Physicians and patients: A changed dynamic
Senior physicians who are often sources for medical media coverage are (left to right): Lawrence Shulman, M.D.; Stephen Sallan, M.D.; Robert Mayer, M.D.; and Eric Winer, M.D.
Winer: "I don't think we really have a sense of how our patients react to stories in the media. I remember when the Endostatin news first broke and 'Nightline' was here for a few sound bites. I expected patients to say, 'We're devastated when we hear these things and they turn out not to be real.' Instead they said, 'This makes us feel hopeful. We understand much of this is hype and won't be helpful to me, but it still makes me feel like things are moving forward.'"
Shulman: "Our patients are individuals who react differently, but I'm sure you've had similar experiences when patients bring newspaper articles with the hope they're giving you news you didn't know about. Many feel that if you'd just get the treatment for them, they'll be cured with this magic bullet. When you tell them you don't think so, and the reasons why you don't, it can be pretty devastating. Some patients have a good perspective, but others are on an emotional yo-yo, seeing what's on TV or in print."
Eric Winer, M.D., listens as Lisa Diller, M.D., makes a point.
Sallan: "I think the public knows the difference between hype and non-hype, but the more desperate you are, the more likely you are to say something isn't hype."
Joffe: "People are now getting used to seeing significant scientific advances, such as the Human Genome Project. The clinical application is years away, but those who see news about it every day want to know the benefit to patients. Substantial amounts of laboratory science never pan out for patients. There's usually a caveat in the second-to-last paragraph of most articles that says so, but it tends to get lost amid all the excitement."
Sallan: "It's not surprising the public has misperceptions. If you ask around Dana-Farber about the value of the genome project, for example, you will get some people estimating that patients will first see benefits in 2003, and others who say it won't be until 2030. That's a wide spectrum for people working in the field so imagine how confusing it is for those who aren't."
Shulman: "We really don't know what most of these genes are. Statistically, an incredibly small number of laboratory experiments are ever successful in human beings. Many things cure cancer in mice, but very few will actually benefit humans. Can we get the news media to put that caveat in every TV report and article? Probably not, but that is certainly the reality."
Lisa Diller, M.D. (left), and Ann Partridge, M.D.
Diller: "Physicians can become the bad guys because we're often advocates of traditional therapy rather than supporters of the latest treatments. The public perception can be that we're cautious, conservative, and slow-moving. They often think, 'If it's out there, why don't we try it?'"
Partridge: "But not going slowly puts patients at risk. If we did not go through the clinical trials process carefully and thoughtfully when developing and testing promising treatments, we'd put a lot of patients in jeopardy. There are numerous examples of that in recent years."
Sallan: "Another current factor is the Internet, where you have real data, scientific data, right next to National Enquirer stories. There's no editor, and no op-ed page. It's just you, with everything coming in. Increasingly, physicians are becoming editors for patients who may bring in something that's valid, along with something that's unreal, and they might not know the difference."
Diller: "I get requests from patients who ask, 'Can you speak to this doctor and find out what his latest data is? Can you call this one and see if there are openings in his trial?' I handle it in the most efficient way possible. I send an e-mail to people who I know have reputable Phase I trials to find out about their openings. But it can disrupt the doctor-patient relationship. I'm advocating the best I can for my patient. If I thought Trial X was going to cure the patient, Trial X it is."
Winer: "At the same time, I don't think we ever want patients to perceive us as people they can't question — that somehow we think we know all the answers, because we don't. There's a fine line between being open to answering questions about a stack of articles, and wanting people to trust the fact that we do know a lot about these diseases."
