More thoughts on ASCO: How the embargo policy can lead to hype

Dr. Len, courtesy American Cancer Society

American Cancer Society deputy chief medical officer Len Lichtenfeld had a smart post last week commenting on a study presented at the American Society of Clinical Oncology (ASCO) of whether adding bevacizumab (Avastin) to standard treatments for ovarian cancer would benefit patients.

That study had been covered positively by much of the media, but Len described how Elizabeth Eisenhauer, of the National Cancer Institute of Canada and Queen’s University in Kingston,  had raised some questions about it when it was presented. I’ll leave those important details for you to read in his post, but let’s just say that Len thought her questions threw some appropriate cold water on the hype. She “concluded that more work needs to be done before this regimen can be considered as a standard treatment option for women with advanced ovarian cancer,” he wrote.

That cold water didn’t make it into most of the stories on the study. What happened? Len explained:

As is the custom at this meeting, other experts are asked to give a formal review of the presentation and provide their opinions on the significance of the results.  These discussions are not generally available to anyone beforehand, unlike the press conferences that highlight the more important studies at the meeting.  The net result is that the media hear the positive results of the study, but don’t have all the information that might balance their reports.  By the time the formal discussion is offered after the abstract presentation, the media reports have been filed and published and it’s on to the next story.  If an expert publicly pokes a hole in the study, the only ones who hear about it usually are those sitting in the audience when it happens.

So how is this an embargo issue?

When journals send out embargoed material, part of the point is to allow reporters to gather comments from researchers unrelated to the study. Nature, for example, makes a point of highlighting this in all of its releases:

Solely for the purpose of soliciting informed comment on this paper, you may show it to independent specialists – but you must ensure in advance that they understand and accept the embargo conditions.

As Len pointed out, however, what happened with the Avastin study, like many at ASCO, was that the press conference for the abstract happened significantly before the plenary session in which outside experts gave their critiques. Because the Avastin study was a “late-breaker,” its embargo lifted during a press conference on it on the morning of June 6, while the plenary didn’t take place until later that day. In today’s media landscape, hours are the equivalent of geologic epochs.

Sure, reporters could wait until the plenary to file their stories.  Some did. But if you’re working at a wire service or some other organization whose clients expect news likely to move stocks as soon as they can get it, you really can’t afford to. And that means a higher risk of hyped stories, as Len points out.

There isn’t an easy solution for this. As I wrote in late April:

We’re all a bit cautious about ASCO since people started realizing a few years ago that stock prices were mysteriously moving between the time that embargoed press material was released, and the embargo lifted. You can guess why. This is a big meeting, that has the potential to move a lot of stock prices, so the “ASCO effect” led the group to change how they release their conference abstracts.

ASCO deserves credit for thinking things through and trying to minimize the sorts of things that were happening in the run-up to their conferences. The problem Len highlights may just be an unintended consequence of their policy.

So one possibility is for ASCO to make abstracts available to other experts under embargo, so that their comments would be available at press conferences. But that would make the process more porous, and we could end up with the ASCO effect all over again.

ASCO could also embargo abstracts that will be discussed at plenaries until those plenaries. They could just do away with the press conferences, which wouldn’t be so bad if the plenaries had enough time for questions.

And of course, reporters could all hold off filing their stories until they’ve heard the plenaries, and sacrifice speed for context. I guess I wish I could say that was realistic, but I don’t think it is.

So I welcome other ideas. In the meantime, you should be reading Dr. Len’s blog, by the way, if you aren’t already. It’s always full of insight and smart takes on complicated issues, and he does a great job of unpacking studies to zoom in on what’s important — often what reporters are missing.