Our Review Summary
Here’s some of what was missing in the story:
- Not all prostate cancers are equal. So the acetaminophen/aggressive cancer study – especially – required some perspective;
- Observational studies can’t prove cause and effect. So a headline that says “studies find benefit” is wrong. You can’t prove benefit when you can’t establish a causal link.
- There was no evaluation of the quality of the evidence. Without knowing the screening history and risk factor profile of the aceteminophen users, it is very difficult to interpret the observed association. Cancer progression is a very heterogeneous endpoint and the article did not address this issue or report meaningful results (absolute risk).
Why This Matters
There’s been a lot of prostate cancer news in the past two weeks, largely because the American Urological Association annual conference was just held. But are we really telling men something they need to know with a story like this? Or are we just turning up the force on the firehose of information that we flood readers with?
Criteria
Not Applicable
Not applicable. Cost is not much of an issue here.
Not Satisfactory
We think a story like this should present raw numbers.
So, instead of:
- “men who took a daily dose of acetaminophen (Tylenol) for five years had a 38% lower risk of developing prostate cancer…(and) daily acetaminophen was associated with a 51% reduced risk of developing an aggressive form of the disease”
Why not explain 38% of what baseline? And 51% of what baseline?
Projected benefits may be exaggerated by presenting them in the manner of this story.
Not Satisfactory
No drug – not even acetaminophen – is without risk. So, when the story starts in cavalier fashion – “Pop a Tylenol…” it should also find time and space somewhere to mention that popping pills comes with some risk – especially given that the safe daily maximal dose of acetaminophen has been lowered in recent years.
Not Satisfactory
There was NO evaluation of the quality of the evidence. There is not one word about the limitations of such observational studies – on walking or on acetaminophen use.
Aside from general problems with adjusting for confounders in observational studies, both exposure measures–exercise and acetaminophen use–were self-reported and thus of uncertain validity. Also, interpreting “daily use” is difficult–is this one pill a day, the maximal dose, somewhere in between? Do you have to use acetaminophen for 5 consecutive years or just a total of 5 years? Another issue related to acetaminophen is that for a variety of medical conditions (kidney disease, heart failure, gastrointestinal bleeding), the non-steroidals are contraindicated and so patients are preferentially placed on acetaminophen. Sicker patients may also be less likely to be screened for cancer, so the observed “protective” effect could be quite spurious.
Further, the column lifted material from another news source (MedPageToday):
- Richman and colleagues noted that the brisk walks may reduce insulin resistance, which decreases bioavailable insulin-like growth factor-1 (IGF1) and increases adiponectin levels, which are all associated with decreased risk of advanced or fatal prostate cancer in vitro and in vivo. Another potential source of the associated reduction was reduced inflammation due to a lower circulation of interleukin-6, high levels of which “predicted a 73% increased risk of dying from prostate cancer among normal-weight men,” the researchers wrote.
The casual reader may assume that the study actually analyzed such physiological reactions, which it did not. The researchers projected interesting hypotheses, but they should have been labeled as such.
Not Satisfactory
We do think there was a subtle element of disease mongering in this story.
The facts at the end are all correct – “Prostate cancer is the second leading cause of cancer death in men. According to the National Cancer Institute, about 32,050 men died from prostate cancer in 2010 and 217,000 new cases were diagnosed. More than 2.2 million men in the U.S. are living with prostate cancer.”
But there is no context given about prostate cancers not being the same as other cancers – that many are not killers – that many men die WITH prostate cancer, not FROM it.
And crediting acetaminophen for a “51% reduced risk of developing an aggressive form of the disease” without every quantifying how relatively few men develop an aggressive form of the disease among the 217,000 new cases diagnosed each year is not helpful. 51% of what?
Not Satisfactory
No independent expert source was cited to comment on either finding.
Not Satisfactory
Neither finding was put into the context of other treatment/prevention approaches for prostate cancer. For example, the 5-alpha reductase inhibitor drugs (finasteride and dutasteride) have been rigorously evaluated for chemoprevention.
Not Applicable
Not applicable. There’s no question about the availability of the two “interventions” – walking and acetaminophen.
Satisfactory
The story explained that there’s been prior research in both fields – studying effects of anti-inflammatory drugs and walking on prostate cancer.
So it didn’t inappropriately paint either pursuit as totally new.
Not Applicable
Not applicable because no one was directly interviewed and quoted. The story did draw from another news source – MedPage Today – but we don’t know if any original reporting was done.
Total Score: 1 of 7 Satisfactory
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