Covering Cancer Treatment:Tricks of the Trade

Ivan Oransky, MDExecutive Editor, Reuters Health

Cancer Research in the MediaInter-American Workshop for Scientific Journalism

Guadalajara, MexicoNovember 8, 2011

How Good is the Study?• Keep yesterday’s criteria in mind:– Peer-reviewed?– Published? Where?

• Was it in humans?– It’s remarkable there are any mice left with

cancer, depression, or restless leg syndrome

• Size matters

• Was it well-designed?

From Covering Medical Research, Schwitzer/AHCJ

Just Say No

Sometimes, it’s better not to cover something. But if you must…

What’s Your Angle?• Are you trying to help readers, listeners, and

viewers make better health care decisions?

• Covering a study because it has a good business angle, or it’s about a local project, is perfectly OK, but it doesn’t mean readers deserve less evidence and skepticism

Who Could Benefit?• How many people have the disease?

• Keep potential disease-mongering in mind

How Effective is the Treatment?• Adding months, or years?

• Preventing complications? How many?

• Always remember to quantify results, not just “patients improved”

What Are The Side Effects?• Every treatment has them

• Where to look:– Go beyond press releases and abstracts– Look at tables, charts, and results sections

Who Dropped Out?• Why did they leave the trial?

• Intention to treat analysis

How Much Does it Cost?• If it’s ready to be the subject of a story, someone

has projected the likely cost and market. – At least ask.

Who Has an Interest?• Disclose conflicts

• PharmedOut.org

• Dollars For Docs series http://projects.propublica.org/docdollars/

Are There Alternatives?• Did the study compare the new treatment to

existing alternatives, or to placebo?

• What are the advantages and disadvantages (and costs) of those existing alternatives?

Don’t Rely Only on Study Authors• Find outside sources. Here’s how:

Use Anecdotes Carefully• Is the story representative?

• Does the source of the story have any conflicts?

• More on this at today’s panel session

Watch Your Language• Lifestyle/diet – are they randomized controlled

trials, or just observational?

• If observational, make the language fit the evidence:

– YES: “tied,” “linked”

– NO: “reduces,” “causes”

Absolute vs. Relative Risk• Consider the risk for blindness in a patient with

diabetes over a five-year period

• The risk for blindness is 2 in 100 (2%) in people who get the conventional treatment and 1 in 100 (1%) with a new drug

• The absolute difference is derived by subtracting the lower risk from the higher risk: 2% - 1% = 1%.

From Covering Medical Research, Schwitzer/AHCJ

Absolute vs. Relative Risk• Expressed as an absolute difference, the new drug

reduces the five-year risk for blindness by 1%.

• The relative difference is the ratio of the two risks.

• Given the data above, the relative difference is:

1% ÷ 2% = 50%

• Expressed as a relative difference, the new drug cuts the risk of blindness in half.

From Covering Medical Research, Schwitzer/AHCJ

Number Needed To Treat• Same concept as number needed to screen

• Can be calculated from absolute risk: – 100/absolute risk difference (as a percentage)

Keep Yourself Honest

• Use HealthNewsReview.org

Acknowledgement/Contact• Nancy Lapid, Reuters Health

ivan-oransky@erols.comTwitter: @ivanoransky