Randomized clinical trials (RCTs) are considered to be the preferred criterion standard in research for assessing the effectiveness of clinical interventions. Yet, a level that lofty has not always prevailed in experimental work. At the turn of the 20th century, a physician from Haverhill, Massachusetts by the name of Duncan MacDougall conducted an experiment that involved weighing six terminally ill patients immediately before and after being pronounced dead. Upon recording a reduction in a single patient’s weight of 21 grams, he believed the loss represented that individual’s departed soul, while excluding data from the other patients. His findings were reported in both a 1907 issue of the Journal of the American Society for Psychical Research and the periodical American Medicine. A reference to the study also was mentioned in the New York Times.
Progress has been made since then as evidenced by the fact that a lot more rigor characterizes clinical investigations conducted today. Nonetheless, as noted in an article that appeared in the May 2019 issue of the journal JAMA Network Open, scientific lapses committed by MacDougall, such as excluding potentially eligible patients, using unreliable measures, and selectively reporting results that are favorable to the investigator’s hypothesis remain distressingly common. A possible explanation is that confirmation bias may lead to accepting data that support a researcher’s preconceptions and to rejecting data that do not.
Another manuscript in the same issue of that journal entails a systematic review of the level and prevalence of spin in published cardiovascular randomized clinical trial reports with statistically nonsignificant primary outcomes. Spin in this instance is defined as the use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome (i.e., inappropriate use of causal language), or to distract the reader from statistically nonsignificant results (i.e., to focus on a statistically significant secondary result). The authors of the review found that RCTs with statistically nonsignificant primary outcomes were published in high-impact cardiovascular journals and that considerable manipulation of language occurred in both the abstracts and full texts of the reports. Their observations have significant implications for the integrity of clinical science, the translation of clinical evidence at the bedside, peer review, and the rate of medical progress. Indeed, manipulation of language to distort findings also may contribute to further public distrust in science.
More Articles from TRENDS May 2019
LANGUAGE TRANSMISSION AND TRANSLATION
Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More
PRESIDENT’S CORNER—ASAHP MEMBER FOCUS
Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More
BIPARTISAN HEALTH LEGISLATION
Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More
HEALTH REFORM DEVELOPMENTS
Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Pregnancy-Related Deaths, United States, 2011-2015
Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States
Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)
Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions
Effects Of Early Care And Education On Children’s Health
Addressing Social Determinants Of Health Through Housing Improvements Read More
VALIDATION OF DIGITAL HEALTH SOLUTIONS
Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More