THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, May 19, 1996 TAG: 9605170042
SECTION: COMMENTARY PAGE: J5 EDITION: FINAL
SOURCE: LYNN FEIGENBAUM
LENGTH: Medium: 82 lines
If it sounds too good to be true, it probably is.
You've heard that before. But it's a point that Arthur Caplan stresses most vigorously when it comes to medical reporting.
Caplan, director of the Center for Bioethics at the University of Pennsylvania, spoke to a gathering of ombudsmen earlier this month in Philadelphia. And his warnings rang in my ears when I saw the Pilot's front-page story Tuesday, ``New test could be early detector of Alzheimer's.''
The ``classic breakthrough story,'' Caplan probably would have called it. And then he would have proceeded to punch holes in it.
There is a great interest these days in new developments that will cure or fight cancer, AIDS, Alzheimer's, heart disease - but much of what we read, Caplan said, offers false hope. Or, at best, hope that's years away.
``Bio-medicine moves in little steps, not leaps,'' he observed.
I was a bit surprised by Caplan's vehemence. These days, most medical stories seem to be carefully worded, with lots of ``coulds'' and ``maybes'' and other qualifications.
Caplan, however, looks deeper. He picked as an example an April 2 story, ``Cancer vaccine ready soon for human testing, researchers say.'' Like the Alzheimer's story, it was written by an Associated Press reporter.
Caplan raised questions that you, as a reader, and we, as editors and writers, should ask when weighing the importance of any medical or science story we write or reprint.
Where was the report published? In both stories, it was a journal called the Proceedings of the National Academy of Sciences. Sounds important to me. But Caplan didn't think much of that journal - it offers no peer review, he said, and is, in effect, simply publishing its own researchers.
Does anyone but the researcher subscribe to this theory? The story quotes the head of an Alzheimer's research institute, but only on the importance of early detection. There is no second opinion on the research itself.
How was the new ``breakthrough'' tested? The cancer story notes that the vaccine had only been tested on rats - and only a dozen rats, Caplan learned later. His warning: ``zillions of things'' shrink tumors in rats that don't work on humans.
The Alzheimer's story said, ``So far, the test has only been conducted experimentally with frozen cells from a few dozen patients.'' Well, at least it was a test on humans. But note the words ``experimentally'' and ``few dozen.'' I suspect Caplan would brand it a pilot study, with real application years away.
In fact, Caplan says that genuine breakthroughs are few and far between, ``a pretty rare event. . . . When I hear about breakthroughs, I'm leery - and you should be, too.''
What makes Caplan leery is his conviction that reporters are too quick to write stories right off press releases, and that much of the research - about 85 percent, he said - is done by private pharmaceutical companies.
The pressure to write breakthrough stories, says Caplan, comes from the fact that people are looking for hope - and ``our love of movie and story-book medical heroics.'' You remember those tearjerker movies where the doctor discovers, overnight, a cure for diabetes or polio.
So are there any genuine medical breakthroughs? According to Caplan, only four in recent years:
The molecular revolution - understanding the molecular makeup of diseases.
Non-invasive imaging, such as CAT scans.
Psychoactive pharmaceutical drugs to treat mental illness.
Large-number computer analyses for epidemiology.
He did not include any AIDS medications in his success stories. There has been no shortage of AIDS breakthroughs, concluded Caplan, ``but everyone is dead at the end.''
And just in case there weren't any believers in his audience of ombudsmen, Caplan asked us how long we thought it took for that really great breakthrough, penicillin, to be developed.
His answer: 40 years, from the time of Alexander Fleming's discovery to large-scale availability.
Keep that in mind the next time you read about a breakthrough vaccine or laboratory test. MEMO: Call the public editor at 446-2475, or send a computer message to
lynn(AT)infi.net by CNB