fox News Channel host Eric Bolling says things like, “America was certainly safe between 2000 and 2008. I don’t remember any attacks on American soil during that period of time.”
I guess 9/11 just slipped his mind–but I become ever more convinced that I can’t leave the presentation of medical treatments in the hands of the media. The reasons for my concern speak for themselves.
