We’ve mentioned before the use of trial registries and the need to publish all trials, and also the trouble with trying to get negative stuff out into press. Archi would like to hand out a gold star in this regard.
It’d be good to point out that a former alumnus of the ADC (well, that might be a bit strong) has taken over the Editor-in-Chief role at JAMA… and that in 2013 JAMA published eighteen RCTs or systematic reviews. Of these, the studies demonstrated in 14/18 cases that a new drug or intensified treatment failed to give any additional benefit above standard therapy, in one case it was worse (steroid injections for tennis elbow ), and in 3 cases there was benefit to a new therapy; IV paracetamol helps reduce morphine requirements in neonates undergoing surgery, 3-drug treatment for pregnant women with malaria is better than 2-drug treatments , and ramipril helps patients with intermittent claudication.
We need to know that treatments work. We also need to know that more isn’t always better and that we as researchers can do good studies, find there’s no benefit, and still get good publications.
1. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 2013;309(5):461-9.
2. Ceelie I, de Wildt SN, van Dijk M, van den Berg MM, van den Bosch GE, Duivenvoorden HJ, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial. JAMA 2013;309(2):149-54.
3. Kayentao K, Garner P, van Eijk AM, Naidoo I, Roper C, Mulokozi A, et al. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis. JAMA 2013;309(6):594-604.
4. Ahimastos AA, Walker PJ, Askew C, Leicht A, Pappas E, Blombery P, et al. Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial. JAMA 2013;309(5):453-60.