Publish or perish (in China)

Nature (2010-Jan-14) has a couple of articles about what happens when real humans (and these are scientists) are rewarded in certain ways. Humans are humans everywhere, and misconduct happens. This article has a discussion of the amount and importance of activities like ghostwriting, bypassing peer review, and forgery. In China there are 800+ websites involved in such activity, with 210,000 hits per day. “There is a massive production chain for the entire publishing process.”

Later in this issue, you can read about a new journal that took articles from existing journals and just replaced all the previous branding. They were otherwise happy with the original electronic typesetting!

Remember to connect to the UBC Library via MyVPN to view these links!

A perfect way to while away a boring interlude in 513 …

Just a reminder that Chancewiki has lots of clinical epidemiology stuff. Have you hit a boring patch of 513? Got a computer in front of you? Head over to http://chance.dartmouth.edu/chancewiki/index.php/Main_Page!

Take a look at Chance News 58, where they talk about negative data. And reverse confounding.

Clinical epidemiology in Canada

Today’s Toronto Globe and Mail has an article about the funding crisis in Canadian clinical epidemiology.

Are there problems with the meta-analytic approach?

In short, yes. Can they be biased? Yes. Can they be unbiased? Yes. Kind of like everything else. An article in the New York Times looks at some of the issues when looking at a recent meta-analysis of antidepressants.

How effective is influenza vaccine?

This article from the Atlantic provides an overview of the ideas I mentioned in class about overall effectiveness of influenza vaccination. They call the membership bias “healthy user effect.” It gives enough information for you to be able to hunt down original sources if you care. Before, this gets controversial, let me say that I got both my flu shots this year. But then I’m one of those people (albeit only a “semi-healthy user” ) who might have produced the bias, right?

Alzheimer’s, Parkinson’s, ALS, Huntington’s: could they all be prion diseases?

An article in Science outlines the hypothesis that all these diseases are caused by prions. There is a UBC angle re Dr Neil Cashman’s work on ALS. Good medical/science journalism: priceless!

Our very own scandal, again!

In case you can’t get to the Medical Post article mentioned previously, here is a link to a story in the Montreal Gazette about our very own academic leader who apparently published (as single author), an article she didn’t write. Fortunately the contents of the article (about estrogen) are all true, and can guide us when we think about estrogen as a therapy.

We (Canada) botched mammography!

Referring to the CNBSS trial at the Radiologists Society of North America annual meeting recently, Dr. Dan Kopans, a prominent American radiologist states the study was “botched”, although he apparently didn’t give any supporting statements. In response, Dr. Steven Narod, a Toronto epidemiologist and leader in breast cancer research, called Dr. Kopans remarks “scientific misconduct.” Dr. Narod also is quoted in the Medical Post article here as stating that “I think he knows absolutely nothing about epidemiology.”

Why do we need to know epidemiology anyway?

PS: YOU MIGHT NEED TO NOW ENROLL IN “www.CanadianHealthcareNetwork.ca” TO GET ACCESS TO MEDICAL POST CONTENT. SORRY ABOUT THE INCOVENIENCE.

Great medical journalism at the New York Times

Being a scientist involves always having an open mind. Today’s New York Times has an article here by Gina Kolata about the work of Dr. Mina Bissell on the cause of cancer.

In 513, you’ll hear me say over and over that we don’t know much natural history of disease, and this is probably the source of a lot of “muddiness” in epidemiology. Here is a link to another Kolata article, in which results of a study on natural history of breast cancer suggest that some cancers go away spontaneously.

How likely is a woman to get breast cancer?

Do women actually have diseases other than breast cancer? You might wonder what the most important diseases are for women (kind of like the WHO’s Global Burden of Disease approach). The Medical Post (2009-Nov-17, page 52) has an article from an academic who contrasts SEER’s risk numbers with those based on other cohorts. The Medical Post seems to have changed their web access policies recently, so I can’t post a link now. Look at the hard copy they mail physicians.

A classic from ChanceWiki

Is it possible that all illness relates to subluxation of your vertebrae? I guess it is, huh? Everyone wants evidence nowadays, so let’s get some. Take a look at chiropractors’ take on what counts as evidence at http://chance.dartmouth.edu/chancewiki/index.php/Chance_News_42. The section titled How People Are Fooled by Ideomotor Action.

We are all fasciscts! Down with evidence!

As someone who uses evidence in your practice of medicine, and benefits from standard approaches to how to do this, you might want to know that people disagree with this viewpoint. I can’t do justice to this article here. Remember that the variation in human traits is what makes your life interesting! You will need to get this electronically from the UBC Library: Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. Int J Evid Based Healthc 2006; 4: 180–186.

Down with the Cochrane Collaboration! Get your evidence from … well what are we supposed to do now? Go with (the negation of) evidence-based medicine?

There have been several episodes recently where people have submitted tongue-in-cheek, or ironic, articles to journals. Could this be one? Look at the grammar and development of ideas in this one. Can it be serious?

You can’t always do an RCT

Today’s New York Times has an article about a 43 hour surgery to remove an abdominal tumor that involved ex-vivo resection of the tumor. Read the article, and ask yourself how much evidence, of what strength, it would take to make you decide to have this operation if you had this condition. You won’t ever be able to find an RCT on the topic!

More on MS as a vascular disease

Today’s Vancouver Sun has an article here about patients coming to the False Creek Surgical Centre to get MRIs and ultrasounds to see if they have the venous outflow obstruction that Dr. Zamboni has hypothesized is causal in MS. There is an interesting discussion, including a mention of the apparently high rate that re-occlusion occurs after initial treatment etc.

One patient, who has MS, but apparently not the venous obstruction, says: “”The results in Vancouver were puzzling because my understanding is that Zamboni is saying that almost all MS patients have blockages, but none were found in my case. A doctor told me that there may be narrowing in veins that weren’t seen. Still, I’m not going to not go [to Italy].”

How likely do you think it is it that this will turn out to be a revolution in thinking about causation and treatment about MS?

You can read Dr. Zamboni’s article here. (VPN connection to eJournals at UBC Library; find Volume 50, Issue 6, Pages A1-A26, 1348-1358.e3 (December 2009) Think about what a reasonable next step would be given the information in the article.

Keep on reading chancenews at ChanceWiki

A reminder to check out chancenews at ChanceWiki. Do their puzzles. Think about chance and bias. Most of the ways that research goes wrong involves macro-, not micro-epidemiology.

chancenews is at http://chance.dartmouth.edu/chancewiki/index.php/Main_Page.

Slate.com articles on autism therapy

I’ve always been fascinated by the phenomenon of simultaneous demand for evidence and resistance to evidence. “Give us evidence, but only if it confirms this idea.” The autism field is what I term “evidence resistant.” Do you know of areas of your discipline that have this feature? I can’t remember the last time an EBM idea was in the title of an article in the popular press. Slate.com autism therapy article (pdf).

Why EBM? An interview with David Sackett

Why EBM? You might just say “because we have estrogen researchers in Canada.” But it’s more than that of course. Much of the rationale for starting the field is just as important today. Recognize your clinical department in his remarks? Check it out at: http://www.theglobeandmail.com/life/health/when-we-began-we-were-almost-pariahs/article1344833/.

Renowned Canadian researcher puts name on paper she did not write, stands by results!

Take a look at the Medical Post (www.medicalpost.com) for an interesting article. You need to register (it’s easy), then go to http://www.medicalpost.com/news/article.jsp?content=20090910_130117_13308. This is an ongoing story with many interesting aspects. You might get there also by Googling “Researcher ensnared by ghostwriting scandal stands by her estrogen work”. Personally, eminence counts for a lot when I read a paper! And “Canada Research Chair” makes my eyes open that much wider.

Is MS a vascular disease?

Take a look at this article from the Toronto Globe and Mail (Saturday Nov-21-2009), which describes how a researcher’s hypothesis about his wife’s MS led to a potential new treatment. There is a description of some trials of a new therapy.

Go out on a limb, now rather than later! How likely is it that we are witnessing an actual breakthrough?