Look here for updates on HealthWatch projects and people, essential publications, online resources and training.
Over a decade pursuing a retraction
The blog RetractionWatch tracks and reports the taking down of scientific publications as a way of shining a light on how poor or mistaken science gets corrected. But a recent entry reminds us of one piece of research that is yet to be retracted, despite concerns raised by one of its own original investigators. It has been 13 years since the journal Circulation originally published the results of the MIST trial in which a heart device was used in a study to investigate links between a heart anomaly and migraine headache. At the time the principal cardiologist in the trial, Peter Wilmshurst, refused to be named as an author, citing concerns that the sponsoring company had withheld data from the study’s authors. His investigations also uncovered evidence of questionable behaviours associated with the trial, including misrepresentation of data, and incomplete disclosure of financial links with the sponsoring company. Yet the MIST study paper remains online and, as recently as February 2021, the American Heart Association, which publishes Circulation, has written to decline further involvement in the case. Dr Wilmshurst’s integrity and pursuit of good science earned him the 2003 HealthWatch Award but has also made him the target of libel suits. Read the RetractionWatch article.
Metrics for evaluation of scientific output Traditional metrics are designed with commercial profit in mind – using them to measure the quality of individual scientists has corrupted science, says Professor David Colquhoun of University College London. Watch him explain why, in a new online seminar, hosted by the non-profit research organisation Consilium Scientific. Or, in another Consilium lecture, see Ian Tannock of the University of Toronto explain what makes some cancer research great but why some trials are just bad science. These talks are among a valuable library of expert-led seminars and debates on subjects ranging from clinical trials, conflicts of interests, academic publishing, and the profession of science, which is accumulating at Consilium Scientific. Just go to Consilium to find out more and register for a free account. Consilium Scientific aims to change the waste of resources, poor methodology and skewed incentives that mar the landscape of clinical trials. They run online seminars most weeks. HealthWatch has recently teamed up with Consilium and we look forward to joint initiatives in the future.
Information that should be free It is becoming increasingly difficult to obtain answers from government departments under the 2000 Freedom of Information Act, and the campaign group openDemocracy has found that requests are being screened and blocked. Hear some impassioned talk from politicians John McDonnell and David Davis, journalists, campaigners and FOI experts, as well as former Cabinet Office minister Lord David Clark who was behind the original Act, in a compelling 60 minute recording of an online event held on 20 April. And if you are ready to start asking your own questions, the Campaign for Freedom of Information organizes excellent virtual “Using the FOI Act” courses. Learn what information you are entitled to ask for and from whom, how to draft an effective FOI request, how long to wait for an answer, and how to challenge refusals. The course lasts one day, takes place fully online with small groups and personal attention from experienced campaigners. It costs £95, or £55 for freelancers and small NGOs. We recommend checking their website for forthcoming course dates.
How drug companies affect medical knowledge Adriane Fugh-Berman’s work to expose the less savoury aspects of drug company marketing has had a profound impact on doctors’ perceptions of pharma-sponsored promotional activities. In a fascinating online seminar she describes how shyness, underarm sweating and even laughter have been framed as medical conditions to promote drugs. Fugh-Berman leads the non-profit group PharmedOut, an initiative of Georgetown University Medical Center to promote evidence-based prescribing and educate health care professionals about pharmaceutical and medical device marketing practices. The 45-minute seminar was part of the University’s Health and the Public Interest series. Watch it here.
Successful outcome from complaint about counselling research ethics
HealthWatch member Shirley Moore wrote recently (Newsletter 113 - Summer 2020) about her concerns over the ethics of research undertaken by students of counselling in some colleges and universities. She made a whistleblowing declaration to Abertay University Secretary related to misconduct by two MSc students, whose research project used SurveyMonkey to collect data from vulnerable individuals without obtaining ethical approval, or observing the rules on handling personal data. The University upheld five of Dr Moore’s six complaints. They responded that the tutors were not fully aware of the students' activities because the course did not require any primary research to be conducted. Had they known such research was being attempted, they would have ensured ethics review was sought. The surveys have now been taken down, and measures have been put in place to improve oversight. Shirley feels the outcome was satisfactory. “I believe they have realized that this was a serious breach of ethics and they appear to have put things in place to ensure this doesn't happen again,” she said.
Professional Standards Authority suspends the Society of Homeopaths
In January this year the Professional Standards Authority (PSA) suspended the accreditation of the Society of Homeopaths (SoH). The PSA, the government watchdog that regulates healthcare regulators and registers, found that the SoH “did not appear to have prioritised public protection over professional interests in its handling of complaints or governance processes, which undermined confidence in its ability to ensure its registrants were compliant with its own Code of Ethics and position statements”. It concluded that the SoH’s failings in this regard led to risks to the public from homeopathy being offered as an alternative for serious conditions. We congratulate the Good Thinking Society for their tenacity in highlighting the risks from the PSA lending credibility to organizations whose members make misleading claims.
The PSA has just published a report following their recent public consultation into the Authority's future direction. The report, titled "The future shape of the Accredited Registers programme" includes a quote from HealthWatch (see page 9): “If people put their faith in ‘alternative’ forms of treatment they may be deterred from seeking help from mainstream medicine and are clearly at risk of being harmed as a result.” We were among several groups and individuals who had stressed the importance of considering evidence of treatments' effectiveness in deciding whether to accredit a practitioner. The PSA plan to publish more detailed proposals after May 2021.
UK govt “dragging its feet” over calls for registry of payments to doctors
This April saw yet another public call for a national registry to capture pharma and medical device industry payments and other benefits made to clinicians, healthcare organizations and patient support groups. David Phizackerley, writing in an editorial in the Drug and Therapeutics Bulletin, reminds us that a register of clinicians’ interests was one of the key recommendations of last July’s Independent Medicines and Medical Devices Safety Review (IMMDSR) into the avoidable harms caused by hormone pregnancy tests, sodium valproate, and pelvic mesh implants. The IMMDSR is rightly concerned that manufacturers’ payments and incentives can impact on clinical recommendations. Most organizations that represent doctors support calls for mandatory reporting, writes Phizackerley, and several other countries – including the USA, France, Portugal and Latvia - already have systems in place. Yet, despite the UK Department of Health and Social Care’s acknowledgement that it will consider the issue, it has not set out a timetable or a work programme to make sure that it happens. HealthWatch hopes that this will not be another missed opportunity.
Phizackerley D. Time for Transparency, Drug & Therapeutics Bulletin, 19 Apr 2021. DOI: 10.1136/dtb.2021.000008
What are the harms from wasteful treatments?
Treatments of questionable benefit are not just a waste of health resources, they can also jeopardize patient safety. But quantifying these harms is not always straightforward, and campaigns that focus on the cost of wasteful treatments can make patients think that their antibiotic prescription or prostate screening is being withheld due to unfair budget constraints. A BMJ Analysis turns a spotlight onto the problem of overuse of “low value healthcare”, that is, tests and procedures that provide little or no clinical benefit, are unlikely to affect clinical decisions, and could risk patient harm. It calls for new research methods to quantify the harms of health service overuse and better collection of harms data from clinical studies.
Brownlee S, Korenstein D. Better understanding the downsides of low value healthcare could reduce harm. BMJ 2021;372:n117
Evidence database adds Guideline Grading feature
“Guideline grading” is a new project from the Trip Database which will aim to help health professionals sort the evidence-based guidelines from the opinion-based ones. This new feature will be added to Trip in the coming weeks. In case you are not familiar, Trip is a clinical search engine for high-quality research evidence to support practice. It uses a publication score, based on quality, to order results. As well as research evidence you can search for images, videos, patient information leaflets, educational courses and news. Trip is a small independent company that has been around since 1997, run by a team passionate about evidence.
Kindred spirits promoting critical thinking
The McGill Office for Science and Society website says it “aims to demystify science for the public, foster critical thinking, and separate sense from nonsense on the scientific stage”. Kindred spirits, clearly. The project, run from the University of Montreal, Quebec and without external funding from vested interests, publishes blogs and short videos challenging pseudoscience and miscommunication. Take a look at https://www.mcgill.ca/oss/
New infographic on Covid-19 transmission
Campaigning charity Sense About Science has produced a new shareable infographic to explain the importance of indoor ventilation in reducing transmission of Covid-19. Public understanding has fallen far behind the accumulating evidence, they say. The infographic shows that transmission risk is eighteen times greater indoors than out, especially where ventilation is poor. By comparison, hard evidence that the virus may be caught from contaminated surfaces or food is lacking.
John Maddox Prize open for nominations
Nominations for the John Maddox Prize 2021 opened on 6th April. A joint initiative of the charity Sense about Science and the scientific journal Nature, the Prize has been awarded annually since 2012 to researchers who have shown courage and integrity in standing up for science and scientific reasoning against opposition and hostility. In 2019 there were over 200 nominations from 38 countries. Nominate for this year's prize at https://senseaboutscience.org/john-maddox-prize/
The Tony Nicklinson Memorial Prize
A new annual award has been launched, sponsored by the grassroots non-profit organisation My Death, My Decision, and inspired by HealthWatch’s long standing student competition for critical appraisals of clinical research protocols.
'The Tony Nicklinson Memorial Prize' is aimed at developing and fostering an interest in end-of-life choices and patient autonomy; it is named after the pioneering right-to-die campaigner Tony Nicklinson, who suffered from locked-in-syndrome, and sought to secure a lasting change in the law to permit assisted dying for adults of sound mind experiencing or facing incurable suffering. With permission from his family, this prize commemorates his legacy. The prize is £500 for the winning entry and a chance at publication in the New Humanist Magazine or British Medical Journal.
3 May 2021