Alex Trebek’s ‘near remission’ story serves as a reminder: Beware celebrity health news

By | November 1, 2019

In People magazine’s latest cover story, Alex Trebek said his advanced pancreatic cancer is in “near remission.”

People portrayed this as a dramatic turnaround:

When Jeopardy! host Alex Trebek was diagnosed with stage 4 pancreatic cancer three months ago, fans were shocked. But now the beloved Trebek has good news to share: He’s in “near remission,” according to doctors.

“It’s kind of mind-boggling,” the 78-year-old says, in PEOPLE’s new cover story. Although the cancer has a 9 percent survival rate, Trebek has been responding very well to chemotherapy. “The doctors said they hadn’t seen this kind of positive result in their memory…some of the tumors have already shrunk by more than 50 percent.”

What’s really mind-boggling is how news organizations across the country ran with this “good news” story without holding it up to scrutiny.

Instead of fact-checking, there was cheerleading.

The People editor who wrote the story called Trebek’s progress “miraculous.” ABC’s chief medical correspondent, Jennifer Ashton, MD, breathlessly declared his tumor shrinkage “a big win.”

Boston’s NPR station, WBUR, reported that Trebek’s story reflects “significant progress” in treating pancreatic cancer, while the Boston Herald quoted a doctor who said it “provides hope to others” who have pancreatic cancer.

Few news organizations asked what “near remission” might actually mean, or whether tumor shrinkage significantly improves a patient’s chances of survival.  Largely missing in the coverage were cautions that even complete remission does not equal cure, and tumor shrinkage does not always correlate with longer life.

“In my opinion it is far too early to get all gaga optimistic,” cautioned John James, a retired toxicologist and founder of Patient Safety America, who said tumor shrinkage is “a long way from a cure in pancreatic cancer.”

Celebrities can use their powerful platforms to educate and inspire, and Trebek has drawn praise for talking openly about the side effects of chemotherapy and his “surges of deep, deep sadness.”

But celebrity heath news — whether about every other year colonoscopy “parties” hosted by Steve Martin and Martin Short, Angelina Jolie’s breast cancer, or Ben Stiller’s advice on prostate cancer screening — can also misinform.

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Reality checks

A few news organizations provided much-needed context by interviewing oncologists. Fox 10 in Phoenix reported that a full remission is “not very likely” for Trebek (despite its news anchors’ description of Trebek’s chemo response as “truly incredible” and “amazing”). Prevention magazine quoted a specialist who said “advanced stage pancreatic cancer is basically incurable.”

In a Twitter thread, surgical oncologist David Gorski, MD, managing editor of the website Science-Based Medicine, called Trebek’s results “a good initial response, nothing more.”

Gorski said he hopes Trebek is among the “rare” pancreatic cancer patients who survive for a long time.

Painting an ‘upbeat’ picture

It’s a mistake to view emotional anecdotes as evidence of a benefit.

If an individual improved after receiving a treatment, it does not necessarily mean that the treatment caused the improvement, or that other people receiving the same treatment will also improve,” said Mary O’Keeffe, a postdoctoral researcher at the University of Sydney who is part of Wiser Healthcare research collaboration, via email.

That may be especially true when it comes to celebrities. Like anyone, celebrities can find it hard to face their own mortality, said Barron Lerner, MD, an internist and faculty member at the NYU School of Medicine who’s written extensively about celebrities and illness. But in their quest to please the public, they also can “tend to paint a very upbeat picture in general and use language like ‘fighting’ and ‘beating.’”

With Trebek’s account, Lerner said: “I think you have to be careful. He’s not giving you scientific data. He giving you a story of how it’s going with him at the moment.”

Journalist Sue Rochman, who covers cancer and has served on our review team, said via email:

There is nothing wrong with optimism and hope following a cancer diagnosis. And who doesn’t want to be optimistic and hope that Alex Trebek’s pancreatic cancer will respond to treatment? Unfortunately, how he is describing his response — or at least how that response was relayed by People magazine — doesn’t add up to journalists who cover cancer. Having tumors shrink in response to treatment makes sense; calling this a “near remission” does not.

Unrealistic expectations

For people with cancer, rah-rah news coverage might create unrealistic treatment expectations.

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Andrae Vandross, MD, a hematology-oncology specialist at UCLA Medical Center who has been a member of the review team, said via email:

I always worry about this type of reporting leading to patients thinking that the famous are getting “better” treatment. If my patient is not having the same response as Mr. Trebek, she may think that I’m not offering or am not aware of the “better” therapy.

In reality it may be that Mr Trebek has a tumor that happens to have a favorable response to standard treatment based on its inherent biology.

Without more detailed information about Trebek’s treatment, Vandross said, “we can’t know if the standard therapies are just working really well for Mr. Trebek, or if he is getting an ‘off label’ therapy,” a treatment that hasn’t been FDA-approved to treat pancreatic cancer. He said news stories could have provided “the basic landscape of what the typical responses to chemotherapy for advanced pancreatic cancer are.”

O’Keeffe also worries about people who are “hopping on” to Trebek’s positive story to praise new treatments for pancreatic cancer.

They seem to be using a testimonial as evidence of therapy effectiveness for a condition which has a poor prognosis. This is misleading. The journalists may improve their reporting by admitting that this is a story from one person and this does not provide evidence that late-stage cancer is curable.

Remembering Farrah Fawcett

Some news organizations have been observing the 10-year anniversary of the death of Farrah Fawcett, who shared publicly what she called her “private war” against aggressive cancer. She allowed the filming of her two years of excruciating treatments — chemotherapy, radiation, drugs, surgeries, and unproven “alternative” therapies.

There’s a parallel between Fawcett’s determined statements and Trebek’s on-air pledge to “beat the low survival rate statistics for this disease.”

Some believe celebrities’ use of such battlefield language may encourage other patients to engage in painful and prolonged treatment regimes that distract them from making the most of the time they have left.

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It’s also risky to portray remission as a victory. In 2007 Fawcett’s medical team declared her “cancer free,” only to see tumors return in less than four months. In 2014 AARP’s website included soul singer Sharon Jones in a listicle of “12 Celebrities Who Beat Cancer.” Two years later, Jones died of pancreatic cancer.

Discussing the end of life

“I wonder why celebrities put out statements about their health, and who these statements serve,” said Sunita Puri, MD, medical director of palliative care at Keck Hospital and Norris Comprehensive Cancer Center of USC. She is the author of That Good Night: Life and Medicine in the Eleventh Hour.

The myth that stopping treatment means giving up blocks rational discussion of what the end of life should look like, Puri said. She’d like journalists to ask Trebek — and other celebrities with fatal illnesses — “about what quality of life would mean the most to him, and what his lines in the sand would be” with continuing treatment.

“If he said, ‘I am having discussions with my family about my wishes when my disease worsens,’ that could potentially normalize these sorts of conversations and inspire others to have them as well,” she said. “I have not seen a celebrity doing that to date.”

Addendum on September 18, 2019:

Yesterday Trebek announced: “This summer, because I was making such good progress, we thought I was finished with chemo. That was a bit premature and certainly overoptimistic. I began immunotherapy, but that didn’t go well. My numbers went south — dramatically and quickly. …One of the things I have learned in the past six months is that the course of pancreatic cancer treatment is not a straightforward affair. There are always curves and unexpected events.”

We are sorry to hear of Trebek’s setback.

But we hope that journalists who were so quick to call his early treatment “miraculous” will learn from this followup news just 3 months later. It’s another opportunity to learn about the pitfalls of jumping on celebrity health news.

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