Investigative Reporting on Medical Science: What Does It Take to Break through the Commercial Spin? '... It Is Almost Impossible to Get the Story Right When the Fundamentally Commercial Goals for Which the Study Has Been Done Are Covered Up with So Much Industry-Sponsored Expertise.'
Abramson, John, Nieman Reports
When it comes to real-time reporting on medical science, journalists (as well as many experts and even medical journals) have been largely relegated to the role of cheerleading for the industry, unable to fulfill their rightful role as critical investigators providing a balanced view. The most recent example is the reporting of the JUPITER trial, which purported to show that people with normal cholesterol but elevated C-reactive protein levels benefit from being treated with the statin drug, Crestor.
My award for the most accurate coverage of this story goes hands down to ersatz (though some--surely including himself--would say uber-)journalist Stephen Colbert, who described the study as "a great breakthrough in the battle to find things to prescribe to people who don't need them." The rest of the coverage trailed far behind.
The Reporting Trail
About a week before reports of the JUPITER trial blanketed the media, a staff writer for a major newspaper sought my comments on the still embargoed New England Journal of Medicine (NEJM) article about the study. The authors reported that treatment of people with normal cholesterol but elevated levels of inflammation (as measured by a C-reactive protein test) with the statin drug Crestor reduced the risk of heart attack by 54 percent, serious cardiovascular complications in toto by 47 percent, and death by 20 percent. The article concluded that:
... the rates of a first major cardiovascular event and death from any cause were significantly reduced among the participants who received [Crestor] as compared with those who received placebo.
Clearly this story was going to have enormous impact on preventive medical care. I asked the writer if I could share the embargoed NEJM article with my colleague Jim Wright, who holds a medical and doctorate degree and is the managing director of the Therapeutics Initiative at The University of British Columbia, arguably one of the best centers for critical drug research in the world. Jim and I reviewed the NEJM article individually and together and arrived at a very different overall impression of the import of the study's actual findings. We then presented our analysis to the journalist in a conference call.
Yes, there were significantly fewer serious cardiovascular events in the people treated with Crestor. But in terms of the actual benefit, 170 people had to be treated for a year to prevent one event at a cost of $270,000 for the Crestor alone. This dollar figure did not include the cost of screening many more people with a C-reactive protein test and the extra doctor visits and lab work to make sure there were no adverse effects of treatment with Crestor.
Nonetheless, fewer people with cardiovascular disease meant fewer people requiring expensive treatment and therefore savings, right? Wrong: The more important finding--which got short shrift in the NEJM article and none in the media coverage that followed--was that there was no difference in the overall rate of serious illnesses (called "serious adverse events") that occurred in the Crestor and placebo groups. In other words, there weren't fewer sick people requiring hospital treatment in the Crestor group (they just had different kinds of serious illness), and therefore the savings realized on less cardiovascular care would be used taking care of other illnesses.
There was also the finding that more people taking Crestor developed diabetes, which would not have been included in the "serious adverse event" category because rarely does an adult who develops diabetes require hospitalization.
The 20 percent lower death rate among people treated with Crestor was certainly noteworthy. However, a closer look showed that 400 people had to be treated with Crestor for a year to prevent one death, at a cost of about $580,000 for the drugs alone, not including all of the blood tests and doctor visits that would be necessary to treat all 400 people with Crestor. …