Posted by Gary Schwitzer in Health care journalism
As followers of this site know, we no longer systematically review network TV health news stories on a regular basis. Instead, we occasionally use this blog to comment on things we see. When a new report was presented this week on the drug solanezumab for Alzheimer’s disease, NBC’s story caught our attention. Robert Bazell reported:
“For the first time ever an experimental drug is showing great promise of slowing the progression of Alzheimer’s disease.”
First time ever? Really?
In a 5-minute web search, we easily found 6 different approaches reported to slow the progression of Alzheimer’s disease in just the past 4 years:
July 17, 2012: New Alzheimer’s Drug Slowing Progression of the Disease (CBS)
March 8, 2012: Alzheimer’s treatment in late stages of disease does slow progression (The Independent)
October 20, 2011: Antiviral Drugs May Slow Alzheimer’s Progression (Science Daily)
May 11, 2009: Can New Drug Slow Progress of Alzheimer’s? (ThirdAge.com)
August 3, 2008: Drugs May Slow Progress Of Alzheimer’s (NPR on two drugs)
The NBC on-air story would not have fared well on our 10 systematic story review criteria. Those criteria provide questions that you might ask:
Quality of the evidence:
Bazell reported: “At first, the experimental drug…seemed to fail as has every experimental drug to date. But when the manufacturer, Eli Lilly, analyzed the data more closely, it found that in those with mild disease, there was 34 percent less memory loss than those on placebo.”
But what does that mean? How did the company analyze the data more closely? Is this an example of the old line that “If you torture the data, it will confess to anything”? Could it be, in the end, just a statistical aberration?
How big were the potential benefits?
The Associated Press gave details that NBC did not about what was actually measured – providing absolute data rather than just the relative risk reduction that NBC provided:
“The main measures were two tests _ one reflecting language, memory and thinking and the other, ability to perform daily activities such as eating and grooming. The combined results on the mild disease patients showed a nearly 2-point difference in the roughly 90-point score on thinking abilities. Previous studies suggest that a change of 3 to 4 on the score is needed to show a clinical benefit, like an improvement in how well patients can take care of themselves. “It’s a small difference,” Dr. Rachelle Doody of Baylor College of Medicine said of the drug’s effect.”
How big were potential harms?
The Associated Press story discussed angina, brain swelling, brain bleeds. NBC mentioned none of these.
So, while NBC framed this as “new hope for effective treatment…showing great promise,” AP reported:
“It’s certainly not the home run we all wanted, but we’re very encouraged by these results,” said Maria Carillo, chief science officer for the Alzheimer’s Association, which had no role in the research.
Dr. Stephen Salloway, an Alzheimer’s expert at Brown University, agreed.
“It’s exciting to see that there may be clinical benefit,” he said, but it is modest and may not make a difference in how well patients live _ what matters most to them and their families, he said.
“I hate to get too enthusiastic … there’s a flicker of a signal” of benefit, but less than what some other once-promising treatments showed, said Dr. Sam Gandy, head of Alzheimer’s disease research at Mount Sinai School of Medicine in New York.
Dr. Ronald Petersen, director of Alzheimer’s research at the Mayo Clinic, called the drug’s effect “subtle” and said it may mean just that “somebody remembers one extra word out of a 15-word list” without any real improvement in how well they live.
The drug, if ever approved, is likely to be expensive, and that means “we need more evidence” of its benefit to justify its use, Petersen said.