A journal retracts an article but they can't change minds back that easily

This week The Lancet formally retracted an article published in 1998 that suggested a link between vaccinations and autism. The article has been highly publicized and had cast doubt about the safety of vaccines among many parents. The ideas in this article and subsequent research have circulated for 10 years and it will likely take more than a retraction in a British medical journal to retract the idea in the minds of many parents and many in the public. A New York Times article suggests the retraction may be little to change skeptics minds at all.

It is like the old story often used in Sunday School lessons about gossip. The setting sometimes changes, but at the crux of the lesson a minister and the town gossip go to the top of the church steeple and the minister cuts open a down pillow and scatters the feathers to the wind. He then asks the town gossip to gather every one of the feathers. It is, of course, impossible. Once the words are out there, they cannot be gathered back.

Research is about innovation. And innovative ideas are often put in the public before they are fully understood. I don't think this should stop us from exploring innovative research. But all of us who do research must realize the power of our words. Once we put the words out there, it is nearly impossible to take them back.

More on ghostwriting in medical journals

A study that was reported this week at a conference of journal editors sheds some new light on the use of ghostwriters in medical journal articles. Ghostwriters are paid writers who do not appear on the list of academic authors, who may be paid by pharmaceutical or medical device companies. The concern is that the unattributed authors introduce bias into a source where physicians turn for the latest in scientific developments.

It appears that some of the discrepancies in the study may be due to different journal policies having different authorship disclosure requirements. But this remains an important issue. Transparency in medical research and reporting is absolutely necessary in order to evaluate the evidence and make the best treatment decisions for the patients. Failing to disclose all the authors and their affiliations withholds an important key to sound medical-decision making. I hope that this study will encourage more journals to evaluate their current policies and work to make their author reporting requirements more transparent, so we can all learn from and evaluate the latest in medical research.

One more word on Meredith and Derek and their clinical trial

A couple weeks ago, I mentioned the season finale of Grey's Anatomy and the unrealistic portrayal of clinical trials. Well, it turns out I'm not the only one who noticed. The Association of Clinical Research Professional June ACRPWIRE reprinted an editorial from the Coalition of Cancer Cooperative Groups expressing concern that the show equated cancer clinical trials with a death sentence.

You can find the article here: http://newsmanager.commpartners.com/acrpwire/issues/2008-06-05/1.html.

It can be potentially dangerous when television shows spread misconception about how medicine works. When a television show or other mass medium breeds potential mistrust of medical research, everybody suffers.

Ghostwriters and clinical drug studies

The New York Times reports on an article published today in JAMA about ghostwriters, hired by Merck, to write up reports on Vioxx. Merck then found prestigious physician researchers to put their names on the reports as they appeared in medical journals.

Some of the physicians argued that they were actively involved in the research. The researchers in question may have been involved, but the troubling point is that the drug company was also involved in the drafting of their journal piece. The practice of the drug companies being actively involved in the drafting of reports raises questions about the objectivity of the research, especially if the company's involvement is not disclosed. The general public will have greater cause to trust the research published, if there is transparency about the research methods and personnel involved.

You can find the NYT article here, with a link to the JAMA article: http://www.nytimes.com/2008/04/16/business/16vioxx.html?ex=1366084800&en=ef29a5f6ea0a6e76&ei=5124&partner=permalink&exprod=permalink

two interesting articles

Yesterday evening I was occupied at an Association of Clinical Research Professionals meeting so I didn't get a chance to post this interesting article from CNN about whether the Tuskegee syphilis trial still has repercussions for African Americans participation in clinical trials today. It is an interesting article that examines whether African Americans distrust clinical trials, or if they do not have equal access to opportunities to participate in clinical trials. You can find the article here: http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/index.html.

Today's New York Times ran an article today on trends in medical education, specifically the trend towards specialization in the highly competitive fields of dermatology and plastic surgery. While dermatology was once derided by other medical specialties, new research is drawing in more medical students and residents. Also enticing is the promise of high pay and stable hours as compared to other medical professions. But this has implications for medical care in that fewer doctors are specializing in primary and preventative care, which have longer hours and lower pay. The article explores these issues here: http://www.nytimes.com/2008/03/19/fashion/19beauty.html?ex=1363665600&en=6af29d977d525093&ei=5124&partner=permalink&exprod=permalink

doctors and coercion

OK, I'll admit it. I watch the melodramatic soap opera that is Grey's Anatomy. And something struck me while I watched last week's episode: coercion by doctors. In one scene, one of the doctors talked a young woman into the shoulder surgery she needed by telling her she would have a hunchback on her wedding day if she didn't have the surgery. In another scene, another doctor talked a patient into a risky heart surgery by telling the patient, an avid birdwatcher, i was the only way he could live to see a rare bird.

Of course, this screams coercion and doesn't even remotely resemble anything like informed consent or patient autonomy. But in both scenes, the doctors were looked highly upon by their colleagues and supervisors for talking the patients into the surgeries.

It makes me wonder, is this how people see doctors? It's not like this show is written by doctors. It is written by people who have interacted with the health care system as patients or as family members of patients. Do people see doctors as coercive and paternalistic? And no one on the show seemed outraged by this coercion. Do people think this paternalism is OK? Or do they not expect autonomy in medical decision-making because they have yet to truly experience it themselves?

Distrust and communication in health care

It seems that at least some of the problems with communication in health care come down to distrust. Some people may not disclose information to their doctor because they feel like they can't trust their doctor. If the patient withholds information, the doctor may not have all the information they need to make a diagnosis. If a doctor senses a patient is not being being honest, he or she may be more guarded with the information he or she shares with the patient. And the communication problem perpetuates.

This is even a larger problem when it comes to medical research. Because of past medical research atrocities, such as the Tuskegee syphilis studies, many African Americans are inherently distrustful of medical research. I am now in the process of beginning some outreach efforts for our communication research project at MCW and because it involves sickle cell trait, we have to be even more deliberate in our efforts to reach out to the community. In the past, some have used sickle cell disease and even sickle cell trait as a reason to discriminate against African Americans for certain jobs, so it is easy to see why some people may potentially question our motives for wanting to talk to people about sickle cell disease.

This distrust of the medical establishment is ultimately one of the reasons why physician-patient communication research is so important. Better communication and better understanding can lead to greater trust between patients and physicians.