Research highlights – 19 November 2010

Research questions “Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

  • Does telling peer reviewers that their signed reviews of original research papers might be posted on affect the quality of their reports?
  • What is the long term risk of hypertension and renal impairment after acute gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter?
  • Is the risk of suicide attempts increased in patients with severe acne, regardless of subsequent exposure to isotretinoin?
  • To what extent has HealthSpace, a personal electronic health record, been adopted in England and what explains its non-adoption and abandonment?
  • Acne, isotretinoin, and suicide
    The severe acne drug isotretinoin has been linked with depression and suicide, and in the European Union the product comes with warnings about psychiatric adverse reactions. Anders Sundström and colleagues were concerned about the lack of a proved causal link, however, so looked back through 21 years’ worth of health records to untangle whether the drug itself is responsible for the increased risk of attempted suicide, or whether people with severe acne may simply be at a higher risk regardless of exposure to isotretinoin .

    The answer seems to be both – people with severe acne appear to have an increased risk of suicide and isotretinoin might further increase this risk. The incidence of attempted suicide in the three years before treatment among 5756 Swedes with severe acne treated with isotretinoin was raised compared with the general population. The incidence then peaked in the first few months after starting treatment and remained raised up to one year after treatment, but dropped to roughly the background rate in the population by two to three years after treatment.

    In a linked editorial, Parker Magin and John Sullivan suggest that “these findings could be interpreted to mean that acne confers an increased risk of attempting suicide (an increased risk that attenuates in the years after successful isotretinoin treatment).” They recommend that patients with acne of a severity for which isotretinoin is indicated, as well as those who are prescribed the drug, should be carefully monitored for depression and suicidal thoughts.

    Personal electronic health records
    In 2007 the NHS launched an online personal electronic health records system called HealthSpace, where patients could enter health data such as blood pressure readings, gain secure access to their summary care record, book outpatient appointments, and exchange email style electronic messages with their doctor. The aim was that the programme would lower NHS costs, produce better quality data, improve health literacy, and lead to greater patient empowerment.

    However, Trisha Greenhalgh and colleagues have found that patients aren’t interested in using HealthSpace and those who did sign up found it neither useful nor easy to use (doi:10.1136/bmj.c5814). The 56 patients and carers who were asked about the programme reported that its functionality aligned poorly with their expectations and self management practices.

    These findings are in line with those of a previous study by Professor Greenhalgh and colleagues, published in the BMJ in 2008, which found that around 60% of the 103 patients interviewed would not want a HealthSpace account and many were unsure of its purpose.
    The authors conclude that “the risk that [personal electronic care records] will be abandoned or not adopted at all is substantial.”

    Opening up peer review
    The traditional peer review system has many flaws, not least the fact that reviewers can delay or prevent the publication of a research study from behind a cloak of anonymity.

    Over the years, the BMJ has undertaken several randomised controlled trials to find out the effect of disclosure of reviewers’ identities on the quality of their reports.

    The third study, published in this week’s issue, was “the most radical,” says author Tony Delamothe, because it entailed telling reviewers that their signed reports would be appearing online alongside the papers reviewed when published on This foreknowledge did not reduce the quality of the peer review reports, although it did increase the time reviewers spent on a manuscript.

    The BMJ will be introducing this approach gradually from spring 2011 with reviewers and authors who would like to try it out. And not just the reviewers’ opinions will be publicly available, but all the documentation relating to the journal’s review process: the authors’ manuscript as originally received; our editorial committee’s comments (if any); our statistician’s comments (if any); and the authors’ explanation of how they had changed their original manuscript in the light of these comments.