It’s hard to know how a charity hoping to raise money for stem cell research could have achieved a better marketing coup than landing this story on the Reuters wire. Millions of readers worldwide were guaranteed to have seen the charity’s slogan about how stem cells can “mend broken hearts” right in the headline and lead of the story. Even the campaign’s mascot — the zebrafish — makes an appearance. What they did not see was any challenge to the extravagant claims made about cardiac cell regeneration, any discussion of the undoubtedly sky-high costs that would be associated with stem cell treatments, or any analysis by independent experts of the quality of the evidence supporting this line of research.
Just about 1 in every 50 Americans has heart failure with about 400,000 diagnosed every year. The prevalence increases with age and the number of people with it will rise as a result of increased life expectancy. Heart failure symptoms can be managed with drugs and, in extreme cases, dysfunction can be helped with implantable assistive devices. But there is no cure. So, the announcement by the British Heart Foundation to raise and spend $80 million on research into cardiac cell regeneration is important and newsworthy. Stem cell therapy, gene therapy, nanotechnology and numerous other futuristic sounding medical treatments are beloved by researchers and health writers alike, and there are promising lines of inquiry to be pursued. The trouble comes when writers attempt to translate the very difficult, complicated and sometimes frustrating scientific process for a general readership. Instead of taking a very long view and writing about these treatments as one of many possibilities for how heart medicine might evolve in the future, stories like this one present the treatments as being tantalizingly available “within the next decade.”
The only cost information is the size of the research project. The story says, “Britain’s leading heart charity launched a 50 million pound ($80 million) research project on Tuesday into the potential of stem cells to regenerate heart tissue and “mend broken hearts”. The story later says, “At a briefing in London to launch a “mending broken hearts” fundraising campaign, scientists said research into stem cells and developmental biology may in future make this possible in people too.” It’s unclear whether they hope to raise $80 million or already have and are hoping to raise more, but what is clear is that there is not a single mention of how much this type of therapy might cost patients and insurers.
Any story about an experimental procedure could at least mention that, while costs cannot yet be determined, such approaches will predictably be very expensive when/if they are in clinical use.
What’s troubling about not even raising the issue is that stem cell therapy could easily become a treatment only available to those with money.
Given that this story is primarily about a fundraising effort, we also think the story should have spent a bit of time explaining the administrative costs of fund raising. The BHF notes a 19% cost for fundrasing, a number comparable to the American Red Cross.
There are no benefits quantified. This might be difficult given that there are no human studies for cardiac cell regeneration, but, at a minimum, the story should have quantified some of the benefits (and harms) that occurred in the mice studied or even in the cells. What happened to that tissue? And how many times did the researchers have to try before it worked? We might have given the story a pass on this criterion were it not for the overly optimistic tone and the series of summaries from lab research that are presented without the proper context.
There is no attempt to even mention any potential harms of a stem cell approach. Any story that fails to challenge claims that mending hearts could be as simple as recovering from a broken leg – and that the approach might eliminate the need for heart transplants – certainly should at least nod in the direction of potential harms. Or an acknowledgement that it may take a long time to learn what the potential harms may be.
The story’s first example for why regenerative cell therapy will work is the often cited zebrafish. “The ability of heart tissue to regenerate already occurs in some animals, such as zebrafish, which can regrow portions of their own hearts if they are damaged.” From there, we are given a menagerie of cellular and animal success stories, never with any discussion of the size of the study, the study design or the many steps in between these studies and human studies. The story says, “Scientists in the United States reported last year that they had been able to turn structural heart cells into beating cells by identifying genes that, in a developing embryo, turn an immature cell into a beating heart cell or cardiomyocyte.” This was done in a lab, not in humans. The same goes for the “thymosin beta 4” study that is referenced. It was done using mice tissue. The disconnected series of “facts” do not provide any context for the average reader and their relationship to the BHF effot remains uncler.
Not applicable. The story provided no meaningful background on heart failure, so it can be neither satisfactory nor unsatisfactory on this criterion.
The story does not quote a single independent expert. It provides quotes from Dr. Weissberg, the BHF medical director and Dr. Schneider, who runs a BHF research center. Dr. Riley, is noted as leading one of the British research teams. What is not noted is that Dr. Riley has conducted research in cooperation with RegeneRX, a company seeking to commercialize regenerative treatments. (see: http://www.news-medical.net/news/20100802/Thymosin-beta-4-is-essential-to-healthy-heart-development-embryonic-survival-Research.aspx ).
The marketing materials actually provide more information about alternatives to regenerative therapy than the story. The British Heart Foundation’s website says, “We can encourage lifestyle changes to reduce risks of getting heart disease, and use surgery and drugs to minimise the effects of it, but the human heart cannot heal itself. At the moment, once your heart ‘breaks’, it stays that way.
Although the story does not suggest that the treatments noted are available, it does provide the reader with a rather optimistic view of the possibility of such in the near term: “Scientists leading the work for the British Heart Foundation (BHF) said they hope that within the next decade they may have experimental drugs in development that would give certain kinds of cells in the heart the ability to regenerate tissue, repair damage and therefore combat heart failure.” Nearly a decade ago, in 2003, a story in the Chronicle of Philanthropy used the same animal – the zebrafish – to predict a therapy allowing humans to regenerate cells: “After all, our livers regenerate to the correct size, and his zebrafish rebuilt the right amount of heart tissue. Once you get cells started along the correct path, he hopes, the genetic instructions will take over, and a broken heart might just fix itself.” Nowhere does the story make it plain that none of the research being discussed has used human subjects and most of it hasn’t even been done in live animal subjects. There are many clinical trials and regulatory hurdles to overcome before a therapy like this would be on the market. The British Heart Foundation is slightly more realistic than this story, saying on its website, “Within five years we hope to begin early clinical trials. Within 10 years we aim to be running full trials. Within a further decade, people living with heart failure could look forward to a brighter future.”
The story does a good job capturing the enthusiasm surrounding this field of study. Were a therapy to be developed that allowed people to regenerate their own heart tissue, this truly would be novel. The story, however, does not make it clear that regenerative medicine is a very broad field with a stack of literature a mile high, none of which has come close to doing anything as earth-shaking as regrowing a human organ in a patient. The suggestion that heart cells could theoretically be reprogrammed is not new, with the first publication now almost a decade ago. (see: http://www.nejm.org/doi/full/10.1056/NEJMoa012081 ) Although there is a much better understanding of the underlying biology, a treatment option is still not a foregone conclusion. None of this is clear from the story, and so the question of novelty is left unanswered.
We don’t have any direct evidence that the story relied on a written news release, but it clearly relied heavily on a “briefing in London to launch a ‘mending broken hearts’ fundraising campaign”. There are no outside perspectives offered. This is essentially the same thing as relying on a news release.