Wednesday, June 9, 2010

Media hype and melanoma

A cardinal rule of medical journalism is to never hype the science. All good reporting should be fair and accurate, but the stakes are much higher in medical writing, where readers’ hopes and dreams often ride on what is reported about some new drug or treatment regimen.

I knew results would be presented last week at the annual meeting of the American Society of Clinical Oncology (ASCO), so it came as no surprise to see a flurry of stories in the mainstream media about ipilimumab. “Ipi,” as oncologists call it, is an immune-enhancing pharmaceutical that’s been in clinical trials for several years for the treatment of advanced melanoma. It’s the sort of drug in which we stage 4’ers take special interest.

In a double-blinded, placebo-controlled trial, about 700 patients with highly advanced melanoma received either the drug or another treatment regarded as mostly ineffective. Those who got ipi lived 10 months on average compared to six months for those who didn’t.

That’s a baby step, and is just the sort of advance that underscores how painstaking progress is in the so-called war on cancer. It must be noted that in 20 to 30 percent of the patients who received ipi, the response was impressive: the metastatic cancer that had spread throughout their bodies was either dramatically reduced or simply disappeared. There was no response to ipi in the other 70 to 80 percent of patients.

I'm sorry, but I don’t find this to be a “seismic shift” in cancer care, nor does the drug appear to be a “breakthrough.” Yet that’s what a couple of news organizations ( and Medical News Today) wrote about the research results for ipi, Other outlets I’ve checked were just as giddy with their reporting. The New York Times, as a notable exception, got things about right. Its reporter cited the results of the ipi trial in the context of a larger story on new cancer drugs and quoted an oncologist at Johns Hopkins, who was not involved in the trial, as saying that the results represented “a single, not a home run.”

A world of difference lies in that distinction. The doctors and researchers who were involved in this study, and in cancer research in general, are inclined to be upbeat about their particular drug, regardless of its actual effectiveness. They want to keep everyone interested in what they’re doing—most of all their corporate sponsors. Because there’s such a miserable record at finding drugs that improve survival for patients with advanced melanoma, the smallest advancements are heralded as triumphs. It’s sadly predictable that the news media are happy to report what people with a vested interest in the study results spoon-feed them. It’s shoddy reporting of what is sometimes ethically suspect research.

Dr. Otis Brawley, the chief medical officer for the American Cancer Society, called this practice out in a piece he wrote this week for He makes the point that over the last several decades, medical meetings like ASCO’s have become venues for drug companies and medical device manufacturers to tell physicians about their products. Much of the research that’s presented is sponsored by industry, and these meetings are a unique opportunity for companies to make a splash by promoting their products.

Brawley also challenges reporters to question the underlying motive for every scientific study on which they report as part of their research. The line between education and marketing at ASCO and other medical meetings is often blurred, and since readers can’t be expected to follow the medical literature, where industry associations are expected to be disclosed, reporters must do this digging for them. In defense, reporters plead a lack of time and expertise to seriously investigate the ties between industry and the medical community. Many of the good medical reporters I’ve known in my career, and who understood these rules of engagement, have left the field. Most medical reporting today is done by people who fail to appreciate how easily medical data can be spun. They happily jump on the cancer cure bandwagon.

It appears that ipilimumab holds promise as a drug that will extend life for some people with advanced melanoma. It gives hope to many patients who desperately need it. Unfortunately, ipi’s hope quotient is out of proportion to what it can actually do. It’s possible that a different dose of ipi or some combination of it and other cancer drugs may improve its effectiveness. Clinical trials will definitely continue. Hope, for now, blooms like roses in spring.

I remain a skeptic on this matter because the self-serving nature of the cancer establishment seems so obvious. Reporters and their media organizations are their pawns, which pains me. It is the job of journalists to shine light in corners that powerful people would prefer remain dark. Cancer research is one such place. The latest news about ipi is personal, as this drug or others still in clinical trials could be in my future. I hate to see an incremental bit of progress, as welcome as it is, be so greatly exaggerated in importance.


Anonymous said...

Current trials are serving up Ipi to what essentially are terminal patients with few, if any, options. One suspects you would review the results of throwing of cup of water on a conflagration and self righteously proclaim that the fire suppressive qualities of water are being hyped. The basic research does not support your tunnel view of Ipi. Others might view the scene as one where the firemen have no clue of how to use a hose and and bureaucrats quarterbacking fire suppression from the sidewalk. Shocked by the banal revelation that corporations and reporters are self-serving? - spend more time out of your cocoon and in the real world - and possibly looking for a recruiting Ipi trial. You are too smart not to know this, or you have not met inclusion criteria. In any event, I wish well in your fight with the real enemy.

Anonymous said...

How statistics are stated can be misleading. The results of the ASCO study could also be stated as "In twenty-five percent of the cases, the cancer was completely halted, and those people are still alive two years later (and counting)." That sounds a bit more impressive. The reason the median life-span was extended for such a short amount of time was that for the other seventy-five percent of the cases, the drug did not not work at all, and they died at their usual rate. The challenge now is to discover why the drug worked for those twenty-five percent.

Paul and Karen said...

I had seen an article about ipi and was interested to hear your take on it. I hadn't been aware of the connection between medical meetings and corporate sponsors. Thanks for filling us in.