Bothered by "breakthroughs"

I have published the following commentary on the HealthNewsReview.org website.

TIME magazine, like many publications, loves year-end lists. Its “Top Ten Medical Breakthroughs of 2007”
list offers brief capsules on developments that someone at TIME decided were in the top ten and also that someone decided qualified as breakthroughs. The list:

Circumcision can prevent HIV

Test for metastatic breast cancer

First human vaccine against bird flu

Help for dieters: Alli

New diabetes genes

No more periods (Lybrel)

Relief from fibromyalgia: Lyrica

Early-stage test for lung cancer

New source of stem cells

Benefits of vitamin D

We believe that with any claim of breakthrough the claimant should include some discussion of the quality of the evidence behind this claim. And for stories that discuss treatments, tests, products or procedures, we should be talking at least a little bit about how much these breakthroughs will cost.

TIME didn’t mention cost with any of the ten breakthroughs it highlighted. The magazine didn’t discuss the quality of the evidence behind the ideas covered in any of the eight product-related stories. The discussion of benefits was lacking in several.

Yes, we know that editors think these lists are cute, promotable features. But the cumulative effect of discussing breakthrough after breakthrough without any mention of cost or evidence leaves the reader waiting for Santa to arrive with the next one.

The Help for dieters: A segment stated that the drug blocks the body’s ability to absorb fat by 30%. But what does that mean to the user? And given the common and unpleasant side effects – cramps, gas, diarrhea and oily discharge that the article acknowledges about the drug, we can only ask: Is this a breakthrough?

We ask the same question about the No more periods segment about the drug Lybrel. This is a breakthrough? The story acknowledges that the new pill is similar to the conventional Pill but doesn’t mention other competing products on the market that may limit the frequency of a womans periods. How do they compare?

The Relief from fibromyalgia: Lyrica segment states: In studies, Lyrica not only soothed the aches of fibromyalgia but also significantly improved patients’ quality of life. How was that measured? How would a reader objectively quantify the chance for benefit? For harms?

For 2008, it is our hope that more news organizations abandon the breakthrough mentality. There aren’t breakthroughs every month as the magazine implies. There are things one stands to gain and things one stands to lose with any treatment, test, product or procedure. Readers need help weighing the evidence. And they certainly need help thinking about health care costs.

We need more informed health care consumers, not more magic bullet believers.