This report about the application of genetic testing in cancer treatment provides useful explanation about a complicated but important development in medicine. It helps readers understand the tests’ promise and pitfalls.
The story has two significant strengths:
The story’s most conspicuous weakness is its failure to examine any research supporting the tests’ use, instead depending almost exclusively on clinicians’ impressions. Most of the claims about what genetic medicine can do are not substantiated by evidence. This should have been stated more clearly.
In terms of its presentation, the material about the tests’ shortcomings should have been mentioned, at least briefly, higher in the story. As the story is written, a reader gets over 600 words of positive views about the tests before getting to the paragraph that begins discussion of the caveats.
The article states the cost of one test, $3,600, meeting the minimum standard for this criterion.
But given the tests’ uncertain utility, as well as the obvious economic motivation of the test marketers, more information on costs would have been very useful. Information on insurance coverage should also have been included.
The article does not quantify the benefits of treatment with and without genetic testing. Since at least one of the tests mentioned has been approved by the FDA, and the FDA may get a larger role in the pre-market vetting of these tests, some data should be available. All of the reporting in the article on benefits is based on anecdotes and clinicians’ summaries of their knowledge.
While none of the genetic tests is harmful, the article states the tests’ limitations: some are costly, their results sometimes of unknown accuracy and difficult to apply to treatment.
A clearer statement about the potential harms–including unnecessary treatment and even mortality–of a treatment decision made on faulty results would have been very useful.
Since the OncotypDX test is used to help identify people who may reasonably forego chemotherapy, the issue is whether skipping a treatment that may have benefit in order to avoid side effects will produce good outcomes.
The article does not report on the amount and quality of evidence about safety and efficacy of the tests. This is the story’s most serious shortcoming.
The article does not exaggerate the dangers of cancer although it does make some pretty big claims about what genetic medicine can and might do – claims that are still unsubstantiated.
The article quotes a variety of sources: two clinicians who use the tests, two physician skeptics, a government regulator, and two patients whose treatment has been determined partly by genetic tests.
The article is focused largely on treatment options facing cancer patients, and the role genetic testing can play in those treatments. It is clear from several examples that using genetic information as part of treatment planning is an option but not fully dependable or universally useful.
The article makes clear that some of the genetic tests for cancer are on the market, some are in limited use, and others are under development.
The article does not make any explicit claims of novelty, but it does indicate, correctly, that this is a fast-developing field of medical science that is creating new insights and products regularly.
There is no evidence that the article relied solely or largely on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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