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News release-based story on cancer drug lacks most of what readers need


2 Star

Merck's Keytruda extends survival in lung cancer study

Our Review Summary

The story reports on new findings from a clinical trial of the drug Keytruda. Specifically, the story says that patients with late-stage lung cancer whose tumors produce a protein called PD-L1 had increased overall survival when taking Keytruda rather than docetaxel, which is is a widely-used drug for treating lung cancer. The story offers little information on how significant the health benefits associated with Keytruda are, what it costs or what its potential harms are. The story claims that more data on the trial findings will be available soon — and, given the paucity of information here, one wonders at the decision not to wait for that additional data.


Why This Matters

Lung cancer is the leading cause of cancer deaths for both men and women in the United States, claiming more than 157,000 lives in 2012 alone. Similarly, cancer treatment is big business. The story notes that cancer immunotherapies, such as Keytruda, are expected to bring in annual sales of $20 billion by 2020. But that may be a conservative estimate. One recent estimate from a market research firm set the annual revenue from cancer immunotherapies at more than $80 billion by 2020. Between the health impact and the economic impact, any advances in treatment that can improve health outcomes for patients battling lung cancer is clearly a big story. But rushing to tell the story before all — or even most — of the facts are in can be a dicey business. Doctors and patients are eagerly awaiting news on new therapies. It’s important to give all parties concerned a clear picture, rather than a rushed one.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention cost at all. Given that this is as much a business story as a health story, and that Keytruda has already been approved for use by regulators, this is a significant oversight. Previous news coverage of Keytruda in other news outlets says that Keytruda will cost $12,500 per month, and that median use of the drug is 6.2 months — or $77,500. If a patient takes it for a year, that comes to $150,000. That’s worth noting.

It would also have been worth noting what the estimated costs of docetaxel are, for comparison purposes.

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

Not Satisfactory

The story notes that patients taking Keytruda had “longer overall survival compared with those taking docetaxel.” The story also notes that “Patients whose tumors had especially high levels of PD-L1 also went longer without a progression of disease than those taking docetaxel.” But the story doesn’t tell readers whether these measures improved by a day, a week, a month, or a year. This is likely because the source of the information — a news release from Merck, which produces Keytruda — doesn’t provide the information either. As the story notes, “More detailed data from the study will be provided soon, Merck said.” That forthcoming information is essential to understanding just how meaningful the Keytruda study’s findings are. Even if the story couldn’t wait for the forthcoming information, the story should have made clear that Merck is simply not telling anyone how much extra time Keytruda is buying people.

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

Not Satisfactory

When making decisions about health care treatment options, patients often consider three factors: cost, benefit, and quality of life (i.e., potential harms/side effects). Some patients may decide not to pursue treatment that may extend life for a short period of time if that treatment will also have a significant adverse effect on their quality of life. In short, discussion of potential harms is extremely important. The story notes only that “[s]afety of Keytruda was consistent with what had been seen in previous trials among lung cancer patients.” Given that potential side effects include hepatitis, hypothyroidism, and Type 1 diabetes mellitus, it would have been worth devoting an additional sentence or two to possible harms.

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

Not Satisfactory

The story describes the findings as coming from a “late-stage study” and describes the dosage that patients received. The Merck news release offers significantly more information. It was a randomized, phase 2/3 trial involving 1,034 patients. 550 of those patients received Keytruda (at either of two doses). But neither the story nor the release tells readers how long the trial lasted, whether there was any difference between the effects of the two doses of Keytruda, or how significant the difference was between Keytruda and docetaxel.

Does the story commit disease-mongering?


No disease mongering here.

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

Not Satisfactory

The story does note that the Keytruda trial information came from Merck, which produces Keytruda. However, the story does not appear to include any input from independent sources.

Does the story compare the new approach with existing alternatives?


The story does make clear that Keytruda was being compared to docetaxel, so we’ll award a Satisfactory here. Again, however, it would have been very good to know how well Keytruda compared to docetaxel. Was the improvement in overall survival time, and in postponing progression for patients with high-expressing PD-L1 cancers, a meaningful one? Even if Merck declined to provide that information, the story could say that. Are they still crunching the numbers? Or the story could have included input from independent experts on what a “meaningful” improvement might look like; reasons to be optimistic; reasons to be cautious.

Does the story establish the availability of the treatment/test/product/procedure?


The story notes that Keytruda has been approved for use in treating lung cancer.

Does the story establish the true novelty of the approach?


The story does explain, in broad terms, the novel way in which Keytruda and a competing cancer immunotherapy drug, work. The story also talks about the expected economic impact of cancer immunotherapies broadly. So we’ll give the benefit of the doubt on the rating. However, it’s not clear how many cancer immunotherapy drugs are on the market — just these two? A dozen? More? The story also doesn’t tell readers how many of these drugs are approved for use against lung cancer. Is it just Keytruda?

Does the story appear to rely solely or largely on a news release?

Not Satisfactory

While the story does offer some additional background information, it appears to draw almost exclusively from Merck’s news release.

Total Score: 4 of 10 Satisfactory

Comments (5)

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Maggie Fox

October 29, 2015 at 7:16 am

I rarely read this blog because it it, to be honest, not useful. But I saw this critique retweeted and feel the need to reply. This story was written for a financial audience. It’s meant to inform traders and investors, quickly, about a development in a publicly traded company. This particular Reuters feed goes to an audience with a high level of knowledge. It’s not aimed at a general public audience. The reviewers almost certainly knew this. Yet they apply irrelevant criteria to the story. Why is it useful to do this in a blog aimed at health reporters?
What would be useful in a blog critiquing media stories would be a fully reported approach. Talk to the reporters about why they wrote a story a certain way. Ask who put the headline on. Find out who the intended audience is. Ask about the pressures involved in getting a story out. And, most of all, prove whether these criteria used by the blog actually make a story a) more likely to be read b)whether they actually do help a reader’s understanding.
Those are the things that matter. That’s the kind of blog I’d be interested in reading and contributing to.
As it stands, this blog reads, to me, like an excuse to smugly point fingers at the work of others without trying to advance anyone’s understanding of how health journalism happens.
For full disclosure, I am the former health and science editor at Reuters and worked directly with the very experienced reporter who wrote this story. I haven’t worked there for years and have no connection with Reuters any more.


    Kevin Lomangino

    October 29, 2015 at 8:25 am

    Thanks for taking the time to comment Maggie. We certainly realize that these Reuters stories are intended for a business crowd. But the problem is, while Reuters may be writing for investors, their feed can be picked up by anyone doing a web search in the same way that we find these stories. And these stories are routinely picked up by health outlets that have nothing to do with business or investing. For the sake of those readers, we ask that any story that addresses medical interventions at least make a nod to our criteria. It wouldn’t have taken more than a couple of sentences to more thoroughly examine the benefits of the drug, mention harms, and put a price tag on it. We don’t think that’s asking too much. And the fact that you seem to think it’s too much, or that these critical elements could be considered “irrelevant” in a story about a new drug, sounds like you’re making excuses for incomplete reporting. Lastly, we actually do regularly do the kind of reporting that you requested in your comment, which includes trying to shine a light on the excellent working being done by your colleagues at NBC about faulty medical devices. (This is done on our blog, which apparently you’re unfamiliar with. The “blog” you refer to in your comment is actually our news story review section.) Unfortunately, we couldn’t get access to NBC reporters to ask the very questions that you’d have us explore. Instead, we were kept at bay by PR officials and couldn’t get the details that would have really engaged readers. Perhaps you can help open some doors for us the next time we call? I agree that such an approach is useful and we are trying to provide it.

    Best regards,

    Kevin Lomangino
    Managing Editor


      Maggie Fox

      November 5, 2015 at 2:00 pm

      So just to get this straight – it’s somehow the responsibility of Reuters to make sure a story is accessible to the general public because the general public might get hold of it? And of course that’s assuming that these Health News Reviews criteria do, in fact, make a story more understandable to a reader – something I have not seen demonstrated. I find it hard to believe many people would read a story long enough to explain everything this blog, site, whatever you want to call it deems necessary for a story.

      Different news outlets are aimed at different audiences. It’s an exercise in futility to demand a one-size-fits-all approach.

      This type of discussion wastes a valuable opportunity to have a real conversation about good health journalism. It’s too bad. I’d welcome the chance to have that, but this particular format doesn’t achieve that goal. And it’s just nasty to accuse me of “making excuses for incomplete reporting.” But then again, that does fit in with the, I am sorry to repeat it, but the smug tone of this site.

      Gary Schwitzer

      November 5, 2015 at 7:35 pm

      It is truly unfortunate that you view a 10-year old project dedicated to helping improve health care journalism and to improve the public dialogue about health care as “smug” and “nasty.”

      Nasty? You are the one who opened communication by writing to us, “I rarely read this blog because it it (sic), to be honest, not useful.”

      Nasty? You are the one who used “smug” twice to describe our project that has drawn accolades from journalists and many others around the globe. Yes, accolades. Even from some whom we’ve criticized. Such as this recent note:

      From a veteran journalist: “This is tremendously helpful. It’s very balanced, very detailed and will go a long way toward helping me improve my journalism in this respect. Thanks again. Hope to be in touch more in the future for sure. … I see this as a great service and I’ll use this criticism to do better work in the future. … This review is going to have impact on more than just me. I forwarded it to our editors and we’re going to use it as a case study in a big editorial meeting this month, talking about the standards by which we’ll be judged (by more insightful/knowledgable readers) and how we will systematically seek to meet those standards going forward.”

      That comment, and the following from another journalist who was reviewed, came to us offline:

      “I appreciate your email and the feedback. I certainly take it to heart, as meant (including the intention behind the criticisms, and don’t take anything raised personally). Please thank those involved in this process, as well, for their time and input.”

      But veteran health care journalist Joanne Silberner commented online recently with an open-minded acceptance of our constructive criticism.

      Such comments are not uncommon. It is comments like the ones you’ve left that are uncommon – and unfortunate. And by the way, the feedback from news consumers is frequent, strong, and grateful.

      You wrote that we “smugly point fingers at the work of others without trying to advance anyone’s understanding of how health journalism happens.” You clearly have no idea how much I – and members of my team – have done to work with health care journalists..

      We’ve posted your comments but I’m not going to allow anyone to malign the work of the more than 40 people who work on this project – journalists, physicians, communication scholars, public information officers, and patients.

      Gary Schwitzer

    Matt Shipman

    October 29, 2015 at 3:33 pm

    Hey Maggie,
    I wasn’t trying to be mean, and I understand that this wasn’t written expressly for a lay audience. But wire service stories are picked up by many different outlets, and the headline on this one means that it would likely be of interest to many kinds of readers — including readers who are Googling for stories on lung cancer. I wouldn’t expect a story like this one to be an exhaustive investigation or explanation of the science involved, but even a few extra sentences would have been enormously helpful — even if it had simply acknowledged that the release from Merck didn’t specify how significant the findings were. I mean, the headline explicitly states that the drug “extends survival” — I don’t think it’s unreasonable to expect the story to explain what that means. Or, at least, to say why it can’t explain what that means. And a lot of the questions raised in the review are very business-relevant. For example, how much the drug is expected to cost.
    Ultimately, the goal of these reviews is not to make people feel bad. The goal is to highlight things that we can do better. For example, we also review news releases. I’m not sure how many of my news releases would earn five-star reviews. But I do know that, because of this site, I spend a lot more time thinking about these criteria and trying to write a more robust release. Not because I fear being called out, but because I want to do the best job I can. I hope most folks take it in that spirit.