Media Doctor Canada Reviewed Articles

Early prostate cancer growth may slow with drug (rated 2.5 stars)

This is a report features a study using dutasteride to prevent the progression of cancers. Despite significant information gaps, reports like this one may cause men (diagnosed with low-grade prostate cancer) to jump at the chance to take this drug.

It is important to recognize that the vast majority of men who are diagnosed with prostate cancer will not die from it. Since this group of men is a key population for dutasteride, it can be hard to decipher the benefit of the treatment. How accurate is your measurement of 'delay of death' when death is not likely to happen?

The article suggests that the drug has the potential to make "watchful waiting" safer. However, this claim is not supported by evidence, especially in light of the lack of adverse events data presented in the report. In addition, we don't learn much about the study design, and are provided little explanation for the following statement: "prostate cancer got worse in 38 per cent of men taking Avodart and 49 per cent of those on dummy pills".

Although there were some significant gaps in this reporting, it should be noted that this did a good job reporting the ties between the various spokespeople and the research funder/manufacturer of the drug.

Antidepressant appears to ease hot flashes (rated 1.5 stars)

This was a very poor report of the use of an antidepressant in treating hot flashes- a common symptom of menopause. The article discusses the randomized trial of escitalopram (Lexapro) which showed a 12% relative difference between the hot flashes experienced by women in the drug and placebo groups. In addition to solely presenting the relative reduction numbers, the article missed a few key points that leave the reader woefully in the dark. There is no mention of treatment availability in Canada, treatment cost and/or alternative treatments options (although they do mention the other antidepressants).

However, the most egregious error of this report is the failure to mention the side effects or potential serious adverse effects associated with antidepressants (e.g. withdrawal symptoms, gastrointestinal upset etc.). Having a spokesperson from outside the research, who could comment critically on these findings and the overall premise of treating menopausal women with antidepressants, would have generated a more balanced story rather than a promotional piece for the drug in question.

A daily Aspirin could help fight some cancers (rated 2 stars)

The news article highlights an important study around the use of low-dose aspirin in cancer prevention. The main drawback of this report is that it only provides readers with relative risk reduction numbers such as 30%, 35% and 40% for various types of cancer (lung, gastrointestinal, and colorectal, respectively). These numbers all sound impressive, but in reality, the benefit to the individual is much smaller. The original research (published in the Lancet) indicates that the absolute risk reductions values were around 1.5% for bowel cancer-that is a reduction from 4% to 2.5% when taking low-dose aspirin everyday.

The article includes another misleading bit of information when it says, "Aspirin, the brand name of the drug acetylsalicylic acid (ASA), is already known to prevent heart attacks or strokes in some people, particularly those who are at increased risk or have already suffered one, because it makes blood less likely to clot." A quick look on Google Scholar would have shown that this Aspirin hypothesis has been questioned in published medical research. In fact, a study published in March 2010 (Journal of the American Medical Association) involved almost 30,000 participants (men and women) and found that aspirin had no significant effect on heart attacks and strokes in low-risk populations.

While this story did mention some of the harms associated with taking daily doses of Aspirin, it did not discuss alternative prevention methods; there are many other things that people can do to prevent cancer (exercise, better nutrition, etc.) and including a brief discussion of these options would have improved the quality of this story.

New cholesterol drug data 'spectacular': MD (rated 3 stars)

While this article did include some elements of a thorough and accurate news piece, it is important to recognize that there was also some room for improvement. First and foremost, the story may have stirred some confusion with seemingly contradictory statements. At the start of the article, we read that "Anacetrapib, described as the first drug of its kind, helps keep fat particles attached to HDL, which carries them in the bloodstream to the liver to be disposed of." However, later on in the article, we read about torcetrapib, a similar drug developed by Pfizer four years ago and abandoned for safety reasons. So is Anacetrapib really the first of its kind?

There were good caveats related to the fact the drug is still being tested and the fact that the effects were only seen in LDL and HDL changes (not deaths, heart attacks or other heart problems). The article appropriately provides the absolute values for the treatment benefits and also mentions the potential conflicts of interests of the researchers and spokespeople.

It is clear that this article reflects the incredible enthusiasm of the researchers and, despite some really good caveats, this tone may give readers the impression that this new drug is more impressive that it really is. While this new treatment MAY someday change the way we treat certain patients, it is important to remember that this drug is still in its testing phase and that it is far too early to make a case for its success.

Approval of new drug heralds 'momentous' advance in stroke prevention (rated 3 stars)

This was a poor quality article reporting on a major drug trial for a product that may potentially be used by vast numbers of Canadians. While the article did include some useful information for the readers (e.g. treatment cost, availability, treatment options), the lack of quality evidence should ring a few alarm bells. The article did not provide sufficient details about the trial design and only included the relative risk reduction values.

This article committed a common "sin" in that it failed to mention absolute differences in side effects between the two therapies (Pradax versus warfarin). Without this information it is impossible to tell whether (or by how much) the benefits of the new therapy outweigh the risks. In the clinical trial, Pradax was associated with a higher rate of treatment discontinuation (5%), a higher rate of major gastrointestinal reactions (11%) and a higher rate of 'major bleeding'. While we may want to replace warfarin with a safer and easier-to-take drug, the question we must ask is whether the reduction in stroke risk achieved by this new product is worth a higher risk of these seemingly major side effects (gastric bleeds and reactions)?

It is important to remember that the drug has only been approved for patients who have undergone total hip or knee replacement therapy. With articles like this one, you can be sure that patients will clamor for it. We need to await the careful considered assessment of the Common Drug Review before we get excited about this new drug approval.

Flu shot could reduce heart attack risk, study suggests (rated 2.5 stars)

While this story had some positive elements, its most prominent downfall was its quantification of the treatment benefits in relative risk reduction terms.The report states that "the overall reduction over the course of the full season works out to an average reduction of 19 per cent for those who get the shots"- but the question we must ask is: 19% of what? What is the baseline risk of heart attack for people who chose not to get the flu shot?

The story provided little information on the risks associated with the flu vaccine and did not mention other treatments for heart attack prevention. Since the author of study seemed to be prime source of comment, the inclusion of information on potential conflicts of interest as well as comments from additional sources could have strengthened the report.

Statins may help treat prostate cancer (rated 2.5 stars)

This story does something that few do: first, it comments on the quality of the study, and second, it mentions the healthy user effect (the possibility that the statin users were healthier to start with, which is likely).

That being said, the fact that the "convincing" evidence came from a large retrospective trial of mice who had received human prostate cells should not have any men (worried for their prostates) jumping for a prescription of statins. The story misses some key points including quantified risks/harms, as well as potential conflicts of interests for the featured spokespeople. In addition, the benefits mentioned in the story are only reported as relative numbers.

If statins do play a role in inhibiting prostate cancer growth, we need, as the radiation oncologist says, a large randomized trial to prove it. The two studies mentioned here generated preliminary results that should not get anyone too excited.

Epidural may aid a woman's long-term health (rated 2 stars)

One of the main problems in the reporting of this Australian study is that it will be drawn on to support the use of epidurals in childbirth on the basis of the measurement of surrogate markers. The use of surrogate markers, in this case "levator microtrauma", implies pelvic floor injuries however, the story does not indicate whether there is sufficient evidence to link this microtrauma to serious pelvic organ prolapse.

The real concern for pregnant mothers, as inspired by the anecdotes included in the report, is that pelvic floor problems may lead to incontinence or sexual dysfunction- however, we don't know this for sure. The take away message for expectant mothers appears to be: "have an epidural and avoid future incontinence"- a message that is very captivating and very misleading.

The report does not discuss the potential harms associated with epidurals and does not indicate that there were conflicted researchers involved in the study. Furthermore, the inadequate quantification of the treatment benefits makes the study results even less informative; all we know from this report is that women who received an epidural experienced a "lower incidence of tearing". How much lower? We don't know. Did this "lower incidence" result in reduced pelvic organ prolapse? The story isn't clear.

There are many unanswered questions arising from this story and it seems fair to say that readers have been short-changed on important study details.

Alzheimer's predicted by spinal-fluid test (rated 1.5 stars)

This story of the use of cerebrospinal fluid analyses to determine who will (or will not) develop Alzheimer's disease failed to include some pertinent information about this new testing procedure and, as a result, received low ratings.

First and foremost, the evidence presented in this story is vague. It does not clearly outline how the test was studied and provides little detail about the results. We learn from the article that the test is 80% accurate, reliable, noninvasive and inexpensive; however, we are not given any details to substantiate these points. There is no mention of the specificity and selectivity of the test (an essential aspect of understanding how well a screening test performs) and the article does not include information regarding the availability of the test and its potential harms.

In light of this proposed treatment, the hardest question to answer is only skirted around: What can we do if we determine someone is a 'likely' candidate to develop Alzheimer's disease? IS that knowledge going to improve their life in any substantive way or is it just going to cast a shadow on what remains of a person's life?

Readers have been short-changed on the evidence surrounding this new spinal-fluid test and deserve better reporting on such an important issue.

HPV vaccine proves effective against warts, cancer (rated 2 stars)

This is a very disappointing report of an important clinical study that appeared in one of Canada's leading national papers. Unfortunately, it reads as if it came from the press office of the vaccine manufacturer and it lacks important context and details which could influence how people think about the vaccine.

While the article says that "the human papillomavirus vaccine strongly and consistently protects against genital warts - one of the more common sexually transmitted infections - as well as the lesions causing cervical cancer", the article fails to mention the fact that most women are naturally exposed to this virus and that it most often clears from their system without incident. An imbalance in the story can be seen in the fact that the article only provides the relative percentages of vaccine benefits and fails to mention any harms associated with the treatment. This is disappointing given that there have been many post-market reports of serious adverse reactions associated with the HPV vaccine (even some deaths).

In addition to a misleading title (which implies that there are cases where HPV has been proven effective), we readers don't know if the researchers or spokespeople quoted in the article were paid consultants or otherwise had conflicts of interest related to the vaccine manufacturers.

It's interesting to note that while provincial authorities in Canada are recommending the vaccination for girls as young as 13, the research discussed in the report involved about 17,500 women in North America, Latin America, Europe and Asia Pacific between the ages of 16 and 26. In addition to finding out more about the lifetime effects of this vaccine, parents should be interested in how well the vaccine works for the population of kids who are currently being told to get it.

Experimental diet pill shows promise, fewer risks (rated 2.5 stars)

This is a story that lacks many details that should be of concern to Canadian readers. What is most prominently missing from this report is information on the safety of this new drug called lorcaserin.

The story describes the drug as the "first truly novel weight-loss pill in a dozen years if it wins approval" and describes the fact that lorcaserin works similar to fen-phen (a drug removed from the market for its effects on the heart). Although the article does indicate that lorcaserin works in a "more selective, and perhaps safer, manner" then fen-phen, the ambiguity of this statement should raise some questions about its safety.

It is important to acknowledge that the scope of medications for weight loss is a huge industry. This story does mention alternative weight-loss treatments such as phentermine, sibutramine (Meridia) and orlistat,(Xenical or Alli); however, it does not compare the effectiveness of lorcaserin to these existing treatment options. In fact, the article adds a significant bias by listing (and emphasizing) the adverse effects of these comparator drugs and by not providing adequate information about the safety of lorcaserin.

Readers of this article need further information about lorcaserin safety, potential conflicts of interest and the availability of this new treatment in Canada. The inclusion of these details would allow readers to be more assured by quotes saying that the drug "looks very safe at this point" (as stated by the study leader).

Drug slows tumour growth in some breast cancers (rated 2 stars)

This is a report of a Lancet-published phase 2 trial of women with advanced breast cancer (BRCA1 genetic mutation) that had not responded to conventional treatment. With a total of 54 women in the trial, half of them got 400 mg of olaparib twice daily and the other half each 100 mg twice a day. According to the article "the heftier dose appeared to work better: a higher percentage of women had tumour shrinkage or slowed tumour growth compared with the lower-dose group. And those on the higher dose survived slightly longer."

This article lacks specific details as to the actual effects of the drug treatment and because there was no control group (receiving no treatment at all), it is hard to say what conclusions can be drawn from the study. The report did include appropriate caveats about the fact the drug is still in development and further research is needed so consumers aren't likely to be clamoring, yet, for such a treatment. What is missing, however, is the much needed discussion of the evidence and an explanation of the fact this is a phase II trial.

Low-dose HRT patches may yield lower stroke risk (rated 1 star)

This article is reporting on a database study comparing the occurrence of strokes in women taking tablet and patch forms of HRT.

The story was missing some important elements and would have benefited from a much clearer explanation of the numbers. For example, readers are told that the study looked at 870,000 women of whom 15,710 suffered a stroke allegedly related to the woman's use of HRT. They are then told that women who took HRT tablets (as opposed to using the HRT patch) increased their stroke risk by 25 to 30 per cent, regardless of whether they were estrogen-only or contained progesterone. In other words, the article suggests that HRT tablets are considered more dangerous than the patch.

But let's be clear here folks: the overall risk of women for a HRT-related stoke was 1.8% (that is 15,710 out of 870,000 participants). If you increase that risk by "30%" your risk goes up from 1.8% to 2.34%. So should this be worrisome? By reporting only the relative risk increases (and not the absolute numbers calculated above), the article is potentially misleading in suggesting that the HRT tablets increase stroke risk by 30%- with articles like this one we need to get accustomed to asking "30% of what?"

In addition to the unclear reporting of the risk reduction number, there was no mention of alternatives to HRT, costs of treatment, other harms related to HRT, or sources from whom the story is drawn.

Stroke prevention options expand to stents (rated 4.5 stars)

This is excellent reporting of a study that examined two ways to prevent stroke- surgical clearing of plaque from the carotid artery and carotid artery stenting. The good use of absolute numbers, and the quantification of harms (future strokes) makes it relatively clear that each procedure carries some level of risk and that neither procedure seems to be overwhelmingly better than the other.

The story would have benefited from some information on the cost of the procedure (surgery vs. stenting) and some indication of how many people in Canada would be affected by these research findings.That being said, this story reaches a standard that few do as it not only explains the quality of the evidence but also explains the magnitude of the benefits.

Study adds evidence that bone drugs work, are safe (rated 3 stars)

This is a decent report on what appears to be a marketing study designed to fend off arguments that osteoporosis drugs do not increase the risk of fractures. While the report was generally well done, a few important elements were missing.

There have been numerous reports and studies looking at the increased risk of specific bone fractures with bisphosphonates and it would have been useful to have reflected this in the report. It is important to recognize that the benefits of these drugs are extremely modest--maybe a 1% reduction in hip fractures over three years or a less than 10% reduction in vertebral fractures (many which the patient doesn't even feel).

In addition to knowing the modest benefits of these drugs, the main thing that consumers need to know, is that the drugs are not benign. In fact, bisphosphonates are associated side effects such as throat or chest pain, difficulty swallowing, and heartburn. Additional rare but serious adverse effects associated with these drugs include abnormal heart rhythm (atrial fibrillation), incapacitating bone/joint/muscle pain and bone loss in the jaw (osteonecrosis).

This study was likely designed by the marketers and subsequently presented as evidence of safety. Although the report was satisfactory, consumers deserve better quality studies especially around issues of patient safety.