Top Medical Journals Research Articles

Journalwatch@pcrj.

Here's the best of the rest: summary reviews of relevant papers from the top respiratory and general medical journals worldwide. Journalwatch@pcrj is produced by the PCRJ Editors-in-Chief - reviews were selected and written by Dr Paul Stephenson and edited by Professor Aziz Sheikh. Each summary contains the name of the first author, the title of the paper, the Vancouver reference and/or doi number, and a link to the abstract of the paper. In the majority of cases these are subscription journals, so to view the full text you will need to subscribe to the journal or pay to view on an individual article basis. These reviews were originally published by the Doctors.net.uk Journal Watch service, which covers other specialties as well as respiratory medicine. Doctors.net.uk is the largest network of GMC-registered doctors in the UK. To find out about membership, click on Doctors.net.uk. The opinions expressed herein may not necessarily reflect the views of the authors of the original articles.

Getting Competition Down to a Science: The Effects of Technological Competition on Firms' Scientific Publications

Prior research about the interaction between private firms and the scientific community has largely viewed firms' articles in scientific publications as a means to improve research and development productivity—by encouraging their researchers to publish scientific papers, firms can maintain linkages with the scientific community, attract talent, and access external knowledge on which they can build to create innovations. This paper, in contrast, emphasizes the role of scientific publications in firms' battles for market dominance and examines how competitive conditions shape firms' propensities to publish scientific articles about their innovations. Focusing on the context of pharmaceutical drugs, we develop propositions about how the competition that one drug faces from similar drugs and potential substitutes influences the innovating firm's inclination to publish articles in the top medical journals about that drug to facilitate its assessment by the U.S. Food and Drug Administration and the medical community. We also propose that scientific articles about competing drugs compel a firm to highlight its own drug in scientific papers to assert the drug's uniqueness and mitigate the threat of substitution. Whereas prior research has elucidated how science contributes to enhancing firms' competence at creating innovations, which is critical to their ability to compete in technology-intensive environments, this paper draws attention to how competition, in turn, permeates into the scientific arena, creating inducements for firms to use scientific publications to position their innovations in the marketplace.

The drugs industry: a bad product well marketed

‘It will work,’ said Paris Hilton. ‘I'm a marketing genius.’ Ms Hilton, you might say, is all marketing—a bad product well marketed. But when does clever, even genius, marketing become sinister? Any company with a product to sell will put a marketing plan at the top of its agenda. But what if your product, your new wonder drug or medical device, doesn't work? What if you have invested billions of dollars in the product's research and development, does it make any commercial sense to crush it up and start again? A decade ago a drug industry insider told me how naive medical journals were. Almost all the papers in top medical journals, he delighted in retelling, were written by industry and placed with precision in the journal of choice. Medical journals, according to our mole, were blind to industry's daylight robbery. It was a surprising statement that immediately rang true. Medical journals, if we take these insights to their logical conclusion, are little more than the marketing arm of pharmaceutical companies.1 Clearly, medical journals that publish research papers about drugs are closest to that description. Randomized controlled trials that evaluate me-too drugs, seek new indications for a waning product, and focus on the marketing speak of equivalence and non-inferiority, are straight from the Paris Hilton school of sexing up a bad product. Instead of perfume and mascara, medical journals are distracted by complex statistics and important sounding authors. The real marketing story behind any research is almost impossible for a journal to read. Journals can guess, infer, suspect, but can do little more without power or resources. But none of these issues are new. The novelty comes with GlaxoSmithKlein's £2bn fine for aggressive marketing of its products in the United States. These were products that were marketed off-label for under-18s, promoted for treatment of conditions without FDA approval, negative trial data were withheld, and the labelling was ‘false and misleading’. Doctors were indulged to speak in favour of products at meetings, often at lavish resorts. Medical journals were used and abused, mere pawns in the marketing chess game.2 A further consequence of GSK's misbehaviour is that the US Department of Justice has persuaded the British company to sign a Corporate Integrity Agreement (CIA), an unfortunate acronym when the purpose is transparency. For the next five years, this CIA includes regular checks on GSK to ensure that it is marketing its products with honesty, isn't rewarding staff based on sales in territories, and includes penalties to claw back executive bonuses in the event of malpractice. This a welcome turn of events but the effect of these measures will be unclear for years to come. Pharmaceutical companies have had slaps on the wrist in the past, regulations have been tightened, yet the whiff of Paris Hilton grows ever stronger. The US Department of Justice's introduction of an integrity agreement for GSK begs two questions. Why not introduce it for all pharmaceutical companies and device manufacturers? Why only five years? Until these measures are industry-wide and long term, the drugs industry will not shake its perception as a bad product well marketed.

Potential impact on estimated treatment effects of information lost to follow-up in randomised controlled trials (LOST-IT): systematic review

Objective To assess the reporting, extent, and handling of loss to follow-up and its potential impact on the estimates of the effect of treatment in randomised controlled trials.Design Systematic review....

Journalwatch@pcrj.

Here's the best of the rest: summary reviews of relevant papers from the top respiratory and general medical journals worldwide. Journalwatch@pcrj is produced by the PCRJ Editors-in-Chief – reviews were selected and written by Dr Paul Stephenson and edited by Professor Aziz Sheikh.Each summary contains the name of the first author, the title of the paper, the Vancouver reference and/or doi number, and a link to the abstract of the paper. In the majority of cases these are subscription journals, so to view the full text you will need to subscribe to the journal or pay to view on an individual article basis.These reviews were originally published by the Doctors.net.uk Journal Watch service, which covers other specialties as well as respiratory medicine. Doctors.net.uk is the largest network of GMC-registered doctors in the UK. To find out about membership, click on Doctors.net.uk.The opinions expressed herein may not necessarily reflect the views of the authors of the original articles.

Evolving From Clinical Case Reports to Clinical Case Letters: A New Direction for the Journal of Oral Implantology

Evolving From Clinical Case Reports to Clinical Case Letters: A New Direction for the Journal of Oral Implantology

The Neglect of Chronic Disease Self-Management in Medical Education: Involving Patients as Educators

An estimated 133 million Americans and 16 million Canadians (roughly half the population of both countries) live with at least one chronic illness; about one in four suffers limitations to daily activities as a consequence. As the population ages and people live longer, we can expect to see an increase in the prevalence and complexity of chronic illness. Chronic disease management will become a major part of the work of health professionals, both as individuals and as members of interprofessional teams. The need to align medical education with changes in health care delivery will require more emphasis on chronic disease management as well as on the related topics of behavioral and social sciences and interprofessional teamwork. 1 Yet medical education is still focused on, and in, acute care. A PubMed search of all issues of two top medical education journals for the term “chronic disease management” yielded four papers in Academic Medicine and nine in Medical Education. In chronic disease, the patient/family is the chief provider of care. Patient chronic disease self-management (CDSM) and selfmanagement support by clinicians have been identified as essential components of chronic care programs. The need for health professionals to be trained in the core competencies required in CDSM support has been identified. Yet there appears to be a wide gap between health professionals’ understanding of CDSM and the wider concerns and realities of patients. Whereas health professionals identify selfmanagement primarily as structured patient education, patients identify selfmanagement as a process initiated to bring about order in their lives that involves recognizing and monitoring the boundaries, mobilizing resources, managing the shift in self-identity, and balancing, pacing, planning, and prioritizing. A seminal study identified three lines of work that people managing chronic illnesses at home must undertake: illness work, referred to as trajectory management (symptom management, diagnostic-related work, crisis prevention and management); everyday life work (house work, looking after family, paid work, eating, etc.); and biographical work (reconstruction of the patient’s biography). 2These tasks may compete or conflict with medical

Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates

BackgroundQualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade.MethodsA bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals.ResultsThe total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals.ConclusionsThis analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood.

Quality of Cohort Studies Reporting Post the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement

The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist are addressed. Six top scientific medical journals with high impact factor were selected including New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal, Archive of Internal Medicine, and Canadian Medical Association Journal. Ten cohort studies published in 2010 were selected randomly from each journal. The percentage of items in the STROBE checklist that were addressed in each study was investigated. The total percentage of items addressed by these studies was 69.3 (95% confidence interval: 59.6 to 79.0). We concluded that reporting of cohort studies published in the most prestigious scientific medical journals is not clear enough yet. The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise.

Biomedical journal editing: elements of success

The current pace of developments in virtually every aspect of our life and scientific innovations pose ever increasing challenges in ensuring the highest possible quality of publications, satisfying the needs of both publishers and readers. Scholarly journals are essential tools for communication between experts and for advancement of research and practice in various fields of science (1). By communicating original research data, comprehensively covering emerging scientific concepts and directions and analyzing news reports, journals are being increasingly recognized as educational tools. Relevant examples are top general medical journals, such as The Lancet, The New England Journal of Medicine, and The British Medical Journal, reflecting developments in science and educating physicians and eventually changing clinical practice worldwide. Multiple functions assigned to scholarly journals raise the issues of trustworthiness and quality of the publications. The latter is of particular importance in view of recent trends in information flow, digitalization, and acceleration of the publishing process, which may increase the rate of errors and mistakes.

Usage of Open-Access Journals: Findings from Eleven Top Science and Medical Journals

In this article, usage patterns of open-access and hybrid-open-access journals in selected scholarly publications are outlined. The authors analyzed more than 1,100 citations from eleven top science and medical journals for 2004, 2006, and 2008. The eleven high-impact journals included eight traditional, one open-access, and two hybrid-open-access journals. In most cases, the data show that the usage of open-access journals increased from 2004 to 2008.

Ghostwriting: Stringent Disclosure Policies Take Aim at Authorship Abuses

In recent years, there has been an evolution, or at least heightened awareness, of ethics in medical journal publishing. Issues surrounding author conflicts of interest have been discussed frequently in the literature1-3 and now the surprisingly common practice of article ghostwriting is also receiving well-deserved (and long overdue) scrutiny. Aesthetic Surgery Journal has positioned itself at the forefront of these developments in journal publishing through increasingly stringent disclosure policies applied to both authors and reviewers of manuscripts. Our most recent disclosure document (“Verification of Authorship”) is aimed at ensuring that individuals listed as authors have actually had substantial involvement in research and manuscript preparation and that any assistance provided by other individuals and/or entities is openly acknowledged. It has been a longstanding (though largely unacknowledged) practice in the world of medical publishing for professional writers or researchers to sometimes be paid by pharmaceutical and medical device companies to develop articles that are subsequently attributed to physician or academic authors whose actual involvement may be minimal. A survey by editors of the Journal of the American Medical Association ( JAMA ), which was reported by The New York Times and other media outlets, revealed that 7.8 percent of the corresponding authors of 630 articles appearing in a number of top medical journals in 2008 admitted (via an anonymous survey) that unacknowledged ghostwriters contributed to their published manuscripts. …

Response to Critically Appraised Paper, ‘Patient perspectives of hand osteoarthritis in relation to current measures of function’

Dear Editor, Thank you for critically appraising our article and for your thoughtful comments and suggestions. We agree fully with what you write; however, we would like to raise the following issue. Several different theories, opinions and methodologies as well as differences in epistemology and ontology underpinning qualitative research exist. Choices and decisions have to be made by the researcher (Finlay & Ballinger, 2006). Qualitative research may benefit from this diversity and methodological discussion. In contrast with acknowledging such diversity in research methods, the dominant research paradigm in health and medicine in Austria, the country where we live and conduct our research, is rather one dimensional and follows a biomedical, positivist and natural science understanding of health and illness (Stamm, 2009). Editors (and reviewers) of international medical journals – which are ‘important’ in Austria in terms of their (medical) impact factor – may share this view. Our experience with raising money for qualitative projects as well as with publishing studies is thus ambivalent. As we feel that it is essential to bring qualitative projects to the knowledge of the (bio)medical audience, we had to argue for these projects and develop them within this existing context to get projects funded and studies accepted. Another example is that we included Kappa calculations for agreement between researchers in qualitative studies to make them more ‘attractive’ for a biomedical audience (Stamm et al., 2007), thus placing our study in a post-positivist research paradigm. However, firstly, we had to establish our position and research group within this predominantly positivist research culture (in terms of funding, impact factor and publications in top-medical journals); then secondly, we had the resources and self-reflection from our learning history within different research cultures to conduct and publish qualitative projects that acknowledged – for example – a textual and narrative approach to understand human experiences (Stamm et al., 2008a, 2008b). As this biomedical, positivist and natural science research tradition in our own learning history played an important part, we still feel that accepting a diversity of research methods in qualitative research that represents the continuum of methodology, including the context and environment in which the data have been ‘produced’, is essential.

LOST to follow-up Information in Trials (LOST-IT): a protocol on the potential impact.

BackgroundIncomplete ascertainment of outcomes in randomized controlled trials (RCTs) is likely to bias final study results if reasons for unavailability of patient data are associated with the outcome of interest. The primary objective of this study is to assess the potential impact of loss to follow-up on the estimates of treatment effect. The secondary objectives are to describe, for published RCTs, (1) the reporting of loss to follow-up information, (2) the analytic methods used for handling loss to follow-up information, and (3) the extent of reported loss to follow-up.MethodsWe will conduct a systematic review of reports of RCTs recently published in five top general medical journals. Eligible RCTs will demonstrate statistically significant effect estimates with respect to primary outcomes that are patient-important and expressed as binary data. Teams of 2 reviewers will independently determine eligibility and extract relevant information from each eligible trial using standardized, pre-piloted forms. To assess the potential impact of loss to follow-up on the estimates of treatment effect we will, for varying assumptions about the outcomes of participants lost to follow-up (LTFU), calculate (1) the percentage of RCTs that lose statistical significance and (2) the mean change in effect estimate across RCTs. The different assumptions we will test are the following: (1) none of the LTFU participants had the event; (2) all LTFU participants had the event; (3) all LTFU participants in the treatment group had the event; none of those in the control group had it (worst case scenario); (4) the event incidence among LTFU participants (relative to observed participants) increased, with a higher relative increase in the intervention group; and (5) the event incidence among LTFU participants (relative to observed participants) increased in the intervention group and decreased in the control group.DiscussionWe aim to make our objectives and methods transparent. The results of this study may have important implications for both clinical trialists and users of the medical literature.

Does the Evidence Make a Difference in Consumer Behavior? Sales of Supplements Before and After Publication of Negative Research Results

ObjectiveTo determine if the public consumption of herbs, vitamins, and supplements changes in light of emerging negative evidence.MethodsWe describe trends in annual US sales of five major supplements in temporal relationship with publication of research from three top US general medical journals published from 2001 through early 2006 and the number of news citations associated with each publication using the Lexus-Nexis database.ResultsIn four of five supplements (St. John’s wort, echinacea, saw palmetto, and glucosamine), there was little or no change in sales trends after publication of research results. In one instance, however, dramatic changes in sales occurred following publication of data suggesting harm from high doses of vitamin E.ConclusionResults reporting harm may have a greater impact on supplement consumption than those demonstrating lack of efficacy. In order for clinical trial evidence to influence public behavior, there needs to be a better understanding of the factors that influence the translation of evidence in the public.

Scientific publications in gastroenterology and hepatology journals from Chinese authors in various parts of North Asia: 10‐year survey of literature

People of Chinese ethnicity are one of the groups at most risk of gastrointestinal and liver diseases in the world. The research status in gastroenterology and hepatology (gastrointestinal [GI]) among Chinese individuals in the three major regions of China-the mainland (ML), Hong Kong (HK), and Taiwan (TW)-are unknown. The outputs of articles published in international GI journals from the three regions were compared in this study. Articles published in 52 journals related to GI originating from the ML, TW, and HK from1996-2005 were retrieved from the PubMed database. The numbers of total articles, clinical trials, randomized controlled trials, case reports, impact factors (IF), citation reports, and articles published in the top general medical journals were conducted for quantity and quality comparisons. The number of articles from the three regions increased significantly from 1996 to 2005. There were 5170 articles from the ML (2969), TW (1551), and HK (650). However, nearly 90% of articles from the ML were published in World Journal of Gastroenterology (WJG), a controversial Chinese journal. Following the exclusion of WJG, the ML had published the least number of articles and had the least total citations. The accumulated IF of the articles from TW (3747.893) was much higher than the ML (775.084) and HK (2272.972). HK had the highest average IF of articles in GI journals and the most articles published in the top, general medical journals among the three regions. The difference between the number of GI research articles published in the ML, TW, and HK still appears to be considerable, particularly when assessed by IF, although the gap appears to be narrowing.

The Use of Statistics in Medical Research

There is widespread evidence of the extensive use of statistical methods in medical research. Just the same, standards are generally low and a growing body of literature points to statistical errors in most medical journals. However, there is no comprehensive study contrasting the top medical journals of basic and clinical science for recent practice in their use of statistics.All original research articles in Volume 10, Numbers 1–6 of Nature Medicine (Nat Med) and Volume 350, Numbers 1–26 of The New England Journal of Medicine (NEJM) were screened for their statistical content. Types, frequencies, and complexity of applied statistical methods were systematically recorded. A 46-item checklist was used to evaluate statistical quality for a subgroup of papers.94.5 percent (95% CI 87.6–98.2) of NEJM articles and 82.4 percent (95% CI 65.5–93.2) of Nat Med articles contained inferential statistics. NEJM papers were significantly more likely to use advanced statistical methods (p < 0.0001). Statistical errors were identified in a considerable proportion of articles, although not always serious in nature. Documentation of applied statistical methods was generally poor and insufficient, particularly in Nat Med.Compared to 1983, a vast increase in usage and complexity of statistical methods could be observed for NEJM papers. This does not necessarily hold true for Nat Med papers, as the results of the study indicate that basic science sticks with basic analysis. As statistical errors seem to remain common in medical literature, closer attention to statistical methodology should be seriously considered to raise standards.

EndNote® and Reference Manager® Citation Formats Compared to “Instructions to Authors” in Top Medical Journals

The study compared citation format in EndNote® version 7 and Reference Manager® version 11 with the citation format for references found in the instructions to authors from the most significant medical literature. The resulting information should be very useful to those who depend on citation management software to format and organize their references for publication in medicine, and librarians and others who teach the use of citation management software.

Fraud Upends Oral Cancer Field, Casting Doubt on Prevention Trial

The world of oral cancer research is reeling after one of its stars, Norwegian oncologist Jon SudbA¸, admitted this week through his attorney to falsifying data in three seminal papers published by top medical journals. (Read more.)

Exploring the thrifty genotype's food-shortage assumptions: A cross-cultural comparison of ethnographic accounts of food security among foraging and agricultural societies

The "thrifty genotype hypothesis" has become firmly entrenched as one of the orienting concepts in biomedical anthropology, since first being proposed by Neel (1962 Am. J. Hum. Genet. 14:353-362) over 40 years ago. Its influence on inquiries into the evolutionary origins of diabetes, lactose tolerance, and other metabolic disorders can hardly be underestimated, as evidenced by its continued citation in many top scientific and medical journals. However, its fundamental assumption, that foragers are more likely to experience regular and severe food shortages than sedentary agriculturalists, remains largely untested. The present report tests this assumption by making a cross-cultural statistical comparison of the quantity of available food and the frequency and extent of food shortages among 94 foraging and agricultural societies as reported in the ethnographic record. Our results indicate that there is no statistical difference (P < 0.05) in the quantity of available food, or the frequency or extent of food shortages in these reports between preindustrial foragers, recent foragers, and agriculturalists. The findings presented here add to a growing literature that calls into question assumptions about forager food insecurity and nutritional status in general, and ultimately, the very foundation of the thrifty genotype hypothesis: the presumed food shortages that selected for a "thrifty" metabolism in past foraging populations.