Many of us watched with hopeful wonder as 60 Minutes reported on an innovative biologic solid tumor cancer therapy Sunday evening.  But is it as good as it seems?

Here’s a link to the broadcast, courtesy one of our readers:

http://www.cbsnews.com/videos/killing-cancer-part-one/?tag=facebook

http://www.cbsnews.com/videos/killing-cancer-part-two/

 

Polio VirusLike the measles virus “break through” for multiple myeloma, the story features several patients with what can be called miraculous responses.  But later attempts haven’t worked as well.  Things seem to be doing better at Duke, but there are some subjects that aren’t doing as well–and lots of questions.

Here’s an article I found critical the broadcast.  Note Mr. Schwitzer’s post article addendum.  Gives us all a lot to think about.

More than half of 60 Minutes devoted to “Killing Cancer” but still no independent perspective

Posted by Gary Schwitzer in – March 30, 2015

he following is a guest blog post from a member of our editorial team, Tom Watkins, who worked at CNN for more than two decades. He has a strong background in health/medical/science journalism.
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CBS News’ “60 Minutes” devoted a massive amount of time, resources and airtime to a story about an experimental treatment underway at Duke University for patients who have had a recurrence of glioblastoma, a brain cancer that kills 12,000 Americans in any given year.

“Something unimaginable has happened for a patient with recurrent glioblastoma,” says Correspondent Scott Pelley about the procedure, in which polio virus is injected into the area of the tumor. “She is cancer-free.”

The news magazine had all the resources needed to do a great piece – including a producer with more than 30 years’ experience doing medical stories, a deadline that extended 10 months from when they undertook the project, acres of air time – nearly 27 minutes in all – and a supportive executive producer who has promised follow-up stories as called for.

On Sunday night, in a two-part program – 60 Minutes told a compelling tale about the complex procedure while sidestepping many of the most common traps that can ensnare TV producers. But not all of them.

Let’s go through the 10 criteria by which we typically analyze news stories in our criteria-driven story reviews:

• What’s the total cost? No mention was made of the cost of the treatment. But we’ll give them a pass, because the treatment is experimental and therefore not available commercially. And we credit Pelley with noting that some of the principals he interviewed have financial interests in the trial’s outcome, but wish he had specified who.

• How often do benefits occur? The story notes that just 22 patients have undergone the experimental procedure, and that half of them died. But it also notes that four of them have passed the six-month mark — in defiance of all expectations. And that, for anyone with the disease, is remarkable. The piece says that the prognosis for recurrent glioblastoma is “a death sentence.”

• How often do harms occur? The story cites a woman who received what was described as too high a dose of polio virus and died, and says that high doses caused some of the other fatalities. But it does not say how many, nor does it detail what other harms may have been experienced.

• How strong is the evidence? The story makes clear that the study was a Phase 1 clinical trial, intended to determine dosage, not efficacy, and offers a voice of restraint. “We have to be cautious because sometimes people just get lucky and the first patients they treat with a therapy respond very well but subesequently additional patients don’t,” says Dr. Peter Marks, deputy director of the FDA. But Marks fails to offer an authoritative, independent view of the work itself and his voice of caution cannot compete with the chorus of enthusiasm expressed by the Duke doctors. Citing FDA rules, the story says that Marks “could not speak specifically about the polio trial.” Alas, the producers did not offer anyone else to fill that role. The story says that the FDA will decide in about a year whether to grant the experimental treatment “breakthrough status” to make it available, but fails to detail what that would mean. The producers may not have been responsible for the absence of an independent voice. When I asked for a comment from the head of the National Cancer Institute’s Cancer Treatment Evaluation

Program, Dr. Jeff Abrams, I got this response:

“We decided that the NCI would not comment ‘on the record’ about this,” Abrams wrote in an email about the work, which was partially funded by NCI. “We are certainly aware of the Duke trial as NCI has produced the vaccine for this study, and we are encouraged by the early results. However, it is still very early in development and we will reserve comment until we see further data from ongoing trials at Duke.”

• Is this condition exaggerated? It’s hard to imagine how one could exaggerate the threat posed by a condition whose outcome is nearly uniformly grim

• Are there alternative options? Here, the story asks us to trust the reporter, who says, “There were no options” to the experimental procedure for patients with recurrent glioblastoma. The National Cancer Institute’s website cites 58 trials for glioblastoma patients, and several of the trials are for recurrent forms of the tumor.

• Is this really a new approach? That depends on your definition of new. In recent years, the Duke University public relations machine has produced at least two videos using many of the same doctors and one of the same patients used in the CBS piece to tout the work:

July 28, 2013: https://www.youtube.com/watch?v=UHmQnGsWiIM

March 20, 2013: https://www.youtube.com/watch?v=KaJop2oti48

• Is it available to me? The program and the website both offer the researchers’ contact information for anyone seeking more information or to enroll in one of their trials. While this may smack to some of self-promotion, it is now routine for news organizations to link to primary sources. A more important question may be the cost of any treatment that may result, given that at least some of the work was publicly funded. The story says nothing about that.

• Who’s promoting this? The producers were granted extraordinary access to patients and doctors. Though the commercial interests of the researchers were not specified, the piece is candid in acknowledging that they exist.

• A big winner for the evening was Duke itself, which is still smarting from involvement in a scandal. And the evening proved to be an all-around success for the team, given that the piece ran shortly after the school’s basketball team won entry into the Final Four by beating Gonzaga 66-52. Promotion of the school continued throughout the piece, as nearly all of the people interviewed – including patients — were wearing Duke T-shirts or sweatshirts.

• Do they have a conflict of interest? “This to me is the most promising therapy I’ve seen in my career,” says Duke neuro-oncologist Henry Friedman. “Period.” Unfortunately, it’s not clear how much weight to give that statement, since it’s not clear whether he is among those who stand to gain commercially if the intervention proves successful.

Unusual for a TV story, the anecdotes presented balanced positive findings with one cautionary tale in the form of a woman who underwent the procedure, became partially paralyzed, dropped out of the trial and died. Asked on a home video shot by her husband whether she would have made the same decision to participate in the trial had she known what awaited her, she said, “I might not have done it.”

And the story treads cautiously around the “C” word. “I’m very reluctant to use the ‘cure’ word,” says Dr. Darell Bigner, head of the study and of Duke’s Brain Tumor Center. “Because we don’t know how long it takes to say that a glioblastoma has been cured. But I am beginning to think about it.”

Much of the credit for such restraint must go to the producers, Michael Radutzky and Denise Schrier Cetta.

In a discussion posted online by CBS, longtime producer Radutzky says several of his relatives have died of glioblastoma, so he knows how dangerous it can be to give false hope to people who are grasping at straws. “I’m very cautious about ‘the next big thing’ being the next big thing,” he says.

Still, the producers allow one doctor to say that the same treatment may prove useful against a laundry list of other cancers, even though their work on the other cancers has thus far been limited to the lab.

Eckard Wimmer, a virologist at Stony Brook University, watched the piece with great interest. Though he lauded it overall, he blamed it for one omission.

“The whole principle was actually developed in my laboratory in 2000,” the distinguished professor of molecular genetics and microbiology told me in a telephone interview.

“Unfortunately, the work at Stony Brook never got mentioned. Duke just said, ‘Forget about Stony Brook. We want to take it all.’”
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Publisher Gary Schwitzer’s addendum:

• See the MedPageToday piece by Shara Yurkiewicz, MD: “Did ’60 Minutes’ Report Raise False Hope?” Excerpts:

“It is premature to draw any conclusion but ‘possibly interesting’ from what was presented,” Bruce Chabner, MD, director of clinical research and Massachusetts General Hospital and former director of the National Cancer Institute’s Division of Cancer Treatment, told MedPage Today in an email.It is unclear how well the preparation works, what mechanism it uses, and what a safe dose is, he added. “It is clearly far behind the new, approved immunotherapies (checkpoint inhibitors) in terms of being ready for marketing.”

Chabner added, “I think it was a disservice to the cancer community (physicians and patients) to present this in such a superficial and premature way.”

The “60 Minutes” report was “irresponsible journalism,” Daniel Hayes, MD, clinical director of the Breast Oncology Program at the University of Michigan and president-elect of the American Society of Clinical Oncology (ASCO), told MedPage Today in an email.

“This is what’s wrong with medical coverage by the press … and cancer coverage specifically. Breathless hype over ‘breakthroughs’ before the scientific process has demonstrated that the new approach is or is not better than what we do,” Hayes said.

“I hope the Duke investigators have really made progress; Lord knows we need better treatment for brain cancers. But this sort of hysterical report, raising false hope, does not further our cause,” he added. “

• See David Kroll’s Forbes blog post: “What ’60 Minutes’ Got Right and Wrong on Duke’s Polio Virus Trial Against Glioblastoma.

• Another Forbes blog post: “Here’s What 60 Minutes Didn’t Tell You about the ‘Miracle’ Glioblastoma Treatment.

• Three times in 18 months in 2008-9, CBS proclaimed a cancer cure for an experimental approach – a low point for the program. We reviewed two of those segments – in April 2008 and in October 2009. According to the 60 Minutes Overtime website, the same producer worked on those two pieces and on the latest piece.

• Tom Watkins, in his guest post, says “they allow one doctor to say that the same treatment may prove useful against a laundry list of other cancers, even though their work on the other cancers has thus far been limited to the lab.” I think they did more than “allow” him to say this; they actually set him up to say it with this Scott Pelley question – “What have you been able to kill so far?” that doesn’t differentiate for the audience the important difference between results in a lab and results in sick people.

Scott Pelley: You have been testing this therapy against a number of other cancers just in a laboratory dish.
Dr. Matthias Gromeier: Yes.

Scott Pelley: What have you been able to kill so far?
Dr. Matthias Gromeier: So we have done this for lung cancers, breast cancers, colorectal cancers, prostate cancers, pancreatic cancers, liver cancers, renal cancers. We probably see this in just about any type of cancer you can imagine.

• Watkins is easier on the piece’s posting of Duke’s phone number and web info than I would be. From a journalistic level playing field perspective, will they now post the phone number and web info of all other glioblastoma research centers? Or all other brain cancer research centers? Or all other cancer centers? If not, how do they decide where and how to draw the line?

• Since the story relied so heavily on the visual impact of before-and-after MRI images, we would have appreciated some discussion of the reliability of MRI images in such cases.

MedPage Today had a story on Stony Brook virologist Wimmer’s work 8 years ago.

• Our review team just today published a review of another glioblastoma research story by NPR – unrelated to the Duke story. It’s another indication that there is, indeed, other newsworthy glioblastoma research underway, something the story was woefully short in discussing.

Two more thoughts on the journalism involved – from Publisher Gary Schwitzer. I forgot to add these in my earlier list, so have added at 6 pm Central time. These are comments on two strange scenes in the program:

• One was as Pelley sat with a woman who had just begun her initial infusion of the experimental procedure. Yet, he immediately asks her, “Do you feel anything yet?” This silly style of journalism does nothing but to reinforce myths about instant cures.

• The other was as Pelley sat, dramatically, with a patient and family as they were about to see her followup post-experiment MRI scan for the first time. Questions arise:

Is CBS trying to tell us that Pelley didn’t already know what the scans showed?
* Because if he didn’t, and if the scans were gloomy, would he have broadcast that same scene?
* In retrospect, CBS can tell us whatever they want about the pre-production decision-making, but it’s hard to believe he didn’t know what the scans showed.

• Regardless, neither of these scenes added to the viewers’ understanding of the research. It was just an attempt at high-drama TV.

Insightful journalism.  A bit pessimistic, but questions that need to be asked.  I recall listening to the end of the report; that they skimmed over a variety of complications and less than impressive results in the second try.

Still, I’m hopeful!  You’re seeing the future of cancer care and hopefully for many, cure.  Only real question: how long will it take?  Still thing five to ten years in order to work out the kinks.  Hope me and my fellow cancer patients can hang in that long!

Feel good and keep smiling!  Pat

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