Complete Health Reporting: Compare Alternatives When Covering Treatments

When a new car comes on the market, car writers rush to drive, dissect, and describe in detail all the ways it will make your life better or worse.

And they almost always do it by way of comparison.

Here’s Dan Neil, now the country’s best car critic at the Wall Street Journal, back when he was at the Los Angeles Times writing about the latest Jaguar XF:

The Jaguar brand is an ongoing narrative of motoring enchantment, whose solemn code is "beautiful, fast cars." In a world full of BMWs, Mercedes and Audis (and Infiniti, which makes perhaps the best car in this class), Jag has no place unless it is -- as the ad campaign says -- gorgeous.

Neil not only compares the Jaguar to competitors, it compares the 2009 XF to earlier versions of the car and other cars in the Jaguar line. If health writers could learn to think more like car writers in this regard, health consumers would be much better informed.

I wrote last week about explaining whether a treatment is truly novel. (Usually it’s not.) An extension of that is explaining how the new approach fits into the realm of existing approaches.

How do you do that?

I talked about ClinicalTrials.gov and PubMed on Friday, and those are both great sources for finding comparisons. The former will show you what treatments are being compared head-to-head by scientists right now. The latter will provide you the published literature on what works and what doesn’t.

Make comparisons early and often in a story. This doesn’t have to take up a lot of space. Kate Kelland at Reuters wrote recently about an emerging treatment for bipolar disorder and packed three great facts into her lead. She compared the new drug to the leading treatment. She told readers that the research was in the animal phase. And, by doing that, she showed readers that the drug was a long way from store shelves:

A drug for bipolar disorder that works like lithium - the most common and effective treatment - but without lithium's side-effects has been identified by British researchers in tests on mice.

Give readers a sense of the overall state of the science. Marilynn Marchione at the Associated Press did this superbly in writing about the different options for breast cancer treatment in light of new findings.

About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.

Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors—sold as Arimidex, Femara, Aromasin and in generic form—do the job with less risk of causing uterine cancer and other problems.

But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.

Later she writes about the different studies that inform choices breast cancer patients must make:

Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.

Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half—more than what was seen in the new study of 10 years of tamoxifen.

"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.

Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.

I started this post by focusing on cars. But what about riding a bike? What about lacing up those shoes and walking? What about flying, even? In my next post, I’ll write about comparing new treatments to approaches that have therapeutic value that can’t be bought with health insurance.

Have some thoughts on comparing alternatives? Send me a note at askantidote@gmail.com or via Twitter @wheisel.