- Email: [email protected]
Role of medical editors
THE LANCET
our methods will, we hope, provide evidence to support this position. *Duncan Colin Jones, Deborah Anthony, Lesley Best, Ruairidh Milne, Ken Stein *Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK; and Wessex Institute for Health Research and Development, University of Southampton, Southampton 1
2
3
4
5
Nussey SS. Rationing of growth hormone: who reviews the experts? Lancet 1997; 350: 743. Anthony D. Growth hormone for growth hormone deficient adults. Report to the Wessex Regional Development and Evaluation Committee. Winchester: Wessex Institute of Public Health Medicine, 1995. Stevens A, Colin Jones D, Gabbay J. ‘Quick and clean’: authoratitive health technology assessment for local health care contracting. Health Trends 1995; 27: 37–42. Best L, Stevens A, Colin Jones D. Rapid and responsive health technology assessment: the development and evaluation process in the South West Region of England. J Clin Effectiveness 1997; 2: 51–56. Anthony D, Milne R. Growth hormone for growth hormone deficient adults. Report to the South and West Regional Development and Evaluation Committee. Bristol: NHS Executive (South and West), 1997.
Author’s reply SIR—Janet Robertson and colleagues should welcome my comments. First, I should point out I run one of the larger endocrine units in South Thames. I was not sent the document officially with an invitation to comment before its publication. In late July, 1997, I received an anonymous unofficial copy which was marked draft but with the publication date August, 1997. Second, my original text to The Lancet referred to the Therapeutic Review Issues 1 as “to be published in August, 1997”, making it clear I was referring to a draft document, but this wording was changed in the editorial office. What is important is that the contents of this draft must have been known to health authorities south of the river Thames since it was (along with the Wessex document) referred to in discussions during August, in which funding for adult patients with growth-hormone deficiency was discussed. Thus, the document was exerting an influence on purchasing issues. Duncan Colin-Jones and colleagues’ criticism of inaccuracy is unfounded. Their 1995 report was essentially anonymous; they fail to name the internationally renowned endocrinologist involved in the review, and the official citation (ref 2) of the report names D Anthony as the sole author. I said that the review was not peer reviewed; they reply that opinion was sought from clinical colleagues on their committee. Is this true peer review? It
1484
is clear that both Robertson and ColinJones accept my point that health authorities are using both the Wessex and the South Thames documents as sources of cost-benefit analysis when they are inadequate for this purpose. It is important that the documents in question are accurate and up to date. Robertson and colleagues state that there is an “absence of valid and reliable measures [of quality of life] in this condition” and cite a 3-year-old reference. A disease-specific quality-oflife questionnaire has been developed for adults with growth-hormone deficiency1 and there is evidence that it is reliable and valid.2 If they were unaware of this work should they be called expert? If they were aware of it but choose not to cite it may not one question whether they are the authors of a review of any quality? Robertson et al are naive in not considering the use cash-starved health authorities would make of such an incomplete review. They readily acknowledge the parts played by pharmacists, public health doctors, and health authority prescribing advisers, yet, in a highly specialised field there is no mention of the involvement of endocrinologists or health economists. Why should the opinions of endocrinologists be held only as supplemental to the review? There workers confuse absence of proof of efficacy with lack of efficacy and rely on the only scientific currency they accept—clinical endpoints of prospective, double-blind, controlled trials. While I fully accept the power and validity of such trials, I should not be quoted as pointing out that evidence of anticipated benefit (on cardiovascular risk and fracture risk) is lacking. Indeed, I say that there is good evidence from the effect of growth hormone on surrogate markers, such as blood lipids and bone density measurements, to anticipate such benefits. In this regard, Colin-Jones and colleagues choose not to believe this hypothesis, despite its appeal, yet give no reasons. Here is a challenge: why would a 10% increase in bone density or a 10% reduction in total cholesterol as a result of growth hormone therapy have no effects, whereas the same changes resulting from other therapies would reduce fracture and rates of coronary death? S S Nussey Division of Gastroenterology, Epidemiology, and Metabolism, St George’s Hospital Medical School, London SW17 0RE, UK 1
Holmes SJ, McKenna SP, Doward LC, Hunt SM, Shalet SM. Development of a questionnaire to assess the quality of life of adults with GH deficiency. Endocrinol Metab 1995; 2: 63–69.
2
Wallymahmed ME, Baker GA, Humphris G, Dewey M, MacFarlane IA. The development, reliability and validity of a disease specific quality of life model for adults with growth hormone deficiency. Clin Endocrinol 1996; 44: 403–11.
Role of medical editors SIR—Richard Horton’s September 27 commentary1 on the role of the reader of medical journals omits to mention why physicians need editors. We need editors to make journals readable. Left to ourselves, we tend to be dry, verbose, pedantic, and boring. There is nothing more annoying to me than having my contribution to a journal printed verbatim, with no editorial changes. We rely on professional editors to make the printed words flow more smoothly. If we cannot read an article because of its style, we can certainly learn nothing from it. Here, The Lancet succeeds. Indeed, I often complain that I spend too much time reading my copy of The Lancet—more than my professional needs demand. I read journals partly to learn, but also because I enjoy reading about my field of interest and being stimulated by new ideas. Physicians need editors to keep us reading. Carl D Atkins 242 Merrick Road, Rockville Centre, NY 11570-5254, USA 1
Horton R. Prague: the birth of the reader. Lancet 1997; 350: 8898–99.
DEPARTMENT OF ERROR Vaccines 1997—In this Commentary by Richard Horton (Oct 25, p 1192), the quote from Richard Moxon’s introduction to the 1990 series on modern vaccines should have read: “Satisfaction with the success of existing vaccines is tempered by profound frustration that so many countries continue to be ravaged by the direct and indirect consequences of preventable infections”. Randomised trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients—In this article by Björn Nashan and colleagues (Oct 25, p 1195), the first sentence of the third paragraph of the rejection episodes section of the results should have begun: “The reduction in the incidence of acute-rejection episodes, confirmed by final clinical diagnosis, in patients treated with basiliximab . . .”. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer—In this paper by the Collaborative Group on Hormonal Factors in Breast Cancer (Oct 11, p 1047), the higher dose of conjugated oestrogen in table 2 should be ⭓1·25 mg.
Vol 350 • November 15, 1997
our methods will, we hope, provide evidence to support this position. *Duncan Colin Jones, Deborah Anthony, Lesley Best, Ruairidh Milne, Ken Stein *Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK; and Wessex Institute for Health Research and Development, University of Southampton, Southampton 1
2
3
4
5
Nussey SS. Rationing of growth hormone: who reviews the experts? Lancet 1997; 350: 743. Anthony D. Growth hormone for growth hormone deficient adults. Report to the Wessex Regional Development and Evaluation Committee. Winchester: Wessex Institute of Public Health Medicine, 1995. Stevens A, Colin Jones D, Gabbay J. ‘Quick and clean’: authoratitive health technology assessment for local health care contracting. Health Trends 1995; 27: 37–42. Best L, Stevens A, Colin Jones D. Rapid and responsive health technology assessment: the development and evaluation process in the South West Region of England. J Clin Effectiveness 1997; 2: 51–56. Anthony D, Milne R. Growth hormone for growth hormone deficient adults. Report to the South and West Regional Development and Evaluation Committee. Bristol: NHS Executive (South and West), 1997.
Author’s reply SIR—Janet Robertson and colleagues should welcome my comments. First, I should point out I run one of the larger endocrine units in South Thames. I was not sent the document officially with an invitation to comment before its publication. In late July, 1997, I received an anonymous unofficial copy which was marked draft but with the publication date August, 1997. Second, my original text to The Lancet referred to the Therapeutic Review Issues 1 as “to be published in August, 1997”, making it clear I was referring to a draft document, but this wording was changed in the editorial office. What is important is that the contents of this draft must have been known to health authorities south of the river Thames since it was (along with the Wessex document) referred to in discussions during August, in which funding for adult patients with growth-hormone deficiency was discussed. Thus, the document was exerting an influence on purchasing issues. Duncan Colin-Jones and colleagues’ criticism of inaccuracy is unfounded. Their 1995 report was essentially anonymous; they fail to name the internationally renowned endocrinologist involved in the review, and the official citation (ref 2) of the report names D Anthony as the sole author. I said that the review was not peer reviewed; they reply that opinion was sought from clinical colleagues on their committee. Is this true peer review? It
1484
is clear that both Robertson and ColinJones accept my point that health authorities are using both the Wessex and the South Thames documents as sources of cost-benefit analysis when they are inadequate for this purpose. It is important that the documents in question are accurate and up to date. Robertson and colleagues state that there is an “absence of valid and reliable measures [of quality of life] in this condition” and cite a 3-year-old reference. A disease-specific quality-oflife questionnaire has been developed for adults with growth-hormone deficiency1 and there is evidence that it is reliable and valid.2 If they were unaware of this work should they be called expert? If they were aware of it but choose not to cite it may not one question whether they are the authors of a review of any quality? Robertson et al are naive in not considering the use cash-starved health authorities would make of such an incomplete review. They readily acknowledge the parts played by pharmacists, public health doctors, and health authority prescribing advisers, yet, in a highly specialised field there is no mention of the involvement of endocrinologists or health economists. Why should the opinions of endocrinologists be held only as supplemental to the review? There workers confuse absence of proof of efficacy with lack of efficacy and rely on the only scientific currency they accept—clinical endpoints of prospective, double-blind, controlled trials. While I fully accept the power and validity of such trials, I should not be quoted as pointing out that evidence of anticipated benefit (on cardiovascular risk and fracture risk) is lacking. Indeed, I say that there is good evidence from the effect of growth hormone on surrogate markers, such as blood lipids and bone density measurements, to anticipate such benefits. In this regard, Colin-Jones and colleagues choose not to believe this hypothesis, despite its appeal, yet give no reasons. Here is a challenge: why would a 10% increase in bone density or a 10% reduction in total cholesterol as a result of growth hormone therapy have no effects, whereas the same changes resulting from other therapies would reduce fracture and rates of coronary death? S S Nussey Division of Gastroenterology, Epidemiology, and Metabolism, St George’s Hospital Medical School, London SW17 0RE, UK 1
Holmes SJ, McKenna SP, Doward LC, Hunt SM, Shalet SM. Development of a questionnaire to assess the quality of life of adults with GH deficiency. Endocrinol Metab 1995; 2: 63–69.
2
Wallymahmed ME, Baker GA, Humphris G, Dewey M, MacFarlane IA. The development, reliability and validity of a disease specific quality of life model for adults with growth hormone deficiency. Clin Endocrinol 1996; 44: 403–11.
Role of medical editors SIR—Richard Horton’s September 27 commentary1 on the role of the reader of medical journals omits to mention why physicians need editors. We need editors to make journals readable. Left to ourselves, we tend to be dry, verbose, pedantic, and boring. There is nothing more annoying to me than having my contribution to a journal printed verbatim, with no editorial changes. We rely on professional editors to make the printed words flow more smoothly. If we cannot read an article because of its style, we can certainly learn nothing from it. Here, The Lancet succeeds. Indeed, I often complain that I spend too much time reading my copy of The Lancet—more than my professional needs demand. I read journals partly to learn, but also because I enjoy reading about my field of interest and being stimulated by new ideas. Physicians need editors to keep us reading. Carl D Atkins 242 Merrick Road, Rockville Centre, NY 11570-5254, USA 1
Horton R. Prague: the birth of the reader. Lancet 1997; 350: 8898–99.
DEPARTMENT OF ERROR Vaccines 1997—In this Commentary by Richard Horton (Oct 25, p 1192), the quote from Richard Moxon’s introduction to the 1990 series on modern vaccines should have read: “Satisfaction with the success of existing vaccines is tempered by profound frustration that so many countries continue to be ravaged by the direct and indirect consequences of preventable infections”. Randomised trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients—In this article by Björn Nashan and colleagues (Oct 25, p 1195), the first sentence of the third paragraph of the rejection episodes section of the results should have begun: “The reduction in the incidence of acute-rejection episodes, confirmed by final clinical diagnosis, in patients treated with basiliximab . . .”. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer—In this paper by the Collaborative Group on Hormonal Factors in Breast Cancer (Oct 11, p 1047), the higher dose of conjugated oestrogen in table 2 should be ⭓1·25 mg.
Vol 350 • November 15, 1997