Through its well-sourced coverage, the story conveys that vaccines probably won’t cure addictions as successfully as they prevent polio. There’s also a nice explanation of the science behind this technology and a summary of the challenges that remain to be addressed. However, we wanted to see a lot more detail on the data that have been presented so far, and, ideally, greater caution about the potential harms of these vaccines. Although they appear safe, more testing is required before we can be confident about their long-term effects.
The search for an easy fix to addictions — a silver bullet — has a long, venerable, and disappointing history. The most effective treatments so far are substitution therapies, such as methadone, buprenorphine, and varenicline. “Blocking” therapies, into which category vaccines would fit, have only been marginally effective, if at all. The pace of development of effective treatments has accelerated in recent years, and vaccine research may one day yield additional options for people who are serious about kicking their habits and need more help. At this point, however, there’s not much reason to believe that this approach will be more successful than existing therapies. It’s more realistic to view vaccines as one among several potential options — not a panacea.
Although there was no discussion of costs, the article was clear in stating that vaccines are for the most part in an early stage of development, so this omission is understandable.
We wanted to see better coverage of the data here. The story leads with an anecdote about a patient who kicked a pack-a-day smoking habit after treatment with a nicotine vaccine in a study. And later, the story says that smokers who received that vaccine were “about three times as likely to be off cigarettes 44 weeks after vaccination than subjects given a placebo.” The story should have provided the absolute rates of success reported in the study, which were only 16% for the treatment group compared with 6% for the placebo group, according to theheart.org. Elsewhere, the story describes an experimental anticocaine vaccine that was apparently very effective in a mouse study; it could have reported on phase II human data that is available for the TA-CD anticocaine vaccine that was also mentioned in the story. These data again suggest that only a minority of patients may benefit from the use of anti-addiction vaccines.
The story states that “clinical trials have so far revealed no significant side effects” from vaccine treatments. However, we think the story should have included an important caveat: that these are early stage trials involving small numbers of patients that can’t provide conclusive evidence of safety. In addition, it should be recognized that addictions are chronic conditions and these vaccine treatments are likely to be long-term as well. Therefore, longer-term adverse effects should be expected, especially for a treatment that interferes with molecules closely related to the body’s natural chemical messengers. The story could have been a bit more circumspect on this point.
The promise of this new vaccine technology is counterbalanced by coverage of the uncertainties. The story gives appropriate weight to the disappointing results reported in a number of early clinical studies, noting: “Failures have so far outnumbered successes.” The story adds that even in one of the successful vaccine studies, the benefits were not as robust as those seen with a smoking cessation drug that is already on the market. There also is no prospect for a vaccine to treat alcoholism, according to the story. The article should have been more direct about the limitations of mouse research, and there was not enough detail on the data published in the various studies reported on (a deficiency we address under the “Benefits” criterion). However, since the story was trying to present a broad overview of happenings in the field and wasn’t attempting to summarize any particular study, we’ll give the benefit of the doubt here and award a satisfactory.
The story didn’t exaggerate the effects of substance abuse disorders or otherwise engage in disease-mongering.
The sourcing of this story was good. We hear from academics, government researchers, and industry executives. Their voices provide balance and give texture to the coverage. It should be noted, however, that most of these experts have a vested interest in the field or the success of a particular treatment, whether because of industry ties or because they are leading experiments on a particular approach. Even the government experts might be biased by their provision of significant financial support for research in this area. It would have been nice to hear a comment about the vaccines from someone who is certifiably free of all potential conflicts. But we can’t justify docking points since there is no voice that is overly enthusiastic about the concept.
The story compares the potential of vaccines with the benefits of existing medications for addiction–and notes that the available drugs might work better. We would like to have seen more ink given to the role of behavioral approaches in the management of addiction, which are supported by considerable evidence. However, the story does acknowledge that vaccines “would likely be used alongside psychological therapy.” We’ll call it good enough for a satisfactory.
The article helpfully states that “It could be years, if ever, before any vaccines to treat addiction reach the market.” The article does a good job of describing how far along the various experimental vaccines mentioned in the article are in their development.
Although the story could have provided more background on the history of anti-addiction vaccines (a heroin vaccine was explored in the 1970s), the treatments being explored now are different from anything currently available. So we don’t think this story overstates the novelty of the research.
This story is not based on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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