Vinay Prasad on the Use of Exaggerated Language in Cancer Research, and How It Can Mislead Doctors, Patients, and the Public

Oncology (Williston Park). 30(2):120–121.

Vinay K. Prasad, MD, MPHOregon Health and Sciences University, Portland, Oregon

1 You recently had a research letter published in JAMA Oncology titled “The Use of Superlatives in Cancer Research,” which essentially demonstrates that the overuse of inflated descriptors of new cancer drugs may lead to misconceptions among readers that certain drugs are more beneficial to patients than they actually are. What led you to investigate this topic, and what were the most surprising findings of your research?

DR. PRASAD: As a hematologist-oncologist, each year I look forward to the American Society of Clinical Oncology (ASCO) Annual Meeting. This year, after ASCO, I felt as if I had read and heard a great deal about “game-changers,” “miracles,” and “revolutions” that were in the cancer drug pipeline. These words are very charged and carry a lot of meaning for patients and doctors; therefore, I thought that we should examine the use of superlatives in a systematic way.

Doing so led us to find several surprises. First, superlatives were used for so many different drugs of different classes. Of course, as you might expect, checkpoint inhibitors, our current hot field, rose to the top, but many other classes that have historically been disappointing, such as cancer therapeutic vaccines, also had superlative mentions.

One point of major concern is that 14% of superlatives were used in the absence of any human testing, but rather in the context of mouse models or cell culture data. Half of superlative mentions were for unapproved drugs.

2 What has precipitated the recent overuse of these exaggerated descriptors, such as “game-changer” and “breakthrough”?

DR. PRASAD: I can’t say for sure that the overuse is a recent phenomenon. But I do have some thoughts for why superlatives are overused in cancer research. In our paper, we found that all of the players in cancer drug development-from small biotech companies to industry experts, physicians, and journalists-all contributed to the use of superlatives. At each stage in drug development, there is likely a perverse incentive to embellish one’s findings. Small companies want to be sold to larger ones. Trialists want to take part in meaningful research, and journalists seek readers and “clicks.” Many forces are aligned to promote the excessive use of superlatives, and there are few countervailing forces to promote accuracy and restraint.

3 In your opinion, have there been any real “breakthroughs” in cancer research thus far that warranted the use of these superlatives? If so, what are they?

DR. PRASAD: Absolutely. In my mind, a “game-changer” is one where, for the majority of patients, a treatment changes the horizon on which they view their life. Gleevec was one such drug. Prior to its discovery, median life expectancy was on the order of 2 to 5 years, and now nearly all patients with chronic-phase chronic myeloid leukemia can have a normal life expectancy. In this context, Gleevec was a game-changer.

Trastuzumab and rituximab are two important drugs that were developed in the last 2 decades. These have shown robust improvements in survival. I would call them great, and even excellent. Many other drugs do deserve praise, but some words, such as “miracle” or “cure,” are nearly always inappropriately used-even by academics.[1]

4 What can scientists and the media reporting their research do to improve the way they communicate study results?

DR. PRASAD: I am going to make one bold recommendation. Do not cover any drug that has not been tested in people. If a drug only has mouse or cell culture or laboratory data, it does not deserve any press. We know for a fact that the majority of the most promising compounds at this stage will fail in human trials, and covering these drugs is akin to doing a nightly news segment on someone who bought a lottery ticket, asking them what they will do if they win.

In other cases, I think scientists and the media have to remember their responsibility to try to convey information in an accurate and nonsensational way. Trials without control arms and drugs without survival benefits should be scrutinized. There are some great rules of thumb to help in the reporting of cancer drugs, and HealthNewsReview.org has spelled these out nicely here.

References:

1. Prasad V. Use of the word “cure” in the oncology literature. Am J Hosp Palliat Care. 2015;32:477-83.