Health News Review

A German physician wrote me about this – so, while CNN may have an international reach, it’s not always with an adoring audience.

The physician was reacting to the weekend “Paging Dr. Gupta” program, which Dr. Gupta referred to once as “SG, MD.” The first thing that struck me was his introduction, in which he said:

“I’m your doctor. I’m also your coach.”

Later in the program he said,

“Think of this as your appointment. No waiting. No insurance necessary.”

I find this very troubling. He’s not my doctor. He’s not my coach. When I watch a “news” program, it’s not my medical appointment. It’s supposed to be news. Not medical advice.

But that’s not what the German physician wrote to me about, so I kept watching. (The segment in question appears about 5:30 deep, and after the :30 commercial you must watch to get there.)

Gupta reacted to a viewer’s message on Twitter in which the tweep asked, “Does anyone know a “miracle” treatment for ovarian cancer?”

Gupta’s answer began cautiously with a note about the word “miracle,” but he then transitioned into a description of a study described at the American Society of Clinical Oncology meeting last week about treatment of advanced ovarian cancer. Gupta said the results showed that adding the drug Avastin to standard chemotherapy “can slow the spread of this cancer pretty dramatically.” He also said that, “Cancer experts believe these results could change how doctors treat women with advanced ovarian cancer.”

Dramatically?

Cancer experts believe this could change practice? Which cancer experts?

Not Dr. Len Lichtenfeld, who’s just across town from Gupta at the American Cancer Society, and who wrote about that same study, “Is It Right To Hype Ovarian Cancer Study?”:

“What appeared to be a very positive study in an abstract may not have been so positive after all.

Patients, families and their physicians are now under the impression that a new advance has been made in this deadly disease, when that may not be the case. The positive press releases and news conferences were not balanced. Most of the media ignored the expert who raised legitimate concerns and cautions. But that information was only available to those who waited for the study to be presented and were in the audience at the time.

Hopes have been falsely raised, when some caution is needed and appropriate.”

Lichtenfeld also pointed out the careful and cautious comments from a Canadian oncologist Dr. Elizabeth Eisenhauer:

“Given the cost issues, the side effect issues, and the unanswerable question as to why bevacizumab appeared to be beneficial as part of a maintenance program but not as a primary treatment, Dr. Eisenhauer concluded that more work needs to be done before this regimen can be considered as a standard treatment option for women with advanced ovarian cancer.”

Lichtenfeld himself concluded:

“…many experts and treating oncologists are going to be scratching their heads wondering what to do and whether or not to believe the results of the abstract, if they even know about the concerns such as those raised by Dr. Eisenhauer. More importantly, patients, families and friends are going to be wondering how a study that received such a positive response in the press could possibly not be the hope they had been waiting for, and had learned about through the media reports.”

Perhaps the news wasn’t as dramatic as Gupta announced, nor does it sound like cancer experts are poised to change their treatment immediately based on this abstract presented at a meeting. And it wasn’t just Lichtenfeld and Eisenhauer. I’ve already blogged about a Forbes piece that reported:

“Memorial Sloan-Kettering colon cancer specialist Leonard Saltz says that …new drugs like Avastin and Erbitux “have added very modest benefits. They increase survival a few months, but they increase the cost of care tremendously.”

…researchers revealed that ovarian cancer patients who got Roche’s Avastin in addition to standard chemo lived 14 months before their tumors progressed, vs. 10 months for those who got standard therapy.

But to get this modest improvement, patients had to remain on the Avastin drug for 15 months, adding to the potential expense, hassle and side effects. So far, there is no statistically significant survival difference between the two groups; because most patients are alive it may be too early to measure this. “We may never know” whether it extends survival, admits lead researcher Robert Burger of the Fox Chase Cancer Center.”

This is balance. This is perspective. This is analysis. Not what we got from a TV MD-journalist telling you he’s your doctor and your coach.

Addendum: See science writer Paul Raeburn’s analysis on this same topic on the Knight Science Journalism Tracker.

Comments

Edward posted on June 15, 2010 at 10:29 am

Medical advice is not suited to the demands of the cable news cycle. Not only is remote, impersonal, Twitter-based medical advice completely ineffectual and misleading, but trying to find a newsy hook to keep people watching each week is going to push Dr. Gupta to hype things that shouldn’t be hyped in any medical context, let alone one as fraught with troubles as this one. Dr. Gupta should stick to news, or stick to practicing medicine, but he shouldn’t try to combine the two in one bitter pill.

Andrew Holtz posted on June 15, 2010 at 10:32 am

This one-sided summary of the Avastin trial results demonstrates why it is important to always include an independent source when reporting news about medical research and practice.
There is a second serious weakness in this CNN report. The description of the trial results assumes that delayed tumor growth is of great importance to patients. Sometimes it is, but other times it is not. While any patient would rather be told that her tumor is not growing, what’s actually important is whether or not the tumor is causing symptoms and whether tumor growth is related to mortality.
This report did not say whether patients who received Avastin had better quality of life or lived any longer than those who did not get the drug. Delayed tumor growth is certainly something that could encourage researchers to take a closer look at the experimental therapy, but if patients who received Avastin did not feel any better nor lived any longer than those who didn’t get the drug, then really, from the perspective of patients and families, how newsworthy were these results?

Sandi Pniauskas posted on June 16, 2010 at 7:51 am

In our own ovarian cancer patient communities and over the long term, as survivours/family caregivers, many of us have learned to question media articles and abstracts. The SGO published a statement regarding the GOG 218 study shortly after the media events. In addition, on June 5th in Chicago on a separate ovarian cancer seminar the issue of the new finding of GOG 218 were discussed. The over-riding bottom line is that Avastin is not the panacea for all that ails ovarian cancer women and should be used very selectively. On which patients is of primary interest (obviously).
The issue at stake for ovarian cancer women is that no new treatments in the past 2 decades have shown any improvements over the standard and current first line therapy of Taxol and Carboplatin.
No matter how bad it gets (QOL) and it does get very ‘bad’, ovarian cancer women want to live and will suffer much to do so. We need to understand this mindset while at the same time considering first most patient safety and always acknowledging the ‘hype’.
There is a duty for all those who care for ovarian cancer women to be informed.
Twitter, blogs, facebook and social media help also to educate patients on these issues – we hope.

e-Patient Dave posted on June 16, 2010 at 8:12 am

Thanks for this, Gary. The more I understand how common-sense the REAL judgment issues are, the more pissed off I’m getting about intelligent people (which I presume Dr. Gupta is) throwing their intellectual training under the bus in order to fabricate the fiction of non-existent good news.
That’s just unethical, I think. I ask that CNN knock it off as a matter of company policy, lest e-patients realize that this outlet is joining to ranks of the “untrustworthy by default.”

Rogue Medic posted on June 18, 2010 at 1:08 am

Sanjay Gupta continues to be CNN’s in-house medical expert, even though he repeatedly demonstrates that he does not understand even his own specialty.
Sanjay Gupta pushes the idea that being brain dead is a reversible condition.
Sanjay Gupta appears to be incapable of reading and understanding research.
Sanjay Gupta is very vocal with his misinformation.
This is what we seem to want from TV doctors. Don’t tell us the truth, just tell us what we want to hear.

JUDITH A DIETSCHE posted on June 18, 2010 at 6:18 pm

As an ovarian cancer patient cost and side effects definatly go to the back burner! Any drug that shows promise in other cancers is and should be considered for use! I recently started on AVASTIN for reoccuring ovarian cancer,the nurses and doctors have seen very positive results in other cancers with the use of avastin as a part of a combination chemotherapy regimen. Ovarian cancer gets very little attention, therefore research is very slow and progress in the cure of ovarin cancer is at best in the distant future, as with any illness staying positive and hopefull is all we can do, HOPE SOMETIMES IS EVERYTHING!

Andrew Holtz posted on June 21, 2010 at 5:38 pm

The withdrawal of the cancer drug Mylotarb is now the newest example of the pitfalls of relying on intermediate endpoints. A decade ago the drug was hailed as a great advance in treatment of AML based on trial results showing higher rates of remission.
Fortunately, the FDA required follow-up studies. Now, Pfizer is pulling the drug because patients didn’t live any longer.
So as I mentioned above… it may be encouraging to learn that Avastin slowed the spread of cancer… but every news report should make very, very clear whether or not survival is extended or quality of life is improved.
The World Cup soccer tournament has great examples of how intermediate endpoints can mislead us: http://is.gd/cY6zK

Gregory D. Pawelski posted on July 4, 2010 at 9:55 am

Tumor shrinkage is the optimal course attainment in most clinical settings. However, survival is affected by another important factor, delay of growth. The survival time of a patients with temporary tumor shrinkage could be shorter than that of a patient with prolonged delay of growth.
Physicians can usually detect a cancer mass around 1cm in size and patients die as the tumor size increases to 10cm. Survival gain comes from the change of the tumor’s natural history utilizing various treatments. Tumor shrinkage is only one way to change the natural history. Delay of growth is another.
According to cell function analysis, by clinical oncologists involved with cell culture testing, Avastin as a single agent is relatively ineffective in virtually all tumor types other than Renal cancer. Beyond that, it appears to better deliver the effects of other classes of durgs (or as Judith mentions, part of a combination chemotherapy regimen). Avastin facilitates vascular access of cytotoxics to tumors. It will take combination antivascular therapy to make a big difference, but this is definitely coming and it’s the most promising thing on the near term therapeutic horizon. This linked video is worth watching.
http://www.ted.com/talks/william_li.html?utm_source=newsletter_weekly_2010-06-02
In regards to taxol, a study by Dr. Katharina Pachmann, et al, had shown that neoadjuvant chemotherapy with paclitaxel (taxol) causes a massive release of cells into the circulation, while at the same time reducing the size of the tumor. The finding could help explain the fact that complete pathologic responses do not correlate well with improvements in survival.
http://cancerfocus.org/common_chemotherapy_drug_triggers_fatal_allergic_reactions/46410
Taxol does not improve standard first-line ovarian cancer treatment. Studies suggest that for initial treatment of women with ovarian cancer, widely used standard drugs are equally as effective as treatments that include Taxol and Carboplatin and may be considered the preferred treatment as they have fewer side effects. The results of these studies doesn’t mean that Taxol has not role in the treatment of ovarian cancer, but they allow doctors and ovarian cancer patients to have choices according to each individual’s needs. (Lancet 2002;360:500-501, 505-515; GOG #132 trial; ICON-3; ICON-4)
What makes more sense, treat ALL patients with carboplatin/taxol, or choose between other reasonable treatment regimens (e.g. single-agent carboplatin, cisplatin/doxorubicin/cyclophosphamide, gemcitabine/cisplatin, cisplatin/topotecan, cisplatin/vinorelbine, cisplatin/Doxil, cisplatin/etoposide, vinorelbine/Taxol, vinorelbine/docetaxel, gemcitabine/vinorelbine, vinorelbine/thiotepa, cyclophosphamide/doxorubicin, etc.