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Cord blood stem cells help meet minority marrow needs

Rating

2 Star

Cord blood stem cells help meet minority marrow needs

Our Review Summary

A scan of the comments by readers shows how such journalism can inspire perhaps false hope. In addition, the lack of evidence evaluation and balance in this story prompted several readers, who claim to work with these patients, to describe a bleaker reality and caution against such false hope. One reader, BMTnurse, a self-described transplant nurse, note that patients he/she has seen "tend to do rather poorly" in comparison to sibling bone marrow transplant recipients, and that the procedure is a "last-resort treatment" and "certainly not a miracle." That nurse’s personal assessment of the survival rate among procedures he/she has seen is "maybe 20 percent tops." Does that even feel like the same procedure described in this story?

It’s a sad commentary when the commenters inject more balance and raise more important questions than the journalists.

 

Why This Matters

Cord blood stem cell transplant is a valuable and evolving treatment option for certain cancers and other diseases. But the story should’ve included specifics on the limitations of the procedure, and a complete picture of benefits and harms. For patients struggling with leukemia treatment right now, or their families, the article might give them the expectation that this procedure is a new miracle cure. It isn’t.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The costs of donation are discussed, but not transplantation — the treatment discussed. It’s not cheap, and it may not be completely covered by insurance.

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

Not Satisfactory

See the larger discussion of the evidence evaluation.

None of the potential benefits were quantified — survival, quality of life, etc. Advantages over bone marrow transplant are enumerated, but the only patient outcome discussed is 100% cure for these two patients and, in a vague afterword, the potential for rejection. The lack of more detail about outcomes fans the flames of this "medical breakthrough that’s saving lives." The truth is that this procedure doesn’t cure everyone who gets it. One 2004 study found that adults with leukemia who received cord blood transplants didn’t live any longer than those who received bone marrow. 

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

Not Satisfactory

See the larger discussion of the evidence evaluation.

The story mentions that the procedure has the same risks as adult bone marrow transplants, and that the procedure requires months of recovery. These risks aren’t quantified — they’re just "well worth it," according to these two success stories. The article makes the procedure seem like a no-brainer. There are many other risks with these transplants, none of which are mentioned. Detail about any of the risks, including the rates of death due to the procedure, are missing. As that reader who claims to be a transplant nurse, BMTnurse, commented on the CNN web page: "Those whose transplants fail tend to die miserably."

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

Not Satisfactory

This article comes off like a commercial advertisement for this therapy. No evidence is presented to support its claims, only selective anecdotes to demonstrate the benefits and risks, both for the procedure itself and for the relative comparison to adult bone marrow transplants. In the video piece, we’re told that this is a "Medical breakthrough that’s saving lives," but the only evidence provided is two patient stories, and a vague comment that the risks are the same as for bone marrow transplant. If the procedure has an empirical 100% success rate — it’s 2 for 2 in these anecdotes — why not choose this over bone marrow transplant?

Based on the vague statement that cord blood transplants have risen to 24% [of what?], apparently the vast majority of cases still don’t use cord blood. If it’s so good, why? The procedure has been around. The story doesn’t explain the reason.

The answer may be in another point about which the story is unclear: when in the course of treatment is this procedure appropriate? Is it a first line of defense? Mr. Mumford’s story does explain that he tried, and failed, to get a bone marrow donor first. But the word "traditionally" in the following sentence implies that this procedure might replace bone marrow transplants: "Traditionally, patients with leukemia, lymphoma and myeloma have first tried to find an adult bone marrow donor either from a close relative or from a national bone marrow registry." However, as described in a recent review of the evidence, cord blood transplant is recommended for patients who cannot have a bone marrow donor. The story makes it sound better than bone marrow transplant, without providing any evidence. 

Does the story commit disease-mongering?

Satisfactory

The article does not appear to engage in disease-mongering.

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

Not Satisfactory

The online story quotes only one physician.  Another independent expert might have raised some of the questions that we have raised throughout this review.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions ways in which cord blood donation is superior to or no worse than adult bone marrow transplant. Overall it implies that cord blood donation is jumping the queue to become the preferred choice of the two, as a "medical breakthrough that’s saving lives.". But the fact that bone marrow is still considered first for adults, and the reasons why, are not discussed.

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

Not Satisfactory

This topic was unclear. The story implies that the chain of events from cord blood donation, national registration, and transplantation is currently available. We would like to have seen a clearer, more direct discussion on its current availability, and the statistics were vague. "Cord blood transplants among unrelated donors have risen from 1 percent in 2001 to 24 percent last year." 24 percent of what? Of all stem cell transplants? How many of those recipients were children?

The important distinction between use of this procedure in children and in adults should have been discussed.

Does the story establish the true novelty of the approach?

Satisfactory

Since the story states that more than 200 hospitals nationally accept cord blood donations, a reader can see that this is not a new procedure. 

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

Satisfactory

The story does not appear to rely solely on a news release.

Total Score: 3 of 10 Satisfactory

Comments (3)

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Rose-Marie Drake

December 1, 2011 at 2:27 pm

In reference to this part of the review:
One reader, BMTnurse, a self-described transplant nurse, note that patients he/she has seen “tend to do rather poorly” in comparison to sibling bone marrow transplant recipients, and that the procedure is a “last-resort treatment” and “certainly not a miracle.” That nurse’s personal assessment of the survival rate among procedures he/she has seen is “maybe 20 percent tops.” Does that even feel like the same procedure described in this story?
I notice that your reviewers put a lot of stock in this ONE RN’s comments. His/ her comments are purely anecdotal and I am surprised your reviewers would focus on this.

BTW nurses often see the patients who don’t do dwell and thus over-inflate negative outcomes. Research EVIDENCE shows cord blood outcomes that are almost equal to matched unrelated adult or non-related donors.
Here is my anecdote. Had a cord blood transplant last year and I am doing great.
Even if the outcomes were as low as the nurse states (20%) that is still somewhat miraculous to those of us who would have died without the cord blood transplant.

My 2 cents- We all fall for anecdotal evidence- doctors call it “clinical experience” but when providing an analysis of an article don’t overly focus on the comments of one slightly jaded RN.

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