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A recent article published in the BMJ raises questions about the extent and type of publication bias that exists in the literature. Publication bias is the selected publication of studies based on the results, such as only publishing studies that demonstrate a drug works while not publishing studies that demonstrate harms.

The study authors, including Ben Goldacre author of the best-seller Bad Science, explore the potential implications of study funding and high reprint orders. They contacted the editors of the top general medical journals (i.e. JAMA, Lancet, NEJM, Ann Intern Med, and BMJ) and requested information on the 20 articles with the highest number of reprint orders. After matching the articles with controls, the authors evaluated whether study funding (i.e. industry, mixed, other or none) was associated with higher numbers of reprints.

The results are telling. The Lancet led the way with a median of 126,350 reprints for the top articles with a range from 24,000 to 835,100. The BMJ was a distant second with a median of 13,248 (range 1,000 to 526,650). Unfortunately JAMA, NEJM and Ann Intern Med did not provide information.

Overall, compared with controls papers with high reprint orders were considerably more likely to be funded by the pharmaceutical industry (odds ratio 8.64, 95% CI 5.09 to 14.68). In addition the cost for reprint orders ranged from £4,002 to £1,551,794: reprints are evidently a lucrative source of supplementary income for journals.

While not designed to detect publication bias, the article highlights the importance of thinking outside the box. Evidence-based medicine is filled with cutting edge issues that are continually evolving and emerging. Do you think that a paper with potentially high reprint orders may affect an editor’s decision to publish? Should journals disclose the number of reprints for each article?

If you are keen to learn more, consider attending Evidence Live, a conference unlike any other event in healthcare, bringing together the leading speakers in evidence-based medicine from all over the world. The conference will include a session dedicated to Publication Bias at Evidence Live 2013 with an international line-up of speakers including Doug Altman, An-Wen Chan, Tom Jefferson and many more.

What do you think are undiscovered sources of publication bias? Here's your chance to share your thoughts with the experts at the University of Oxford, 25-26 March 2013.

*Note: this blog has also been posted on Evidence Live Blog.

Increasing access to journals through peer reviewers

Peter Gill
Last edited 23rd April 2012

A recent letter to the editor in the Canadian Medical Association Journal (CMAJ) highlighted a potential opportunity to increase access to subscription-based journals for individuals in low and middle-income countries. It turns out that a few journals give their peer reviewers’ free journal access or a free subscription as a thank you gift for their effort.

How widespread is this policy in the medical publishing world?

Unfortunately not very. Of the 21 journal editors contacted (including CMAJ, Lancet, BMJ, JAMA, etc.), only three actually provide reviewers with free journal access. The gift ranges from a 3-month (Lancet) to a 12-month subscription (BMJ and the Journal of Intellectual & Developmental Disability).

On the positive side, 20 out of the 21 journals were members of the Health InterNetwork Access to Research Initiative (HINARI), the World Health Organisation’s programme to provide free or low cost online access in the developing world to scientific research. This is encouraging, but HINARI is not perfect and many are still left without access.

For example, a BMJ Rapid Response highlighted that health care workers in middle-income countries such as Malaysia are often caught in the middle. Too rich for aid but not wealthy enough to afford the high cost of journal subscriptions.

However, despite the fact that most original research relevant to low and middle-income countries is open-access, the majority of the education articles, clinical reviews, news pieces and commentaries are still often behind firewalls that require payment.

The move for more open-access journals is encouraging. For example, the Howard Hughes Medical Institute, the Max Planck Society and the Wellcome Trust will be launching eLife, a new open access journal later this year.

Why don’t more journals provide peer reviewers with free subscriptions? Not only is it a symbol of appreciation for the hours of gratuitous time altruistically invested but it could be used to help others. Likely there is no pressure or demand for it. The majority of peer reviewers are already at academic institutions with subscriptions.

Has this happened to you before? What have you done with this free gift? Although few journals seem to be endorsing this policy, it may serve as a small way to increase access to those who otherwise do not have it.

In the future, if you review an article for the BMJ, the Lancet or the Journal of Intellectual & Developmental Disability (or other journals that provide free subscriptions after peer reviewing), rather than deleting the email consider who might benefit.

If you review for a journal that does not, ask the editor why not?

Bachmann and HPV: the danger of speculation over evidence

Peter Gill
Last edited 16th September 2011

This week brought back fears from a decade ago. Michele Bachmann, a US Republican presidential candidate, claimed that the HPV vaccine was a "very dangerous drug" that could lead to "mental retardation".

HPV or human papillomavirus is a virus that is associated with the development of genital warts and cervical cancer. Just this week, the Lancet reported that the global cervical cancer rates have increased over the past 30 years to 454,000 cases in 2010.

Clearly cervical cancer is an issue that cannot be ignored. Vaccines against HPV are life-saving.

Bachmann’s claims drew a sharp response from the American Academy of Pediatrics who stated that her comments have “absolutely no scientific validity.” To date over 35 million doses have been administered in the US with an excellent safety record.

Why did she bother to meddle with science? The answer is deadly simple: politics. Republican rival Rick Perry issued an executive order requiring girls in Texas to get the HPV vaccine in 2007. In a heated debate, Bachmann suggested that the decision was made in return for political donations from Merck, the manufacturers of Gardasil (the HPV vaccine used in the US).

Conflicts of interest are a separate issue; the focus here is on science.

The concern amongst health care professionals is the damaging impact false claims have on vaccination rates. The perceptions of vaccines changed forever after a now retracted article was published in the Lancet in 1998. In this small study of 12 children the now-disgraced British doctor Wakefield linked the Measles Mumps and Rubella (MMR) vaccine to autism. The media coverage and speculation that followed led to UK vaccination rates dropping to 80% in 2003-4.

Vaccine fears have fueled the recent outbreaks of measles. Before the MMR vaccine, measles was thought to be “as inevitable as death and taxes”, mumps infection could lead to sterility in post-pubescent boys and pregnant women that contracted rubella had children with serious congenital defects. The MMR vaccine was a public health success before Wakefield.

Politicians can throw mud at each other all they like but when they enter the ring of public health, they jeopardise putting all our health at risk. Society cannot let another vaccine crisis strike.

A US bioethicist has stepped forward and offered $10,000 to Bachmann’s charity of choice if she can prove a claim that the HPV vaccine caused mental retardation. Will she take on the challenge? For the sake of public health, hopefully not.

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