Monday, April 4, 2011

Richard Smith's advice to scrap peer review and wariness of “top journals

Richard SmithThe neurologist and epidemiologist Cathie Sudlow has written a highly readable and important piece in the BMJ exposing Science magazine’s poor reporting of a paper on chronic fatigue syndrome, (1) but she reaches the wrong conclusions on how scientific publishing should change.

For those of you who have missed the story, Science published a case control study in September that showed a strong link between chronic fatigue syndrome and xenotropic murine leukaemia virus-related virus (XMRV). (2) The study got wide publicity and was very encouraging to the many people who believe passionately that chronic fatigue syndrome has an infectious cause. Unfortunately, as Sudlow describes, the study lacked basic information on the selection of cases and controls, and, worse, Science has failed to publish E-letters from Sudlow and others asking for more information.

In the meantime, three other studies have not found an association between chronic fatigue syndrome and XMRV. (3-5)

To avoid such poor reporting in the future Sudlow urges strengthening the status quo—more and better prepublication peer review. Not only is she trying to close the stable door after the horse has bolted she has also failed to recognise the possibilities of the new Web 2.0 world. The time has come to move from a world of “filter then publish” to one of “publish then filter”—and it’s happening.

Prepublication peer review is faith based not evidence based, and Sudlow’s story shows how it failed badly at Science. Her anecdote joins a mountain of evidence of the failures of peer review: it is slow, expensive, largely a lottery, poor at detecting errors and fraud, anti-innovatory, biased, and prone to abuse. (6 7) As two Cochrane reviews have shown, the upside is hard to demonstrate. (8 9) Yet people like Sudlow who are devotees of evidence persist in belief in peer review. Why?

The world also seems unaware that it is scientifically dangerous to read only the “top journals”. As Neal Young and others have argued, the “top journals” publish the sexy stuff. (10) The unglamorous is published elsewhere or not at all, and yet the evidence comprises both the glamorous and the unglamorous.

The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant is simply false. People who do systematic reviews know this well. Anybody reading only the “top journals” receives a distorted view of the world—as this Science story illustrates. Unfortunately many people, including most journalists, do pay most attention to the “top journals.”

So rather than bolster traditional peer review at “top journals,” we should abandon prepublication review and paying excessive attention to “top journals.” Instead, let people publish and let the world decide. This is ultimately what happens anyway in that what is published is digested with some of it absorbed into “what we know” and much of it never being cited and simply disappearing.

Such a process would have worked better with the story that Sudlow tells. The initial study would have appeared–perhaps to a fanfare of publicity (as happened) or perhaps not. Critics would have immediately asked the questions that Sudlow asks. Instead of hiding behind Science’s skirts as has happened, the authors would have been obliged to provide answers. If they couldn’t, then the wise would disregard their work. Then follow up studies could be published rapidly.

Unfortunately, unlike physicists, astronomers, and mathematicians, all of whom have long published in this way, biomedical researchers seem reluctant to publish without traditional prepublication peer review. In reality this is probably because of innate conservatism and the grip of the “top journals” who insist on prepublication review, but biomedical researchers often say “But our stuff is different from that of physicists in that it may scare ordinary people. A false story, for example, “Porridge causes cancer” can create havoc.”

My answer to this objection is that this happens now. Much of what is published in journals is scientifically poor—as the Science article shows. Then, many studies are presented at scientific meetings without peer review, and scientists and their employers are increasingly likely to report their results through the mass media.

In a world of “publish then filter” we would at least have the full paper to dissect, whereas reports in the media even if derived from scientific meetings, include insufficient information for critical appraisal.

So I urge Sudlow, a thinking woman, to reflect further and begin to argue for something radical and new rather than more of the same.

1. Sudlow C. Science, chronic fatigue syndrome, and me. BMJ 2010;340:c1260

2. Lombardi VC, Ruscetti FW, Das Gupta J, Pfost MA, Hagen KS, Peterson DL, et al. Detection of an infectious retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome. Science 2009;326:585-9.

3. Van Kuppeveld FJM, de Jong AS, Lanke KH, Verhaegh GW, Melchers WJG, Swanink CMA, et al. Prevalence of xenotropic murine leukaemia virus-related virus in patients with chronic fatigue syndrome in the Netherlands: retrospective analysis of samples from an established cohort. BMJ 2010;340:c1018.

4. Erlwein O, Kaye S, McClure MO, Weber J, Willis G, Collier D, et al. Failure to detect the novel retrovirus XMRV in chronic fatigue syndrome. PLoS One 2010;5:e8519.

5. Groom HC, Boucherit VC, Makinson K, Randal E, Baptista S, Hagan S, et al. Absence of xenotropic murine leukaemia virus-related virus in UK patients with chronic fatigue syndrome. Retrovirology 2010;7:10.

6. Godlee F, Jefferson T. Peer Review in Health Sciences. 2nd ed. London: BMJ Books; 2003.

7. Smith R. Peer review: A flawed process at the heart of science and journals. J R Soc Med 2006;99:178-182.

8. Jefferson T, Rudin M, Brodney Folse S, Davidoff F. Editorial peer review for improving the quality of reports of biomedical studies. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: MR000016. DOI: 10.1002/14651858.MR000016.pub3 

9. Demicheli V, Di Pietrantonj C. Peer review for improving the quality of grant applications. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: MR000003. DOI: 10.1002/14651858.MR000003.pub2 

10.  Young NS, Ioannidis JPA, Al-Ubaydli O, 2008 Why Current Publication Practices May Distort Science. PLoS Med 5(10): e201. doi:10.1371/journal.pmed.0050201

Competing interest: RS is on the board of the Public Library of Science and an enthusiast for open access publishing, but he isn’t paid and doesn’t benefit financially from open access publishing.

I got this from Ves Dimov's tweet this morning and read the blog entry. This has been debated for a long time in different circles about doing better than relying on pre publication peer review as a means of quality control. Ron LaPorte et al wrote in "Scientific Journals are ‘faith based’: is there science behind Peer review?" (see here http://goo.gl/lHULk) that this was due to (I quote verbatim) because of the "almost non-existent use of the scientific method to question and test the publication process itself". This brings back the old debate of using scientific methods to question the process of science publication itself. A good post and worth reading and discussions.

Carl Heneghan's selection of top ten most influential Epidemiological studies

I’ve created a list of what I think are the top ten the most influential epidemiological studies – I’m looking for feedback to see what folk think.

Therefore, if you believe there should be something different on the list then can you post a comment. Rules are it has to be a clinical study that involves people, which excludes basic sciences. In addition the study has to have subsequently influenced the field significantly.

1954
Doll Richard, Bradford Hilly A (June 26, 1954). "The mortality of doctors in relation to their smoking habits. A preliminary report". British Medical Journal 1 (4877): 1451–55. PMID 13160495

1994
Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients BMJ. 1994 Jan 8;308(6921):81-106. PMID 8298418

1989
Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989;321:406-412. PMID 2473403

1948
MRC Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment of pulmonary tuberculosis. BMJ. 1948;ii:769–783. James Lind summary

1954
Thomas Francis, Robert Korn, et al. "An Evaluation of the the 1954 Poliomyelitis Vaccine Trials." American Journal of Public Health 45 (1955), 50 page supplement with a 63 page appendix. The salk vaccine trials

1994
Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study Lancet 1994; 344 1383-1389 PMID 7968073

1998 (now retracted)
The Editors Of The Lancet (February 2010). "Retraction--Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children". Lancet 375 (9713): 445. doi:10.1016/S0140-6736(10)60175-4. PMID 20137807.

1976
Bonadonna G, Brusamolino E, Valagussa P, Veronesi U. Adjuvant study with combination chemotherapy in operable breast cancer. Proc Am Assoc Cancer Res Am Soc Clin Oncol 1975;16:254-and N Engl J Med. 1976 Feb 19;294(8):405-10. PMID 1246307

1950
Thomas R. Dawber, M.D., Gilcin F. Meadors, M.D., M.P.H., and Felix E. Moore, Jr., National Heart Institute, National Institutes of Health, Public Health Service, Federal Security Agensy, Washington, D. C., Epidemiological Approaches to Heart Disease: The Framingham Study Presented at a Joint Session of the Epidemiology, Health Officers, Medical Care, and Statistics Sections of the American Public Health Association, at the Seventy-eighth Annual Meeting in St. Louis, Mo., November 3, 1950.
Framingham Heart Study

1855
On the Mode of Communication of Cholera by John Snow, M.D.
London: John Churchill, New Burlington Street, England, 1855 On the Mode of communication of cholera

Look forward to seeing what you think
you can post it to me on twitter
@cebmblog

Cheers Carl

Interestingly almost all the studies were either randomized trials or cohort studies (Framingham study).

Sunday, April 3, 2011

No genius plays only for himself

An excellent commentary on the recent Indian world cup win from Akbar.


Byline by M J Akbar: No genius plays only for himself .

The difference between the Indian team that won the World Cup in 1983 and the one in 2011 is an uncomplicated one: the economy. The 1983 victory was a consequence of talent, extraordinary self-belief and some luck. In 2011 the Indian cricket team is by far the richest eleven in the game, sucking the oxygen out of other sports, a template for ambition in homes across the small cities that will become the Delhis and Mumbais of tomorrow, a magnet for middle class and rural India which understands that the distance from obscurity to superstardom is a game that bypasses the educational demands of conventional professional upward mobility, and fetches rewards quite outside the zone of merit and salary. Cricket has become a supreme totem pole of the Indian economy both on an individual as well as a collective level, a classic instance of the virtuous cycle in which money breeds success and success generates greater profits. India begins with a substantial advantage over the other cricket teams of South Asia. Victory and defeat are determined of course by the human element, otherwise sport would be too dull to bother about; but the institutional spread offers both a massive pool of talent as well as the motivation that only an exploding bank account can bring. Yusuf Pathan cannot find a place in the final eleven, but is nearly Rs 10 crores richer out of the IPL which will follow the World Cup. He was born in circumstances where such a figure was beyond imagination.

How much better, therefore, would the brilliant players of Pakistan and Sri Lanka have been had they had the good fortune of such an economy to hone and add lustre to their superb capabilities? The tragedy of a negative environment is profound: when Pakistan players make a mistake (and they made too many in the semi finals against India to be forgiven) cruel whispers of match-fixing swirl around. The post-match talk is all about whether the Pak interior minister had been briefed by his intelligence agencies when he publicly warned the team about throwing the game away against India. The logic is mathematical, rather than moral. There is immediate and continuing monetary reward for an Indian player which makes the risk involved in a fix a stupid option. A crook might be able to continue playing cricket, but no crook is going to get paid to appear on an advertising billboard. But if a player is in the unenviable situation where cash from illegal betting is higher than legitimate earnings, temptation will always hover inside the dressing room. It hardly helps that some Pakistani players were recently caught making deals with bookies, despite high levels of vigilance imposed by ICC. In Mohali, the Pakistan captain Shahid Afridi won millions of Indian hearts when he accepted the adversity of defeat amid a cloud of inevitable suspicion, with the grace of a great champion: how much more would his genius have flowered if he had lived in a more stable age of Pakistan's history!

The tortured internal conflicts within Muralitharan's soul can barely be imagined: a Tamil who got an impossible 800 Test match wickets playing for Sri Lanka during decades shredded by a civil war between a Sinhala-majority government and the Tamil Tigers. Did the ferocity in his eyes belong to inner demons? If they did, he is a man of great character, for he silenced them through a display of commitment to his team and flag that has made him a hero of his nation. No genius plays only for himself: talent might belong solely to the self, but withers when it becomes selfish. Murali, or Sachin Tendulkar have achieved much more than their ability warranted because they also surrendered their genius to a higher, national cause. Neither needed to be captain to prove they were superior; the responsibilities of captaincy diminished Sachin. Those of us who delight in cricket should consider ourselves blessed because we will see, on Saturday, the finest batsman in history compete with the greatest spinner ever born in a match of wits that could define which side will take the cup. This is obviously written before the result, but the result is only going to be a statistic. A statistic has no place in an epic. We shall see the last, dazzling burst of meteors that have enflamed our firmament.

So far, Sri Lanka have been the best team in the tournament. They have been so good with the bat that we do not know how good, or indeed how fragile, they are down the line. The partisan within me admits this reluctantly, but the past is, in such an event, irrelevant to the present. Murali will bowl his last ball in a World Cup, and Sachin stroke his final off-drive through a motionless field. Those are memories that will mature into magic as we weave our own way to our last days.