A bionic pancreas! The true and Holy Grail! – BMJ blog sarcasm with a lesson

I don’t think that Dr. Richard Lehman was addressing last week’s news coverage of the artificial pancreas when he wrote in his weekly journal review on a BMJ blog:

A hush falls over the great cathedral as the evening light grows dim. As if from above, unearthly music fills the incense laden air. The kneeling knights look up and lo! between the towering stone arches, a white dove sails and descends. Amid the gathering darkness, a glow shines ever brighter from the tabernacle behind the altar. Slowly the wounded king-priest raises the source of mystic light. A bionic pancreas! The true and Holy Grail! Or you may prefer this: “Here, we present the results of two 5-day trials, one involving adults and one involving adolescents [with type 1 diabetes], in which we tested an autonomous, wearable, bihormonal, bionic pancreas in two distinct outpatient settings. These studies minimally constrained patients’ behavior but allowed close observation for risk mitigation and high-density data collection.” “As compared with an insulin pump, a wearable, automated, bihormonal, bionic pancreas improved mean glycemic levels, with less frequent hypoglycemic episodes, among both adults and adolescents with type 1 diabetes mellitus.” And Sir Perceval sayde, Thanks be to God, for verraily thys is the Grail for which we have soght longe & suffred great peryll.

But while he may not have been directly addressing news coverage, he might just as well have been doing so.

“Bionic” in the title of the New England Journal of Medicine paper almost guaranteed news coverage.

NBCNews.com reported:” ‘Bionic Pancreas’ Astonishes Diabetes Researchers.”  The story quoted one young patient saying, “It is like a dream for a diabetic.  It takes away the responsibility.”  That’s a quote that almost demanded an immediate followup explanation, clarification, or caveat.

Bloomberg headlined the story, “Diabetics Get Freedom in Bionic Pancreas Real-World Trial.”  Yes…for a 5-day trial. The story quoted one study participant:  ““Some kids were having ice cream sundaes and French fries and forbidden foods, just to see if the device could handle it. Normally after a hot fudge sundae you would be pumping yourself full of insulin, but the bionic pancreas handled it.” Again, an immediate followup caveat could (should?) have been inserted, but wasn’t.

The “c” word was inevitable, and Medical News Today helped us realize that inevitability with its headline, Bionic pancreas ‘could lead to cure for type 1 diabetes’.”  Yes, perhaps someday it might.  Or it might not.  But we don’t tell stories that way.

Other stories referred to the technology as a “lifesaver,” a “final solution against diabetes,” and “may be the next great Type I diabetes treatment.”

While some stories referred to the study as “real world” proof of efficacy, the New York Times reported that “The adults in the trial each had the constant attention of a nurse, and they lived in a hotel for the five-day study.”  Hardly a real-world setting.

TIME.com used only a few words to inject some appropriate caution:  “The findings are promising, but we are still a far ways off before the bionic pancreas becomes a clinical reality. For one, the study had a relatively small sample size and lasted only five days.”

It should be noted that on the same day that the New England Journal of Medicine paper about the “bionic pancreas” was published, the Daily Mail reported on a study of an artificial pancreas in the UK, under the headline: “Artificial pancreas could help stem the diabetes epidemic: Device could help patients lead normal lives by stopping need for constant insulin.” No reference was made to the NEJM paper.  The NHS Choices Behind the Headlines project wrote that the Daily Mail story was potentially misleading on multiple levels.

Few stories gave any historical context or any comparative context about all the prior research on an artificial pancreas that has gone on.  In our systematic story reviews, we reviewed a story about related research going back as far as 6 years – and even then we noted that “This story reported on a so-called artificial pancreas, but gave no real evidence of what has been found in clinical trials so far. Indeed, similar research has been going on for 20 years, so the story should have established what is truly new, different and promising – backed up by evidence.”

But, you see, that’s what you capture when you do this kind of watchdog work every day, and when Holy Grails come and go like unholy reminders.


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