[Reblog] Last week “clinical trial system broken”; this week “luxury journals distort/damage science”

From the 10 December 2013 HealthNewsReview.org post 

In the BMJ recently:

“The clinical trial system is broken and it’s getting worse, according to longstanding Food and Drug Administration investigator, Thomas Marciniak. …

“Drug companies have turned into marketing machines. They’ve kind of lost sight of the fact that they’re actually doing something which involves your health,” Marciniak says. “You’ve got to take away the key components of the trials from drug companies.”

Now, in The Guardian, Nobel Prize winner Randy Schekman writes, “How journals like Nature, Cell and Science are damaging science: The incentives offered by top journals distort science.” Excerpt:

“These luxury journals are supposed to be the epitome of quality, publishing only the best research. Because funding and appointment panels often use place of publication as a proxy for quality of science, appearing in these titles often leads to grants and professorships. But the big journals’ reputations are only partly warranted. While they publish many outstanding papers, they do not publish only outstanding papers. Neither are they the only publishers of outstanding research.

These journals aggressively curate their brands, in ways more conducive to selling subscriptions than to stimulating the most important research.”

And he goes on to state that he will avoid such journals in the future.

“Like many successful researchers, I have published in the big brands, including the papers that won me the Nobel prize for medicine, which I will be honoured to collect tomorrow.. But no longer. I have now committed my lab to avoiding luxury journals, and I encourage others to do likewise.”

Note:  in case you missed it, yesterday I linked to Dr. Richard Lehman’s BMJ journal review blog, in which he wrote:

“The Lancet is a very odd journal, in case you hadn’t noticed. Some weeks it contains pharma-funded phase 2 trials of astounding clinical irrelevance.”

One of my boilerplate slides in talks I give to journalists is the following, cautioning them not to treat journal publications as if they were Moses bringing the stone tablets from the mountaintop to the people.

Addendum on December 11:  The Retraction Watch blog states that Schekman’s “argument isn’t airtight” and that “the picture may be a bit more complicated than his Guardian piece let on.”  Excerpt:

“…just how many retractions have these journals had? And how does that compare to the number in the Proceedings of the National Academy of Sciences (PNAS) while one Randy Schekman was editor? Here’s the 2006-2011 data, analyzed according to Ferric Fang and Arturo Casadevall’s Retraction Index, which calculates the rate of retraction per 1,000 papers published:

Journal	Retractions	Articles	Retraction Index	Impact Factor
Science	10	5702	1.754	32.452
Nature	7	5403	1.296	36.235
Cell	11	2899	3.794	34.774
PNAS	23	21614	1.064	10.472

So yes, PNAS had a lower Retraction Index than the other journals, but not really that much lower than Nature. Put another way, however, PNAS retracted 23 papers from 2006 to 2011, while Cell, Nature, and Science retracted 28. And perhaps even more important, there were 1,300 retractions in journals other than those four.

“Wait,” you’re saying, “are more retractions really a bad thing? Didn’t you just publish a post about a study that said the opposite?” Well yes, yes we did. But Schekman is suggesting retractions are a mark against a journal, which we think makes PNAS’s record of retractions fair game.”

 

Related articles

• How Journals like Nature, Cell and Science Are Damaging Science (transcend.org)
• Randy Schekman Nobel winner boycotts top science journals (giftoftruth.wordpress.com)
• Nobel laureate Schekman boycotts top-tier science journals (dailycal.org)
• Nobel winner declares boycott of top science journals (3quarksdaily.com)
• “Distorting incentives” in academic research (peakmemory.me)
• Nobel Winner Schekman Boycotts Journals For ‘Branding Tyranny’ (science.slashdot.org)
• Nobel winning scientist to boycott top science journals (planet.infowars.com)
• ASCB: Nobel Winners for Discoveries on Cellular Vesicle Transport Voice Thoughts (medindia.net)
• To boycott or not to boycott: a privilege for the successful or a need for change? (upwithclimate.wordpress.com)

 

[Reblog] What happens to medicine when it has no heroes?

What happens to medicine when it has no heroes?.

From the 4th December 2013 KevinMD article  by A COUNTRY DOCTOR, MD |

A few years ago, a medical journal piece about electronic medical records with built-in decision support announced that the days of super-physicians and master diagnosticians were over.

Being a doctor isn’t very glamorous anymore, and being a good one seems rather obsolete with so many guidelines and protocols telling us what to do.

A hundred years ago, William Osler, a practicing physician, had single-handedly written the leading textbook of medicine, reformed medical education, helped create and chaired Johns Hopkins and become the chair of medicine at Oxford.

Today, it is virtually necessary to be a researcher to teach at a university, let alone chair a medical school. The only other way to advance in medicine is to go into administration. Leaders in medicine are not chosen for their mastery of clinical practice, but for their managerial or business acumen.

The culture of clinical excellence has few heroes in our time. Pharmaceutical companies sometimes speak of “thought leaders” on the local level, which is more often than not only their way of building momentum for their drug sales through promoting early adoption of new medicines. Doctors today practice on a level playing field, where we are considered interchangeable providers in large organizations and insurance networks. Media doctors don’t earn their position based on clinical mastery, but rather their communication and self promotion skills.

What happens to medicine when it has no heroes? Who defends the ideals of a profession that is becoming commoditized? What keeps new physicians striving for clinical excellence with only numerical quality metrics and policy adherence as yardsticks? How are the deeper qualities of doctoring preserved for new generations of doctors, and how are they kept in focus with all the distractions of today’s health care environment — because people still worry and suffer; they are more than bodies with diseases or abnormal test results.

Every day, doctors on the front lines treat two dozen fellow human beings with every imaginable condition. How do we carry on, with only our own ideals as beacons in the fog, if we are left to ourself to defend our higher purpose, without champions, mentors, or heroes?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Related articles

• Bringing emotions back into medicine (kevinmd.com)
• [Reblog] In Medicine, More May Not Be Better (jflahiff.wordpress.com)
• “Relationship Is Everything” MED Grads Told (bu.edu)

[Infographic] The Top Five Most Expensive Conditions Treated in US Hospitals, 2011

From the Agency for Healthcare Research and Quality

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