Fw: Corruption of medical journals

[Guest guest]

Again, I ask, can we trust our doctors to be telling us the truth, and not

" myths " ?

" Buyer beware " applies--even in the field of medicine!

Patty

----- Original Message -----

From: " ilena rose " <ilena@...>

Sent: Wednesday, September 19, 2001 5:57 PM

Subject: Corruption of medical journals

http://www.economist.com/science/displayStory.cfm?Story_ID=779761

Publication ethics

Truth or consequences

Sep 13th 2001

From The Economist print edition

Biomedical journals are agitating about the risks of corporate money

corrupting peer review. They should worry about a lot more than that

SOME of the most powerful words in print today are those in journals of

biomedical research, for they can literally wield the power of life and

death over future patients. If published clinical trials establish a drug's

safety and efficacy, doctors will eventually prescribe it. If not, it will

be relegated to the laboratory's hazardous-waste basket. Ensuring the

accurate reporting of such trials is therefore a matter of some importance.

Unfortunately, maintaining the integrity of this sort of science seems to be

getting ever more difficult. To select and revise promising papers, journal

editors have long relied on the process of peer review, in which a

manuscript is sent out for criticism to several experts in the field. If

peer review is to work, each party must fulfil its side of the bargain.

First, authors must genuinely have done the things they claim to have done,

and written the documents they claim to have written. Second, reviewers must

show that they are able to assess the research as objectively as possible.

It appears that, in too many cases, neither side of the bargain is being

kept. This weekend, several hundred researchers and medical journalists are

supposed to be gathering in Barcelona for a conference organised by the

World Association of Medical Editors on the effects of peer review on

biomedical research. Some of the findings to be presented are damning of

researchers, of reviewers and of journals themselves. Although, to their

credit, editors of medical journals are seizing every opportunity to tighten

the reins of control over biomedical research, many of the problems defy any

quick fix.

Quis custodiet ipsos custodes? [Who watches the watchmen?]

The issue topping the editorial agenda is the honesty of research that is

sponsored by drug companies to test the safety of their wares. These

companies have found that scientists at private contract-research firms can

perform drug trials far more cheaply than the academic researchers who have

traditionally been drafted in for this job. Such firms drew 60% of the

research funds spent by drug companies last year; academic scientists were

left scrabbling for the rest.

Unfortunately, the companies are saving more than money by using such hired

guns; they are also saving face. Through the use of restrictive research

agreements, drug companies often ensure that only favourable results are

published. In some cases, they not only retain the right to suppress

publication of results, they also deny the authors of papers about such

studies access to full sets of study data.

In the face of this, such authors cannot give honest accounts of the

research; nor can editors and reviewers make honest appraisals of the

results. This week, the editors of 13 top medical journals issued a

statement condemning such abuses of corporate sponsorship. The members of

the International Committee of Medical Journal Editors (ICMJE) will now

revise their publication guidelines to require that researchers disclose

their sponsors' involvement to editors when they submit articles. Some

editors will require researchers to certify that they take responsibility

for how the trial they are reporting was conducted. And authors may be asked

to declare that they had access to all trial data, and had the power to

decide whether or not to publish the trials' results.

In a sense, these rules are formal demands for things that ought to be taken

for granted. But, as a paper due to be presented at Barcelona demonstrates,

it is not even clear that authors pay enough attention to the existing ICMJE

guidelines, let alone that they will be willing to abide by extra ones.

The existing guidelines state that people on a paper's author list should

have contributed, at the very least, to the conception of a study, the

analysis of the data and the writing of the manuscript. Yet, when van

Rooyen and Goldbeck-Wood of the British Medical Journal and Fiona

Godlee of BioMed Central, a database of scientific abstracts, analysed 129

research articles submitted to the BMJ by 588 authors, they found that this

was not always the case. Depending on how strictly they interpreted the

ICMJE guidelines, between 24% and 71% of authors qualified-hardly a stellar

performance.

Horton, the editor of the Lancet, took an even looser definition of

authorship. He studied a small sample of research papers to find out if the

views expressed in those articles were accurate representations of

contributors' opinions-a basic enough requirement, one might think. He

examined in detail five papers published in the Lancet last year, and found

that contributors disagreed about almost everything, including a paper's key

findings, weaknesses, implications and future prospects.

That may not surprise anybody who has ever worked on a team project. Dr

Horton, however, also sniffed out a more disturbing trend. The contributor

who stood to gain the most credit from a publication would often erase from

the final report the weaknesses acknowledged by co-contributors. A research

paper rarely represents the opinions of all the scientists whose work it

reports, Dr Horton concludes.

Ideally, the " suppressed opinion, censored criticism and serious bias " among

contributors found by Dr Horton would be corrected by the unfettered

opinions and criticism offered by unbiased reviewers. But authors may

obstruct reviewers' judgments by leaving out important information about

their results, such as details of other similar trials. According to

research conducted by the Cochrane Collaboration, an international group

that studies clinical trials, reviewers do not seem to be up to catching

these omissions. Indeed they may be getting worse at their task.

In May 1997, a group of Cochrane researchers, led by Iain Chalmers,

investigated whether reports of trials published in the five top medical

journals adequately outlined research on other relevant trials, by studying

one month's worth of reports. Almost none of the 26 reports passed the test.

This year, the team repeated the procedure, using the 33 trials published by

these five journals in May. None of the trials put its findings in the

context of earlier trials. Four reports falsely stated that they were the

first published trial on a particular topic. Six more kept mum about related

trials. Dr Chalmers and his colleagues find that the situation has

deteriorated in the past four years.

This is strong stuff. But it may get worse. Phil Alderson and his colleagues

performed a " meta-analysis " of editorial peer review-that is, they used

published studies as their data, and applied statistical methods to the

outcomes of those studies, as though each study were a single experimental

result. They looked at the effects of peer review on various criteria,

including methodological soundness, completeness and accuracy.

Although journal editors go to great pains to ensure that authors do not

know the identity of their reviewers, or vice versa, the researchers found

that this laborious and expensive process had little impact on the

reviewers' appraisals of quality of research. When they surveyed the sum of

research on peer review, they found only scattered empirical evidence

supporting the use of editorial peer review as a mechanism to ensure quality

of biomedical research. Until better studies are conducted, peer review may

need to undergo more, well, peer review.

Copyright © 2001 The Economist Newspaper and The Economist Group. All rights

reserved.