Interesting post by the Retraction Watch blog, pointing to an interesting paper published last week in the Annals of Emergency Medicine. An excerpt from the blog post:
Over 14 years, 84 editors at the journal rated close to 15,000 reviews by about 1,500 reviewers. Highlights of their findings:
…92% of peer reviewers deteriorated during 14 years of study in the quality and usefulness of their reviews (as judged by editors at the time of decision), at rates unrelated to the length of their service (but moderately correlated with their mean quality score, with better-than average reviewers decreasing at about half the rate of those below average). Only 8% improved, and those by very small amount.
How bad did they get? The reviewers were rated on a scale of 1 to 5 in which a change of 0.5 (10%) had been earlier shown to be “clinically” important to an editor.Read more »
Dr. Carl Elliott writes about ghostwriting in the December issue of The Atlantic magazine, “Playing Doctor: How to spin pharmaceutical research.” He profiles a young scientist (“David”) who became a ghostwriter about 10 years ago.
Excerpts:
“Ghostwritten articles surface again and again in litigation (in cases concerning Vioxx, Fen-Phen, Zyprexa, Premarin, Neurontin, and Zoloft, to mention just a few). Years before the Avandia scandal, GlaxoSmithKline paid $2.5 million to the State of New York to settle a lawsuit alleging that it had concealed studies suggesting an increased risk of suicidal behavior in children and teenagers taking Paxil, most notoriously in an article “authored” by Dr. Martin Keller of Brown University. One 2003 study in The British Journal of Psychiatry found that ghostwriters working for a single medical-communications agency had produced more than half of all medical-journal articles published on Zoloft over a three-year period.
To many critics, the moral outrage of ghostwriting is like that of plagiarism: academic physicians are getting credit for articles they didn’t actually write. To David, letting someone else take the credit for his work is a minor humiliation. The real problem, of course, is much worse: spinning data perverts science. It also downplays risks that can lead to serious injuries, and deaths. As David puts it, “The moral crime I was being asked to commit was to do with truthfulness.”Read more »
Last week, after the National Lung Screening Trial results were released, David Sampson, American Cancer Society director of medical and scientific communications, wrote that “our greatest fear was that forces with an economic interest in the test would sidestep the scientific process and use the release of the data to start promoting CT scans. Frankly, even we are surprised how quickly that has happened.”
And, yes, the marketing has even hit fly-over country in the Twin Cities, with this ad appearing in the Sunday MinneapolisStar Tribune in the “A” section:
Of course, no where in the ad will you read about the potential harms of such scans, the false positive rate, what happens when you get a false positive (unnecessary followup testing and perhaps unnecessary treatment), and more costs. And nowhere in the ad will you read that 300 heavy smokers had to be scanned in order for just one to get a benefit of extending his life. But six clinics in this chain are standing by to take your money and do your scan.
Take medical uncertainty. Add financial incentive to treat. Voila! Increased utilization. Now take away financial incentive to treat. Guess what you get?
Medicare accomplished what clinical guidelines and evidence-based medicine couldn’t: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.
Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.
“Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy,” Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.
“The corollary is that reimbursement policies should be carefully considered to avoid providing incentives for care for which no clear benefit has been established. The extreme profitability of the use of gonadotropin-releasing hormone (GnRH) agonists during the 1990s probably contributed to the rapid growth in the use of ADT for indications that were not evidence-based.”
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