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Is my chemo working? Scans may give faster answer

Rating

1 Star

Is my chemo working? Scans may give faster answer

Our Review Summary

As the scores below indicate, this report on the use of PET scans to determine the effectiveness of cancer treatment oversells its promise, under-reports its limits and creates an emotional context that exaggerates both.

This is not to suggest that this use of PET scans isn’t promising and worth a story. It is.

But the story needs balance and context and a kind of basic "reality check" to help readers understand their value. This is especially important in any story involving the promise of any new cancer treatment, because the audience for these stories is understandably full of hope and fear. 

Following best practices in sourcing could have mitigated at least some of the story’s shortcomings.

But there is a much more fundamental problem. The reporter fails to acknowledge that PET scans, like many forms of nuclear imaging, are currently the subject of fierce debate about their costs and benefits.

The volume of this debate is increasing as the leaders of health care reform begin to look closely at the role of expensive new technologies in driving up healthcare costs.

Advocates of these technologies–industry, hospitals, physician groups, patient groups–have strong motivation to get positive stories about their benefits into the national debate.  

It’s hard to imagine how a report on wider use of PET scans could be published in 2009 without acknowledging this context. Oddly, the best case would be that the reporter and editor were simply unaware of the backstory. Because if they understood it but decided not to mention it and produced a one-sided report nonetheless. . .well, one is reluctant to speculate further.

This is a good example of a rising challenge–and opportunity–that health and medical reporters now face. With health care reform on the table, propagandists from all sides will be trying to use the media to publish stories favorable to their political or financial interests. The risk of reporters being used, which is always present, is greater than ever.

Which is to say this is a moment when skilled, independent, savvy, knowledgeable health care and medical journalism could have significant impact on public health. It can provide guidance to decision makers they will not get from industry or other interest groups.

Let’s hope the nation’s health and medical journalists can rise to the challenge.

Sadly, the team that produced this story did not. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention costs of PET scans under the proposed use. In this case in particular–where the costs and benefits of PET scans are in hot dispute–this is inexplicable.

Conventional PET scan cost is estimated at $3,000 to $5,000.

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

Not Satisfactory

The story makes brief references to two studies, one involving 28 people in Korea, the other 7 patients in the U.S.

The reporter cites positive results of the studies, implying efficacy. But no caveats other than small study size are offered to provide a more balanced view.

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

Not Satisfactory

The report should have mentioned the radiation doses used in PET scans. While these are not large–about the amount of a typical X-ray–they are worth noting.

PET scans are not indicated for women who are pregnant. 

If multiple PET scans were to become part of a treatment or diagnositic protocol the radiation dose could become significant.

In addition, there is no mention of the possibility that a scan might erroneously identify a treatment as ineffective, causing an unwarranted and harmful change in the treatment approach.

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

Not Satisfactory

The story is based on extremely early clinical testing of the technique. Its safety and efficacy are uNPRoven. This should have been stated early, plainly and uncategorically.

On a positive note, the story eventually does say the research is in early stages, with fewer than a dozen human studies into the most promising type of scan, all too small to be conclusive.  

The story makes brief references to two studies, one involving 28 people in Korea, the other 7 patients in the U.S. The positive aspects of the results are used to imply efficacy, but no caveats are offered. 

Does the story commit disease-mongering?

Not Satisfactory

The story dramatizes one patient’s story in a way that overemphasizes the emotional impact not of treatment, but of having to wait for weeks or longer to learn whether a cancer treatment is working. It suggests the novel use of PET scans could "shorten [the patient’s] stay in purgatory" by providing an answer "possibly within days."

The writer uses loaded language to describe the patient’s status, and at the end includes a vivid, dramatic quote in which the patient who did not have access to this PET scan technology compares his situation to "having a rope tied around you and you’re leaning over a canyon at about a 45-degree angle, and you don’t know if someone is going to pull you back in. . . " 

We have no idea whether the patient is receiving the experimental treatment. We learn later that he was diagnosed in 2005 and that with conventional treatments his cancer has remained stable. 

The overall effect is to magnifity the problem and overpromise a solution–a nearly "perfect" illustration of disease-mongering.

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

Not Satisfactory

Sources include:

  • One cancer patient who apparently has played no role in the research
  • Two doctors who conduct the research
  • One doctor who heads a medical group partly funded by industry and devoted to promoting use of nuclear imaging
  • One industry spokesman whose firm stands to benefit from wider use of PET technology

No independent sources are consulted to provide context or less enthusiastic viewpoints.

The story did not report whether any of the sources has a financial conflict of interest.  

Does the story compare the new approach with existing alternatives?

Not Satisfactory

While the story demonstrates the shortcomings of current methods of determining cancer treatments effectiveness, it fails to say what those methods are. 

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

Not Satisfactory

The treatment is experimental and not currently available. Yet it is not until late in the story that we learn the research is very preliminary. The caveats appear eventually but should have framed the story from the outset. 

The story allows advocates to offer unsupported speculation that the government may agree to pay for the procedure in "two or three years" and new PET technologies will transform cancer treatment within 10 years. 

The use of the anecdote in the lede implies availability. 

Does the story establish the true novelty of the approach?

Satisfactory

The report makes clear that PET scans are commonly used, but [with the exception of lymphoma] not to determine whether a cancer treatment is working.

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

Not Applicable

We can’t be sure if the story relied on a news release.

Total Score: 1 of 9 Satisfactory

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