Monday, 15 July 2019

It’s estimated that the waste in biomedical research reaches 85%

In 2014, following concerns over the poor quality of biomedical research, The Lancet published a series of 5 articles analysing the scope of the problem and proposing solutions and as a result of this Reward Alliance was born, a platform that aims to defend the value of the research, from which I have extracted the scandalous figure of 85% and, according to Paul Glasziou and Iain Chalmers, two of the leaders of the movement, the volume of money squandered by biomedical research could reach 170 billion dollars annually, an amount higher than Hungary's gross domestic product. The two authors, who already predicted this figure in 2009, argue that this amount comes from an accumulation of up to three times 50%.

The first (almost) 50%: the lack of methodological rigour

It would be desirable that when a new investigation is going to start, before doing a thorough review of everything that has been previously investigated on that subject, in addition to sticking to a comparable methodology and an impeccable elaboration, but it seems that, in this aspect, things just don’t work. A team of researchers analyzed 1,286 clinical trials included in 205 meta-analyzes of the Cochrane reviews and concluded that the waste of research due to avoidable methodological gaps was 42%.

The second 50%: the non-publication

In the United States, another review of 635 officially registered clinical trials funded by INH found that only 294 (46%) had been published in an indexed journal in a period of 30 months from the end of the project, a figure that is also repeated in other countries. The non-publication of clinical trials (especially the inconclusive ones) is a huge waste of time, effort and money, as well as a source of biases towards the optimism of future revisions.

The third 50%: the publication of poor quality

Research papers should be published in a sufficiently clear, complete and precise manner, in order to get the interested people to interpret them properly. Unfortunately, another study concludes that more than half of research reports describe the projects sporadically, to the extent that they don't allow replication. In addition, it has been found that many of them have at least one final indicator changed, or subsequently introduced.

Where does the overall figure of 85% come from?

According to the sources cited above, a little more than half of the studies would filter the quality of method and execution, of these, half would not be published and of those who did, only half would be presented in a transparent and understandable report so you get to 12.5-15% of quality and effective studies. That is to say, that their well contrasted information would arrive unequivocally to its addressee, for which, the rest, between 85 and 87.5%, would be wasted studies.

What does the Reward Alliance propose to remake the situation?

The Reward Alliance says that part of the research funds should be used to rescue part of the wasteful clinical trials, except for those that don’t have enough methodological rigour in origin. This would be done by introducing repairs to poor editorial quality aspects, in addition to promoting the publication of all studies, as advocated by the "All Trials Initiative", through a universal and independent database, which would facilitate quality access to research findings. Consider that, right now, documentary and editorial sources, scattered, and many of them paid, offer a very poor service. There is an analysis that considers that each year that passes the end of a project the probability of losing the reference increases by 7%.

With the data in hand, 50% of the research doesn’t have sufficient methodological rigour, and this requires a thorough rethinking of both the financing model and quality controls. Now, according to Reward Alliance, of the other 50%, that of serious research, almost everything could be recovered only with better editorial policies and quality open databases. Doing nothing implies that, between one thing and another, only 15% of what is investigated is used, the rest is wasted.

Jordi Varela

Monday, 8 July 2019

The individualistic short-sightedness of health care

The Global Action Plan for the prevention and control of non-communicable diseases of the WHO aims to reduce by 25% the premature mortality due to these pathologies by the year 2025 (strategy 25 x 25) and, therefore, concentrates on strategies that reduce the following 7 risk factors: a) alcohol consumption, b) insufficient physical activity, c) tobacco consumption, d) high blood pressure, e) excessive salt intake, f) diabetes, and g) obesity. Confronted by this individualistic drift of public health, an international group of researchers has published in the Lancet the results of a meta-analysis with 48 cohort studies and 1.7 million individual records, where they have shown that poverty has more explanatory force by itself over the number of years of life lost that many of the factors 25 x 25, in addition to having an undeniable cross-influence by enhancing the aforementioned risk factors. It’s important to clarify that the cohorts selected by the researchers correspond to first world countries, so the analyzed groups of low socio-economic level  represent poverty pockets that are basically concentrated in deprived neighbourhoods of large cities or in certain collectives such as the destitute or the immigrants.

Monday, 1 July 2019

On average, humans have one testicle

Joan Escarrabill

This article deals with the interpretation of data. The title is an example made by Daniel Levitin in his suggestive book Weaponized Lies: How to Think Critically in the Post-Truth Era (Penguin Random House, New York, 2017), about the mistakes that can be made and the lies that can be said according to how numerical data is exposed. Obviously, the title of the article is exact. If the proportion of men and women is about 50%, certainly humans, on average, we have a testicle (and an ovary).

Monday, 24 June 2019

Integrated care or person centred care?

At the 6th "Right Care" Conference of the Clinical Management Section of the Societat Catalana de Gestió Sanitària we had the opportunity to get to know Don Redding, director of Policy and Partnerships for National Voices of the National Health Service and a well known promoter of the involving people in their own clinical processes. Redding said that the integration of services doesn’t make any sense if it’s intended only as an exercise of resource rationalization. On the contrary, he argued that coordination must be conceived based on the specific needs of each person, stating that every patient can be involved in their own care plan in agreement with close involved professionals and working as a team to achieve outcomes perceived as valuable by the patients themselves.

Monday, 17 June 2019

The excesses of image diagnostics

The practice of modern medicine is subject to much pressure from the use of diagnostic imaging technologies, many of which are truly dazzling for the eyes of clinicians and patients and, as a result, health budgets are constantly increasing. This being the case, everyone agrees that more professional debate should be generated to put the matter in its place and avoid the excesses that damage resources, irradiate people and don’t add value to clinical reasoning.

Monday, 10 June 2019

Cancer research: little science, big data or big science

Apparently, the duration and costs of clinical trials of new oncological drugs could be reduced if surrogate measures, such as tumour reduction or time to progression, were to be used instead of survival, but a meta-analysis of 146 clinical trials of colorectal cancer and 191 of lung cancer found that only 10-16% of survival was explained by these variables; obviously a poor correlation. On the other hand, there is the question of the methodology used. A review of 43 studies found that, in 81% of the cases, promising results from phase II (without a control group) failed to transfer to phase III (double-blind randomized trial). The latter is another finding unfavourable to the rush with which many oncological drugs are introduced in the market. Perhaps it’s for this reason that, in an observation of 94 articles on the subject, Abola and Prasad have discovered that in half of them, the editors had resorted to adjectives of the type: miraculous, revolutionary, innovative, wonderful, transformative, etc...

Monday, 3 June 2019

The future of primary care: "Build the plane while it flies"

Josep M. Picas

Recently, The King's Fund, based on a study by the National Centre for Social Research (BSA), reported a significant decline (7%) in the assessment of satisfaction with English primary care by its citizens. This is probably due to the difficulties of access, caused by the scarcity of resources and the increasing complexity of patients. We do not know this information in other countries and especially in Spain, but it would surely be very similar, since the problems are global.