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New Take on a Prostate Drug, and a New Debate

Rating

3 Star

New Take on a Prostate Drug, and a New Debate

Our Review Summary

This is a story about the use of the drug finasteride to try to prevent or reduce the risk of prostate cancer.  

The story did a good job of: 

  • giving the history of research on finasteride and the reasons why it "has had its ups and downs";
  • citing several top clinician-researchers in the field of prostate cancer.

But the story had several important flaws:

  • the balance of the piece was thrown off by a beginning and an ending that framed the drug’s benefits only in the often-more impressive-sounding relative risk figures, not absolute risk figures;
  • the top sources it used were out of balance, with advocates of the drug’s use having been given more space and more prime real estate (again the beginning and end of the story), while the story’s one skeptic got far less space in the middle;
  • the story didn’t adequately discuss other options – including NOT taking the drug.

Why wasn’t that lone skeptic’s view the lead or the summary point?  His points:  "While 10 percent of men 55 and older find out they have prostate cancer, the cancer is lethal in no more than 25 percent of them. So if finasteride reduced the prostate cancer’s incidence by 30 percent, about 7 percent of men would get a cancer diagnosis and approximately 1.8 percent instead of 2.5 percent would have a lethal cancer. Finasteride might make a difference but only in a very small subset of men." 

 

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story included an estimated price for the generic version of this medication.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Mixed grade on this criterion.  The story provided both relative and absolute risk reduction figures – although it gave more space and prime real estate (the beginning and end of the story) to the more impressive-sounding relative risk figures. But, with some hesitation, we’ll give the story the benefit of the doubt.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story did raise an important question about harms:  "Should healthy men take a drug for the rest of their lives to avoid getting and being treated for a cancer that, most often, would be better off undiscovered and untreated?Is it worth risking a chance that unanticipated side effects may emerge years later if millions of men with no prostate problems take this drug…"  Although the balance of the story was out of whack – citing more proponents of using the drug than opponents – we’ll give the story the benefit of the doubt on this criterion.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

To its credit, the story included data in terms of absolute risk from the 2005 study published in New England Journal of Medicine. Unfortunately, the story began and ended with the relative risk reduction calculation that might mislead readers about the true potential benefit.   While not incorrect, a 30% drop in disease incidence is more compelling than a 2.2% reduction in the absolute risk of potentially lethal prostate cancer.

Does the story commit disease-mongering?

Not Satisfactory

Having experts in the field talk about medicating all men instead of providing them with some understanding of the magnitude of the risk seems like disease mongering. And ending the piece with two of these experts (Scardino and Thompson) discussing their own possible plans for taking the drug introduces an imbalance to the piece.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story cited several highly-credentialed prostate cancer clinician-researchers.  However, the only one expressing a somewhat more negative tone got the least space. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story did not adequately describe the option of not taking this drug as a preventive measure.  A lot of space was given to the arguments for prescribing a drug without mentioning the possibility of the clinician having a shared decision-making discussion with the man about not taking the drug – and about the potential tradeoffs of this or any other prostate cancer treatment. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story accurately mentions the availability of this drug as a prescription medication.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story begins with the phase "For the first time…." – an odd choice of words for an effect of the drug that was discussed in the medical literature for at least 3 years.  Although the story was about the results of a new analysis of data, that opening line suggests a novelty to the approach that isn’t true.  In fact, the story itself shows it’s not the first time – that "In March 2003, 15 months before the study’s scheduled end, its directors halted it abruptly. The reason was that the results were overwhelmingly compelling — men taking the drug were not getting prostate cancer."  It’s like an opening line begging for page 1 attention. 

Does the story appear to rely solely or largely on a news release?

Satisfactory

While there is no press release in evidence, it is curious that the journal in which the new analysis was published has a link to the New York Times article on the journal’s website.  Why would a journal do that?  Isn’t the journal article itself good enough for its readers?  Does it need the Times to legitimize the study?  Odd. 

Total Score: 6 of 10 Satisfactory

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