We often read headlines about breakthroughs in breast cancer which give us hope that perhaps finally a cure has been found and no one will die of breast cancer again. These headlines sell subscriptions and ad space to help the publication make money, but they often are misleading. It’s important to think critically about any headline that looks too good to be true and to ask some basic questions.
One of the best resources to help you understand quality medical journalism is http://www.healthnewsreview.org/
This website gives you tools to evaluate whether the reporting on the new medical finding is balanced and gives an accurate assessment of benefits and risks that come with the “breakthrough’ described in the headline.
Most importantly, they give you some questions to ask so you can determine yourself if a story is balanced and factual or if it only gives you the hype and hysteria meant to sell newspapers and pharmaceuticals.
The main questions you should ask according out health news review is:
- Does the story adequately discuss the cost of the intervention?
- Does the story give you a good picture of the true benefits of the medical intervention?
For example did the author discuss Absolute Risk vs Relative Risk (please see discussion of Absolute Risk vs. Relative Risk
- Does the story give you a good explanation of the possible harmful effects of the intervention?
- Did the story describe the quality of the evidence?
- Does the story exaggerate the disease? Does it describe the rare case? Does it play into fears and try to make it more dramatic than it is in reality?
- Does the story use independent resources and declare any possible conflicts of interest?
- Does the story compare the new intervention with existing treatments?
- Does the story discuss the availability of the new intervention?
- Does the story establish the novelty of the approach?
- Does the story solely appear to be based upon a news release?
The answers to these questions can tell the reader if the story is truly something to celebrate.
If you read or see something in the media about research that interests you, search for the primary source or journal article that the story comes from. Read that! Read the headline of the source, then read the abstract of that source which is a summary of the whole article, and then, if you are still excited about the intervention or discovery, read the whole article.
What is the researcher’s hypothesis? If they prove it true, what does that mean to me? Who did they study? Who paid for the study? Were they doing their research in cell lines or petri dishes? Were they studying mice or pigs? How long before they might study humans? If they studied humans, how many? How long were these people followed? Were those humans like me? How did they differ from me? Who paid for the study?
The best kinds of studies are prospective randomized clinical trials in which control groups receiving the standard of care and treatment are compared with a group receiving the newer treatment. If an intervention is proven effective through a randomized clinical trial with a large number of participants over a significant, meaningful length of time, then this is something to get excited about.
It is important that the trial measure meaningful outcomes. We can learn an important lesson from the Avastin Trials in breast cancer. Avastin was given Accelerated Approval (this means that FDA authorized doctors to give Avastin off label before the study was completed because early results showed promise in February 2008), but in 2011 the FDA revoked this approval for breast cancer saying that although the drug shrunk the local tumor, with more time to study, it became clear that Avastin did not extend life or improve quality of life. In addition, Avastin exposed women to serious adverse effects, including severe high blood pressure; bleeding that can be severe; heart attack or heart failure; and the development of perforations (holes) in different parts of the body such as the nose, stomach, and intestines. All in all, the studies did not show that Avastin was better than standard chemotherapy and worth the unwanted risks that it exposed patients to.
June 28, 2011, the New York Times printed an article with the headline:
The article mainly covered the fact that breast cancer survivors begged the FDA not to take away Avastin. The most important part of the story is that Avastin does not improve survival, or quality of life, but the New York Times chose to take the story another way. This is a prime example of unbalanced reporting.
In evaluating claims about benefits from an intervention, it is important to understand the difference between absolute risk and relative risk.
Absolute Risk is your actual chance of developing a disease or other measurable situation. For example, in a clinical trial of a cancer drug, 2 in 100 (or 2%) people taking the drug see tumor growth. 4 in 100 (or 4%) in the control group see tumor growth. The absolute risk of the patients in the intervention group is 2%; the absolute risk of the patients in the control group is 4%.
Relative Risk compares the risk in two groups. Researchers and pharmaceutical companies often express gains in relative terms because it sounds so good. Using the above example, 4% of people in the control group had tumor growth, but only 2% of those taking the drug saw tumor growth, which means the drug lowered their risk of tumor growth by 50%. 50% sounds impressive! But that’s relative risk. When you think about the absolute risk and ask yourself “50% of what?”, you see that it is 50% of 4%, which is only 2%. These numbers are essential to consider when looking at possible adverse effects that most drugs carry with them. If you were told that you lowered your risk by 50% if you take the more expensive newer drug, you would jump at it, but when you learn that it is 50% of 4% which is only a 2% chance of reduction in tumor growth, you might wonder if the expense and side effects are worth this 2% chance of improvement.
Thinking critically is important when evaluating any medical intervention. Know what you might gain and what you might lose before you decide which drugs you want to take and ask yourself does the benefit outweigh the risk?