The vividness of anecdotes “makes” and — if you’re particular about evidence — “breaks” this story about the use of phages as an alternative to antibiotics. The story’s gripping narrative is dominated by one woman’s tale of successful, apparently life-saving treatment with phages. No concerns or doubt about the treatment creep in until more than than halfway down this 2,900-word story, when we’re offered a competing anecdote about a failed treatment. The question of systematic evidence (or the lack thereof) is raised very far down in the story and isn’t emphasized as much as was warranted.
These concerns aside, we’re pleased to see a news outlet devoting such significant space and resources to an important health story. We look forward to sinking our teeth into future BuzzFeed offerings.
Antibiotic resistance is a big problem that is getting worse. The pharmaceutical industry has not provided any meaningful advances in this area for decades, and the bugs are getting smarter. Alternative approaches, such as bacteriophage therapy, may be worth pursuing. But since people are desperate for new options now, stories have an obligation to treat emerging therapies very carefully and make clear when there is a lack of supporting evidence.
The cost of phage therapy is provided for each of the two patients highlighted in the story. In one case, a three month supply cost $800. We are not told of any additional costs related to genetic identification of the infecting bacteria or of the costs of repeat testing every three months. Although unstated explicitly, the story does suggest that the treatment isn’t covered by insurance.
The story is dominated by the tale of one woman’s apparently lifesaving treatment, which is balanced much later down in the piece with an anecdote about a patient who had a poor outcome. As a result of this positioning, the tone of the story is distinctly benefit-oriented. No systematic or quantifiable evidence about benefits is offered, which may well be because there isn’t any such evidence. But the example of Wolcott, the Lubbock wound care doctor, seems to cry out for more details. Eleven of his cases are said to have healed enough to save limbs. But out of how many? We’re told there were “hundreds” of patients. What was the experience with them? Even if imperfect, is there any case series data? How about this Phase I safety trial, co-authored by Wolcott, that reported on the use of phages for chronic venous leg ulcers?
Certainly the overseas treatment experiences must have generated some data about potential harms. But other than the failure of one patient’s treatment, we are not provided with any clinical downsides. That case also points out the financial risks assumed by patients in obtaining unapproved treatments outside the US.
The primary evidence offered by the story is anecdotal. In fact, it thoroughly explores one successful intervention anecdote and also gives generous space to an unsuccessful anecdote. The story references no systematic evidence that might be available in Russia, where phages seem to be regularly used. It does indicate that two studies are now under way, one in the US and the other in Europe. But it doesn’t reference the findings of a published Phase I safety trial.
While there’s an implicit suggestion in this story that there just isn’t much real evidence to talk about, we think the story should have been more up-front about this. We wish the story had stated this clearly near the top of the story so that the anecdotes are framed appropriately. We shouldn’t have to wade 2,300 words into a 2,900-word story to start learning about the evidence.
There’s no doubt that antiobiotic resistance is a serious and deadly problem. But unsourced projections such as, “By 2050, an estimated 10 million people worldwide will die by superbug” lead one to believe that the end is perhaps near. We think a source should be cited for such projections.
The majority of the sources in the story appear to be advocates for phage therapy. Dr. Wolcott has conducted research for at least one company promoting phage therapy and sits on the scientific advisory board of another that produces phages commercially. Other sources are associated with companies or clinics promoting phage therapy. However, toward the end of the piece, the story does quote an NIH scientific officer who offers some independent perspective. Borderline satisfactory.
The story does note that the alternative to phage therapy is a group of antibiotics that are rapidly becoming marginalized. That being said, we wish the story had explored the issue of other alternatives more thoroughly. What other alternatives, you ask? They may be few, but the FDA, in a recent blog post, touted the approval, in 2014, of “four novel systemic antibiotics.”
The story provides the reader with information on the lack of availability of phage therapy in the US, and how to circumvent US customs to obtain supplies from the Republic of Georgia.
The story rightly points out that phage therapy has been in existence longer than antibiotic therapy and the use in Eastern Europe is not new or novel.
There is no evidence of material being picked from a press release
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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