Healthy Skepticism Library item: 2616

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cassels A.
Cancer drug warrants healthy skepticism
Common Ground ( Canada) 2005 Oct 2
http://www.commonground.ca/iss/0510171/cg171_cancerdrug.shtml

Keywords:
trastuzumab Herceptin

Notes:

Ralph Faggotter’s Comments:
Alan Cassels takes a critical look at Herceptin and tries to evaluate just how useful it really is.
The much promised explosion of exciting new drugs based on our new-found understanding the human genome may turn out to be a damp squib.

Full text:

Cancer drug warrants healthy skepticism

by Alan Cassels

As this is my inaugural column in Common Ground, I would like readers to know that I am keenly, almost pathologically, interested in the quality of information people receive about health and drug treatments. I’ll draw on my voracious appetite for pharmaco-journalism, and use this space to deconstruct some of the prevailing mythology about prescription drugs, which many of us absorb unthinkingly from a variety of sources – popular culture, our doctors, and especially the media. In this column, I hope to deliver a bracing rebuke to much of the hype, and hope, surrounding legal drugs, and encourage readers to develop their powers of healthy skepticism.
October is Breast Cancer Awareness Month in Canada. This year, it tops off a summer that simmered with scintillating stories of hope for breast cancer victims around the world, due to some new research on a “breakthrough” breast cancer drug, announced earlier this year. The stories that hogged the headlines, and which generated a Katrina-like political storm, concerned the costs of an allegedly life-saving drug called Herceptin. Also known as trastuzumab, Herceptin is used, in conjunction with chemotherapy, on patients who produce an excess of the HERS-2 gene – a particularly virulent form of breast cancer.
The first headlines arrived fast and furious immediately following the American Society of Clinical Oncology conference, an annual hype-generator for manufacturers of cancer drugs. The findings from two Herceptin trials were released, and Herceptin’s manufacturer Genentech, in the business of biotechnological research, set the tone with its news release, which announced: “Women with aggressive breast cancer, who took the drug after surgery and chemotherapy, had a 52 percent reduction in the risk of a recurrence, compared with women who did not take the drug.”
The media pushed the glee meter into the red zone, with words like “breakthrough,” “wonder drug,” and “impressive advance,” overblown, laudatory adjectives that I admonish journalism students to strenuously avoid.
The breathless headlines quickly morphed – anger replacing hope – as the storyline shifted into what I call the “access phase.” The price tag hanging off Genentech’s miracle drug was $35,000 to $45,000 per patient annually, or in other words, an additional cost of $150 million to Canada’s annual cancer treatment bill. This phase of a wonder drug story draws its emotional force from the perceived scarcity or expense of the new treatment. “Oh no, lifesaving drug X is not available, or is too expensive for patients to get.” The Globe summed up the theme with these headlines: “New cancer drug limited to few.” “Impressive in cutting disease recurrence, Herceptin still lacks government funding.”
Mon dieu! Forty-five thousand dollars is a lot of money, but if it is actually preventing women from dying from breast cancer, it’s worth it, right? At least, that’s what you’d think listening to the very compelling, personal stories from women who cashed in their RRSPs, and women who travelled to clinics in the US to get a shot at the new treatment. The drama was further spiced with a few quotes from angry doctors who were feeling betrayed that we would put a price on human life. One Canadian cancer doctor stated: “It’s a big frustration. As a physician, you are on a sacred mission…and the only reason you are being blocked from that mission is for fiscal reasons.” OK, fair enough. But the plot thickens as headlines mount and governments are forced to open our wallets to cover the new treatment. BC is the first province to publicly fund Herceptin, and other provinces are close behind.
The third and final part of the wonder drug story is what I call the “reality check” phase – the emergence of the inevitable safety warnings that remind people that the new treatment could harm patients. In fact, after a summer of hype, the USFDA issued a warning on August 31, which advised of “potential heart problems associated with use of the breast cancer drug Herceptin.” That’s a cute way to describe congestive heart failure and cardiac death that occurred in 4.1 percent of the patients taking the treatment, versus 0.8 percent of those in the trials who were denied Herceptin.
What were the benefits of the drug, again? A reduction of 52 percent in the recurrence of tumours, right? What that means is that 15 percent of women on Herceptin undergoing chemo had a recurrence of breast cancer within four years of diagnosis, compared to 33 percent of women who had chemo alone. That is an absolute risk reduction of 18 percent (33 minus 15 = 18). But it is presented as a 52 percent reduction because 15 is 52 percent less than 33. Get it? This is only “tumour recurrence,” something you’d obviously want to avoid, but it is survival that ultimately counts. How did Herceptin fare? In this case, the difference in the death rate between the women who got Herceptin versus those who didn’t was between two to four percent, depending on how long they took it.
So for every 100 women getting Herceptin, between two and four more will survive, but three more women will also develop congestive heart failure while on this treatment, which is also potentially fatal. Hmm, still a wonder drug? Should we be paying $40,000 a year to maybe help one in a 100 women who have this type of breast cancer? And then the inevitable question: “Well, what if it was your sister?”
Me? Well, I’d hope and pray. I would hope that she’d demand the evidence of the drug’s effectiveness and safety before leaping into the fray. And I would pray she’d be the one in a 100 who benefited. This is a standard miracle story. I’ve seen dozens of them. Take a moment this month to consider raising your awareness of breast cancer, and think why it may be wholly appropriate to hold off ever believing breathless reports of the benefits of a new treatment.
We all want new and better breast cancer treatments, but that doesn’t mean we should allow selective and misleading reports of a drug’s benefits to drain our public health care system of precious dollars, and put suffering patients on a roller coaster of hope and despair.

Alan Cassels is the co-author of Selling Sickness: How the World’s Largest Pharmaceutical Companies Are Turning Us All Into Patients and a drug policy researcher at the University of Victoria. He has spent most of the last 10 years studying how clinical research about prescription drugs is communicated to policy makers, prescribers, and consumers and has produced several full-length documentaries for CBC Ideas, including Manufacturing Patients, which deals with the subject of selling sickness.
Alan Cassels presents a free talk in the authors’ tent at The Word on the Street Festival, Sunday, September 25, 11:20 am, Library Square (at Georgia and Homer). Book signing follows. For more info, visit thewordonthestreet.ca