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12 May 2016

Your Daily 'Miracle Cure' for Cancer: Media Discussions about Cancer Research

"Cancer is a subject that grabs the focus of the world. The trust of the lay public depends on our credibility, whether as a media source or as a medical expert, which can and will erode if the only reliable thing is how much we disappoint the public for believing our constant refrain that every result represents a revolutionary breakthrough in cancer care."

Your Daily 'Miracle Cure' for Cancerby H. Jack West, MD, Commentary, medscape.com, 2 May 2016

Can we elevate the level of media discussions about cancer research?

It sometimes seems as if every story on emerging cancer treatments heralds a remarkable breakthrough, leading to unprecedented benefits for patients and offering tantalizing hope of cures for a wide range of cancers.

In fact, a recent analysis[1] shows that there's good reason we perceive an overabundance of hyperbole in reporting about cancer: In 94 different media stories about cancer, such superlatives as "breakthrough," "game changer," "miracle," "cure," "revolutionary," and a few other heavy-handed terms appeared 97 different times.

Although novel targeted therapies; immunotherapy; and emerging molecular diagnostic techniques, such as next-generation sequencing and testing circulating tumor DNA, represent real advances, the appearance of an average of more than one misleading cliché promising a transformative breakthrough cure per media report undermines the credibility of our field. Hapless clinicians are unable to deliver real-world results to match the hype of such overly optimistic claims—which too often leave unstated the important caveat that these results are only in animal models or phase 1 trials rather than prospective randomized multicenter studies; that the groundbreaking outcomes are seen only in very small, molecularly defined subpopulations rather than the majority of cancer patients; or that the amazingly effective treatment is not yet approved by the US Food and Drug Administration.

There is a major gulf between what is being promised and what we are actually able to deliver, and the people making these hyped promises don't see or appreciate the negative consequences of disappointed patients and the frustrated oncologists who actually manage their unrealistic expectations.

There is a major gulf between what is being promised and what we are actually able to deliver

But why are delusionally optimistic reports so prevalent? No doubt, much of the hype stems from the need to generate interest among audiences with a nearly infinite array of content available to them.

Part of the issue is the fact that many, if not most, reporters covering science and medicine have little understanding of the process of winnowing encouraging findings from preclinical to early clinical settings and then, ultimately, to careful prospective testing in late trials. The New York Times may have a staff of dedicated writers about health issues, but most news outlets simply assign an available hand without sufficient knowledge or training. They don't appreciate that with today's ease of sharing content on social media, it's all too easy for stories by people who don't have the knowledge base to merit publication in a major media outlet to get viral exposure. But the fact that the Internet gives everyone a microphone doesn't mean that what everyone says deserves to be amplified.

Another source of hyperbole in reporting about cancer is the product of "churnalism"—the practice of running a verbatim or minimally edited version of a press release from a company or institution as a news report that essentially "flips" it without a critical view of its credibility. In an ideal world, we could say that the company or institution should provide a balanced, circumspect perspective that absolves an uncritical reader from having to view the content through a lens of skepticism, but this is a hopelessly naive position. All too commonly, press releases from just about every company or institution offer the flavor of a typical family's annual holiday newsletter: a highly filtered view that casts the subject in the most favorable light without being explicitly deceitful. The true story is almost always more complex.

Vigilant journalists commonly seek the insights of a medical expert to provide context. Although this is a terrific approach in theory, too often this starts and ends with the principal investigator or leading figure in the sponsoring company. We might hope that these key figures serve as the most knowledgeable people and can therefore provide a very measured assessment of the value of the work in question, but the reality is that the lead investigator or company representative happen to also be the most biased sources. We rightfully discount it when nearly every mother finds her child beautiful, so why should we be surprised when a lead investigator responds that his or her work is brilliant and critically important? Conflict of interest isn't merely monetary; we should recognize the inability for an investigator to view the potential impact of his or her work objectively.

The cancer community should seek to change these practices by publicly calling out inappropriate hyperbole and highlighting the harm it causes by manipulating the emotions of patients and caregivers and undermining patient/provider relationships.

Although we might take a permissive approach of excusing these practices, the lay public has a right to expect credibility from both the mass media, and especially the institutions and experts offering commentary about cancer treatments. Clinical oncologists should not inevitably serve as a "wet blanket," bringing patients back down to earth as they explain that the miracle treatment described on the evening news or a patient's Facebook feed is actually only relevant for 2% of cases of their cancer or is still investigational.

Breathless hype is not inevitable. The cancer community should seek to change these practices by publicly calling out inappropriate hyperbole and highlighting the harm it causes by manipulating the emotions of patients and caregivers and undermining patient/provider relationships.

Those of us called upon to offer commentary, whether in the form of writing a press release or offering a perspective on the significance of a new research finding, must set an appropriate example by speaking within the limitations of the evidence rather than using media reporting of cancer research as an opportunity to advance our personal or institutional ambitions.

Cancer is a subject that grabs the focus of the world. The trust of the lay public depends on our credibility, whether as a media source or as a medical expert, which can and will erode if the only reliable thing is how much we disappoint the public for believing our constant refrain that every result represents a revolutionary breakthrough in cancer care.

Follow H. Jack West, MD, on Twitter: @JackWestMD

References
Abola MV, Prasad V. The use of superlatives in cancer research. JAMA Oncol. 2016;2:139-141.

Medscape Oncology © 2016 WebMD, LLC

http://www.medscape.com/viewarticle/862504

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