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The BMJ Today: Practising what you preach, corporal punishment, and scientific misconduct

29 Sep, 15 | by BMJ

data_share• Walking the walk?
Drug and device manufacturers have been keen to publicise their rhetoric to share clinical trial data, but is it happening in practice? Mayo-Wilson and colleagues found out by asking Astra Zeneca for data from trials about quetiapine. After 9 months of correspondence their request was declined. Is this a typical scenario? We want to hear your experience of the processmore…

Richard Smith: If Volkswagen staff can be criminally charged so should fraudulent scientists

28 Sep, 15 | by BMJ

richard_smith_2014A man who steals a milk bottle may face a criminal charge. In contrast, a scientist who invents data, defrauds funders, and publishes fabricated data that may lead to patient harm is highly unlikely to face criminal charges. The news that Volkswagen staff may be criminally prosecuted for manipulating emission tests raises again the question of whether scientific fraud should be a criminal offence.

I’ve blogged on this before, arguing that there are three main arguments for making scientific misconduct a criminal offence. Firstly, it’s no different from financial fraud, which is a criminal offence, in that resources (often public funds) are misused. Secondly, universities are poor at conducting investigations and gathering evidence, whereas it’s an everyday job for the police. Thirdly, universities and other employers of researchers face a painful conflict of interest in exposing one of their researchers as fraudulent and have often failed to properly investigate, punish, and put the record straight. more…

The BMJ Today: Diagnosing miscarriage and IBS

28 Sep, 15 | by BMJ

empty_gestational_sac• When is it safe to diagnose a miscarriage?

There has been some debate about miscarriage diagnostic criteria over past years, with evidence emerging in 2011 that criteria at the time might be too liberal. Newer 2013 criteria were more conservative, but are they conservative enough? This week The BMJ published a large multicentre prospective observational study by Preisler and colleagues and an accompanying editorial questioning when it is OK to make the call on miscarriage. The study includes data from 2558 women from seven centres across the UK and concludes that “recently changed cut-off values of gestational sac and embryo size defining miscarriage are appropriate and not too conservative but do not take into account gestational age. Guidance on timing between scans and expected findings on repeat scans are still too liberal.” The authors call for miscarriage protocols to be reviewed to avoid putting viable pregnancies at risk. more…

Richard Lehman’s journal review—28 September 2015

28 Sep, 15 | by BMJ

richard_lehmanNEJM 24 Sep 2015 Vol 373
1220 I suspect that good randomized trials of common procedures are difficult to do. Each French doctor probably has a favourite way of gaining central venous access, probably dependent on how they were first taught. But in this trial they were commanded to use the femoral, jugular, or subclavian route according to permuted-block randomization with varying block sizes. Who would dare to do otherwise when supported by funds from the French Ministry of Health Programme Hospitalier de Recherche Clinique National to the Délégation de la Recherche Clinique et de l’Innovation of the Caen University Hospital? Eh bien, it was a win for the subclavian. This route was associated with the fewest bloodstream infections and episodes of thrombosis, though it led to pneumothorax in 1.5% of patients.


What can we learn from the success of the polio eradication initiative in India?

25 Sep, 15 | by BMJ

jeevanPopular opinion from many failed previous health programme implementations is that vertical programmes are resource consuming and might not be very helpful to strengthen health systems. [1] The same was said for polio eradication programmes a few years ago. But I tend to disagree due to my experience of working on this programme for many years. In fact, the Indian health programme has benefited a lot from the polio eradication initiative (PEI). It has built strong foundations for many other health programmes that are being implemented, scaled up, or are yet to be started in the country. While a few smaller and less populated countries are still battling with polio, India is basking in its polio free glory that it achieved in 2014. It was not an easy task at all. India took the right steps from the inception of the PEI to the end, and whenever at the crossroads it chose the sensible path based on existing global evidence, local situations, and current data. The initiative started as small campaigns and then scaled up to the whole country. more…

Jeffrey Aronson: When I use a word . . . Adam’s apple

25 Sep, 15 | by BMJ

jeffrey_aronsonThe Hebrew name of the first man, Adam (אדם), was also used to mean “man” itself, although the more usual word is “ish” (איש). The origin of the name is unknown, but the punning author of Genesis juxtaposes the name Adam with the word for the dust of the earth, in Hebrew adamah (אדםה), from which Adam was made. The Latin equivalent is the idea that homo was made from humus. The Hebrew word for red, adom, reflecting the colour of the dust, may be connected, but there are other theories, such as connections with an Ethiopian word meaning “fair”, an Akkadian word meaning “maker”, and an Arabic word meaning “creature”. One cannot also ignore the fact that the Hebrew word for “blood” is dam (דם). more…

David Zigmond: Competence or compliance? The corrosive cost of professional practitioner appraisals

25 Sep, 15 | by BMJ

david_zigmond2Current appraisal systems sacrifice more of value than they can assure. Clarifying why and how this happens gives us wider insights into our ill faring welfare systems.

“The more laws, the less justice”
German Proverb

Some healthcare management axioms seem incontestable: all our healthcarers should have a good standard of human and technical competence; these should then be held within a firm frame of moral probity. Therefore we need systems for professional appraisals, then validation. more…

Neville Goodman’s metaphor watch: Blind alleys and wrong trees

25 Sep, 15 | by BMJ

neville_goodmanResearch is difficult. Long hours in the laboratory, or tedious hours in the clinic, guarantee nothing. There are lots of blind alleys, dead ends, cul-de-sacs, false trails, wild goose chases, and red herrings; lots of barking up the wrong tree and flogging dead horses.

Like single words with similar meanings, these synonymous metaphors are subtly different one from another. They are all good metaphors, and despite familiarity they seem resistant to cliché in the way “moving the goalposts,” “levelling the playing field,” and many other metaphors taken from business are not. Without specialist knowledge, though, it is difficult to know if they are used appropriately in medical writing: a false trail is not a dead end, nor does it necessarily lead to one; it may just peter out. Following a red herring (which, in medical research, has lost the sense of a diversionary trail laid on purpose) is more akin to barking up the wrong tree than flogging a dead horse, although in retrospect the result is the same: wasted time, energy, and resources. more…

The BMJ Today: The FDA, drug addicts, and standing with junior doctors

25 Sep, 15 | by BMJ

fda_approved• The FDA’s new clothes
Two new research papers (here and here) and a linked editorial take a detailed look at the FDA’s regulatory process. They present concerns that the FDA has prioritised expedited approvals at the expense of adequately assessing whether new drugs are more effective than existing products or whether they are safe. The editorial calls for a new way of doing things: “The United States and other countries need an alternative paradigm—one in which research focuses on better medicines for patients rather than for profits, where clinical trials with low risk of bias look for real benefits and faithfully reports harms.” more…

Samir Dawlatly: Why bother with my cholesterol?

24 Sep, 15 | by BMJ

For reasons that I have previously written about, I have to have my blood pressure, cholesterol, and blood glucose checked every year. These measurements have always been normal. Of these, I don’t know a single one of my cholesterol measurements. Not one. In fact, one of my previous GPs asked me if I wanted to know what my cholesterol measurement was. I remember smiling at her and saying that I didn’t, because even if it was elevated my risk would still be low. She nodded and smiled back. I don’t know whether she thought I was eccentric but she didn’t pursue the matter. more…

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