The BMJ Today: A story in need of an end

helen_macA good story has a beginning, a middle, and an end. A few days ago, we published a sad story in The BMJ Analysis section about the use of beta-blockers in patients undergoing major surgery at high risk of cardiovascular disease.

The story had a hopeful beginning, in the 1990s, as the medical community was striving to reduce perioperative morbidity and mortality. Researchers investigated whether beta-blockers could reduce perioperative myocardial infarction in patients at high risk of cardiovascular disease. Some of the family of DECREASE trials were key in demonstrating they did, and the European Society of Cardiology Guidelines 2009 gave a strong steer to doctors to prescribe the drug.

The middle of the story unravels. It has since emerged that the majority of the DECREASE research was fraudulent. And, without the backing of discredited studies, meta-analysis of the remaining credible trials shows an excess risk of death, cardiologists Darrel Francis and Graham Cole write.

But the most saddening part of the story is that, three years later, the medical community has not been able to bring this story to end. Francis and Cole describe how difficult it has been to challenge and change the European guidelines and question why the medical establishment has not demanded change sooner. They explain how data from the DECREASE I trial—which escaped the scrutiny and dismissal that its sister trial met— is still used to back use, and explain their fears that this study may be unreliable.

As we published the story, Francis boarded a plane to the European Society of Cardiology Conference. What will the cardiology society and community make of Francis and Cole’s concerns?

Helen Macdonald is the analysis editor, The BMJ.