When are journalists and scientists going to learn? "Cure" just isn't an acceptable term to use in describing test tube research, unless you're talking about a new way to treat ham.
An Associated Press story Friday began: "Scientists at the University of Michigan Medical School are part of a team that has discovered a possible cause of prostate cancer, a finding they say could result in better forms of treatment or possibly a cure."
Maybe this is an important finding. Maybe years from now it will lead to a treatment. But cure? It's a bit premature to talk about possible cures when you haven't even treated one person based on the new finding.
The former deputy director of the Canadian national breast screening study has a thoughtful essay in the BMJ this week, reflecting on her own diagnosis.
She asks, and passes along the questions of others who ask, "What's the use of breast screening?" and "Might screening actually be detrimental?" She urges that women be "completely informed" before they accept screening, even though the information might "not be what they want to hear."
And she concludes that the current enthusiasm for screening is based more on fear, false hope, and "greed" than on evidence.
A study in the October 20 issue of Nature shows how many authors of published guidelines for prescribing medications often have financial interests in the companies whose treatments they recommend.
Almost half of the published guidelines examined in the study contained no information about potential conflicts, and more than one-third of the guidelines stated that the authors of the recommendations had no conflicts. Researchers found that in about half of the guidelines, at least one author had received research financing from a company that had a connection to the recommendation, and in 43% of the guidelines surveyed, at least one author had been a paid speaker for a relevant company.
Medical journals, journalists who cover health-medicine-science, and consumers must continue to strive for full disclosure.
Two interesting columns are published today, each addressing some of the problems with current risk communication, and with public perception of risk.
The Washington Post has another excellent piece by the Dartmouth team of Woloshin-Schwartz-Welch, this one on how the flu death risk is often exaggerated, and so is the possible benefit of the flu vaccine.
The New York Times offers physician Abigail Zuger's essay, "Scare Yourself Silly, but the Real Terrors Are at Your Feet." She writes: "Of four patients I saw in a single hour last week, three announced how scared they were of the avian flu. I reassured them, but there was quite a bit I did not say, and here it is.
I did not say: If you want to be scared, then how about that drug habit of yours you think I don't know about? How about the fact that you are 100 pounds overweight and eat nothing but junk? How about the fact that in a few short months Medicaid is going to stop paying for your very expensive medications and no one knows how just high that Medicare Part D deductible and co-payment are going to be? I did not say: If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic. ... Apparently they all lack the drama, the suspense, the titillating worst-case situations that energize our politicians and turn into a really newsworthy health care scare."
The Star Tribune notes: "Washington's smart-alecks joke that if Hillary Clinton had proposed health-care reform as complicated as the new Medicare drug benefit, her critics would've laughed her out of town. But wait -- she did, and they did."
And the Wall Street Journal reports: "Today, the Republican lawmakers who rejected 'Clinton Care' are investing billions of dollars more every year in the veterans health-care system, which has become a huge experiment in government-run managed care. Annual spending on VHA, which is part of the Department of Veterans Affairs, has grown by 58% after inflation. The number of veteran patients treated has almost doubled to 4.66 million annually in 2004."
Herceptin has been used to treat advanced breast cancer, but three New England Journal of Medicine articles this week suggest the drug could work against an aggressive early-stage breast cancer.
Some news stories allow researchers (including a National Cancer Institute researcher) to use words like "cure" in describing the drug. Other experts were quoted calling the latest studies on the drug "revolutionary...stunning...jaw-dropping." And some stories didn't challenge those claims or that language.
But Rita Rubin of USA Today included caution in her story: "Barbara Brenner of Breast Cancer Action, an education and advocacy group, called use of the word 'cure' in this case 'outrageous,' because the studies on average followed women for only a year or two."
In the San Jose Mercury News, Brenner was quoted again: "The annals of breast cancer are filled with stories like this one in which the hype hurts thousands of women and their loved ones."
Jeff Donn of the Associated Press had a quote in his story: "I think it's way too soon to talk about a cure,'' said Debbie Saslow, director of the breast cancer section of the American Cancer Society."
Good science doesn't need hype. Good drugs need to stand the test of time. Thank goodness some journalists are countering the hype that they're encountering and concentrating more on evidence than emotion and excitement.
The Wall Street Journal now offers an Avian flu news tracker.
In it is a story wherein a Roche pharmaceutical exec cautions that governments need to do much more than stock up on the antiviral drug Tamiflu to fight any bird-flu pandemic, and says "mad" consumer purchases of the drug to ward off possible bird flu were making it difficult to supply patients for the normal flu season.
To that I would add some words of caution: there is not overwhelming evidence of how Tamiflu would even work against the Avian flu. And there is already at least one case reported of resistance to the drug.
This week the feds launched two new tools on the Medicare Web site to help beneficiaries select prescription drug plans. The tools are supposed to help seniors compare deductibles, copayments and monthly premiums available under each prescription drug plan. Medicare administrator Mark McClellan says, "Right now (the Web site's) main use is for training and familiarity purposes for those who work with beneficiaries. It's not yet time to use the tool to make your decision."
Sounds like that's an understatement. The San Francisco Chronicle reports that some consumer advocates who tested the tools said that they were difficult to use. Volunteers at Senior Action Network in San Francisco said that the tools will confuse seniors who are not familiar with the Internet or computers. Gail Shearer, a policy analyst at Consumers Union, told the New York Times, "It's tough to use, even for advocates." Bill Vaughn, also a policy analyst with Consumers Union, told the Miami Herald, "All of the different volunteers need to roll up their sleeves and get ready for some massive education."
The Washington Post offers a profile of an educated health care consumer, counsel for the Senate Finance Committee, who was "pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan."
The headline of the article calls consumer-directed plans "a health gamble."
That savvy consumer said, "I appreciate the concept of making consumers more aware about health care costs," but "I didn't understand the full consequences" of choosing a high-deductible policy. She says her health plan left her confused and with a pile of paperwork. She says her experience was "awful," adding, "I don't consider it consumer-directed and it's certainly not consumer-friendly."
All of those TV ads for Lunesta, Ambien and other sleeping pills --- and all that drug industry-sponsored promotion of the "National Sleep Awareness Week" may be paying off.
A new report by a prescription management company shows that among adults aged 20 to 44, use of sleep medications doubled between 2000 and 2004, while spending among the age group for sleeping pills jumped 190 percent.
But among children aged 10 to 19, use of sleep aids shot up 85 percent and spending was up 223 percent.
The report estimated that Americans filled more than 35 million prescriptions for sleeping pills in 2004, spending $2.1 billion.
The Washington Post reports that former FDA chief Lester Crawford did not cooperate with an inquiry by the Government Accountability Office into the agency's controversial decision to reject over-the-counter (OTC) sales of the emergency contraceptive Plan B.
Senator Hillary Rodham Clinton released a statement that said, "The draft GAO report appears to confirm what we have suspected for some time: Science was compromised in the FDA's decision-making process on Plan B."
Senator Patty Murray said, "We need an FDA commissioner who is willing to go before the public and explain how agency decisions are made. Refusing to explain his role in this decision is not acceptable."
Of course, Crawford resigned from the FDA job last month. And the FDA assistant commissioner for women's health resigned in late August in protest of the Plan B decision.
Why do health insurers send out unintelligible statements with billing codes tha none of us can decipher? The New York Times has a good column on these questions. It includes quotes from the president's senior adviser on health information technology, who admits he can't figure out the insurance statements he receives.
Insurers call these mailings EOBs -- or explanations of benefits. Consumers may want to scream EOB -- or "end our bondage" -- in this meaningless labyrinth of paperwork. After all, isn't this the era of CONSUMER-DRIVEN HEALTH CARE, when all the informational tools will be available to consumers to help them make better choices?
The University of Minnesota issued a news release this week reading, in part: "For the first time, stem cell researchers at the University of Minnesota have coaxed human embryonic stem cells to create cancer-killing cells in the laboratory, paving the way for future treatments for various types of cancers (or tumors). The research will be published in the October 15 issue of the Journal of Immunology."
Local media picked up the story, including a WCCO report that said, in part: "Researchers expect to begin testing on animals within a couple of months, but it will be a few years before the research will be tested on people. The research will be published in the Oct. 15 issue of the Journal of Immunology."
If such a result had been reported by the University of Wisconsin or the University of Iowa, you can bet that WCCO would not have reported on it. Tell me the last such study they reported on from the Journal of Immunology. But because it was local, it was newsworthy. I don't buy it. It was a preliminary finding in lab dishes -- not even in mice yet. Good science, no doubt. But let's apply consistent news judgment to such preliminary science stories.
KSTP reported: "Researchers at the University of Minnesota have made progress in fighting cancer." That's hyperbole. They made progress in a test tube. Nothing has yet been shown in people -- not even in mice.
“Pinkwashing” is a term used to criticize corporate campaigns and practices in which the sponsoring companies position themselves as leaders in the struggle to eradicate breast cancer. But the advocacy group Breast Cancer Action, with its "Think Before You Pink" campaign, questions how and why breast cancer has become the poster child of corporate cause-related marketing campaigns, as companies try to boost their image and their profits by connecting themselves to a good cause. Breast Cancer Action urges people to ask some critical questions before opening their wallets for these marketing campaigns: How much money goes to the cause? What is it supporting? How is it being raised? And will it truly affect the fight against breast cancer?
Drug expenditure in the Canadian province of British Columbia doubled between 1996 and 2003, and 80% of this increase was due to me-too drugs -- drugs that don't offer substantial improvements over less expensive alternatives already on the market. Details available in the BMJ.
One of the best comedy shows of the new season is the handling of the Medicare prescription drug "benefit." The feds are sending out millions of "Medicare and You" handbooks that contain misinformation. The handbooks mistakenly say low-income beneficiaries will be able to enroll in any prescription drug plan available in their area without paying premiums. But the reality is that beneficiaries who qualify for the premium exemption only can take advantage of the additional financial assistance if they sign up for a plan with a premium at or below the regional average. About 40% of plans qualify to offer no premium, according to the Associated Press.
A Medicare administrator attributed the error to "inadequate proofreading."
This will only add to criticism of how confusing the new law and the new benefit will be for seniors. Senate Minority Leader Harry Reid (D-Nev.) said, "The administration has created a drug benefit that is so confusing, even the people running Medicare can't get it right." Rep. Sherrod Brown (D-Ohio) said he hopes Medicare "isn't serious that seniors can 'go online' to get the correct information," adding, "How will they know it's incorrect in the first place? Misinformation will turn a frustrating decision-making process into a complete waste of time."
(Credits to the Cleveland Plain Dealer, The Hill, and American HealthLine of the National Journal.)
Canadian drug policy researcher Alan Cassels observes October as breast cancer awareness month by analyzing the hype of breast cancer drug Herceptin. He writes: "The media pushed the glee meter into the red zone, with words like 'breakthrough,' 'wonder drug,' and 'impressive advance,' overblown, laudatory adjectives that I admonish journalism students to strenuously avoid."
Cassels concludes his column: "We all want new and better breast cancer treatments, but that doesn’t mean we should allow selective and misleading reports of a drug’s benefits to drain our public health care system of precious dollars, and put suffering patients on a roller coaster of hope and despair."
More than half of Medicare beneficiaries do not understand the new Medicare prescription drug benefit and do not plan to enroll in the program, according to a USA Today/CNN/Gallup survey conducted last week.
"The (poll) numbers suggest an abysmal program," Robert Hayes, president of the Medicare Rights Center, said, adding, "This benefit was designed to make it impossible for consumers to understand it." Vicki Gottlich, senior policy attorney for the Center for Medicare Advocacy, said, "People are very confused. Part of the confusion stems from all the variables. If you're going to get mailings from 15 different companies offering a different array of plans, you might throw it all in the garbage."
Dr. Andrew von Eschenbach announced late Friday that he will temporarily give up the head job at the National Cancer Institute in order to lead the Food and Drug Administration.
Merrill Goozner has written about how von Escenbach, at the NCI, "was a forceful advocate for more rapid approvals of new drugs based on inconclusive markers of their efficacy."
Now he'll head the FDA.
Meantime, TIME magazine, in an article entitled "How Many More Mike Browns Are Out There?" reflects on how "many within the department, as well as in the broader scientific community, were startled when, in July, Scott Gottlieb was named FDA deputy commissioner for medical and scientific affairs." TIME reports that Gottlieb had been an editor of a Wall Street newsletter, writing many articles that "criticized the FDA for being too slow to approve new drugs and too quick to issue warning letters when it suspects ones already on the market might be unsafe." Former FDA chief Donald Kennedy, now editor of the journal Science, told TIME, "The appointment comes out of nowhere. I've never seen anything like that."
Journalist Goozner writes, "It this is a harbinger of things to come, the FDA may soon rival FEMA in its ability to serve the needs of the American public."