Friday, October 28, 2005

The Breast Views Blog: Understanding Herceptin

Alan Cassels, author of Selling Sickness writes, "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."

I'd say Alan is a man after my own heart. Here's his inaugural column.

Common Ground - Oct 2005 - Cancer drug warrants healthy skepticism.

Sue Richards

4 Brilliant Observations:

Blogger Michael said...

And I would say everyone needs to calm down on this one.

First we must not confuse the problems, ethics and reputation of the pharmaceutical industry with the evidence.

Secondly we have to separate the message from the medium. If we believed every news story about wonder drugs and breakthroughs we could pack up the entire health care system and go and sit on the beach. Insulin and Penicillin were breakthroughs. Why? because without them everyone died, with them everyone survived.

Herceptin is the first drug to make much of a difference in the outcome of early breast cancer for a long time. Is it a miracle? No. Have we seen this degree of effectivenes for a drug in breast cancer in the past? No.

Every woman must examine the evidence for herself and decide what her preferences are. Research to date suggests that most women consider a 1% difference in survival worthwhile (their doctors choose 10%). Should they be denied their individual choices, if properly informed. No.

Statistics are always potentially misleading. The answer - look at the data and I agree, do not be misled by percentages. Anyone can and should read the actual papers in the New England Journal of Medicine (October 20) on line.

Yes differences are mainly in recurrence - these occur early, survival data (fortunately) take much longer because there is treatment for recurrence. Actually the survival was 91% vs 87% which is 4% in absolute terms, 31% in relative terms - but this difference is rapidly widening. It would be extraordinary if the larger differences in freedom from recurrence (85% v 67%) did not eventaully become survival differences. There may be those who wish to wait to see that. A woman with breast cancer probably will not.

Are there side effects? Yes. The main problem with this drug is a reduction in heart function. The difference was 4.1% v 0.8%. Only one woman died from this (out of 2,000) and she was in the group that did not receive herceptin. Of 31 women with heart failure only one still has it.

In my experience most women with breast cancer make sensible choices related to their own personal values, and very few ever regret those choices.

It would be tragic if women were scared away by articles like this. They must ask to see the actual data and make up their own minds.

Women with breast cancer do best when they take control over their own bodies.

4:14 PM  
Blogger Ruth said...

"Women with breast cancer do best when they take control over their own bodies." - that summed it up nicely Michael. Thank you.

8:14 AM  
Blogger Sue Richards said...

Michael,

I'm not sure why you would worry that women might be scared away by articles such as this when the writer himself "encourage readers to develop their powers of healthy skepticism."

How better to take control over your own body than to broaden your scope of understanding and knowledge by looking at both sides of every coin.

Main stream ideas aren't alway wise... but they certainly are popular.

Sue Richards

9:42 AM  
Blogger Michael said...

Thanks Sue, in some ways the ideology that makes Cassels 'a man after your heart' is a bias we all share. I do not know a lot about Mr Cassels' academic qualifications, other than what you have provided, and that he works at the Department of Health Information Science in the Faculty of Human and Social Development.

We all have our biases and I will declare mine in having been deeply involved in organisations developing a healthy scepticism to the pharmaceutical industry, based on a study of the evidence, and in particular the medicalisation of society. I also have a personal bias which would actually make me unfriendly to this particular drug. However I am also involved in the research described and on the front lines of dealing with women with breast cancer. Breast cancer is of course, no imaginative illness.

I think it is critical to distinguish between ideological scepticism and a critical examination of the evidence. On these grounds I found Mr Cassels' writing unbalanced for someone putting themselves forward as an academic. So yes, I do stand for looking at all sides of a coin.

9:13 AM  

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