Search

BackgroundAcknowledgment of all serious limitations to research evidence is important for patient care and scientific progress. Formal research on how biomedical authors acknowledge limitations is scarce.ObjectivesTo assess the extent to which limitations are acknowledged in biomedical publications explicitly, and implicitly by investigating the use of phrases that express uncertainty, so-called hedges; to assess the association between industry support and the extent of hedging.DesignWe analyzed reporting of limitations and use of hedges in 300 biomedical publications published in 30 high and medium -ranked journals in 2007. Hedges were assessed using linguistic software that assigned weights between 1 and 5 to each expression of uncertainty.ResultsTwenty-seven percent of publications (81/300) did not mention any limitations, while 73% acknowledged a median of 3 (range 1-8) limitations. Five percent mentioned a limitation in the abstract. After controlling for confounders, publications on industry-supported studies used significantly fewer hedges than publications not so supported (p = 0.028).LimitationsDetection and classification of limitations was--to some extent--subjective. The weighting scheme used by the hedging detection software has subjective elements.ConclusionsReporting of limitations in biomedical publications is probably very incomplete. Transparent reporting of limitations may protect clinicians and guideline committees against overly confident beliefs and decisions and support scientific progress through better design, conduct or analysis of new studies.

I define and refine Habermas’s notion of systematically distorted communication by means of focused, structured comparison among three of its instances. Next, I show that its critique is possible within the confines of his theory by recourse to a minimalist concept of rationality and a version of the truth that avoids the unwelcome metaphysical baggage of truth with a capital T. For critique to be complete, however, it must be supplemented by the full range of rhetorical proofs. Even so, there are limits to the power of critique. In the end, only social and political action can alter oppressive institutional arrangements.