ASCO Issues Grudging Nod of Approval for Complementary Cancer Therapies

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When I started seeing headlines that ASCO had “endorsed” certain complementary therapies for breast cancer, I was intrigued. It’s estimated that around¬†half of patients use complementary therapies in their cancer treatment, though I suspect the actual number is higher. We’ll never know for sure because it’s mostly done in secret, as saying the word “curcumin” in an oncologist’s office usually escalates to a mix of deep concern and condescension; you may hear yourself say “vitamin”, but it comes out as “sacrificing sheep to the onc-goddess.” Is this witchcraft coming into the light? I clicked.

“Music therapy.” “Relaxation.” “Yoga.” ASCO concurs that these interventions, as evaluated by the Society for Integrative Oncology and published in their 2017 guidelines, are “safe” for ameliorating side effects in patients undergoing breast cancer treatment. This is no ordinary “safe”, either. While I appreciate the effort to stratify the various complementary modalities based on evidence, which should clarify the vitamin/animal sacrifice distinction, the SIO screened for interventions based on the existence of a confirmatory RCT. These results were then held to an outrageous standard; an “A” rating (i.e, one voodoo doll out of five) meant that there was a “high certainty that the net benefit is substantial”. I don’t think my Tykerb meets that standard.¬† Continue reading “ASCO Issues Grudging Nod of Approval for Complementary Cancer Therapies”

It’s not just Baselga

One of the most intriguing parts of the ProPublica/New York Times piece on Jose Baselga’s persistent, ahem, irregularities in disclosing industry relationships was the section where he reviewed a list of his own publications and provided the reporters with a color-coded document explaining why he did or did not disclose certain relationships. This document also included a selection of the publications whose disclosures he plans to correct, which represented a fraction of the total (and I don’t think it’s lost on anyone that the further we scroll down the list, the fewer publications we see coded as properly disclosed, with no additional qualification). 

I don’t need to affirm that scientific work needs to include proper disclosures, and I can’t imagine anyone who has had any contact with Big Cancer was surprised by this article. It’s probably unfair to say that it could have been anyone, but effectively, it could have been anyone, and if you’re writing this piece, Baselga is absolutely where you start. He is as flagrantly corporate as they come, and his baffled response to the accusations (“Asked if he planned to correct his disclosures, Baselga asked reporters what they would recommend.” He said that, seriously?) seems to suggest that he really didn’t see this coming. I can believe it, especially when you factor in the extent to which MSKCC has institutionalized its industry relationships.    

This is not to defend Baselga or to minimize the failures to disclose, which can be attributed to laziness or stupidity or deliberately obscuring financial relationships, which are likely all at least occasionally true, depending on the publication in question. None of those reasons are good, and all tie to character. But there’s nothing about this that’s personal to him; the issues of conflict and bias exist for everyone, and the only thing that Baselga and his Word doc personally remind us of is the belief that disclosure is optional or the relationships themselves a matter of interpretation. Business drives patient care in these big-center settings, and that’s not going to change. So how can our conflict reporting rise to reality?

If you start clicking around on ASCO abstracts this year (no particular reason it’s ASCO, just an easy way to spot-check for these issues) you can see the huge variability in what authors report. Some don’t seem to think the travel category applies to them. Some have so much detail that there are little narratives – “we’re working on a patent for [whatever]”. There’s similar inconsistency in whether institutional funding gets reported. There’s also an “other relationship” category that pops up sometimes, which … I have no idea what that means. And of course you get the Baselga version, which was basically blank. Yup, no red flags there. He clearly did all that taselesib work for free. 

The point is that it’s entirely left up to author discretion. There are no checks. It doesn’t matter that they got paid; these people didn’t take vows of poverty when they became physicians, and they do the work (I’m sure all that enthusiasm for taselisib did not come easy), so pay them. But they must be required to report it, cleanly and consistently, and not in a half-assed but-it’s-the-rule way, which does not work. We know they don’t care. The phrase you hear over and over at the start of slide presentations at conferences is, “I have no relevant disclosures.” I’m glad you think that. That wasn’t the question. Then there are the blanket “No disclosures” people, which no one believes (who paid for the work? Who paid for your flight?), and there doesn’t seem to be a mechanism to challenge that.

In a perfect world, the submission pages for journals and conferences would link to your OpenPayments profile. Would that be impossible to implement? It’s impractical for society and editorial staff to check every single entry on every single author, but could OpenPayments fulfill its commitment to transparency and make it possible to port data out? Proper disclosure has any number of forces working against it, but it would help if it were easy and automated. I get that the nature of the physician filling out his own form is that it’s an opportunity to differentiate between a $200k consulting relationship and some biotech that bought him a $9 sandwich two years ago, but until there’s a better way – that sandwich is on the record, for the good of science and his own integrity. 

This is a systemic issue, and Baselga is having an example made of him. He deserves it. But it’s not about him, and hopefully this is a public shaming that moves Baselga and his peers away from the idea that compliance is optional, trivial, a matter of preference rather than a professional obligation.