WSJ business story on Alzheimer’s drugs missed key aspects of health angle

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

While the story tells readers that solanezumab and aducanumab could generate annual sales of $3 billion and $10 billion respectively, it says nothing about the potential cost of the drugs to consumers or insurance companies. Those billions would likely come largely from Medicare. These drugs are still far removed from the marketplace, but presumably the experts they spoke to were basing their annual sales estimates on more than guesswork. That makes it particularly problematic that the story doesn’t touch on cost at all.

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

Not Satisfactory

The story describes the benefits of these drugs in broad, qualitative terms. E.g., a drug appeared to slow down cognitive decline. That makes it difficult or impossible to tell how well either of these drugs performed in the relevant trials. Were these marginal benefits? In other coverage of these studies, an Eli Lilly consultant noted that the results “do not have a direct relationship to clinically apparent benefit.” So it seems premature for anyone other than investors to be getting too excited about these findings just yet.

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

Not Satisfactory

The story doesn’t address harms at all. One of the most important aspects of clinical trials is determining whether an experimental drug causes significant side effects. And at least one of these drugs is associated with brain swelling associated with headache and confusion. To be clear, this is not about asking reporters to paint a grisly picture of potential harms. If a drug had no adverse side effects, that’s great — but tell readers that. And if a drug does have adverse side effects, tell readers that too.

[Editor’s note: An updated version of the story now includes the following line: “Some patients receiving solanezumab experienced swelling in the brain and other adverse events, but researchers said the drug was generally well tolerated.” This line was not in the version of the story that we originally reviewed. We applaud any effort to get better, more complete information to readers. But such updates do miss readers like us who only saw the original version of the story.]

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

Not Satisfactory

The story gets credit for making clear that previous studies of solanezumab did not have promising results, and that a separate, ongoing trial scheduled to end in late 2016 will have more definitive results on the drug. However, the story tells readers very little about the solanezumab trial it is reporting on. How large was the trial? What was the study design? Who conducted it? What were its limitations? The portion of the story on aducanumab is equally vague. All readers are told is that the relevant results stem from a “early-stage clinical trial” in which varying doses of the drug were given to “a very small group of participants with mild memory problems.” How small is “very small”? How long was the trial? What do they mean by “mild memory problems” — were any of the study participants diagnosed with early-stage Alzheimer’s? We understand that not every story can provide an exhaustive overview of a clinical trial’s study design, but the limited information offered here provides more questions than answers.

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

Not Satisfactory

Two clearly independent sources are quoted, but both are market analysts who offered only global, annual sales estimates for the drugs. There seem to be no independent sources cited in regard to how promising the drugs are, what the clinical trial findings might mean, how far the drugs might be from reaching the market, etc. That’s a significant oversight. Even if readers are interested in this solely as a business story, expert evaluations from independent sources on those issues would be enormously valuable. The conflicts of interest seem clear, with one exception. The story quotes Paul Aisen, director of the Alzheimer’s Therapeutic Research Institute at the University of Southern California, “who presented the results” on solanezumab. Aisen is also a consultant to Eli Lilly and many other drug companies, which should have been mentioned.