The costs and benefits of the latest, greatest cancer drugs [Respectful Insolence]

I’m currently in Las Vegas anxiously waiting for The Amazing Meeting to start. Believe it or not, I’ll even be on a panel! While I’m gone, I’ll probably manage to do a new post or twoy, but, in the meantime, while I’m away communing with fellow skeptics at TAM7, I’ll be reposting some Classic Insolence from the month of July in years past. (After all, if you haven’t been following this blog at least a year, it’ll be new to you. And if you have I hope you enjoy it again.) This particular post first appeared in July 2008.

Last week, The New York Times started a rather unusual series in its medical section entitled, The Evidence Gap, described thusly:

Articles in this series will explore medical treatments used despite scant proof they work and will consider steps toward medicine based on evidence.

When I first saw the series, I was prepared for a crapfest. My experience has generally been that when reporters start examining the evidence for and against a treatment they usually do a pretty lousy job. This is most obvious when it comes to “complementary and alternative medicine” (CAM), where we are routinely treated to utterly credulous articles touting the latest poorly designed study demonstrating that this or that fairy dust cures cancer and the common cold (I exaggerate, but not by much) or “exposes” on the latest misdeeds by big pharma, in which risks are either exaggerated or not put into perspective. Oddly enough (or not so oddly enough) seldom does the misinformation go in the other direction, with excessive credulity towards pharma-produced evidence and excessive skepticism for evidence relating to the efficacy and safety of CAM modalities, but that’s a topic for another day. I don’t so much mind the tighter skepticism regarding the claims of big pharma, given its history; I only wish that similar skepticism applied to the claims of big CAM. In any case, the point is that generally medical reporting tends to be very poor at doing a fair, objective analysis of the state of the actual evidence regarding a treatment modality, so much so that I sit up and take notice when I find an exception.

Depending on how the the rest of the articles in the series play out, this New York Times series may very well be one of those exceptions. As a maven of science- and evidence-based medicine, I approve–thus far, anyway. The first two entries are on cardiovascular testing and cancer chemotherapy. I’ll spend the most time on the latter, but I can’t resist a brief treatment of the former before I get to the latter.

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