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NLST article not balanced, critic of screening trial asserts

NLST article not balanced, critic of screening trial asserts


The story "Researchers defend NLST protocol against its critics" (ONI, January 2008, page 14) quoted three individuals in the United States who strongly support the NLST [National Lung Screening Trial] and no one on the other side of the issue.

The article should have noted that two of the NLST investigators quoted (Drs. William C. Black and Denise R. Aberle) have taken money from tobacco companies for expert witness testimony or reports in medical monitoring lawsuits designed to compel the tobacco industry to pay for lung cancer screening of their customers/victims.

Peter Bach, MD, who was also quoted, should have been identified as a senior consultant to the director of the Centers for Medicare & Medicaid Services (CMS), the government entity that would have to pick up the check for lung cancer screening of high-risk individuals if it became standard practice.


Problems with the control arm

A more balanced news story would have pointed out that the randomized controlled study is only "golden" when it is properly designed. The NLST is not properly designed.

The experimental intervention (low-dose spiral CT in this case) should be compared with the current standard (zero screening) as in the NELSON trial, rather than an intervention that is not currently utilized, ie, chest x-ray (CXR).

The National Cancer Institute is crystal clear in its repeated recommendation that chest roentgenograms are considered ineffective and should not be used for population lung cancer screening. The NLST design improperly violates this principle and utilizes CXR as a screening arm.

This is bad science! And contrary to Dr. Black's assertion, it does make a major difference in the statistical power of the NLST trial. In fact, it may guarantee a false-negative result.


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