Wednesday , December 11 2019
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Can You Trust What Medical Journals Publish?

Summary:
I have repeatedly questioned the validity of medical journal claims in regards to politically charged issues like air pollution and climate change, as well as global warming here at AT.  More recently, I showed how a major medical journal violates basic rules on scientific inquiry. There is another important problem with medical research as reported in medical journals and then often expanded by the lay press as big news: that medical journal articles are often proven wrong for unreliable results or promotion of treatments that are not beneficial or not any more efficacious than treatments they propose to replace. I was reminded recently of this problem by an article in Emergency Medicine News, a medical specialty newspaper, that

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I have repeatedly questioned the validity of medical journal claims in regards to politically charged issues like air pollution and climate change, as well as global warming here at AT.  More recently, I showed how a major medical journal violates basic rules on scientific inquiry.

There is another important problem with medical research as reported in medical journals and then often expanded by the lay press as big news: that medical journal articles are often proven wrong for unreliable results or promotion of treatments that are not beneficial or not any more efficacious than treatments they propose to replace.

I was reminded recently of this problem by an article in Emergency Medicine News, a medical specialty newspaper, that reported on a study by Dr. Vinay Prasad, a comprehensive review of randomized clinical trials in the Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine identifying 396 medical reversals.  Reversals are cases where medical journal articles are found to be faulty, misleading and just plain wrong.

When high-flying medical researchers on environmental issues use bad methods and report false results, it is motivated by political agendas usually, but when medical researchers report what end up being unreliable results in other areas, it is often due to biases and fallacious thinking and lack of effort to assiduously test their results and repeat them to assure that the hypothesis is valid and reliable and the results are testable and verified.

Some “rules” turned out to be wrong, for example tight blood sugar control, mechanical chest compressions, protocols for treatment of sepsis (infections with severe complications).  The unreliability problem is troublesome, since the study shows that many recommended treatments and strategies are not efficacious.

Here are some additional specifics from the Prasad study:

  • Mechanical compression was not better than manual compressions for CPR. (JAMA. 2014;311[1]:53)
  • Early and aggressive methods for care of patients with sepsis (severe infection) were no better than usual care. (JAMA. 2017;318[13]:1233)
  • The REACT-2 trial found that routine use of an immediate total-body CT did not impact mortality or benefit compared with conventional imaging and selective CT scanning in patients with severe trauma. (Lancet. 2016;388[10045]:673)
  • Platelet transfusion after acute hemorrhagic stroke was found by the 2015 PATCH study to worsen survival in the platelet transfusion group (68%) compared with the standard care group (77%). (Lancet. 2016;387[10038]:2605)

The authors were so alert to the problem that they created a website for best practices that, like other such practice websites, intends to alert physicians to the realities of the research mistakes and misinformation.

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