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A doctor who tried to submit for publication two research papers written by others has been suspended for 12 months by a medical practitioners tribunal. Mohammed Shali, who qualified in Mysore (now Mysuru), India, in 1998, sent an email in February 2013 to the editor of the International Journal of Clinical Skills attaching two papers. He named himself as first author of “An Unusual Cause of Dyspnoea—Mural Thrombus” and as coauthor of “An Unusual Cause of Dyspnoea—Atrial Myxoma.” The first paper had already been published elsewhere under a different title, and Shali had no role in its authorship. He falsely …

The white paper focuses to a large extent on dismantling the internal market and the development of primary care. The provision of specialist services—which investigate and treat the bulk of serious ill health—get scant mention, despite their accounting for about £1.4 billion of NHS expenditure annually.1 In an almost throw away line, the white paper insists that “everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they need to be seen urgently and requesting an appointment.” It is not difficult to understand why cancer has been singled out for this treatment. It is a common and greatly feared disease. Much work has been done around the country following the Calman-Hine report2 to set standards for cancer care, define protocols and guidelines, develop multidisciplinary teams, and identify …

The current prescription charging system could seriously undermine the aims of the government's new white paper to make healthcare services more accessible to people who need them most, MPs heard last week. The charges are likely to hinder attempts to make the health service better at helping groups of people who currently find it difficult to get the right health care, such as people in underserved deprived areas, witnesses told the health select committee as part of its continuing inquiry into NHS charges. Witnesses were asked how the present system of prescription charges affected the policy set out in the …

Surely the answer to this difference in interpretation of Freemantle and colleagues’ paper is to ask Freemantle and colleagues to respond to Jeremy Hunt in a letter to The BMJ .1 2 It is easy for lay people, such as the health secretary, to misinterpret data in scientific papers, but part of the blame lies with the authors for not making their findings clearer …

Parity of authorship should be a priority for journals, universities, and funding agencies Women have been attending medical school in numbers equal to or greater than those of men since 1996 in the United Kingdom,1 and in nearly equal numbers in the United States since 2003.2 However, despite parity in medical school admissions, substantial gender differences in rank and leadership remain in academic medicine. The progress of women attaining first and senior authorship of original research publications, the currency of success for promotion in academic medicine, will directly translate into equity of academic advancement for women in the future. In a linked paper (doi:10.1136/bmj.i847),3 Filardo and colleagues examined the prevalence of female first authorship among original research articles published over the past two decades (1994-2014) in six high impact general medical journals. This study is notable for its rigor, examining six issues a year for all selected journals throughout the 20 year study period and using online searches of authors to identify gender in those with ambiguous names. The authors report some good news—an …

To mark the 20th anniversary of The BMJ ’s website, the journal asked 20 UK and international readers, authors, friends, and former colleagues to name an outstanding article published since the mid-1990s. The result is an extraordinary mix of editorials, research papers, analysis, and comment, including an investigation, on topics as wide ranging as the MMR vaccine scare, death, evidence based medicine, and the use of stirrups for pelvic examinations. Some represent seminal moments in recent medical history, others are pieces of research that, for their sheer simplicity and focus on patient experience, have inspired our readers to think and work differently. So here is The BMJ ’s top 20 and why, according to our 20 chosen readers, they are the best. “The development of the EQUATOR Network (www.equator-network.org) to improve reports of research and the 2014 Lancet series of papers on ways of increasing value and reducing waste in research (www.researchwaste.net) are just two examples of testimony to the enduring influence of Doug’s 1994 call for “less research, better research, and research done for the right reasons.” Iain Chalmers, health services researcher and a founder of the Cochrane Collaboration “Over the past 30 years we have seen medicine transformed from being based on the opinions of ‘experts’ to being based on systematic collation of evidence from clinical studies. There is still a vast amount to do to improve the evidence base itself. But articles such as this have helped explain to doctors the key principles of evidence based medicine and have inspired a new generation of clinicians and researchers.” Fiona Godlee, editor in chief, The BMJ “This paper and a linked one ( BMJ 1996;313:987, doi:10.1136/bmj.313.7063.987) revealed the profound sense of responsibility that parents felt for their children and how deep seated their fears are of serious …

The UK Research Paper of the Year category recognises outstanding research by one or more UK authors that has potential to considerably improve health and healthcare. Nigel Hawkes describes the shortlisted papers Do stem cells taken from the bone marrow and injected into patients with heart disease improve heart function? Lots of people believe so, and meta-analyses by the Cochrane Collaboration show a significant positive effect. But individual trials produce conflicting results, for no very obvious reason. Darrel Francis, professor of cardiology at Imperial College in London, says: “Some things in the early trials didn’t add up and when we went to the journals that published them, we were fobbed off. So we decided to look at discrepancies in all the published trials.” Discrepancies were defined as two or more reported facts that cannot both be true because they are logically or mathematically impossible. The team’s paper, published in The BMJ, concluded that the more discrepancies a paper contained, the more positive its results. “This field of therapy appears to be most effective in the hands of researchers whose reports contain factual impossibilities,” say Francis and colleague Graham Cole. “Indeed, when the factual impossibilities disappeared, so did any effect of the therapy.” They expected a sharp reaction from researchers with many discrepancies. “We tried to soften the blow by not naming the hundreds of report authors directly,” Francis says. “But it was authors with few discrepancies, and small or zero effect sizes, who criticised the study most vocally.” This includes the Cardiovascular Cell Therapy Research Network, funded by the US National Institutes of Health with $30 million, whose data coordinator, Lem Moye of the University of Texas, told people to disregard the …

The Lancet has retracted a 1992 study by the Canadian self proclaimed “father of nutritional immunology,” Ranjit Kumar Chandra, on the grounds that its reliability “can no longer be assured.”1 The study—a major trial that reported an improvement in older people’s immunity and infection risk after taking nutritional supplements2—was the second of Chandra’s studies to be retracted within the past six months. In October The BMJ retracted his 1989 study into the immune benefits of baby formula after receiving a suppressed report of an inquiry of his research, completed in 1995 by his former employer, Memorial University of Newfoundland, after allegations of data fabrication.3 Doubts about the plausibility of the Lancet study first …

Two papers that reported that the blood pressure drug ramipril was beneficial in patients with intermittent claudication due to peripheral artery disease have been retracted after an investigation found that data were fabricated by the studies’ lead author, Anna A Ahimastos, a researcher at the prestigious Baker IDI Heart and Diabetes Institute in Melbourne, Australia. The first paper,1 published in JAMA in …

Errors are linked to retraction, but are an unreliable marker for fraudulent or harmful research

New electronic media such as the internet offer great possibilities for spreading serious medical information from healthcare professionals, organisations, and authorities to the public. However, there is also a reverse side to this coin. Some companies misuse the new medium for uncontrolled distribution of drugs that have not been tested properly by national authorities or medical societies. These companies deceive patients in their advertising messages. By using citations from serious medical journals, they lead people to believe that their drugs are “highly effective.” In addition, use of such drugs may encourage patients to abstain from the usual drugs administered by doctors. In response to a patient's question about the usefulness of a multivitamin preparation in preventing and treating some cardiovascular diseases, we evaluated some of the claims made about Vitacor 20/90, which is being advertised intensively on the internet by Health Now (San Francisco, California, USA,www.healthnow1.com and is distributed in Germany from the Netherlands. #### Summary points

Researchers are facing calls to retract published findings that link chronic fatigue syndrome to a retrovirus called xenotropic murine leukemia virus related virus (XMRV) after new scientific criticism of their validity. Editors of the journal, Science , have issued an “editorial expression of concern” over a research paper it published in October 2009, saying the report is “now seriously in question.” The study, “Detection of an infectious retrovirus, XMRV, in blood cell of patients with chronic fatigue syndrome,” was led by Vincent Lombardi and Judy Mikovits of the Whittemore Peterson Institute, Reno, Nevada ( Science 2009;326:585). It purported to show that a retrovirus XMRV was present in the blood of 67% of patients with chronic fatigue syndrome (CFS) compared with 3.7% of healthy controls. The study caused a stir when it appeared and led to some CFS patients, believing XMRV to be a possible contributor to their condition, seeking antiretroviral treatments marketed to combat HIV. But Science , which is the weekly journal of the American Association for the Advancement of Science, has now highlighted “flaws” in the paper. Since 2009, it says, at least 10 studies conducted by other investigators and published elsewhere have failed to detect XMRV in independent populations of CFS patients. Furthermore, Science …

This year’s judges have to choose between three randomised controlled trials, each of which finds that a relatively simple intervention could save many lives. The research topics ranged from screening for colorectal cancer and reducing bleeding in injured patients to treating malaria in children (see box). #### Research questions of the shortlisted papers Elizabeth Loder (clinical research editor) and I looked separately at all 150 or so nominated papers and then met to discuss our choices. We hadn’t planned to shortlist only trials: there were plenty of great papers whose research questions were appropriately and robustly answered with observational study designs. But, in the end, we were clear that these …

An analysis that compared clinical trial documents that were released because of a lawsuit with the corresponding papers published in medical journals has generated further concern about the integrity and reliability of research and of publishing. The analysis, by researchers at Johns Hopkins University, Baltimore, and published in PLoS Medicine , was based on 21 trials of the off-label uses of gabapentin sponsored by the drug companies Pfizer and Parke-Davis.1 Only 11 of the trials were eventually published. But the extensive cache of documents was made public because of litigation over illegal marketing practices for the drug. “For three trials there was disagreement on the number of randomized participants between the research report and publication,” summarized the senior …

The Lancet has retracted the 12 year old paper that sparked an international crisis of confidence in the safety of the measles, mumps, and rubella (MMR) vaccine when its lead author suggested a link between the vaccine and autism. Andrew Wakefield was found guilty by the General Medical Council last week of dishonesty and flouting ethics protocols. The UK regulator held that Dr Wakefield abused his position, subjected children to intrusive procedures such as lumbar puncture and colonoscopy that were not clinically indicated, carried out research that breached the conditions of ethics committee approval, and brought the medical profession into disrepute. In a statement published online (www.thelancet.com) the editors of the Lancet said: “Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. “In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been …

A former professor of pediatrics who held an endowed chair in diabetes research at the University of Kentucky has been censured by the US Office of Research Integrity (ORI) for research misconduct spanning 10 years.1 Eric J Smart, who held joint appointments as professor of pediatrics and of physiology, resigned from the university last May after an investigation. He faked data in 10 published papers, seven grant applications, one submitted manuscript, and three progress reports, ORI said. Smart, who held a number of research grants from the National Institutes …

It's not often that a paper changes practice before it is published. It happened to m,however, and, as its a paper that's only recently been published, 1 2I wait to see whether it will change many other general practitioners'practice too. Paul Little and colleagues' study published on 3 August 2002 on the different methods of measuring blood pressure in general practice was carried out in my practice (though I was not involved). Having tried wearing an ambulatory blood pressure monitor for 24 hours some years ago, I knew …

During my medical house job the only people with hypertension whom I saw were those who were admitted with the consequences of cardiovascular disease. I was therefore desperately worried that my father who was hypertensive was about to have a stroke or a myocardial infarction. Fortunately, my next job was a trainee in general practice, where I daily saw people with hypertension who were living fairly normal lives, which helped to get things back in perspective. That latter post, and one in accident and emergency, followed by three years out of medicine, helped me to put the acute and chronic pathology I had seen and read about into a population …

Research studies on the side effects of commonly prescribed drugs constituted the three most read papers published by the BMJ in 2005, according to an internal audit that assessed their use by readers. Studies that showed increased risk of myocardial infarction in patients taking cyclo-oxygenase-2 (COX 2) inhibitors and that explored the link between selective serotonin reuptake inhibitors and suicide came top. For the audit Sara Schroter, the BMJ 's senior researcher, analysed research papers using three measures: the number of citations a paper received, the number of times it was accessed on the web, and the number of rapid responses it generated. The top scoring paper was a case-control study that showed greater risk of myocardial infarction in patients taking the COX 2 inhibitor rofecoxib (Vioxx) and in patients taking diclofenac …

This annual BMJ award recognises outstanding original research with potential to contribute considerably to improving health and healthcare. Trish Groves introduces the shortlist

Despite increases in the number of women doctors in the United States over the past 40 years they are still under-represented as first or senior authors on papers published in leading journals, finds research in the New England Journal of Medicine (2006;355:281-7). The observation that many papers in leading journals were written by men prompted the authors to wonder what message that sent to ambitious young women. “Publication in medical journals is an important measure of academic productivity. It is also highly emphasized in the academic promotion process and an important means by which the academic medical community communicates,” they wrote. The study looked at original articles published in 1970, 1980, 1990, 2000, and 2004 in the New England Journal of Medicine , JAMA , the Annals of Internal Medicine , the Annals of Surgery , Obstetrics & Gynecology , and the Journal of Pediatrics . The researchers were able to identify the sex of 99% of 7249 US doctors listed as first or senior authors on these papers. They also looked at the sex of authors of guest editorials in the New England Journal of Medicine and JAMA . Overall the percentage of female first or senior authors increased from 6% in 1970 to 29% in 2004. The percentage of women who wrote guest editorials also rose overall. In JAMA the percentage rose from 0% in 1970 to 19% in 2004, while in the New England Journal of Medicine it rose from 2% in 1970 to 20% in 2000, although it then fell to 11% in 2004. The greatest increases occurred in the Journal of Pediatrics and Obstetrics & Gynecology , while the smallest gains were made in the Annals of Surgery , changes that broadly reflect the numbers of women in these specialties. In 1960 6% of medical students were women; now they make up 49% of the total number. One in four practising doctors is a woman, and in academic medicine almost a third of full time faculty members are women. But women represent only 10% of medical school deans, 11% of departmental chairs, and 14% of full professors. In an accompanying editorial (2006;355:310-2) four women doctors say that the authorship sex gap will narrow only when more women reach senior faculty positions. They wrote, “Each author … has experienced the challenges of raising children while working full-time in careers in medicine and science. Spending more time on scholarly activities necessarily means less time with family; women may be less likely than men to accept this trade-off.” Career paths in medicine should be more flexible and success less narrowly defined, they say. The paper’s first author, Reshma Jagsi, an assistant professor of radiation oncology at the University of Michigan Medical Center in Ann Arbor, said that formal mentoring and additional financial support would help the goal of increasing diversity in the medical workforce to be met.

The Lancet has retracted a paper by researchers at the Medical University of Innsbruck in Austria after an official investigation found that the clinical trial it reported had serious ethical and procedural flaws. Austria’s Agency for Health and Food Safety says that the urologists who conducted the trial of stem cell treatment for stress incontinence in women failed to get proper ethical approval and neglected to adequately inform patients of the experimental nature of the procedures. In one case an insurance confirmation form seemed to have been forged. “In our view, the conclusions of this official investigation pinpoint so many irregularities in the conduct of their work that, taken together, …

EDITOR—Dimoliatis raises some important points in his personal view asking whether reviewers of papers should have their names published.1 There are two aspects of the debate on open access reviewing that strike me as interesting points from a qualitative perspective. The first is whether the authors think that the paper has been genuinely …

I recently reviewed a paper, which I ended up loving. I felt as though the paper was mine. Although my name is nowhere to be found in the published version, I am in there. I spent much time and effort on it: I wrote hundreds of words in recommendations, some of which were important and accepted by the authors, improving the first version of the manuscript and resulting in version two. Then a new cycle began. And all this depended on my dedication and voluntary contribution—at the expense of my own papers, and at the expense of building my own curriculum vitae. Reviewing does not seem to count for much. But why not? Shouldn't it? Some two months later the editor asked me to review the second version of the manuscript. In doing so I felt—besides helping the authors and editors—a great responsibility to readers. I felt I needed to protect the readers from “junk information” and to contribute to the dissemination of the truth (and …

More than three years after publishing a research paper in Nature Medicine , 15 German scientists retracted it because of “several incorrect statements and the erroneous presentation of primary data, results and conclusions” ( Nature Medicine 2003;9: 1221 ). The paper, whose lead author was Alexander Kugler, then senior registrar in the urology department of Gottingen University Hospital, presented a small clinical trial …

Editor—In January 1996, Gough et al reported the potential adverse effects of minocycline1; an editorial in the same issue amplified the position.2 Their paper highlighted the fact that minocycline is the most widely prescribed systemic antibiotic for acne, and one for which no resistance has yet been described. They noted, …

Now in its third edition, this respected book guides the reader through medical research and the jungle of jargon it comprises. The subject matter is divided into types of research, literature searches, presenting and analysing data, and publication and appraisal of research. Its definitions are superb, and it clearly delineates between commonly confused topics such as reliability and validity, systematic reviews and meta-analyses, and protocol and guidelines. In the 12 years since the book’s inception evidence based medicine has evolved from illegitimacy to prodigy, thanks to champions such as David Sackett, Brian Haines, and Greenhalgh herself. They encourage clinicians to formulate the right question with three specific …

EDITOR—I am a jobbing general practitioner, and the paper by Holland and Weiner on Bell's palsy left me confused.1 To treat somebody is a hard decision—not to treat somebody, even harder. In 2002 the BMJ published an article about recent advances in neurology that proposed that there might be a case for prednisolone but …

EDITOR—Dimoliatis's cri de coeur for better recognition of reviewers of papers has much merit.1 Some of your respondents,2 however, are concerned that the quality of peer review could suffer as reviewers succumb to the temptation of seeing their …

EDITOR——The BMJ includes a small box with each paper, summarising the prior knowledge and what the study adds. This is laudable, but inevitably overlaps with the abstract. We suggest an alternative use for a box. We are torn between …

New allegations have been made that German scientists who received major funds from the tobacco industry played down the health effects of smoking. The allegations are in a report published online on 29 November in the American Journal of Public Health (doi:10.2105/AJPH.2004.061507). Earlier this year an article in the magazine Der Spiegel accused several German public health scientists of receiving funds for tobacco friendly research ( BMJ 2005;331:70). The article was based on an analysis of tobacco industry documents available on the internet. The new publication, by researchers from the Royal Free Hospital, London, and the London School of Hygiene and Tropical Medicine, names eminent …

EDITOR— The Journal of Medical Internet Research (http://www.jmir.org/), an open access journal that I edit, has for five years practised routinely what Dimoliatis proposes1: reviewers are acknowledged at the end of each published article. In our experience, concerns over reviewers becoming too uncritical only to see their name published are unfounded. Moreover, editors …

Most patients are not manipulative but those who are can produce strong feelings of anger and hostility in doctors who treat them. George Murphy and Samuel Guze's paper, “Setting limits: the management of the manipulative patient,” is the perfect antidote.1 If you can suspend your prejudices against the facts that the authors are psychotherapists and that they wrote the article at the dawn of the permissive era you will be rewarded with a completely jargon free, well written, and commonsense guide on how to recognise and manage manipulative patients. The examples used …

As we struggle to optimise the delivery of limited medical resources our interventions become increasingly complex. Britain is a nation of couch potatoes, and increasing the prevalence of physical activity may be more important for public health than our professional preoccupations with diet, blood …

Trisha Greenhalgh, BMJ Publishing Group, £14.95, pp 196 ISBN 0 7279 1139 2 Evidence based medicine is clearly a major medical “buzz-phrase” of the 1990s. Much work has already been published on “How to do it,” and, no doubt, clinicians will continue to see much more in the future. Greenhalgh's book is intended for people wishing to “find their way into the medical literature, assess the scientific validity and practical relevance of the articles … and … put the results into practice.” Her extensive experience in teaching evidence based medicine is clearly evident, and her humorous and conversational no-nonsense style is refreshing and delightful. The …

To write prescriptions is easy, but to come to an understanding of people is hard. Franz Kafka, A Country Doctor Only about 50% of patients with chronic diseases take their medicines in therapeutically effective doses.1 Although the cost of non-compliance in illness and premature death is staggering, the issue has been neglected in the debates on healthcare resources and rationing. This week a working party of the Royal Pharmaceutical Society of Great Britain publishes its report on medicine taking.2 It was set up to consider the scale and consequences of non-compliance and to make recommendations. Many of our group, which was made up of doctors, pharmacists, nurses, and social scientists, admitted early on that we rarely took medicines as prescribed. Some confessed to abandoning courses of antibiotics after the first day or two. After we reviewed published work it became apparent that non-compliance might be no more deviant behaviour …

Many doctors seem to believe that governmental controls on drug safety came into being only as a result of the thalidomide disaster. In fact, the first public demands for government action on drug safety came as a result of the fatal poisoning in 1938 of 107 Americans by a liquid formulation of sulphanilamide. The manufacturers found that the drug was insoluble in water and made up an elixir based on diethylene glycol. No toxicity tests were carried out before the mixture was given out to dentists and doctors. The scandal that resulted from the deaths led to the United States Congress passing a law requiring all new products and reformulations to be submitted to the Food and Drug Administration. In the early 1960s, however, most countries still had no formal machinery for regulating the introduction of new drugs? when the impact of the thalidomide affair was sufficiently dramatic for there to be a public demand for official bodies to monitor drug safety. In Britain Sir Derrick Dunlop became the first chairman of the Committee on Safety of Drugs, which acted without statutory powers until the establishment of the Medicines Commission with its Committee on Safety of Medicines. Most Western countries now have comparable organisations?and so do an increasing proportion of the nations of Africa, Asia, and South America.

Regulation of complementary practitioners such as acupuncturists, herbalists, and therapists to weed out the charlatans and protect the public sounds uncontroversial. But, as Michael Day reports, proposals announced in last month's white paper seem to have brought more questions than answers

Objectives To investigate the relative impact on publication bias caused by multiple publication, selective publication, and selective reporting in studies sponsored by pharmaceutical companies. Design 42 placebo controlled studies of five selective serotonin reuptake inhibitors submitted to the Swedish drug regulatory authority as a basis for marketing approval for treating major depression were compared with the studies actually published (between 1983 and 1999). Results Multiple publication: 21 studies contributed to at least two publications each, and three studies contributed to five publications. Selective publication: studies showing significant effects of drug were published as stand alone publications more often than studies with non-significant results. Selective reporting: many publications ignored the results of intention to treat analyses and reported the more favourable per protocol analyses only. Conclusions The degree of multiple publication, selective publication, and selective reporting differed between products. Thus, any attempt to recommend a specific selective serotonin reuptake inhibitor from the publicly available data only is likely to be based on biased evidence.

The Indian Academy of Pediatrics has called for doctors working in the private sector to report adverse events after immunisations to the national surveillance system to ensure more complete vaccine safety data. In a position paper published in Indian Pediatrics , the academy said that the adverse event following immunization (AEFI) surveillance system run by the government needed to be strengthened by including reports from the private sector.1 India has one of the largest universal immunisation programmes in the world, with 26 million babies born every year. Approximately …

The views of thousands of people on primary care are to be gathered by the Department of Health later this summer in a consultation exercise. These views will help to inform a white paper, to be published at the turn of the year. Patricia Hewitt, the health secretary, said that this would be a “major public engagement exercise” to help shape the future of all NHS services provided outside hospitals, including GPs' surgeries, walk-in centres, and social and community care. Doctors and other staff groups will be invited to …

Improves decision making and reduces costs This month the British National Formulary goes electronic. Since it was first published in 1981 the paper version of the formulary has provided doctors and pharmacists with biannually updated information on all drugs that can be prescribed in Britain. It is now available on CD ROM.1 The move is welcome because there is growing evidence that tools for computer based prescribing help doctors to make better and cheaper prescribing decisions. Doctors in Britain prescribe drugs costing pounds sterling3.3bn annually, pounds sterling450m of which could potentially be saved.2 But deciding which drug to prescribe can be difficult.3 One in 20 admissions to hospital is for the treatment of side effects related to drugs or the results of drug interactions4 (perhaps due to the difficulties that doctors have in calculating drug doses5) or other prescribing problems.3 Various approaches to improving the quality of prescribing have been tested. Local formularies and visits by prescribing advisers seem to improve the appropriateness of prescribing and reduce the costs,6 7 and computer based prescribing seems to confer similar benefits. Almost …

In randomised controlled trials, allocation concealment (separating the process of randomisation from the recruitment of participants) is important for rigorously designed trials.1–4 In 1996 many major medical journals adopted the CONSORT statement (whereby researchers have to include a short checklist of essential items and a flow diagram when reporting trials),5 and this move encouraged the reporting of allocation concealment. We reviewed the prevalence of adequate allocation concealment and its association with the statistical significance of trial results. We searched by hand four general medical journals (the BMJ, JAMA , the Lancet , and the New England Journal of Medicine ) to identify randomised controlled trials published from January 2002 to December 2002. We included articles if the authors reported that participants were randomised and if the trial was published as a full report with the results of the main analyses. We categorised articles according to whether allocation concealment was adequate (the person who executed the allocation sequence was different from the person who recruited …

Economic evaluations conducted alongside randomised controlled trials enable analysis of detailed, patient level data on efficacy, cost, and quality of life in a controlled setting. They can provide timely and reliable assessments of value for money, to inform decisions on coverage and reimbursement.1–3 The BMJ recently decided to consider trial based economic evaluations for publication only if the clinical results are submitted to the journal as well.4 We assessed the extent to which cost utility analyses are conducted alongside trials, estimated the time lag between the publication of trials' clinical and economic results, and compared the characteristics of journals publishing the clinical trial data and the cost utility analyses. We conducted a systematic search for original English language cost utility analyses published in 1976-2001 by using Medline and other electronic databases. Two readers independently reviewed each study and came to a consensus on whether the analysis was conducted alongside a trial (data on both efficacy and resource use from the trial were used for the analysis). We …

Many randomised controlled trials have been conducted in China to evaluate the effectiveness of traditional Chinese medicine, but much of the information is inaccessible to Western doctors. We estimated the total number of randomised controlled trials published in China and identified problems in applying such methodology to the evaluation of traditional Chinese medicine, which would serve as preparatory work for systematic review and dissemination of the randomised evidence for such medicine. We randomly selected 28 journals using stratified sampling from a total of 100 Chinese journals of traditional Chinese medicine (4 national, 10 university, 10 provincial or regional, and 4 specialist journals). After special training, eight fifth year medical students (working in pairs) hand searched all the issues of the journals published before 1 January 1997 to identify randomised controlled trials. Discrepancies were settled by one of the principal investigators (S-YZ). Data on methodological quality of randomised controlled trials were extracted from 414 full length articles …

Recently, prescribing of antidepressant drugs has increased exceptionally.1 At the same time, concerns have been raised about the medicalisation of human distress and, more recently, about the safety of antidepressants.1 Many general practitioners would like to refer patients for psychological treatment, for which there is good evidence of effectiveness,2 but are constrained by the lack of NHS therapists. We estimated the opportunity cost of the recent rise in antidepressant prescribing by valuing it in terms of an effective alternative treatment—cognitive behaviour therapy. We used Department of Health data on the number and cost of antidepressant drugs dispensed in the community in England to quantify the changes between 1991 and 2002. The baseline year (1991) was chosen to ensure a meaningful timescale and to cover a period of consistent approaches to recording. We took population statistics from http://www.statistics.gov.uk/statbase/, and applied an inflation rate of 32% (from http://www.statistics.gov.uk/rpi/) to 1991 costs. We estimated the number of patients that could have been treated using cognitive …