Wednesday, July 26, 2006

New England Journal of Medicine: health effects of illiteracy

In today’s New England Journal of Medicine, an interesting disucssion of the impact of both general literacy and health literacy on patient’s health-related practices and involvement in their care – illiteracy referred to as a relatively “silent epidemic” in health care due to the difficulty of clinician assessment of skills and the possibility that this issue isn’t “on the radar” for clinicians given the complexity of managing the spectrum of patient care.

Reference: Marcus EN. The silent epidemic — the health effects of illiteracy. New Engl J Med 2006 Jul 27; Volume 355:339-341.

Recent media commentary on the peer review process

With recent high-profile study retractions or corrections regarding conflicts of interest and other issues in a number of prominent scientific journals, the media is paying increasing attention to the peer review process -- considering whether the process is "working" and opinions from experts regarding what problems the process can (and probably can't) catch and how it migth be improved.

Friday, July 21, 2006

Image editing in the medical literature

An editorial in the July issue of the Journal of Clinical Investigation (2006;116: 1740-1) by the journal's executive editor, Ushma S. Neill, entitled "Stop Misbehaving!" notes that the editors often find evidence of "blot doctoring" - instances in which software such as Adobe Photoshop has been used to augment contrast, sharpen images, edit out noise. The editor coments "Though several of the articles had successfully passed through the peer review process, we did not publish those papers, as the intent clearly was to deceive — and there was no way to tell whether other data had been similarly contrived."

The editorial further notes that it is not appropriate to edit multiple images of cells into one image or reuse previously published images (including those that have been cropped or otherwise edited to make them appear new or different).

The editor also points out a few other issues that seem to keep cropping across the spectrum of scientific publishing -- don't submit the same article to more than one journal at once, be transparent as possible about conflicts of interest, openly discuss authorship and attribution of a paper.

Neill concludes the editorial, "As I stated before, by and large, most of our authors are honest scientists who are indeed beyond reproach, but the pressure to "publish or perish" is felt by all researchers. It is your responsibility to consistently act ethically when performing and presenting your research. You need to be vigilant about what is being done in your laboratories, and you must foster honest and open lines of communication with your students, colleagues, and peers. Failure to do so only hinders our ability to gain true insight into physiologic and pathophysiologic processes, which is what we’re all striving to achieve."

Anonymous articles in the scientific literature

The author of the British Medical Journal's Minerva column this week comments on pros and cons of unsigned articles, noting her interest in "...the pros and cons of unsigned articles in scientific journals, which Chest (2006;129: 1395-6[Free Full Text]) has been exploring. She is sympathetic to the view that anonymity protects authors from academic or financial reprisals and that this enables honest and open comment. On the other hand, she sees the force of argument that unsigned articles violate the spirit of transparency intended to minimise, or at least reveal, potential conflicts of interest."

The Chest article concludes, "While there are modest benefits for maintaining a policy of unsigned scientific editorials, these are outweighed by the costs and harms of such a policy. Avoiding anonymity in scientific editorials will improve the transparency of the system of publication and discussion. Most leading medical journals now publish only signed editorials."

Thursday, July 20, 2006

New Institute of Medicine report - Preventing Medication Errors

Preventing Medication Errors, released by the IOM today – part of the Quality Chasm series (to see the full text, click the “Read and Purchase” link and then click the red “Read this book online, free!” link toward the top left-hand corner).

Excerpt from overview: According to one estimate, in any given week four out of every five U.S. adults will use prescription medicines, over-the-counter (OTC) drugs, or dietary supplements of some sort, and nearly one-third of adults will take five or more different medications... Preventing Medication Errors puts forward a national agenda for reducing medication errors based on estimates of the incidence and cost of such errors and evidence on the efficacy of various prevention strategies.

The report finds that medication errors are surprisingly common and costly to the nation, and it outlines a comprehensive approach to decreasing the prevalence of these errors. This approach will require changes from doctors, nurses, pharmacists, and others in the health care industry, from the Food and Drug Administration (FDA) and other government agencies, from hospitals and other health-care organizations, and from patients.

Update: FDA response to the IOM report (7/20/06) noting current and future plans to address medication error

Friday, July 14, 2006

Statistical analysis errors in the medical literature

An article in this month's Archives of Dermatology examines errors in statistical analysis and in reporting of results of such analyses in published, peer-reviewed articles from two dermatology journals during a one-year period. The investigators found that 59 papers (38.1%) contained errors or omissions related to the statistical analyses, finding that
  • 22 (14.2%) contained errors that could affect the validity of the study’s results
  • 41 (26.5%) contained errors in presentation of study results
  • 4 (2.6%) contained errors in both areas

Neville JA, Lang W, Fleischer AB Jr. Errors in the Archives of Dermatology and the Journal of the American Academy of Dermatology from January through December 2003. Arch Dermatol 2006;142:737-40.

Wednesday, July 12, 2006

More commentary on the MEDiC bill and medical malpractice

Ezra Klein at Slate magazine provides an interesting comparison/contrast of strategies by the Republican and Democratic parties to address patient safety and medical error, "The Medical Malpractice Myth: Forget tort reform. The Democrats have a better diagnosis."

Klein notes that the Republicans (led by Bill Frist, Senator from TN) seem to be focusing on limiting medical malpractice awards while the National Medical Error Disclosure and Compensation (MEDiC) legislation proposed by Democrats Hilary Clinton (Senator, NY) and Barack Obama (Senator, IL) seems to focus more on providing systems for improving patient safety and tracking medical error (previous post on this legislation).

Klein sums this contrast up by commenting "In other words, to the Republicans, suits and payouts are the ill. To the Democrats, the problem is a slew of medical injuries of which the suits are a symptom" and concludes the opinion piece with a brief examination of recent healthcare research on clinician error, which does seem to be more in line with the MEDiC strategy for a more systematic approach to reducing error and improving safety.

Update: The New England Journal of Medicine today has a piece examining the both individual and systems-level accountability for patient safety using the issue of clinician hand washing in the prevention of cross-infection among patients.

The commentary: Goldmann D. System failure versus personal accountability - the case for clean hands. New Engl J Med 2006 Jul 13; 355: 121-3.

Tuesday, July 11, 2006

More evidence to support the "healthy adherer" effect

A meta-analysis in the July 1st issue of the British Medical Journal provides additional evidence to support the existence of a "healthy adherer" effect, i.e. individuals who adhere to treatment in clinical research have improved mortality/morbidity as compared with non-adherers, even if they're only receiving a placebo therapy. The authors further note, "...adherence to drug therapy may be a surrogate marker for overall healthy behaviour."

The meta-analysis included 21 studies representing a total of 46,847 participants.

Excerpt from the abstract: "Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11)."

Reference: Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006 Jul 1;333(7557):15.