I Got the Wrong Request from the Wrong Journal to Review the Wrong Piece. The Wrong kind of Open Access Apparently, Something Wrong with this Inherently…

27 08 2011

Meanwhile you might want to listen to “Wrong” (Depeche Mode)

Yesterday I screened my spam-folder. Between all male enhancement and lottery winner announcements, and phishing mails for my bank account, there was an invitation to peer review a paper in “SCIENCE JOURNAL OF PATHOLOGY”.

Such an invitation doesn’t belong in the spam folder, doesn’t it? Thus I had a closer look and quickly screened the letter.

I don’t know what alarmed me first. The odd hard returns, the journal using a Gmail address, an invitation for a topic (autism) I knew nothing about, an abstract that didn’t make sense and has nothing to do with Pathology, the odd style of the letter: the informal, but impersonal introduction (How are you? I am sure you are busy with many activities right now) combined with a turgid style (the paper addresses issues of value to our broad-based audience, and that it cuts through the thick layers of theory and verbosity for them and makes sense of it all in a clean, cohesive manner) and some misspellings. And then I never had an invitation from an editor, starting with the impersonal “Colleagues”… 

But still it was odd. Why would someone take the trouble of writing such an invitation letter? For what purpose? And apparently the person did know that I was a scientist, who does -or is able to- peer review medical scientific papers. Since the mail was send to my Laika Gmail account, the most likely source for my contact info must have been my pseudonymous blog. I seldom use this mail account for scientific purposes.

What triggered my caution flag the most, was the topic: autism. I immediately linked this to the anti-vaccination quackery movement, that’s trying to give skeptic bloggers a hard time and fights a personal, not a scientific battle. I also linked it to #epigate, that was exposed at Liz Ditz I Speak of Dreams, a blog with autism as a niche topic.

#Epigate is the story of René Najeraby aka @EpiRen, a popular epidemiologist blogger who was asked to stop engaging in social media by his employers, after a series of complaints by a Mr X, who also threatened other pseudonymous commenters/bloggers criticizing his actions. According to Mr. X no one will be safe, because all i have to do is file a john doe – or hire a cyber investigator. these courses of action cost less than $10,000 each; which means every person who is afraid of the light can be exposed”  In another comment at Liz Ditz’ he actually says he will go after a specific individual: “Anarchic Teapot”.

Ok, I admit that the two issues might be totally coincidental, and they probably are, but I’m hypersensitive for people trying to silence me via my employers (because that did happen to me in the past). Anyway,asking a pseudonymous blogger to peer-review might be a way to hack the real identity of such a blogger. Perhaps far-fetched, I know.

But what would the “editor” do if I replied and said “yes”?

I became curious. Does The Science Journal of Pathology even exist?

Not in PubMed!!

But the Journal “Science Journal of Pathology” does exist on the Internet…. and John Morrison is the editor. But he is the only one. As a matter of fact he is the entire staff…. There are “search”, “current” and “archives” tabs, but the latter two are EMPTY.

So I would have the dubious honor of reviewing the first paper for this journal?…. 😉

  1. (First assumption – David) – High school kids are looking for someone to peer review (and thus improve) their essays to get better grades.
    (me: school kids could also be replaced by “non-successful or starting scientists”)
  2. (Second assumption – David) Perhaps they are only looking to fill out their sucker lists. If you’ve done a bad review, they may blackmail you in other to keep it quiet.
  3. (me) – The journal site might be a cover up for anything (still no clue what).
  4. (me) – The site might get a touch of credibility if the (upcoming) articles are stamped with : “peer-reviewed by…”
  5. (David & me) the scammers target PhD’s or people who the “editors” think have little experience in peer reviewing and/or consider it a honor to do so.
  6. (David & me) It is phishing scam.You have to register on the journal’s website in order to be able to review or submit. So they get your credentials. My intuition was that they might just try to track down the real name, address and department of a pseudonymous blogger, but I think that David’s assumption is more plausible. David thinks that a couple of people in Nigeria is just after your password for your mail, amazon, PayPal etc for “the vast majority of people uses the same password for all logins, which is terribly bad practice, but they don’t want to forget it.”

With David, I would like to warn you for this “very interesting phishing scheme”, which aims at academics and especially PhD’s. We have no clue as to their real intentions, but it looks scammy.

Besides that the scam may affect you personally, such non-existing and/or low quality open access journals do a bad service to the existing, high quality open access journals.

There should be ways to remove such scam websites from the net.

Notes

“Academic scams – my wife just received a version of this for an Autism article, PhD/DPhil/Masters students beware that mentions a receipt of a similar autism”
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The Second #TwitJC Twitter Journal Club

14 06 2011

In the previous post I wrote about  a new initiative on Twitter, the Twitter Journal Club (hashtag #TwitJC). Here, I shared some constructive criticism. The Twitter Journal Club is clearly an original and admirable initiative, that gained a lot of interest. But there is some room for improvement.

I raised two issues: 1. discussions with 100 people are not easy to follow on Twitter, and 2. walking through a checklist for critical appraisals is not the most interesting to do (particularly because it had already been done).

But as one of the organizers explained, the first session was just meant for promoting #twitjc. Instead of the expected 6 people, 100 tweople showed up.

In the second session, last Sunday evening, the organizers followed a different structure.

Thus, I thought it would only be fair, to share my experiences with the second session as well. This time I managed to follow it from start to finish.

Don’t worry. Discussing the journal club won’t be a regular item. I will leave the organization up to the organizers. The sessions might inspire me, though, to write a blog post on the topic now and then. But that may only work synergistic. (at least for me, because it forces me to rethink it all)

This time the discussion was about Rose’s Prevention Paradox (PDF), a 30 year old paper that is still relevant. The paper is more of an opinion piece, therefore the discussion focused on the implications of the Prevention Paradox theory. It was really helpful that Fi wrote an introduction to the paper, and a Points of Discussion beforehand. There were 5 questions (and many sub-questions).

I still found it very hard to follow it all at Twitter, as illustrated by the following tweet:

  • laikas I think I lost track. Which question are we? #twitjc Sun Jun 12 20:07:03
  • laikas @MsPhelps ik werd wel helemaal duizelig van al die tweets. Er zijn toch wel veel mensen die steeds een andere vraag stellen voor de 1e is beantwoord -9:47 PM Jun 12th, 2011 (about instant nausea when seeing tweets rolling by and people already posing a new question before the first one is answered)

I followed the tweets at http://tweetchat.com/room/twitjc. Imagine tweets rolling by and you try to pick up those tweets you want to respond to (either bc they are very relevant, or because you disagree). By the time you have finished your tweet, already 20 -possibly very interesting tweets- passed by, including the next question by the organizers (unfortunately they didn’t use the official @twitjournalclub account for this).

Well, I suppose I am not very good at this. Partly because I’m Dutch (thus it takes longer to compose my tweets), partly because I’m not a fast thinker. I’m better at thorough analyses, at my blog for instance.

But this is Twitter.  To speak with Johan Cruyff, a legendary soccer-player from Holland, “Every disadvantage has its advantage”.

Twitter may not favor organized discussions, but on the other hand it is very engaging, thought-provoking and easy accessible. Where else do you meet 100 experts/doctors willing  to exchange thoughts about an interesting medical topic?

The tweets below are in line with/reflect my opinion on this second Twitter Journal Club (RT means retweeting/repeating the tweet):

  • laikas RT @themattmak@fidouglas @silv24 Congratulations again on a great #twitjc. Definitely more controversial and debate generating than last week’s! -9:18 PM Jun 12th, 2011
  • laikas @silv24 well i think it went well (it is probably me, I’m 2 slow). This paper is broad, evokes much discussion & many examples can B given -9:45 PM Jun 12th, 2011
  • DrDLittle Less structure to #twitJC last night but much wider debate 7:41 AM Jun 13th, 2011
  • amitns @DrDLittle It’s obviously a very complex topic, more structure would have stifled the debate. A lot of food for thought.#twitJC -7:45 AM Jun 13th, 2011

Again, the Twitter Journal Club gained a lot of interest. Scientist and teachers consider to borrow the concept. Astronomers are already preparing their first meeting on Thursday… And Nature seems to be on top of it as well, as it will interview the organizers of the medical and the astronomy journal club for an interview.

Emergency Physician Tom Young with experience in critically appraisal just summarized it nicely: (still hot from the press):

The two meetings of the journal club so far have not focussed in on this particular system; the first used a standard appraisal tool for randomised controlled trials, the second was more laissez-faire in its approach. This particular journal club is finding its feet in a new setting (that of Twitter) and will find its strongest format through trial and error. indeed, to try to manage such a phenomenon might be likened to ‘herding cats’ that often used description of trying to manage doctors, and I think, we would all agree would be highly inadvisable. Indeed, one of its strengths is that participants, or followers, will take from it what they wish, and this will be something, rather than nothing, whatever paper is discussed, even if it is only contact with another Tweeter, with similar or divergent views. 

Indeed, what I gained from these two meetings is that I met various nice and interesting people (including the organizers, @fidouglas and @silv24). Furthermore, I enjoyed the discussions, and picked up some ideas and examples that I would otherwise wouldn’t know about. The last online meeting sparked my interest in the prevention paradox. Before the meeting, I only read the paper at a glance. After the session I decided to read it again, and in more detail. As a matter of fact I feel inspired to write a blog post about this theory. Originally I planned to write a summary here, but probably the post is getting too long. Thus I will await the summary by the organizers and see if I have time to discuss it as well.

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Health Experts & Patient Advocates Beware: 10 Reasons Why you Shouldn’t be a Curator at Organized Wisdom!! #OrganizedWisdom

11 05 2011

Last year I aired my concern about Organized Wisdom in a post called Expert Curators, WisdomCards & The True Wisdom of @organizedwisdom.

Organized Wisdom shares health links of health experts or advocates, who (according to OW’s FAQ), either requested a profile or were recommended by OW’s Medical Review Board. I was one of those so called Expert Curators. However, I had never requested a profile and I seriously doubt whether someone from the a medical board had actually read any of my tweets or my blog posts.

This was one of the many issues with Organized Wisdom. But the main issue was its lack of credibility and transparency. I vented my complaints, I removed my profile from OW, stopped following updates at Twitter and informed some fellow curators.

I almost forgot about it, till Simon Sikorski, MD, commented at my blog, informing me that my complaints hadn’t been fully addressed and convincing me things were even worse than I thought.

He has started a campaign to do something about this Unethical Health Information Content Farming by Organized Wisdom (OW).

While discussing this affair with a few health experts and patient advocates I was disappointed by the reluctant reactions of a few people: “Well, our profiles are everywhere”, “Thanks I will keep an eye open”, “cannot say much yet”. How much evidence does one need?

Of course there were also people – well known MD’s and researchers – who immediately removed their profile and compared OW’s approach with that of Wellsphere, that scammed the Health Blogosphere. Yes, OW also scrapes and steals your intellectual property (blog and/or tweet content), but the difference is: OW doesn’t ask you to join, it just puts up your profile and shares it with the world.

As a medical librarian and e-patient I find the quality, reliability and objectivity of health information of utmost importance. I believe in the emancipation of patients (“Patient is not a third person word”, e-patient Dave), but it can only work if patients are truly well informed. This is difficult enough, because of the information overload and the conflicting data. We don’t need any further misinformation and non-transparency.

I belief that Organized Wisdom puts the reputation of  its “curators” at stake and that it is not a trustworthy nor useful resource for health information. For the following reasons (x see also Simon’s blog post and slides, his emphasis is more on content theft)

1. Profiles of Expert Curators are set up without their knowledge and consent
Most curators I asked didn’t know they were expert curators. Simon has spoken with 151 of the 5700 expert curators and not one of those persons knew he/she was listed on OW. (x)

2. The name Expert Curator suggests that you (can) curate information, but you cannot.
The information is automatically produced and is shown unfiltered (and often shown in duplicate, because many different people can link to the same source). It is not possible to edit the cards.
Ideally, curating should even be more than filtering (see this nice post about 
Social Media Content Curators, where curation is defined as the act of synthesizing and interpreting in order to present a complete record of a concept.)

3. OW calls your profile address: “A vanity URL¹”.

Is that how they see you? Well it must be said they try to win you by pure flattery. And they often succeed….

¹Quote OW: “We credit, honor, and promote our Health Experts, including offering: A vanity URL to promote so visitors can easily share your Health Profile with others, e.g. my.organizedwisdom.com/ePatientDave.
Note: this too is quite similar to the Wellsphere’s approach (read more at E-patients-net)

4. Bots tap into your tweets and/or scrape the content off their website
(x: see healthcare content farms monetizing scheme)

5. Scraping your content can affect your search rankings (x)
This probably affects starting/small blogs the most. I checked two posts of well known blogs and their websites still came up first.

6.  The site is funded/sponsored by pharmaceutical companies.
 “Tailored” ads show up next to the so called Wisdom Cards dealing with the same topic. If no pharmaceutical business has responded Google ads show up instead.
See the form where they actually invite pharma companies to select a target condition for advertizing. Note that the target conditions fit the OW topics.

7. The Wisdom Cards are no more than links to your tweets or posts. They have no added value. 

8. Worse, tweets and links are shown out of context.
I provided various examples in my previous post (mainly in the comment section)

A Cancer and Homeopathy WisdomCard™ shows Expert Curator Liz Ditz who is sharing a link about Cancer and Homeopathy. The link she shares is a dangerous article by a Dr. who is working in an Homeopathic General Hospital, in India “reporting” several cases of miraculous cures by Conium 1M, Thuja 50M and other watery-dilutions. I’m sure that Liz Ditz, didn’t say anything positive about the “article”. Still it seems she “backs it up”. Perhaps she tweeted: “Look what a dangerous crap.”
When I informed her, Liz said:“AIEEEE…. didn’t sign up with Organized Wisdom that I know of”. She felt she was used for credulous support for homeopathy & naturopathy.

Note: Liz card has disappeared (because she opted out), but I was was surprised to find that the link (http://organizedwisdom.com/Cancer-and-Homeopathy/wt/medstill works and links to other “evidence” on the same topic.


9. There is no quality control. Not of the wisdom cards and not of the expert curators.
Many curators are not what I would call true experts and I’m not alone: @holly comments at a Techcrunch postI am glad you brought up the “written by people who do not have a clue, let alone ANY medical training [of any kind] at all.” I have no experience with any kind of medical education, knowledge or even the slightest clue of a tenth of the topics covered on OW, yet for some reason they tried to recruit me to review cards there!?! )

The emphasis is also on alternative treatments: prevention of cancer, asthma, ADHD by herbs etc. In addition to “Health Centers”, there also Wellness Centers (AgingDietFitness etc) and Living Centers (BeautyCookingEnvironment). A single card can share information of 2 or 3 centers (diabetes and multivitamins for example).

And as said, all links of expert curators are placed unfiltered, even when you make a joke or mention you’re on vacation. Whether you’re a  Top health expert or advocate (there is a regular shout-out) just depends on the number of links you share, thus NOT on quality. For this reason the real experts are often at lower positions.

Some cards are just link baits.

 

10.  Organized Wisdom is heavily promoting its site.
Last year it launched activitydigest, automatic digests meant to stimulate “engagement” of expert curators. It tries to connect with top health experts, pharma -people and patient advocates. Hoping they will support OW. This leads to uncritical interviews such as at Pixels and Pills, at Health Interview (
Reader’s Digest + Organized Wisdom = Wiser Patients), Xconomy.com organizedwisdom recruits experts to filter health information on the web.

What can you do?

  • Check whether you have a profile at Organized Wisdom here.
  • Take a good look at Organized Wisdom and what it offers. It isn’t difficult and it doesn’t take much time to see through the facade.
  • If you don’t agree with what it represents, please consider to opt out.
  • You can email info@organizedwisdom.com to let your profile as expert curator removed.
  • If you agree that what OW does is no good practice, you could do the following (most are suggestions of Simon):
  • spread the word and inform others
  • join the conversation on Twitter #EndToFarms
  • join the tweetup on what you can do about this scandal and how to protect yourself from being liable. (more details will be offered by Simon at his regularly updated blogpost)
  • If you don’t agree this Content Farm deserves HONcode certification, notify HON at  https://www.healthonnet.org/HONcode/Conduct.html?HONConduct444558
Please don’t sit back and think that being a wisdom curator does not matter. Don’t show off  with an Organized Wisdom badget, widget or link at your blog or website.  Resist the flattery of being called an expert curator, because it doesn’t mean anything in this context. And by being part of Organized Wisdom, you indirectly support their practice. This may seriously affect your own reputation and indirectly you may contribute to misinformation.

Or as Heidi’s commented to my previous post:

I am flabbergasted that people’s reputation are being used to endorse content without their say so.
Even more so that they cannot delete their profile and withdraw their support.*

For me those two things on their own signal big red flags:

The damage to a health professional’s reputation as a result could be great.
Misleading the general public with poor (yes dangerous) information another

Altogether unethical.

*This was difficult at that time.

Update May 10, 2011: News from Simon: 165 individuals & 5 hospitals have now spoken up about unfolding scandal and are doing something about it (Tuesday )

Update May 12, 2011: If I failed to convince you, please read the post of Ramona Bates MD (@rlbates at Twitter, plastic surgeon, blogger at Suture for a Living), called “More Organized Wisdom Un-Fair Play. Ramona asked her profile to be removed from OW half a year ago).  Recommended pages at her blog seem to be written by other people.
She concludes:

“Once again, I encourage my fellow healthcare bloggers (doctors, nurses, patient advocates, etc) to remove yourself from any association with Organized Wisdom and other sites like them”

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3rd Call for Submissions for “Medical Information Matters”: Tools for Searching the Biomedical Literature

8 05 2011

It takes some doing to breathe life into Medical Information Matters” (blog carnival about medical  information).
A month ago I wrote a 2nd call for submissions post for this blog carnival. Unfortunately the next host, Martin Fenner, didn’t have time to finish a blog post and has come up with a new (interesting) variation on the theme “A Wish list for better medical information”.

Martin asks you to philosophize, blog and/or comment about “Tools for Searching the Biomedical Literature.

You can base your contribution on a recent (editable) survey of 28 different PubMed derivative tools by Zhiyong Lu (NCBI) [1].

Thus, write your thoughts on the various PubMed derivative tools mentioned here or write about your own favorite 3rd party PubMed tool (included or not).

For details, see Martin’s blog post announcing this upcoming edition. The Blog Carnival FAQs are here.

And if you don’t have time to write about this topic, you may still find the survey useful, as well as the views of others on this topic. So check out Martin’s blog Gobbledygook once in a while to see if the blog edition has been posted.

Note [1]: If you have already submitted a post to the carnival, or would like to write about another theme, we will take care that your post (if relevant)  will be included in this or the next edition. You can always submit here.

Note [2]: Would you like to host “Medical Information Matters” at your blog? Please comment here or write to: laika dot spoetnik at gmail dot com. We need hosts for June, July, August and September (submission deadline first Saturday of every month, posting on the next Tuesday)

  1. Lu Z. PubMed and beyond: a survey of web tools for searching biomedical literature. Database. 2011 Jan;2011. doi: http://dx.doi.org/10.1093/database/baq036




PubMed’s Shutdown Averted… For Now.

12 04 2011

MEDLINE is the National Library of Medicine‘s (NLM) premier bibliographic database of citations from biomedical journals. The content of MEDLINE is available via commercial, fee-for-service MEDLINE vendors, like OVID.

On June 26, 1997, Vice President Al Gore officially announced free MEDLINE access via PubMed. This was one of the consequences of  the Freedom of Information Act (FOIA), a federal law that allows for the full or partial disclosure of previously unreleased information and documents controlled by the United States Government. (http://www.nih.gov/icd/od/foia/index.htm). National Library of Medicine (which is “just” one of the NIH web servers) gives access to many other databases besides PubMed/MEDLINEMeSH, UMLS, ClinicalTrials.gov, MedlinePlus, TOXNET.

I may complain about PubMed once in a while and I may criticize some of its new features, but I cannot imagine a working  life without PubMed. Probably this is even more true for biomedical scientist and physicians who have only access to freely available PubMed and not to OVID MEDLINE, EMBASE and Web of Science, like I do. PubMed and many other NLM databases have become an indispensable source of Medical Information.

We are so used to these free sources, that we take them for granted. Who would imagine that PubMed -or any other great free NLM/NIH database would cease to exists? Still, shutdown of these databases was imminent last weekend. Remarkably it largely went unnoticed, especially for people outside the U.S.

Did you know that there was a great chance of PubMed being killed this weekend?

I happened to get the news via my Twitter stream. I joined in around Friday midnight -Dutch time, 3-4 days ago.

Here are some selected tweets. Have a look. See and feel the panic:

As somebody far from the epicenter  it is hard for me to unravel the logic (?) behind the shutdown threat.

I understand that the near-breakshutdown is the result of the disagreement between the democrats and republicans on the ways to cut the federal costs. By refusing to pass a bill allowing the federal government to be funded, the Republican dominated House of Representatives was forcing a showdown with the White House and Barack Obama. The arrows of the Republicans were mainly directed at Planned Parenthood, the health organisation that Republicans portray as primarily focused on performing abortions, using American taxpayer dollars to do it. However, Planned Parenthood provides an array of services, from screenings for cancer to testing for sexually transmitted diseases (see Huffington post).

Well the tweet of Sarah Palin illustrates the view of the Tea Party (in typical Palin style).

For now, the threat has been averted. The Republicans forced the Democrats to agree to $39bn (£23bn) in spending cuts in this year’s budget to September, $6bn more than the Democrats were prepared to accept earlier this week. In return, the Republicans dropped a demand to cut funding for Planned Parenthood (Guardian). But no one knows whether the aversion is definitive.

This post isn’t meant to dive deep into the US political debate. It is just meant to reflect on the possibility that one of those federal databases, on which we rely, is wiped away overnight, thereby seriously affecting our usual workflows.

Some consequences when PubMed (and MEDLINE?)  would disappear:

  • Many Doctors can no longer search efficiently for medical information (only brows medical journals,  “Google” or look up outdated info).
  • The same is true for many scientists. Look at FlutesUD remarks about the references for her thesis.
  • The disappearance of Pubmed would especially affect rural areas and third world countries.
  • EBM would become difficult to practice:
    • The comprehensive search of PubMed, obligatory for systematic reviews, has to be skipped.
    • It would become almost impossible to do a critical appraised topic (i.e. interns are often used to search/have only access to PubMed)
    • CENTRAL (the largest database of controlled trials) can no longer retrieve its records from PubMed.
  • Librarians can delete many tutorials, e-learning materials and -even- classes.
  • Perhaps many librarians can even say goodbye to their jobs?
  • MYNCBI Saved searches and alerts are gone.
  • MYNCBI Saved papers (collections) are no more.
  • 3rd party Pubmed tools (Novoseek, GoPubMed, HubMed) would also cease to exist.
  • Commercially available MEDLINE sources will be affected as well.
  • By the way clinical.trials.gov, TOXNET etc would also stop. Another hit for librarians, doctors and patients.

For many, disappearance of PubMed is a relative “minor” event compared to the shutdown of other services like the NASA, or healtcare institutions. The near-disappearance of PubMed made me realize how fragile this excellent service is on which we -librarians, physicians, medical students and scientists- rely. On the other hand, it also made me realize how thankful we should be that such a database is available to us for free (yes, even for people outside the US).

Note: (Per 2011-04-14)

I have changed the title from “PubMed’s Sudden Death averted” to “PubMed’s Shutdown averted”, because Death is permanent and it was unknown if the shutdown, if any, would be permanent.

I have also changed some words in the text (blue), thus changed disappearance to “shutdown” for the same reasons as mentioned above.

On the other hand I’ve added some tweets which clearly indicate that the shutdown was not “nothing to worry about”.

The tweets mentioned are not from official resources. And this is what this post is partly about. The panic that results if there is a lack of reliable information. Other main points: (2) the importance of PubMed for biomedical information and (3) that PubMed’s permanent (free) existence is not granted.

Nikki D at Eagledawg describes the event (lack of info and panic) very clearly in her post: Pubmed. Keep Calm and Carry On?

More Info:





Medical Information Matters: 2nd Call For Submissions

1 04 2011

You may have noticed that my blog was barely updated between November and February. Lets say I had the winter blues.

As a consequence, the Blog Carnival “Medical Information Matters” hibernated as well. Unintended… But as a host you need to actively engage in blog carnivals. Else few people will submit.

This is the reason that Martin Fenner at Gobblydook didn’t post “his edition”, but luckily he is willing to give it another try.

Here was his call for submissions (in December). I have adapted it a little to make it “up to date”.

In December April I am hosting the blog carnival Medical Information Matters, a blog carnival about – medical information. The deadline for submissions is next Tuesday this weekend, and I have already received a number of interesting posts. As Christmas is right around the corner, I thought that a good theme for the carnival would be a wish list for better medical information. This could mean many different things, e.g. a database that covers a specific area, better access to fulltext papers or clinical trial results, etc. Please submit your posts here.

So, if you have written (or are able to write) a post which fits in with this topic – or fits in with the broader theme of “medical information” or “medical library matters”, please submit the URL (permalink) of your post HERE at the Blog Carnival.

You may also submit a post of someone else. Tips are also appreciated.

See the archive for more information.

For more ideas about what to submit, here is the previous edition at Dean Giustini’s “The Search Principle blog”Medical Blogging Matters: A Carnival of Ideas, November 2010

And, no this is not a April fools day joke….





Kaleidoscope #3: 2011 Wk 12

23 03 2011

It has been long since I have posted a Kaleidoscope post with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks. There have been only 2 editions: Kaleidoscope 1 (2009 wk 47) and 2 (2010 wk 31).

Here is some recommended reading from the previous two weeks. Benlysta (belimumab) approved by FDA for treatment of lupus.

Belimumab is the first new lupus drug approved in 56 years! Thus, potentially good news for patients suffering from the serious auto-immunity disease SLE (systemic lupus erythematosus).  Belimumab needs to be administered once monthly via the intravenous route. It is a fully human monoclonal antibody specifically designed to inhibit B-lymphocyte stimulator (BLyS™), thereby reducing the number of circulating B cells, and the produced ds-DNA antibodies (which are characteristic for lupus).
Two clinical trials showed that more patients experienced less disease activity when treated with belimumab compared to placebo. Data suggested that some patients had less severe flares, and some reduced their steroid doses (not an impressive difference using “eyeballing”). Patients were selected with signs of B-cell hyperactivity and with fairly stable, but active disease. Belimumab was ineffective in Blacks, which are hit hardest by the disease. The most serious side effect were infections: 3 deaths in the belimumab groups were due to infections.
Thus, overall the efficacy seems limited. Belimumab only benefits 35% of the patients with not the worst form of the disease. But for these patients it is a step forward.

  1. Press Announcement (fda.gov).
  2. Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK,Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Feb 26;377(9767):721-31. Epub 2011 Feb 4. PubMed PMID: 21296403.
  3. Belimumab: Anti-BLyS Monoclonal Antibody; Benlysta(TM); BmAb; LymphoStat-B. Drugs in R & D (Open Access): 28 May 2010 – Volume 10 – Issue 1 – pp 55-65 doi: 10.2165/11538300-000000000-00000 Adis R&D Profiles (adisonline.com)

Sleep-deprived subjects make risky gambling decisions.

Recent research has shown, that a single night of sleep deprivation alters decision making independent from a shift in attention: most volunteers moved from seeking to minimize the effect of the worst loss to seeking increased reward. This change towards risky decision making was correlated with an increased brain activity in brain regions that assess positive outcomes (ventromedial prefrontal activation) and a simultaneous decreased activation in the brain areas that process negative outcomes (anterior insula). This was assessed by functional MRI.

One co-author (Chee) noted that “casinos often take steps to encourage risk-seeking behavior — providing free alcohol, flashy lights and sounds, and converting money into abstractions like chips or electronic credits”

Interestingly, Chee also linked their findings to empirical evidence that long work hours for medical residents increased the number of accidents. Is a similar mechanism involved?

  1. Venkatraman V, Huettel SA, Chuah LY, Payne JW, Chee MW. Sleep deprivation biases the neural mechanisms underlying economic preferences.  J Neurosci. 2011 Mar 9;31(10):3712-8 (free full text)
  2. Sleep deprived people make risky decisions based on too much optimism (Duke Healthpress release)

Grand Rounds

Grand Rounds is up at Better Health. Volume 7, Number 26 is an “Emotional Edition” where posts are organized into emotion categories. My post about the hysteria and misinformation surrounding the recent Japanese earthquake is placed under Outrage.

There are many terrific posts included. A few posts I want to mention shortly.

First a post by a woman who diagnosed hers and her sons’ disease after numerous tests. Her sons’ pediatrician only tried to reassure, so it seems. (“don’t worry…”).

I was also moved by the South African surgeon, Bongi, who tells the tragic story of a missed diagnosis that still haunts him. “For every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind…”

Bongi’s blog Other Things Amanzi is one of my favorites. Another blog that has become one of my favs is 33 Charts by Dr. Bryan Vartabedian. Included in this Grand Round is “And a child will lead them“. It is a beautiful post about the loss of a young patient:

….”And facing Cooper’s parents for the first time after his passing was strangely difficult for me.  When he was alive I always had a plan.  Every sign, symptom, and problem had a systematic approach.  But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog”….

Other Medical Blogs

Another of my recent fav blogs is the blog of cardiologist, dr. Wes. Two recent posts I would especially like to recommend.

The first asks a seemingly simple question: “So which set of guidelines should doctors use?” The answer, however,  may surprise you.

In another post dr Wes describes the retraction of an online-before-print case report entitled “Spontaneous explosion of implantable cardioverter-defibrillator” with dramatic pictures of an “exploded ICD” .(here is the PDF of the cache). This retraction took place after dr. Wes reported the case at his blog. Strange enough the article was republished this February, with another title, “Case report of out-of-hospital heat dissipation of an implantable cardioverter-defibrillator.” (no explosion anymore) and no shocking photos. Food for thought….  The main conclusion of dr Wes? Independent scientific peer-reviewed journals might not be so independent after all. Library matter

Sorry, but I had to laugh about David Rothman’s Common Sense Librarianship: An Ordered List Manifesto. As put it so well by Kathryn Greenhill at her blog Librarians Matter: “It is a hot knife of reason through the butterpat of weighty bullshit that often presses down as soon as we open our mouths to talk about our profession.”

Oh, and a big congrats to Aaron Tay for his  Library Journal moversShakers award. Please read why he deserves this award. What impresses me the most is the way he involves users and converts unhappy users “into strong supporters of the library”. I would recommend all librarians to follow him on Twitter (@aarontay) and to regularly read his blog Musings about Librarianship. Web 2.0

The iPad 2 is here. A very positive review can be found at Techcrunch. The iPad 2 has a camera, is thinner, lighter, and has a much more powerful dual-core chip. Still many people on Twitter complain about the reflective screen. Furthermore the cover is stylish but  not very protective as this blogger noticed 2 days after purchase.
Want to read further: You might like “iPad 2: Thoughts from a first time tablet use” (via @drVes)

It has been five years since Twitter was launched when one of its founders, Jack Dorsey, tweeted “just setting up my twttr’. Now Twitter nearly has 200 million users who now post more than a billion tweets every week. (see Twitter Blog)

Just the other week  Twitter has told developers to stop building apps. It is not exactly clear what this will mean. According to The Next Web it is to prevent confusion of consumers third-party Twitter clients and because of privacy issues. According to i-programmer the decision is mainly driven by the desire of Twitter to be in control of its API and the data that its users create (as to maximize its -future- revenue). I hope it won’t affect Twitter-clients like Tweetdeck and Seesmic, which perform much better (in my view) than Twitter.com.





Don’t forget to vote for your favorite Medical Weblog at Medgadget!

13 02 2011

I almost forgot to vote for the best medical blogs in the Seventh Annual Medical Weblog Awards Contest, organized by Medgadget.

But, I voted just in time, and so can you if you haven’t done so. Please support your favorite blogs!

Voting will close 23:59:59 this Sunday, February 13, 2011 (EST).

You can vote here at Medgadget

There are several categories:

  • Best Medical Weblog
  • Best New Medical Weblog (established in 2010)
  • Best Literary Medical Weblog
  • Best Clinical Sciences Weblog
  • Best Health Policies/Ethics Weblog
  • Best Medical Technologies/Informatics Weblog
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    Medical Information Matters 2.10 is up at The Search Principle Blog

    16 11 2010

    In case you missed it: the new edition of Medical Information Matters (edition 2.10) – formerly MedLibs Round is up at the well-known blog “Search Principles” of the equally well-known Dean Giustini, a knowledgeable, helpful and friendly Canadian medical librarian, one of the first bloggers, a web 2.0 pioneer, author of many papers (like this one in the BMJ), main contributor to the UBC Health Library Wiki, educator and expert in EBM. Need I say more?

    With a wink to the name of the blog carnival, Dean gave his post the title: Medical Blogging Matters: A Carnival of Ideas, November 2010

    And indeed, his post is a real ode to medical bloggers and medical blogging

    Dean:

    With the rise of Twitter, and the emphasis placed on ‘real time’ idea-sharing and here-I-am visibility on the social web, I often wonder where blogging (all kinds) will be in five years. Perhaps it’s a dying art form.

    However, this month, the ‘art of blogging’ seems to be in ample evidence throughout the medical blogosphere and the array of postings illustrates a vast diversity of approaches and opinions. In the posts mentioned, you’ll recognize many of the top names in medical blogging – these dedicated, talented professionals continue to work hard at updating their blogs regularly while carrying on with their work as medical librarians, informaticists and physicians.

    Dean started his post by saying

    It’s my great honour to be this month’s host for Medical Information Matters — the official name for the medical blog carnival (formerly MedLibs Round) where the “best blog posts in the field of medical information” are shared by prominent bloggers. I am very proud to consider many of these bloggers to be my colleagues and friends.”

    But the honor is all mine! I’m glad I finally “dared” to ask him to host this blog carnival and that he accepted it without hesitation. And I, too, consider many of these bloggers, including Dean, to be my colleagues and friends. (Micro)blogging has made the world smaller…

    Here are a few tweets mentioning this edition of the blog carnival, showing that it is widely appreciated (see more here):

    1. Dean Giustini
      giustini Here comes “Medical Blogging Matters: A Carnival of Ideas, November 2010” http://bit.ly/aDzkLT [did I miss anyone? let me know]
    2. Francisco J Grajales
    3. westr
      westr Some big names in there! RT @pfanderson Medical blogging MATTERS http://bit.ly/aDzkLT
    4. Ves Dimov, M.D.
      DrVes Medical Information Matters: the weekly best of related blog posts http://goo.gl/sBgw2
    5. Kevin Clauson

    this quote was brought to you by quoteurl

    Next month Medical Information Matters will be hosted by another well known blogger: Martin Fenner of Gobblydook. Martin’s blog belonged to the Nature Network, but it was recently moved to the PLOS blog network.

    According to the about section:

    Martin Fenner works as a medical doctor and cancer researcher at the Hannover Medical School Cancer Center in Germany. He is writing about how the internet is changing scholarly communication. Martin can be found on Twitter as @mfenner.

    So it seems that Martin combines 3 professions, that of a doctor, researcher, and a medical information specialist. This promises a wonderful round again.

    The deadline for submission is Saturday December 4th (or perhaps even Sunday 5th).

    The theme, if any, is not known yet. However, you can ALWAYS submit the URL/permalink of a recent, good quality post at:

    http://blogcarnival.com/bc/submit_6092.html

    (keep in touch, because we will write a call for submissions post later)

    Finally a request to you all:

    For 2011, I’m looking for new hosts, be it scientists, researchers, librarians, physicians or other health care workers, people who have hosted this blog carnival before, or not, people who have a longstanding reputation as blogger as well as people who just started blogging. It doesn’t matter, as long as you have a blog and you like hosting this blog carnival.

    Please comment below or mail me at laika dot spoetnik at gmail dot com





    Medical Information Matters: Call for Submissions

    6 11 2010

    I would like to remind you that it is almost the first Saturday of the Month and thus submission time for Medical Information Matters, the former MedLibs round.

    Medical Information Matters is a monthly compilation of the “best blog post in the field of medical information”, hosted by a different blogger each time. The blogger who will host the upcoming edition is Dean Giustini.

    I am sure that every librarian, and many doctors, know Dean. As a starting blogging librarian, I knew 2  international librarian bloggers: Dean Giustini and Krafty Librarian (make that 3, I forgot to mention David Rothman*) . I looked up to them and they did (and do) inspire me.
    It is nice that blogging and Social Media can make distances shorter, literally and figuratively…

    As far as I know, Dean has no theme for this round. But you can always submit any good quality post about medical information to the blog carnival. Whether you are a librarian, a doctor, a nurse, a patient and/or a scientist and whether your post is on searching, reference management, reliability of information, gaps in information, evidence, social media or education ( to name a few).
    You can submit your own post or a good post of someone else, as long as it is in English.

    So if that isn’t easy….

    Please submit the URL/permalink of your post at:
    http://blogcarnival.com/bc/submit_6092.html

    If everything goes according to plan, you can read the Medical Information Matters 2.9 at the blog of Dean Giustini next Tuesday.

     

    * Thanks to @DrVes via Twitter. Social Media is sooo powerful!





    Search OVID EMBASE and Get MEDLINE for Free…. without knowing it

    19 10 2010

    I have the impression that OVIDSP listens more to librarians than the NLM, who considers the end users of databases like PubMed more important, mainly because there are more of them. On the other hand NLM communicates PubMed’s changes better (NLM Technical Bulletin) and has easier to find tutorials & FAQs, namely at the PubMed homepage.

    I gather that the new changes to the OVIDSP interface are the reason why two older OVID posts are the recent number 2 and 3 hits on my blog. My guess is that people are looking for some specific information on OVID’s interface changes that they can’t easily access otherwise.

    But this post won’t address the technical changes. I will write about this later.

    I just want to mention a few changes to the OVIDSP databases MEDLINE and EMBASE, some of them temporary, that could have been easily missed.

    [1] First, somewhere in August, OVID MEDLINE contained only indexed PubMed articles. I know that OVID MEDLINE misses some papers PubMed already has -namely the “as supplied by publisher” subset-, but this time the difference was dramatic: “in data review” and “in process” papers weren’t found as well. I almost panicked, because if I missed that much in OVID MEDLINE, I would have to search PubMed as well, and adapt the search strategy…. and, since I already lost hours because of OVID’s extreme slowness at that time, I wasn’t looking forward to this.

    According to an OVID-representative this change was not new, but was already there since (many) months. Had I been blind? I checked the printed search results of a search I performed in June. It was clear that the newer update found less records, meaning that some records were missed in the current (August) update. Furthermore the old Reference Manager database contained non-indexed records. So no problems then.

    But to make a long story short. Don’t worry: this change disappeared as quickly as it came.
    I would have doubted my own eyes, if my colleague hadn’t seen it too.

    If you have done a MEDLINE OVID search in the second half of August you might like to check the results.

    [2] Simultaneously there was another change. A change that is still there.

    Did you know that OVID EMBASE contains MEDLINE records as well? I knew that you could search EMBASE.com for MEDLINE and EMBASE records using the “highly praised EMTREE“, but not that OVID EMBASE recently added these records too.

    They are automatic found by the text-word searches and by the EMTREE already includes all of MeSH.

    Should I be happy that I get these records for free?

    No, I am not.

    I always start with a MEDLINE search, which is optimized for MEDLINE (with regard to the MeSH).

    Since indexing by  EMTREE is deep, I usually have (much) more noise (irrelevant hits) in EMBASE.

    I do not want to have an extra number of MEDLINE-records in an uncontrolled way.

    I can imagine though, that it would be worthwhile in case of a quick search in EMBASE alone: that could save time.
    In my case, doing extensive searches for systematic reviews I want to be in control. I also want to show the number of articles from MEDLINE and the number of extra hits from EMBASE.

    (Later I realized that a figure shown by the OVID representative wasn’t fair: they showed the hits obtained when searching EMBASE, MEDLINE and other databases in Venn diagrams: MEDLINE offered little extra beyond EMBASE, which is self-evident, considering that EMBASE includes almost all MEDLINE records.- But I only learned this later.)

    It is no problem if you want to include these MEDLINE records, but it is easy to exclude them.

    You can limit for MEDLINE or EMBASE records.

    Suppose your last search set is 26.

    Click Limits > Additional Limits > EMBASE (or MEDLINE)

    Alternatively type: limit 26 to embase (resp limit 26 to medline) Added together they make 100%

    If only they would have told us….


    3. EMBASE OVID now also adds conference abstracts.

    A good thing if you do an exhaustive search and want to include unpublished material as well (50% of the conference abstracts don’t get published).

    You can still exclude them if you like  (see publication types to the right)

    Here is what is written at EMBASE.com

    Embase now contains almost 800 conferences and more than 260,000 conference abstracts, primarily from journals and journal supplements published in 2009 and 2010. Currently, conference abstracts are being added to Embase at the rate of 1,000 records per working day, each indexed with Emtree.
    Conference information is not available from PubMed, and is significantly greater than BIOSIS conference coverage. (…)

    4. And did you know that OVID has eliminated StopWords from MEDLINE and EMBASE? Since  a few years you can now search for words or phrases like is there hope.tw. Which is a very good thing, because it broadens the possibility to search for certain word strings. However, it isn’t generally known.

    OVID changed it after complaints by many, including me and a few Cochrane colleagues. I thought I had written a post on it before, but I apparently I haven’t ;).

    Credits

    Thanks to Joost Daams who always has the latest news on OVID.

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    Problems with Disappearing Set Numbers in PubMed’s Clinical Queries

    18 10 2010

    In some upcoming posts I will address various problems related to the changing interfaces of bibliographic databases.

    We, librarians and end users, are overwhelmed by a flood of so-called upgrades, which often fail to bring the improvements that were promised….. or which go hand-in-hand with temporary glitches.

    Christina of Christina’s Lis Rant even made rundown of the new interfaces of last summer. Although she didn’t include OVID MEDLINE/EMBASE, the Cochrane Library and Reference manager in her list, the total number of changed interfaces reached 22 !

    As a matter of fact, the Cochrane Library was suffering some outages yesterday, to repair some bugs. So I will postpone my coverage of the Cochrane bugs a little.

    And OVID send out a notice last week: This week Ovid will be deploying a software release of the OvidSPplatform that will add new functionality and address improvements to some existing functionality.”

    In this post I will confine myself to the PubMed Clinical Queries. According to Christina PubMed changes “were a bit ago”, but PubMed continuously tweaks  its interface, often without paying much attention to its effects.

    Back in July, I already covered that the redesign of the PubMed Clinical Queries was no improvement for people who wanted to do more than a quick and dirty search.

    It was no longer possible to enter a set number in the Clinical Queries search bar. Thus it wasn’t possible to set up a search in PubMed first and to then enter the final set number in the Clinical Queries. This bug was repaired promptly.

    From then on, the set number could be entered again in the clinical queries.

    However, one bug was replaced by another: next, search numbers were disappearing from the search history.

    I will use the example I used before: I want to know if spironolactone reduces hirsutism in women with PCOS, and if it works better than cyproterone acetate.

    Since little is published about this topic,  I only search for  hirsutism and spironolactone. These terms  map correctly with  MeSH terms. In the MeSH database I also see (under “see also”) that spironolactone belongs to the aldosterone antagonists, so I broaden spironolactone (#2) with “Aldosterone antagonists”[pharmacological Action] using “OR” (set #7). My last set (#8) consists of #1 (hirsutism) AND #7 (#2 OR #6)

    Next I go to the Clinical Queries in the Advanced Search and enter #8. (now possible again).

    I change the Therapy Filter from “broad”  to “narrow”, because the broad filter gives too much noise.

    In the clinical queries you see only the first five results.

    Apparently even the clinical queries are now designed to just take a quick look at the most recent results, but of course, that is NOT what we are trying to achieve when we search for (the best) evidence.

    To see all results for the narrow therapy filter I have to go back to the Clinical Queries again and click on see all (27) [5]

    A bit of a long way about. But it gets longer…


    The 27 hits, that result from combining the Narrow therapy filter with my search #8 appears. This is set #9.
    Note it is a lower number than set #11 (search + systematic review filter).

    Meanwhile set #9 has disappeared from my history.

    This is a nuisance if I want to use this set further or if I want to give an overview of my search, i.e. for a presentation.

    There are several tricks by which this flaw can be overcome. But they are all cumbersome.

    1. Just add set number (#11 in this case, which is the last search (#8) + 3 more) to the search history (you have to remember the search set number though).

    This is the set number remembered by the system. As you see in the history, you “miss” certain sets. #3 to #5 are for instance are searches you performed in the MeSH-database, which show up in the History of the MeSH database, but not in PubMed’s history.

    The Clinical query set number is still there, but it doesn’t show either. Apparently the 3 clinical query-subsets yield a separate set number, whether the search is truly performed or not. In this case  #11 for (#8) AND systematic[sb], #9 for (#8) AND (Therapy/Narrow[filter]). And #10 for (#8) AND the medical genetics filter.

    In this way you have all results in your history. It isn’t immediately clear, however, what these sets represent.

    2. Use the commands rather than going to the clinical queries.

    Thus type in the search bar: #8 AND systematic[sb]

    And then: #8 AND (Therapy/Narrow[filter])

    It is easiest to keep all filters in Word/Notepad and copy/paste each time you need the filter

    3. Add clinical queries as filters to your personal NCBI account so that the filters show up each time you do a search in PubMed. This post describes how to do it.

    Anyway these remain just tricks to try to make something right that is wrong.

    Furthermore it makes it more difficult to explain the usefulness of the clinical queries to doctors and medical students. Explaining option 3 takes too long in a short course, option 1 seems illogical and 2 is hard to remember.

    Thus we want to keep the set numbers in the history, at least.

    A while ago Dieuwke Brand notified the NLM of this problem.

    Only recently she received an answer saying that:

    we are aware of the continuing problem.  The problem remains on our programmers’ list of items to investigate.  Unfortunately, because this problem appears to be limited to very few users, it has been listed as a low priority.

    Only after a second Dutch medical librarian confirmed the problem to the NLM, saying it not only affects one or two librarians, but all the students we teach (~1000-2000 students/university/yearly), they realized that it was a more widespread problem than Dieuwke Brand’s personal problem. Now the problem has a higher priority.

    Where is the time that a problem was taken for what it was? As another librarian sighed: Apparently something is only a problem if many people complain about it.

    Now I know this (I regarded Dieuwke as a delegate of all Dutch Clinical Librarians), I realize that I have to “complain” myself, each time I and/or my colleagues encounter a problem.

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    Medical Information Matters 2.8 is up!

    15 10 2010

    The new edition of Medical Information Matters (formerly Medlibs round) is up at Danielhooker.com.

    The main theme is “Programs in libraries or medical education”.
    Besides two posts from this blog (A Filter for Finding Animal Studies in PubMed” and more on the topic: An Educator by Chance) the following topics are included: a new MeSH (inclusion under mild librarian pressure), PubMed in your pocket, embedding Google Gadgets in normal webpages and experiences with introducing social bookmarking to medical students.
    If you find this description to cryptic (and I bet you do), then I invite you to read the entire post here. I found it a very pleasant read.

    Since we are already midway October, I would like to invite you to start submitting here (blog carnival submission form).

    Our next host is Dean Giustini of the The Search Principle blog. The deadline is in about 3 weeks ( November 6th).

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    How will we ever keep up with 75 Trials and 11 Systematic Reviews a Day?

    6 10 2010

    ResearchBlogging.orgAn interesting paper was published in PLOS Medicine [1]. As an information specialist and working part time for the Cochrane Collaboration* (see below), this topic is close to my heart.

    The paper, published in PLOS Medicine is written by Hilda Bastian and two of my favorite EBM devotees ànd critics, Paul Glasziou and Iain Chalmers.

    Their article gives an good overview of the rise in number of trials, systematic reviews (SR’s) of interventions and of medical papers in general. The paper (under the head: Policy Forum) raises some important issues, but the message is not as sharp and clear as usual.

    Take the title for instance.

    Seventy-Five Trials and Eleven Systematic Reviews a Day:
    How Will We Ever Keep Up?

    What do you consider its most important message?

    1. That doctors suffer from an information overload that is only going to get worse, as I did and probably also in part @kevinclauson who tweeted about it to medical librarians
    2. that the solution to this information overload consists of Cochrane systematic reviews (because they aggregate the evidence from individual trials) as @doctorblogs twittered
    3. that it is just about “too many systematic reviews (SR’s) ?”, the title of the PLOS-press release (so the other way around),
    4. That it is about too much of everything and the not always good quality SR’s: @kevinclauson and @pfanderson discussed that they both use the same ” #Cochrane Disaster” (see Kevin’s Blog) in their  teaching.
    5. that Archie Cochrane’s* dream is unachievable and ought perhaps be replaced by something less Utopian (comment by Richard Smith, former editor of the BMJ: 1, 3, 4, 5 together plus a new aspect: SR’s should not only  include randomized controlled trials (RCT’s)

    The paper reads easily, but matters of importance are often only touched upon.  Even after reading it twice, I wondered: a lot is being said, but what is really their main point and what are their answers/suggestions?

    But lets look at their arguments and pieces of evidence. (Black is from their paper, blue my remarks)

    The landscape

    I often start my presentations “searching for evidence” by showing the Figure to the right, which is from an older PLOS-article. It illustrates the information overload. Sometimes I also show another slide, with (5-10 year older data), saying that there are 55 trials a day, 1400 new records added per day to MEDLINE and 5000 biomedical articles a day. I also add that specialists have to read 17-22 articles a day to keep up to date with the literature. GP’s even have to read more, because they are generalists. So those 75 trials and the subsequent information overload is not really a shock to me.

    Indeed the authors start with saying that “Keeping up with information in health care has never been easy.” The authors give an interesting overview of the driving forces for the increase in trials and the initiation of SR’s and critical appraisals to synthesize the evidence from all individual trials to overcome the information overload (SR’s and other forms of aggregate evidence decrease the number needed to read).

    In box 1 they give an overview of the earliest systematic reviews. These SR’s often had a great impact on medical practice (see for instance an earlier discussion on the role of the Crash trial and of the first Cochrane review).
    They also touch upon the institution of the Cochrane Collaboration.  The Cochrane collaboration is named after Archie Cochrane who “reproached the medical profession for not having managed to organise a “critical summary, by speciality or subspecialty, adapted periodically, of all relevant randomised controlled trials” He inspired the establishment of the international Oxford Database of Perinatal Trials and he encouraged the use of systematic reviews of randomized controlled trials (RCT’s).

    A timeline with some of the key events are shown in Figure 1.

    Where are we now?

    The second paragraph shows many, interesting, graphs (figs 2-4).

    Annoyingly, PLOS only allows one sentence-legends. The details are in the (WORD) supplement without proper referral to the actual figure numbers. Grrrr..!  This is completely unnecessary in reviews/editorials/policy forums. And -as said- annoying, because you have to read a Word file to understand where the data actually come from.

    Bastian et al. have used MEDLINE’s publication types (i.e. case reports [pt], reviews[pt], Controlled Clinical Trial[pt] ) and search filters (the Montori SR filter and the Haynes narrow therapy filter, which is built-in in PubMed’s Clinical Queries) to estimate the yearly rise in number of study types. The total number of Clinical trials in CENTRAL (the largest database of controlled clinical trials, abbreviated as CCTRS in the article) and the Cochrane Database of Systematic Reviews (CDSR) are easy to retrieve, because the numbers are published quaterly (now monthly) by the Cochrane Library. Per definition, CDSR only contains SR’s and CENTRAL (as I prefer to call it) contains almost invariably controlled clinical trials.

    In short, these are the conclusions from their three figures:

    • Fig 2: The number of published trials has raised sharply from 1950 till 2010
    • Fig 3: The number of systematic reviews and meta-analysis has raised tremendously as well
    • Fig 4: But systematic reviews and clinical trials are still far outnumbered by narrative reviews and case reports.

    O.k. that’s clear & they raise a good point : an “astonishing growth has occurred in the number of reports of clinical trials since the middle of the 20th century, and in reports of systematic reviews since the 1980s—and a plateau in growth has not yet been reached.
    Plus indirectly: the increase in systematic reviews  didn’t lead to a lower the number of trials and narrative reviews. Thus the information overload is still increasing.
    But instead of discussing these findings they go into an endless discussion on the actual data and the fact that we “still do not know exactly how many trials have been done”, to end the discussion by saying that “Even though these figures must be seen as more illustrative than precise…” And than you think. So what? Furthermore, I don’t really get their point of this part of their article.

     

    Fig. 2: The number of published trials, 1950 to 2007.

     

     

    With regard to Figure 2 they say for instance:

    The differences between the numbers of trial records in MEDLINE and CCTR (CENTRAL) (see Figure 2) have multiple causes. Both CCTR and MEDLINE often contain more than one record from a single study, and there are lags in adding new records to both databases. The NLM filters are probably not as efficient at excluding non-trials as are the methods used to compile CCTR. Furthermore, MEDLINE has more language restrictions than CCTR. In brief, there is still no single repository reliably showing the true number of randomised trials. Similar difficulties apply to trying to estimate the number of systematic reviews and health technology assessments (HTAs).

    Sorry, although some of these points may be true, Bastian et al. don’t go into the main reason for the difference between both graphs, that is the higher number of trial records in CCTR (CENTRAL) than in MEDLINE: the difference can be simply explained by the fact that CENTRAL contains records from MEDLINE as well as from many other electronic databases and from hand-searched materials (see this post).
    With respect to other details:. I don’t know which NLM filter they refer to, but if they mean the narrow therapy filter: this filter is specifically meant to find randomized controlled trials, and is far more specific and less sensitive than the Cochrane methodological filters for retrieving controlled clinical trials. In addition, MEDLINE does not have more language restrictions per se: it just contains a (extensive) selection of  journals. (Plus people more easily use language limits in MEDLINE, but that is besides the point).

    Elsewhere the authors say:

    In Figures 2 and 3 we use a variety of data sources to estimate the numbers of trials and systematic reviews published from 1950 to the end of 2007 (see Text S1). The number of trials continues to rise: although the data from CCTR suggest some fluctuation in trial numbers in recent years, this may be misleading because the Cochrane Collaboration virtually halted additions to CCTR as it undertook a review and internal restructuring that lasted a couple of years.

    As I recall it , the situation is like this: till 2005 the Cochrane Collaboration did the so called “retag project” , in which they searched for controlled clinical trials in MEDLINE and EMBASE (with a very broad methodological filter). All controlled trials articles were loaded in CENTRAL, and the NLM retagged the controlled clinical trials that weren’t tagged with the appropriate publication type in MEDLINE. The Cochrane stopped the laborious retag project in 2005, but still continues the (now) monthly electronic search updates performed by the various Cochrane groups (for their topics only). They still continue handsearching. So they didn’t (virtually?!) halted additions to CENTRAL, although it seems likely that stopping the retagging project caused the plateau. Again the author’s main points are dwarfed by not very accurate details.

    Some interesting points in this paragraph:

    • We still do not know exactly how many trials have been done.
    • For a variety of reasons, a large proportion of trials have remained unpublished (negative publication bias!) (note: Cochrane Reviews try to lower this kind of bias by applying no language limits and including unpublished data, i.e. conference proceedings, too)
    • Many trials have been published in journals without being electronically indexed as trials, which makes them difficult to find. (note: this has been tremendously improved since the Consort-statement, which is an evidence-based, minimum set of recommendations for reporting RCTs, and by the Cochrane retag-project, discussed above)
    • Astonishing growth has occurred in the number of reports of clinical trials since the middle of the 20th century, and in reports of systematic reviews since the 1980s—and a plateau in growth has not yet been reached.
    • Trials are now registered in prospective trial registers at inception, theoretically enabling an overview of all published and unpublished trials (note: this will also facilitate to find out reasons for not publishing data, or alteration of primary outcomes)
    • Once the International Committee of Medical Journal Editors announced that their journals would no longer publish trials that had not been prospectively registered, far more ongoing trials were being registered per week (200 instead of 30). In 2007, the US Congress made detailed prospective trial registration legally mandatory.

    The authors do not discuss that better reporting of trials and the retag project might have facilitated the indexing and retrieval of trials.

    How Close Are We to Archie Cochrane’s Goal?

    According to the authors there are various reasons why Archie Cochrane’s goal will not be achieved without some serious changes in course:

    • The increase in systematic reviews didn’t displace other less reliable forms of information (Figs 3 and 4)
    • Only a minority of trials have been assessed in systematic review
    • The workload involved in producing reviews is increasing
    • The bulk of systematic reviews are now many years out of date.

    Where to Now?

    In this paragraph the authors discuss what should be changed:

    • Prioritize trials
    • Wider adoption of the concept that trials will not be supported unless a SR has shown the trial to be necessary.
    • Prioritizing SR’s: reviews should address questions that are relevant to patients, clinicians and policymakers.
    • Chose between elaborate reviews that answer a part of the relevant questions or “leaner” reviews of most of what we want to know. Apparently the authors have already chosen for the latter: they prefer:
      • shorter and less elaborate reviews
      • faster production ànd update of SR’s
      • no unnecessary inclusion of other study types other than randomized trials. (unless it is about less common adverse effects)
    • More international collaboration and thereby a better use  of resources for SR’s and HTAs. As an example of a good initiative they mention “KEEP Up,” which will aim to harmonise updating standards and aggregate updating results, initiated and coordinated by the German Institute for Quality and Efficiency in Health Care (IQWiG) and involving key systematic reviewing and guidelines organisations such as the Cochrane Collaboration, Duodecim, the Scottish Intercollegiate Guidelines Network (SIGN), and the National Institute for Health and Clinical Excellence (NICE).

    Summary and comments

    The main aim of this paper is to discuss  to which extent the medical profession has managed to make “critical summaries, by speciality or subspeciality, adapted periodically, of all relevant randomized controlled trials”, as proposed 30 years ago by Archie Cochrane.

    Emphasis of the paper is mostly on the number of trials and systematic reviews, not on qualitative aspects. Furthermore there is too much emphasis on the methods determining the number of trials and reviews.

    The main conclusion of the authors is that an astonishing growth has occurred in the number of reports of clinical trials as well as in the number of SR’s, but that these systematic pieces of evidence shrink into insignificance compared to the a-systematic narrative reviews or case reports published. That is an important, but not an unexpected conclusion.

    Bastian et al don’t address whether systematic reviews have made the growing number of trials easier to access or digest. Neither do they go into developments that have facilitated the retrieval of clinical trials and aggregate evidence from databases like PubMed: the Cochrane retag-project, the Consort-statement, the existence of publication types and search filters (they use themselves to filter out trials and systematic reviews). They also skip other sources than systematic reviews, that make it easier to find the evidence: Databases with Evidence Based Guidelines, the TRIP database, Clinical Evidence.
    As Clay Shirky said: “It’s Not Information Overload. It’s Filter Failure.”

    It is also good to note that case reports and narrative reviews serve other aims. For medical practitioners rare case reports can be very useful for their clinical practice and good narrative reviews can be valuable for getting an overview in the field or for keeping up-to-date. You just have to know when to look for what.

    Bastian et al have several suggestions for improvement, but these suggestions are not always underpinned. For instance, they propose access to all systematic reviews and trials. Perfect. But how can this be attained? We could stimulate authors to publish their trials in open access papers. For Cochrane reviews this would be desirable but difficult, as we cannot demand from authors who work for months for free to write a SR to pay the publications themselves. The Cochrane Collab is an international organization that does not receive subsidies for this. So how could this be achieved?

    In my opinion, we can expect the most important benefits from prioritizing of trials ànd SR’s, faster production ànd update of SR’s, more international collaboration and less duplication. It is a pity the authors do not mention other projects than “Keep up”.  As discussed in previous posts, the Cochrane Collaboration also recognizes the many issues raised in this paper, and aims to speed up the updates and to produce evidence on priority topics (see here and here). Evidence aid is an example of a successful effort.  But this is only the Cochrane Collaboration. There are many more non-Cochrane systematic reviews produced.

    And then we arrive at the next issue: Not all systematic reviews are created equal. There are a lot of so called “systematic reviews”, that aren’t the conscientious, explicit and judicious created synthesis of evidence as they ought to be.

    Therefore, I do not think that the proposal that each single trial should be preceded by a systematic review, is a very good idea.
    In the Netherlands writing a SR is already required for NWO grants. In practice, people just approach me, as a searcher, the days before Christmas, with the idea to submit the grant proposal (including the SR) early in January. This evidently is a fast procedure, but doesn’t result in a high standard SR, upon which others can rely.

    Another point is that this simple and fast production of SR’s will only lead to a larger increase in number of SR’s, an effect that the authors wanted to prevent.

    Of course it is necessary to get a (reliable) picture of what has already be done and to prevent unnecessary duplication of trials and systematic reviews. It would the best solution if we would have a triplet (nano-publications)-like repository of trials and systematic reviews done.

    Ideally, researchers and doctors should first check such a database for existing systematic reviews. Only if no recent SR is present they could continue writing a SR themselves. Perhaps it sometimes suffices to search for trials and write a short synthesis.

    There is another point I do not agree with. I do not think that SR’s of interventions should only include RCT’s . We should include those study types that are relevant. If RCT’s furnish a clear proof, than RCT’s are all we need. But sometimes – or in some topics/specialties- RCT’s are not available. Inclusion of other study designs and rating them with GRADE (proposed by Guyatt) gives a better overall picture. (also see the post: #notsofunny: ridiculing RCT’s and EBM.

    The authors strive for simplicity. However, the real world isn’t that simple. In this paper they have limited themselves to evidence of the effects of health care interventions. Finding and assessing prognostic, etiological and diagnostic studies is methodologically even more difficult. Still many clinicians have these kinds of questions. Therefore systematic reviews of other study designs (diagnostic accuracy or observational studies) are also of great importance.

    In conclusion, whereas I do not agree with all points raised, this paper touches upon a lot of important issues and achieves what can be expected from a discussion paper:  a thorough shake-up and a lot of discussion.

    References

    1. Bastian, H., Glasziou, P., & Chalmers, I. (2010). Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Medicine, 7 (9) DOI: 10.1371/journal.pmed.1000326

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