Wednesday, March 6, 2013

Forwarded almost without comment

This story from Reuters is outside of my area of expertise so I'm just going to make this blanket recommendation. This is a solid piece of reporting on the not easy-to-cover fields of epidemiology, biostatistics and the economics of health care.

Special Report: Behind a cancer-treatment firm's rosy survival claims

Edit (Joseph): Andrew Gelman correctly points out that the authors are Sharon Begley and Robin Respaut.  This report is useful to me as another reason that we need to have a control arm for randomized trials.  It isn't enough to know what the rate is for conventional care and contrast a novel therapy with it.  You need to also account for the selection effects among the population receiving the novel therapy.  Randomization is a very nice way to accomplish this outcome in a generally understood manner. 


  1. Mark:

    This is a pet peeve of mine but I'll say it again. Sure, it's a story from Reuters, but "Reuters" didn't write it. The authors are Sharon Begley and Robin Respaut.

    I would not like it if people cited my work as "an article from the Journal of the American Statistical Association" or "a book from Chapman and Hall." I think the authors deserve some credit!

    Also, in this case the author names are relevant, in that Sharon Begley is an award-winning science reporter.

    1. Andrew,

      For the typical reader, I think publication is generally more valuable than author for articles.

      That said, exceptionally good or bad work should be called out by name both to add to the meta data and to give credit where credit is due.

      This is certainly one of those cases. I'll update the post this evening.

  2. I added a postscript, but feel free to delete it if you prefer updating in a different manner.

  3. Though it was not mentioned in the article, it's worth noting that most cancer centers also report a "lost to follow up" or LTF rate with their survival rates.

    It is not uncommon once a patient achieves remission for them to stop keeping follow up appointments, move, or otherwise lose contact with their treatment center.

    Additionally, there is also a presumption that a certain number of these patients have actually died and that it is their relatives who are not answering the phone. It is normally assumed that the mortality rate in the LTF group is higher than in the group of patients who are still reporting.

    I went on CTCAs website to see if they reported such a number, and they do not. They do put a disclaimer that they "exclude any patients who are missing part of their medical record", which I would imagine would include the LTF group, but it's distressing they don't give a percentage for how many patients that entails.

    Everyone experiences a certain percentage of LTF patients, so a number too high or too low in this group is one of the first red flags we look for when figuring out if centers are trying to juke their stats. Too low and you suspect they cherry picked very motivated patients, and too high and you presume they're being sloppy. The fact that CTCA reports nothing makes me incredibly suspicious.

    For years teachers have complained that reforms have changed their job in to "teaching to the test", I think we all have to be on the lookout for hospitals that start "treating for the stats"...especially for-profit centers like CTCA.