Breaking down the breakthrough claims

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Prevention magazine wrote about “9 remarkable innovations that promise to revolutionize how doctors prevent, diagnose, and treat common conditions and diseases.” The NBC Today Show chopped the list from 9 down to 6 and then put it on the air and on their website, labeling it as “6 breakthroughs that could change medicine: Prevention magazine shares some game-changing new developments.” NBC even further blessed the list by having its medical correspondent Dr. Nancy Snyderman go on the air to talk about each one. The anchorwoman said Snyderman would explain “how they could affect all of us.”

Steve Atlas.jpgWell, we asked one of our medical editors, Dr. Steve Atlas of the Massachusetts General Hospital, to critique the story. To begin with, Dr. Atlas says:

“Catchy title, too bad it’s not true. Most clinicians know that true ‘game changers’ in medicine are real but uncommon.”

So let’s review these “game changers.”

1. Vaguely described as “breakthrough that could stave off cancer naturally.” They were talking about exercise and the fact that the American College of Sports Medicine is now certifying “cancer exercise trainers.”

Dr. Atlas says:

“Of course exercise is a good thing for everyone, including those with cancer. Is this a breakthrough? Hardly. How does the cancer exercise trainer compare to someone who just provides support and no exercise to the cancer patient or compared to a recommendation to walk for 3 hours a week?”

2. “A new drug called dabigatran prevents more strokes with less bleeding than warfarin.” Dr. Atlas says:

“Dabigatran may be a game changer, but there is one thing the story didn’t mention. The group that got Dabigatran had more heart attacks than those who got coumadin. Oops! This could be the real game changer from the FDA’s perspective. Note it’s still under review there.”

3. Research that offers new hope for an HIV vaccine. Dr. Atlas says:

“Good news, but it will be years before additional research leads to a vaccine. And the results weren’t spectacular by any means. Just better than the dismal prior attempts.”

4. “Omega-3 fatty acids have been upgraded from nutritional supplement to bona fide heart medicine: Lovaza, a prescription medication.” Dr.Atlas says:

“There hasn’t been a large randomized trial comparing (the cholesterol-lowering drug) Lipitor alone to Lipitor plus omega-3 fatty acid. That’s the breakthrough study I’m waiting for! Data so far is hopeful. What’s the bang for the buck? No clue.”

5. Device to predict heart attack or stroke risk. Dr. Atlas says:

“This is hardly worth mentioning. Every year there are 10 new predictors. The Framingham prediction rule is still going strong after many, many years.”

6. Breakthrough that could lead to a cure for Alzheimer’s. This was about a test and also a drug – a drug that doesn’t even go into clinical trials until this year. Dr. Atlas says:

“This one’s cruel. Desperate families with Alzheimer’s patients can have no hope that this drug will be available outside of studies for 3-5 years. Who knows if it will help?”

Breakthroughs? That could affect all of us?

Just look at the simple, cautious, common-sense, evidence-based approach Dr. Atlas applied to each of the claims. That’s something any of could start to do better. And THAT would be a breakthrough!

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January 15, 2010 at 11:15 am

Re: the bang for buck calculations on Lovaza, the back-of-envelope calculations are not good. Check out this post from William Davis’s Heart Scan Blog. “Prescription” does not necessarily mean better, though many will assume that it does.

Bill Gleason

January 15, 2010 at 8:48 pm

Exaggerations seem to be de rigueur for medical school deans, also. Here at the University of Minnesota our medical school dean bragged today in the Strib:
“‘Curing Alzheimer’s, curing diabetes, making new hearts to replace diseased ones — that’s what this investment* will make possible,’ he [Cerra] said. A state that’s eager to control medical costs and improve people’s lives does well to make that investment, even — or especially — during lean times.”
Let me know when all of these things happen, please, Dr. Cerra. No doubt there will be a large number of Nobel prizes at Minnesota by then?
*The “investment” is going for multiple new biomedical research buildings whose need is debatable, to put it politely. The U is also engaged in a childrens hospital arms race that is not going to help in keeping health care costs down. And of course we are too busy with all of this to attend to the open wound that is a new conflict of interest policy.
And so it goes…