Monday, April 11, 2016
New England Journal of Medicine increasingly targeted by critics
Their editor's oppposition to data sharing is inexcusable. Lots of articles in medical journals cry out for reanalysis of their data. All the extreme quintile studies, for instance, cry out for a re-exploration of what actually went on in the data. Throwing out four fifths of your data in order to demonstrate something is a recourse of desperation and worthy of no confidence in what is reported. And calling people who do reanalysis "research parasites" is just abuse and evidence of a weak case. "Research symbionts" might be justifiable but that is obviously not abusive enough. NEJM is clearly out of step with current concerns about research integrity
The New England Journal of Medicine is arguably the best-known and most venerated medical journal in the world. Studies featured in its pages are cited more often, on average, than those of any of its peers. And the careers of young researchers can take off if their work is deemed worthy of appearing in it.
But following a series of well-publicized feuds with prominent medical researchers and former editors of the journal, some are questioning whether the publication is slipping in relevancy and reputation. The journal and its top editor, critics say, have resisted correcting errors and lag behind others in an industrywide push for more openness in research. And dissent has been dismissed with a paternalistic arrogance, they say.
In a widely derided editorial this year, Dr. Jeffrey M. Drazen, the journal’s editor-in-chief, and a deputy used the term “research parasites” to describe researchers who seek others’ data to analyze or replicate their studies, which many say is a crucial step in the scientific process. And last year, the journal ran a controversial series saying concerns about conflicts of interest in medicine are oversimplified and overblown.
“They basically have a view that . . . they don’t need to change or adapt. It’s their way or the highway,” said Dr. Eric Topol, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, Calif.
Topol and another cardiologist were criticized by Drazen and his co-authors last year after they wrote an opinion piece in The New York Times saying the data behind a groundbreaking study about blood pressure treatment should be made available to doctors right away — not delayed for journal publication.
“Most people are afraid to say anything about the New England Journal because they’re afraid they won’t get something published there,” said Topol, whose work last appeared in its pages in 2011. “That’s part of this oppression.”
In an interview, Drazen said the recent criticisms are misguided. The goal for the research the journal publishes is to be accurate, he said, while its editorials are sometimes designed to be “controversial” as a means of triggering discussion.
“If there’s anything that I have a passion for, it’s getting it right,” he said. “We work very hard at that. We’re not arrogant. We’re not dismissive.”
Brooding over the New England Journal of Medicine’s future comes at a pivotal moment for medical journals more broadly.
Like the larger publishing world, their traditionally slow pace and often imperious control have been jolted by the freedom and brashness of the Internet. So-called open-access journals, which publish online and don’t charge for subscriptions, are proliferating, as are websites that allow researchers to post their results before they have been externally vetted. Respected academics, including Harvard’s medical school dean, Dr. Jeffrey Flier, are calling for fundamental changes in the way research is reviewed and published, even proposing that peer reviewers give up their historic anonymity.
This push for transparency tracks the rise of research watchdogs who hunt for evidence of fraud and misconduct, then publicize their findings, often blasting out viral bombs via social media. There’s even a popular website called Retraction Watch, whose main goal is to flag such lapses, which had largely gone unnoticed even a few years ago.
In response, some top journals, including The BMJ, formerly the British Medical Journal, have begun moving toward more openness in their operations. The BMJ now requires researchers to share the underlying data that forms the basis of their clinical trials and allows comments on all of its articles, upending the strong hand editors previously had to determine which dissent was worthy of airing. It has even had outsiders examine questions raised about controversial studies.
The New England Journal, in contrast, its critics say, has steadfastly clung to an increasingly antiquated view of medical journals as sole arbiters of what should be made public and whether dissenting views should be heard.
“The BMJ wants to take us forward in the new century and the New England Journal of Medicine is trying to take us backwards,” said Dr. Vinay Prasad, an expert in evidence-based medicine and an assistant professor of medicine at Oregon Health & Science University, who has become an outspoken critic of the New England Journal.
The publication Drazen inherited was initially launched as a quarterly in January 1812 with the less pithy title of the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science. Today, it is read each week by more than 600,000 people in 177 countries, according to the journal’s website.
In 1984, the journal was at the forefront of a nascent effort to respond to the potential bias arising from financial ties between pharmaceutical and device makers and physicians. Editor Arnold S. Relman established a new policy, calling on doctors and researchers to disclose their funding and commercial interests. Six years later he went a step further, prohibiting authors with ties to companies from writing editorials or reviews of medical literature relating to their products.
Drazen’s own ties to the pharmaceutical industry presented something of an obstacle when he was named editor in May 2000. A well-known pulmonologist, he had received money for consulting or research into asthma and its treatments from nine drug companies. Because of those ties, he recused himself for two years from editing or personally selecting any papers related to asthma or those companies.
Two years into his editorship, Drazen loosened the journal’s conflict policy. He wrote that the policy Relman had put in place — and that his successors had affirmed — had constrained editors from publishing the best information for doctors. The new guidelines said authors of editorials and reviews couldn’t have “significant” ties to a company, which are defined as receiving more than $10,000 annually from a single company.
The journal dug into the topic again last May with a three-part series of articles questioning efforts to curb financial conflicts of interest among doctors and researchers.
“Although, by definition, a conflict of interest represents a risk that judgment will be compromised — not a determination that such a lapse has occurred — the pharmascolds’ narrative about conflicts of interest often conflates the two,” author Lisa Rosenbaum wrote, using a pejorative word some have used to describe those who lament the influence of industry on medical decisions.
Drazen’s predecessors Jerome P. Kassirer and Marcia Angell, and former senior editor Robert Steinbrook took to the pages of The BMJ to criticize their former home. “Judges are expected to recuse themselves from hearing a case in which there are concerns that they could benefit financially from the outcome. Journalists are expected not to write stories on topics in which they have a financial conflict of interest,” they wrote. “Yet Rosenbaum and Drazen seem to think it is insulting to physicians and medical researchers to suggest that their judgment can be affected in the same way.”
Asked whether the journal had plans to further revise its policy on conflicts of interest, Drazen said, “We always continually evaluate what we do to make sure we’re doing the best job possible.” None of Rosenbaum’s pieces, he added, “mentioned anything about us changing our policy.”
Since 2010, ProPublica has written extensively about conflicts of interest in medicine and has created a tool called Dollars for Docs that allows users to look up payments to doctors by drug and medical device companies. A second tool, Surgeon Scorecard, which includes complication rates, was criticized by Rosenbaum in a perspective piece in the journal last year.
Rosenbaum, in an e-mail, said the reaction to the series on conflicts of interest was much as she had hoped. “One of the primary goals of the series was to start a conversation so that we could move beyond what has become a very reflexive (and typically negative) response to physician-industry interactions,” she wrote.
Some researchers and doctors have also decried what they perceive as the journal’s resistance to becoming more transparent about the research it publishes.
In February, a group of British scientists faulted the journal, as well as some of its peers, for failing to disclose that the questions being answered in certain studies were not the same as those in the researchers’ original protocols. Changes are normal and sometimes to be expected, but they need to be disclosed, the group believes.
When the group shared its findings in a series of letters to the editor, the journal’s editors sent dismissive responses, they said, declining to make any changes to the papers or publish the team’s criticisms.
In an interview, Drazen said his staff initially reviewed a couple of the group’s claims, found them without merit and moved on. Through a spokeswoman, he e-mailed documents that he said rebutted the group’s contentions regarding two of the studies.
Drazen also noted that in recent years, the journal began posting the protocols and statistical analysis plan for all clinical trials it publishes.
Shown the journal’s rebuttals, British researcher and author Ben Goldacre and his team said it not only failed to rebut their contentions, but showed that the editors may not have fully understood the studies’ findings and metrics.
The critiques of the journal have moved onto the pages of competing journals and mainstream news sources, with several recently questioning why it has been slow to correct or clarify studies.
A piece last month in The BMJ reported on mounting concerns over the journal’s handling of a major 2012 study that compared the risks of two products — saline and hydroxyethyl starch — that boost blood volume in critically ill patients. Though the results were not conclusive, the study suggested that starch solutions were more dangerous, leading to a warning from the Food and Drug Administration and a precipitous drop in sales.
The company that makes starch solutions wrote a letter skeptical of the study’s methodology and results. The journal, according to The BMJ article, wouldn’t correct the article or publish the company’s letter.
Within days of The BMJ article, the New England Journal appended a correction to the study about the values in a table, but editors otherwise stood by the findings.
Drazen said that when concerns are raised about a study, the authors are asked for a response, which is analyzed by statistical reviewers.
“Recently we got another query about the same issue,” Drazen said. “When we went back to requery the author, there, in fact, was an error in the paper that was published.”
The incident that has provoked the biggest storm came in January, when Drazen and a deputy editor wrote an editorial that some interpreted as critical of burgeoning efforts to share data on clinical research so others can assess the findings and perhaps replicate the analyses.
“There is concern among some front-line researchers that the system will be taken over by what some researchers have characterized as ‘research parasites,’” Drazen and deputy editor Dan Longo wrote.
The criticism was immediate, fierce, and widespread — probably more than for anything else the journal has done in many years. In an editorial in the journal Science, titled “#IAmAResearchParasite,” editor Marcia McNutt wrote: “No more excuses: Let’s step up to data sharing.”
Barry Marshall, a winner of the Nobel Prize in Physiology or Medicine, wrote on Twitter: “Plenty of Nobel prizes came from a new look at other people’s data.”
Drazen quickly published a second editorial in which he appeared to backtrack somewhat (he used the word “clarify”), saying he and the journal did support data sharing.
The worry he was initially trying to articulate, Drazen said is that scientists not involved with original research will swoop in, conduct additional analyses (perhaps without understanding the data) and then take credit from those who spent months or years working on the underlying research.
“The data sets are very, very, very complex,” he said. “You don’t want someone to analyze the data set not fully understanding it.”
For his part, Drazen said he doesn’t see the controversies that have arisen in recent months as any different from those of other periods of his tenure. He is one of the longest-serving editors of a major medical journal at this point.
“In the 16 years, I can’t say that I think this particular last 12 months has been different by a lot,” he said. “When issues come up we pay attention to them, and there are always issues coming up.”
Russian women who decide against having an abortion can SELL their babies to the state for $3,700 under proposed new law
This is in line with ideas expressed by G.W. Bush and Vatican Cardinal Pell, who urge more support for pregnant women as an abortion preventative
Russian women who decide to sell their babies instead of having an abortion will receive $3,700 under a proposed new law.
Officials are hoping the measure, which was put forward by a MP for the country's nationalist party, will boost the country's birth rate and give children 'a chance to live'.
Around 200,000 women are expected to take part in the proposals, which has not yet passed through government.
Aleksandr Sherin, State Duma MP, wrote in a note accompanying the proposal that it will help 'children who were doomed to die before being born', according to RT.com.
He added: 'Currently only about 20 per cent of women who want an abortion abandon their intention. 'Material stimuli could help to significantly improve this figure.'
The women will have to hand authorities details of their pregnancy - including due date and a letter saying they will not have an abortion - if they want to receive the money.
The money is expected to be given out at a set rate to start with but will be recalculated in line with inflation.
In Russia, abortion up to 12 weeks of pregnancy is legal. Women who have been raped can request an abortion up to 22 weeks of pregnancy. In the UK, an abortion can be legally carried out if it is within the first 24 weeks.
UK: Labour councillor, 20, suspended over claims she called Hitler 'the greatest man in history'
A labour councillor has been suspended for shockingly offensive anti-Semitic tweets, The Mail on Sunday can reveal.
The discovery of Aysegul Gurbuz’s vile comments is the latest in a series of anti-Semitic scandals to hit the Labour Party. The 20-year-old student is alleged to have called Adolf Hitler the ‘greatest man in history’ and said she hoped Iran would use a nuclear weapon to ‘wipe Israel off the map’.
Miss Gurbuz, who is Muslim, became Luton’s youngest councillor when she was elected to the High Town ward last year. But last night Miss Gurbuz was suspended after the Campaign Against Anti-Semitism found a series of disturbing posts on her Twitter account from 2011 to 2014.
One tweet, written in January 2013, said: ‘The Jews are so powerful in the US it’s disgusting.’ Another post, in October 2012, said: ‘Ed Miliband is Jewish. He will never become prime minister of Britain.’ And Adolf Hitler was praised as the ‘greatest man in history’ in a tweet in October 2011.
Miss Gurbuz last night denied she had written the tweets and claimed her sister may have posted them.
A Labour spokesman said: ‘Councillor Gurbuz has been suspended from the Labour Party pending an investigation.’
Miss Gurbuz is in her final year at Warwick University, where she is also events organiser for the student union’s Friends of Palestine society.
She told the Campaign Against Anti-Semitism: ‘It was a joint account I had with my sister so I don’t know if she’s gone out and tweeted that, but I’m absolutely appalled right now. ‘Where I live we’ve got very good cohesion with the Jewish community... I’m absolutely shocked.’
Miss Gurbuz did not respond to our calls for comment last night.
Jonathan Sacerdoti, from the Campaign Against Anti-Semitism, said: ‘These tweets are anti-Semitic. They appear on Aysegul Gurbuz’s personal account and there is no defence for that.
‘Anti-Semitism is rising in Europe and the UK, and the regular anti-Semitic tweets and opinions emanating from the Labour Party have failed to elicit any meaningful response from Jeremy Corbyn. How many more cases must we see before Labour take action?’
Trevor Holden, chief executive of Luton Borough Council, said: ‘This will be referred as a matter of urgency to the council’s independent standards committee to allow a full investigation to take place.
‘The council expects the highest standards of councillors and will not accept any behaviour which could undermine community cohesion.’
More Muslim hate in Britain
A Channel 4 reporter has been reprimanded by the broadcaster after claiming British Muslims are 'sell-outs and Uncle Toms' if they attend government-organised Islamic events.
Investigative journalist Assed Baig, 34, who was born in Birmingham but now lives in London, has also used the pejorative term ‘house Muslim’ on Twitter in relation to moderate Muslims.
And the former BBC reporter referred to any Muslims who attend British government iftars as ‘Uncle Toms’, which is a derogatory term meaning a black person showing obedience to whites.
Although Mr Baig posted the tweets prior to his Channel 4 days, he has been reminded by the broadcaster ‘of his responsibilities as a journalist to be fair and impartial’ when representing it.
In 2011, he tweeted: ‘Anyone that attends a British government iftar is a sell-out and an Uncle Tom.’ And he said in 2012 that the 'term Uncle Tom should be readopted in media and political circles'.
In the same year Mr Baig also insisted on Twitter that the phrase - along with 'choc-ice' and 'coconut' - is not racist, but rather something 'used to described fake and sell-out people.'
Also, in reference to a video of British Muslims dancing to the Pharrell Williams song ‘Happy’, he wrote in April 2014: ‘A man dances for hos master because he's a house Muslim [sic].’
Mr Baig later clarified his views the next day by saying: 'I do not believe everyone in that video to be a house Muslim
Mr Baig, whose tweets were reported by the Guido Fawkes political blog, was criticised by some on Twitter today, but backed by others who said 'keep up the good work' and praised his 'excellent reporting'.
But Fiyaz Mugha, founder of Tell Mama, a Government-backed group which tracks anti-Muslim crimes, told MailOnline: ‘The term “house Muslim” effectively is synonymous with someone using house and using the N-word.
‘It means that people are subservient to a white master or a power structure. We think it actually has some racial connotations to it and also in many instances is used to provide a “them and us”.
‘It really reinforces a “them and us” regarding the racial connotations around the term. So actually it's a deeply problematic term and one we've actually been saying should not be used.’
However a spokesman for Media Diversified, a group promoting ‘writers of colour’, tweeted: ‘We are in full support of Assed Baig and the work he has done for both Vice UK and Channel 4 News.
‘Tweets made when there was no verified tick and in conversation are his business to resolve - nobody else’s - and we know he will. So [we] suggest others back off unless they have some other agenda, then that should be revealed.’
A Channel 4 News spokesman told MailOnline this afternoon: 'We are aware of the tweets in question by Assad Baig which pre-date his employment by Channel 4 News.
'They are clearly a personal view relating to that particular period in time. However, he has been reminded of his responsibilities as a journalist to be fair and impartial when representing Channel 4 News at all times.'
Mr Baig can speak Urdu, Punjabi and Arabic - and has worked in countries including the Central African Republic, Myanmar and Libya.
He has also reported from nations including Pakistan, Bosnia and Somalia - and has lived in countries such as Syria and Mauritania. He has not yet responded to a request for comment.
Ray Lewis Tackles Black Lives Matter
Legendary Baltimore Ravens linebacker Ray Lewis posted a powerful video on Facebook challenging the followers of the Black Lives Matter movement to actually care about black lives. The timing of his post is related to the upcoming anniversary of the Baltimore riots over the death of Freddie Grey.
Although the video was posted April 2nd, it is finally coming to national attention because of its content:
“I’m trying to ask the question to the organization of black lives, if they really mattered, why not riot now? There were 141 murders, 82 murders last year at this time. I’m trying to figure out in my mind why no one is paying attention to black men killing black men. Why we always find ourselves half the victims, and now we have the separation once again that we’re being victimized because of one bad white cop, two bad white cops, three bad white cops, killing a young black brother, but every day we have black-on-black crime, killing each other.”
You can watch the full video by clicking here.
Often known as the “reverend” or the “preacher” for his intense, inspirational speaking style that combines morality and religion, Lewis is trying to address the problems affecting our inner cities that are being ignored. As Lewis points out, the murder rate of black men in Baltimore City and Chicago are increasing while politicians and activists ignore them.
Lewis has had his own troubled past, but his youthful indiscretions led to a radical spiritual change in the mid-2000s. Allowing God to shape his life, he began to use his fame and money to help the less fortunate and make great changes. He became a leader on and off the field, and he has continued that path following his retirement.
There has been some backlash to these words, but most of that backlash has come from the more radical of the political activists. Lewis has undermined their efforts and exposed that they are paying lip service to their communities. He has upset their position and forced truth to come to light.
Political correctness is most pervasive in universities and colleges but I rarely report the incidents concerned here as I have a separate blog for educational matters.
American "liberals" often deny being Leftists and say that they are very different from the Communist rulers of other countries. The only real difference, however, is how much power they have. In America, their power is limited by democracy. To see what they WOULD be like with more power, look at where they ARE already very powerful: in America's educational system -- particularly in the universities and colleges. They show there the same respect for free-speech and political diversity that Stalin did: None. So look to the colleges to see what the whole country would be like if "liberals" had their way. It would be a dictatorship.
For more postings from me, see TONGUE-TIED, GREENIE WATCH, EDUCATION WATCH INTERNATIONAL, FOOD & HEALTH SKEPTIC, AUSTRALIAN POLITICS and DISSECTING LEFTISM. My Home Pages are here or here or here. Email me (John Ray) here.