This story miscasts an experimental treatment for obesity as a potential “silver bullet” for people wanting to drop a few pounds. Although the reporter emphasizes that one component of the Contrave pill has been linked to higher risk of suicidal thoughts, other harms and limitations of the drug are skipped over. Notably, viewers are not alerted to the absence of independent information. They are not told that the drug trial results have not been reviewed by any independent experts. What’s more, the fact that the doctor interviewed in the studio is a paid consultant of the manufacturer is portrayed as evidence of expertise, rather than a warning sign of conflicts of interest.
There is no mention of the possible costs of this obesity treatment, although the reporter allows a doctor who works with the manufacturer to claim that the treatment will reduce the costs of treating obesity-related diseases.
One industry blogger estimates that Contrave treatment may cost about $5 a day, which is similar to prices charged for the two drugs that are combined in the new pill.
http://seekingalpha.com/article/129490-orexigen-s-contrave-generic-would-be-no-cheaper
Most of the hype and hoopla in this story came from the reporter rather than the maker of the pill. He asked, “Could a cure for obesity be just a pill away?” and “[C]ould Contrave be the silver bullet Americans struggling to lose weight are hoping for?”
By comparison, the company representatives seemed almost restrained, saying that the pill is not intended as a weight loss treatment for people with a few extra pounds, but just as one potential treatment for obesity so severe that the next step is surgery.
Still, a doctor who works with the company was allowed to imply that taking this pill could lower the risk of diabetes by 60%, even though diabetes progression was not measured in the drug trial. Nor did anyone say what the underlying rate of diabetes is in this population… so there’s no way to know how important a 60% reduction really is.
A close call – but we ruled positively for the story on two other close calls and the call goes against them on this one.
This is a close call. The reporter emphasized that the FDA recently asked for a black box warning related to suicidal thoughts among patients taking one component of the new pill (buproprion). A doctor who works with the manufacturer acknowledged that while the company’s research to date hasn’t documented similar risks, more will be known only after there is more experience with widespread use.
However, while the reporter did highlight one potential harm, there was no mention of side effects reported in the company trial that included seven cases of serious problems [cholecystitis (gallbladder inflammation) (2), seizure (2), palpitations (1), paresthesia (1) and vertigo (1)] and other adverse events such as nausea, constipation and headache.
Nor did the story note that while 1,453 participants started this latest trial, only 870 completed it. The reporter should have asked why 40% of participants did not complete the trial.
Viewers are not told that all of the results reported in this story are from trials controlled by the manufacturer. There is no warning to viewers that the methods and results have not been reviewed by independent experts.
What’s more, the results of the latest trial are reported in isolation, without even the context of results from other trials disclosed by the company. For example, in January the company reported results of a trial in which participants received an intensive diet and exercise behavioral modification either with or without drug treatment. Although the two trials can’t be directly compared, the overall impact of the story might have been far different if the reporter had said while the average weight loss in this latest drug trial was about 6%, an earlier trial by the company showed that diet and exercise produced an average 5% weight loss.
http://ir.orexigen.com/phoenix.zhtml?c=207034&p=irol-newsArticle&ID=1256571&highlight=
The reporter also seems somewhat confused about how the pill appears to work. He said, “Clinically, this works on your hormone balance.” That statement may refer to a hypothesis that obesity may cause certain cells in the brain to become resistant to the hormone leptin, which helps the brain know when to stop eating, and that the two drugs in this pill (buproprion and naltrexone) may combine to help stimulate these cells.
The reporter allows a doctor who works with the manufacturer of Contrave to say that obesity is associated with 60 illnesses. While obesity is indeed a very serious public health threat, the doctor uses that statistic to then leap to the conclusion that the new product will save money and reduce the extent of obesity-related disease. These claims have yet to be tested. The harms of obesity are emphasized in order to boost the desirability of the new product.
In a bizarre twist, the reporter used the potential conflicts of interest of the doctor he interviewed in the studio as evidence of his expertise. He noted that the doctor is a consultant to the manufacturer of the pill and then said, “you’re the right man to talk to.” Really?
In a recent journal publication, this researcher listed financial ties to 17 drug and device makers, including the maker of the Contrave pill. (Author disclosures in the American Journal of Medicine. 2009 Apr;122(4 Suppl 1))
There was only one brief and vague comment from the only apparently independent source in this story. Also, as noted, viewers were not clearly told that all of the results reported in the story came from a trial controlled by the company that has not been independently reviewed.
While lifestyle changes were mentioned in this story, viewers were not told that an earlier trial showed that diet and exercise alone could produce about as much weight loss as seen in the latest trial of the Contrave pill. And while the pill was presented as a something to be tried before resorting to surgery, there was no comparison of the effectiveness of the pill to surgical interventions for obesity.
The reporter says the drug could be on the market next year. While the new pill is merely a combination of two approved drugs, the reporter should have stuck to the facts – saying that the manufacturer intends to apply for FDA approval next year.
The story notes that the new pill is a combination of two drugs that are already available. However, the reporter did not ask why people would want to take the combination pill instead of the available drugs, and the hype in the lead about a new drug tends to overwhelm the fact that the pill is a combination of drugs already on the market.
Although this story did not merely quote from a news release, the reporter did not explain that the company was the sole source of information on the pill, since the trial methods and data have not been independently reviewed.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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