William Cayley: Life saving science?

bill_cayley_2This past week saw the interestingly coincident publication of a reanalysis of “Study 329” in The BMJ and an opinion piece in the New York Times, calling for more rapid dissemination of news about “medical breakthroughs.”

Restoring Study 329” reanalyzed data from the (controversial) 2001 study and demonstrated that, lo and behold, paroxetine and imipramine may not help depressed adolescents, but may, in fact, hurt them (neither treatment was better than placebo, but both were associated with adverse events).

Don’t Delay News of Medical Breakthroughs” argues that the early cessation of the SPRINT trial because of its exceptional results demonstrates medicine needs to “change its approach to releasing new, important information,” prior to formal peer reviewed publication, because “data that was good enough to persuade experts to stop the trial should be good enough to share.” In short, the authors call for web based, pre-publication release of data when an important “breakthrough” is on the line.

This is indeed a complex set of issues, but, well, life is complex.

The instantaneous and social nature of the web is certainly tantalizing (yes, I’ve “tweeted” about Study 329), but the purpose of the multiple levels of review, analysis, etc that data undergo to reach publication is to be sure of the validity of the information.

The stories of Study 329, oseltamivir, and rosiglitazone all demonstrate that even the best efforts of “science” don’t always produce well founded and reliable patient oriented evidence. Nevertheless, to try to advance the sharing of information too rapidly risks over-enthusiasm for interventions, which may not in the end help, or which may even be harmful.

Any time I see news of a “life saving breakthrough,” my first reaction is “Oh, really?”—most supposedly miraculous interventions aren’t. (Rather, when we search for the “miraculous” in medicine, we are searching for something that medicine cannot give—but that’s another blog post!

If we can find ways to make genuine scientific inquiry, peer review, and vetting of results move more expeditiously towards the sharing of solid, patient oriented evidence, then great!

I fear, however, that a too quick rush to share supposedly “breakthrough” information may degrade the overall quality of information available to patients and professionals, and in the end mislead or harm our patients.

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: “I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare beyond the wellbeing of my patients. A shorter version of these comments has been posted to an email forum, and as a comment on nytimes.com ”