Michael Joyce is a writer-producer with HealthNewsReview.org and tweets as @mlmjoyce
The infographic mentioned in the headline was featured in a news release published earlier this week from the annual meeting of the American Society of Hematologists (ASH).
It was meant to draw attention to four “late-breaking abstracts” that were all from drug studies funded by the pharmaceutical companies developing the therapies. Companies that were also major sponsors of the meeting.
The abstracts were presented by authors who had all disclosed (as per meeting policy) ties to these companies in the form of honoraria, consulting fees, board membership, or advisory roles.
As compelling as these relationships are, I found the infographic even more provocative (click the graphic for a larger version):
There are several things to point out here.
First, is the quote by Robert Brodsky, MD — the press briefing moderator — who makes it quite clear the purpose in highlighting these abstracts is bringing “the most exciting, up-to-date science to the world’s attention.”
That’s precisely why many health care journalists cover big meetings like this.
But does an infographic like this help or hurt this purpose? On the one hand, you could argue it helps because it’s exciting and certainly attention-grabbing. That’s part of what infographics are designed to do: be visually appealing and concise. But infographics are also supposed to present data in an informative way.
This infographic is incomplete and imbalanced in the way it conveys information. And that’s worrisome since it’s part of a news release from a major medical meeting. As Dr. Brodsky rightfully points out, this is where we turn for the latest, “up-to-date science.” It’s a source of news — like the source of a river — and if it’s imbalanced or incomplete at the source, that simply increases the chances of polluted news further downstream.
Most importantly, it exclusively highlights positive findings. It gives absolutely no downsides, caveats, or context. Is that the spirit of science or of promotion?
Given the fact that we’re talking about three investigational drugs in phase III trials, and one FDA-approved therapy that is not the standard of care, don’t you think that doctors, patients, and journalists would want to know the downsides? All four of the therapies studied were found to have significant toxicities that doctors and patients would need to know about in making an informed treatment decision. But this information is excluded from the infographic.
Secondly, two of the studies — one investigating a monoclonal antibody for treating multiple myeloma, and the other a new drug for chronic lymphocytic leukemia (CLL) — rely on surrogate markers for their primary endpoints. [Here’s an excellent primer on surrogate endpoints.]
The dramatic changes highlighted in “minimal residual disease” (MRD) and “disease-free progression” do not equate with increased overall survival from these two blood cell cancers. Nor do they necessarily equate with other outcomes that matter to patients with these diseases such as quality of life or day-to-day functional capacity.
Could these surrogate markers ultimately be shown to be associated with these important outcomes? Yes. But in these studies that has not been established.
Finally, the language matters. In highlighting the study of the direct oral anticoagulant, edoxaban, the point is made that it works as well as the current standard of care (heparin injected into the skin) which is labeled as “burdensome and expensive.” But the infographic gives no cost comparison or explanation of what is “burdensome.” We’re also told that edoxaban works as well as the current standard of care but the data (which are not given) only marginally support this. It feels like puff and promotion.
In fact, the whole infographic feels that way.
Andrae Vandross, MD is a hematology-oncology specialist at UCLA. I asked him by phone what he thinks about the infographic:
“I like that they’re trying to get the information out there in an interesting way. But if you just convey a sense of it’s all new, great, and exciting then that is what I think journalists and patients will remember. The adverse outcomes — which are just as important — end up not being talked about. And then I end up with patients asking me about these ‘groundbreaking’ therapies, even when the data don’t support that.”
It’s interesting to note that, so far, there has been almost no mainstream coverage of these four studies that I could find. The little coverage I’ve encountered comes from websites geared towards doctors, and is actually quite good. There’s also been extensive coverage in business-focused publications geared towards investors that’s been unsurprisingly glowing.
But a nagging question remains and that is this: what or who are medical meetings for?
Are they forums for the presentation and debate of new research? Are they a marketing or promotional opportunity for device and drug companies, medical societies, and academic research institutions? Or are the millions of dollars poured into them simply to ensure the best possible environment for learning about cutting edge advances?
I mentioned at the beginning of this article that the four abstracts chosen to be highlighted by the meeting’s news room were all industry-funded and presented by physicians with industry ties. The companies involved were all major sponsors of the meeting. Calling attention to these relationships isn’t meant to minimize or dismiss the results, and perhaps these four abstracts really were the most deserving of the media spotlight at the meeting — it’s obviously a judgment call. But when nothing that isn’t industry-funded and showing a benefit from sponsors’ drugs makes the cut, I think it raises questions about how the choices were made. It makes we wonder whether this truly reflects the “breadth of the science” at the meeting.
And that leaves us with the question we started with: what’s the most responsible way to bring “the most exciting, up-to-date science to the world’s attention”?